Clinical trials
oracknows | May 24, 2008Damn Steve Novella.
Well, not really, but I always get annoyed when someone comes up with an analogy or description of a phenomenon that I should have thought of first. I don't really get annoyed at the person who came up with such ideas, but rather at myself for not thinking of something so obvious or precious first. Whether this self-criticism is a symptom of the megalomania or massive ego that I have been accused of having by some of my less--shall we say?--enamored readers or simply a personality quirk, I'll leave to the reader to decide.
Whatever the case, writing for Science-Based…
oracknows | May 22, 2008There's a new blog in town that I've been meaning to pimp. It's a blog by a retired epidemiologist who got things started looking at the role of diagnostic substitution in autism diagnoses and argued that the autism "epidemic" is an artifact of changing diagnostic criteria.
The blog is Epi Wonk, and it's a good one so far.
This week, I'm really glad Epi Wonk exists. The reason is that somehow, another Geier père et fils crapfest of dumpster-diving has somehow slimed its way into the medical literature, just in time to be used in the Autism Omnibus hearings no doubt. The "study" (if you can…
oracknows | May 20, 2008ERV asks: What happens when a PI holding an NIH grant dies, given that PIs support post-docs, graduate students, and technicians in his or her lab?
In other words:
Or what would happen to me if Bossman got hit by a bus or got brain cancer.
Does the NIH have some sort of protocol for what to do when a PI dies? Do they just take the grant back and recycle it into a different award? Do they try to transfer it to someone else at the Uni who can do similar work?
Hell, screw the money, what happens to the ideas?? Thats what horrified me during our scare-- We were helping this fellow with a really…
oracknows | May 20, 2008I hate it when I fall behind in my journal reading. Of course, it happens all the time, as you might expect, with my time sandwiched between running my lab, writing grants, seeing patients, and operating. Sometimes, though, I get a chance to try to catch up a bit. Such was the case the other day, but unfortunately I came across an article that almost made me wish I hadn't. It was a study published in the February issue of Annals of Surgery1 and it showed that the situation is much worse than I expected. it also shows that I may be a rarer bird than I thought I was, and not just because of my…
oracknows | May 19, 2008I realize that I've been very, very remiss in attending to a task that I've been meaning to get to since late January. There are several reasons, albeit not excuses, for why I have failed to do this task. Perhaps the most powerful impediment to my overcoming my inertia and just diving in and doing what needs to be done is that it depresses me to no end to contemplate what needs to be contemplated to complete this task. Moreover, although I have completed a great deal, I sense that I have barely even scratched the surface of what needs to be done to complete the task, which also continuously…
oracknows | May 15, 2008Perhaps one of the most common misconceptions held about cancer among lay people is that it is one disease. We often hear non-physicians talk about "curing cancer" as though it were a single disease. Sometimes, we even hear physicians, who should know better, using the same sort of fuzzy thinking and language about "curing cancer" as well. But cancer is not a single disease. Indeed, it's a collection of dozens of different diseases, with different cell types of origin, pathophysiologies, behaviors, and treatments. True, there are a fair number of commonalities between cancers in terms of…
oracknows | May 14, 2008Regular readers here are probably most familiar with the so-called "complementary and alternative medicine" therapy known as chelation therapy in the context of its use, or, more specifically, its misuse in "treating" autistic children, a misuse that has resulted in at least one death, a five-year-old autistic boy named Abubakar Tariq Nadama. However, before the profit potential of chelating nonexistent mercury in autistic children was even a gleam in Dr. Roy Kerry's eye, there was another equally dubious use of chelation therapy: to treat atherosclerotic coronary artery and peripheral…
oracknows | May 13, 2008Last week, I wrote about factors that lead to the premature adoption of surgical technologies and procedures, the "bandwagon" or "fad" effect among surgeons, if you will. By "premature," I am referring to widespread adoption "in the trenches," so to speak, of a procedure before good quality evidence from science and clinical trials show it to be superior in some way to previously used procedures, either in terms of efficacy, cost, time to recover, or other measurable parameters. As I pointed out before, laparoscopic cholecystectomy definitely fell into that category. The popularity of the…
oracknows | May 12, 2008"Detoxification."
Whenever I hear that term, I'm at least 90% certain that I'm dealing with seriously unscientific woo. The reason should be obvious to longtime readers of this blog or to anyone who has followed "alternative medicine" for a while, because "detoxification" is a mainstay of "alternative" treatments and quackery for such a wide variety of diseases and conditions. Of course, toxins are indeed a bad thing, and we close-minded reductionist "allopathic" physicians do indeed use detoxification when appropriate. What differentiates us from "alternative" medicine practitioners is that…
When medical experimental therapeutics gets co-opted as complementary and alternative medicine (CAM)
terrasig | May 8, 2008Sorry to get to this so late but I wanted to weigh on an excellent post from my cancer blogging colleague, Orac, the other day on the investigation of CAM therapies in cancer. The post covers a lot of ground, as expected from any of Orac's exhaustive missives, but I wanted to focus on the comparison and contracts between NIH's National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Cancer Complementary and Alternative Medicine within the National Cancer Institute (NCI-OCCAM).
I am on record as a strong critic of NCCAM but a supporter of NCI's OCCAM in that the…
oracknows | May 8, 2008In science- and evidence-based medicine, the evaluation of surgical procedures represents a unique challenge that is qualitatively different from the challenges in medical specialties. Perhaps the most daunting of these challenges is that it is often either logistically impossible or unethical to do the gold-standard clinical trial, a double-blind, randomized placebo trial, to test the efficacy of an operation. After all, the "placebo" in a surgical trial involves exposing patients to anaesthesia, making an incision or incisions like the ones used for the operation under study, and then…
"Why aren't there more clinical trials studying the effect of CAM on cancer?" cries the CAM advocate
oracknows | May 6, 2008I've lamented time and time again just how much money the National Center for Complementary and Alternative Medicine (NCCAM) wastes on basic research and clinical trials of modalities that are, from a scientific viewpoint, so highly implausible that the chances of finding a clinically useful or relevant--or even a consistent statistically significant--effect (for example, homeopathy or reiki) or on therapies for which there is already abundant negative evidence (chelation therapy, for example) are vanishingly small. In this fifth year of a flat or declining NIH budget and of scientists facing…
oracknows | May 1, 2008Yet another dubious study has been making the rounds of mercury militia websites and discussion forums. The study is being played up and touted by certain very excitable and scientifically not-too-bright militia members and woo-meisters like Mike Adams as some sort of vindication of the scientifically discredited hypothesis that mercury in vaccines somehow causes autism.
It doesn't.
It is, however, somewhat interesting in that their embrace of this bit of questionable research shows how desperate the mercury militia is to grasp to any bit of peer-reviewed published research that they can spin…
oracknows | April 16, 2008I'm not normally one to do link roundups or Instapundit-style one sentence "link and comment" posts. Sure, I do them occasionally, but I think the reason that I don't is that to me blogging is a way to express my views, not just to point to the views at others (in other words, because I'm just too enamored of my own prose). However, because of a bizarre confluence of my being at the AACR meeting and a bunch of good stuff showing up, there were some items that I just didn't have the chance to comment on, even though I wanted to. Moreover, because I want to do a couple of posts on the AACR…
oracknows | April 8, 2008I thought I might start developing chest pain when I read it, but to my shock NCCAM has actually funded some worthwhile research! Even more amazingly, NCCAM described it in a press release!
Too bad it supports the contention that acupuncture is nothing more than placebo and that the attention given by the practitioner is what really accounts for much of the perceived therapeutic effect that patients attribute to it.
I'll explain.
The press release to which I refer leads to a rather interesting study that examines the components of the placebo effect. The article, published online yesterday in…
oracknows | April 7, 2008This story, first brought to my attention by Drugmonkey, is something that I've been meaning to blog about since I first saw it. The reason, of course, should be obvious, given that my career is an example of the end product that the medical school described is going to be designed to produce: that of a physician-scientist:
The Scripps Research Institute and Scripps Health are working to set up what they hope will be the nation's first medical school entirely geared to training physicians for dual careers in research and patient care.
[...]
The Scripps institute must raise $150 million in…
oracknows | March 20, 2008There's no doubt about it: Stem cells are hot.
Yes indeed, they're not only hot, but they're hip, they're happenin', they're right now, baby. Scientists are falling all over themselves with excitement at the potential applications that could potentially come from stem cell technology. True, no validated therapies for embryonic stem cells have yet made it into clinical practice, and the challenges that need to be overcome before that can happen are arguably greater than what was believed in the heady days a few years ago, before President Bush declared his ill-advised restriction on embryonic…
oracknows | March 14, 2008The must-read post of the day comes from Mark Crislip of the (in)famous Quackcast and was posted over at the Science-Based Medicine blog. It's about two things primarily: How evidence and science result in physicians practicing science- and evidence-based medicine to change their practice and why that seems disturbing to those who don't understand how science works and would prefer unchanging certainty and how this changeability of practice based on the lastest evidence is in marked contrast to most so called "complementary and alternative" medicine, the vast majority of which is based on…
oracknows | March 13, 2008As an NIH-funded surgeon/scientist, I just had to read this report at BrokenPipeline.org when I became aware of it, courtesy of Bora and Drugmonkey. Basically, it describes how bleak the NIH funding situation has become, particularly for young investigators. The report (PDF) comes from several prominent research universities and warns that we are at risk of losing a generation of new biomedical researchers. Even taking into account the knowledge that this report is anything but unbiased (indeed, it is explicitly in favor of increased NIH funding), the situation it paints is still pretty grim…
oracknows | March 12, 2008After a bit of ranting earlier this week, I thought now would be a good time to cool it down a bit, if only for a moment. There's plenty more out there to rant about, but I'm intentionally ignoring it, if only for a day (or even half a day). If there's one thing I've learned about blogging in the three years I've indulged in this little habit of mine, it's that a blogger has to mix things up. Too many rants in a row, and even I start to get bored. And if I'm bored you're almost certainly bored.
We wouldn't want that, now, would we?
So it was with great interest that I came across, albeit…