An interesting controversy that has simmered in the medical literature for years is the effect on health and survival of moderate alcohol consumption. Epidemiological studies consistently show that moderate drinkers live longer than abstainers, while heavy drinkers fair the worst. Before we discuss possible mechanisms for this effect, we have to consider whether or not the effect is real – and here controversy remains.

One of the reasons for the controversy is that the data supporting a protective effect of moderate alcohol is all observational, rather than experimental. It is simply not possible to do a study in which subjects are randomly assigned to either no, moderate, or heavy alcohol consumption (especially in a blinded fashion). Therefore researchers must be content with mere correlation. This is useful but very problematic evidence.

The weakness of observational evidence like this is confounding factors. Since people self-select their own alcohol consumption there may be many other lifestyle choices that go along with that and affect health and survival. There may even be genetic types that lead people to drink and also confer greater longevity. Without randomization the possible confounding factors are enormous. Continue Reading »

This is a quick update on the Autism Omnibus hearings – representative cases heard before a special court to decide if there is any credible evidence to conclude that autism may be a vaccine injury. After hearing exhaustive testimony by all sides, the special masters determined that the evidence does not support a link between autism and vaccines.

One of the cases heard was the Cedillo case, which was used as the test case for the theory that the MMR vaccine plus exposure to thimerosal can trigger brain damage that looks clinically like autism. In February of 2009 the court rejected the claim that Michelle Cedillo’s autism was caused by vaccines. No only was the theory of causation without scientific backing, evidence was presented to show that Michelle Cedillo demonstrated early symptoms of autism prior to ever receiving the MMR vaccine.

In fact the Cedillo case is representative of a fact that scientific research is increasingly demonstrating – that subtle signs of autism are present prior to parents noticing that there is a problem and long before formal diagnosis. The consensus of evidence is that signs of autism appear between 6-12 months of age, and maybe earlier in some cases. Meanwhile, the first MMR vaccine is given at 12 months. Since causes must precede effects, this fact alone is fatal to the MMR-autism hypothesis.

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There is an AIDS epidemic in Africa, and efforts to fight it are hampered by the endemic social problems of that continent. Chief among them are the lack of sufficient modern health resources, the spread of destructive rumors and myths about HIV/AIDS, and even the persistence of HIV denial in Africa (although this last factor is better than in the past).

The World Health Organization (WHO) and the International HIV/AIDS Alliance are teaming up with the Traditional Health Practitioners Association of Zambia (THPAZ) to address the first problem – the lack of health services. Most Zambians use traditional healers for primary health care. The WHO has therefore decided to utilize traditional healers in the fight against AIDS. There are interesting pros and cons to this policy, but it must first be recognized that there is no ideal solution to the problem. The resources to provide optimal modern health care to treat and prevent HIV/AIDS (which would need to include a massive education program) in Zambia and the rest of Africa simply do not exist. One might argue that the world should provide those resources, but let’s put that issue aside and focus on what to do in the meantime.

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Note: Late post today. I am covering the in-patient service and more time constrained than usual.

By now most people know that the dinosaurs (now clarified as non-avian dinosaurs), along with 85% of species alive at the time, became extinct 65.5 million years ago as a result of a massive meteor impact. This is almost certainly the impact crater at Chicxulub, which dates to the correct time. In addition, examination of fossils and geological layers centers this extinction event at Chicxulub.

This is referred to at the K-T extinction, referring to the end of the Cretaceous and beginning of the Tertiary periods. However, use of the designation “Tertiary” is being phased out, and the K-T extinction is now being referred to as the K-Pg extinction – for Cretaceous-Paleogene.

While the single impact theory is the current consensus, there are two significant if minority competing theories. One is the Deccan Traps flood basalts – a 200 thousand year long event spanning the K-Pg boundary that involved massive volcanic eruptions, which could have causes extinctions through release of dust and sulfuric aerosols into the atmosphere. While not dead, this hypothesis has not fared well under recent evidence and is supported by only a small minority of paleontologists.

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A new study published in the Journal of Medical Ethics reports on a survey of various characteristics of physicians – specialty, ethnicity, and religious faith – and the way they deal with end of life care. According to these results, ethnicity had little to no effect. The specialty of the practitioner has the greatest effect, with hospital-based doctors discussing and using methods that may hasten death in the terminally ill at 10 times the rate of palliative care specialists. But the most widely reported result is that doctors who are agnostic or atheist were twice as likely to use such methods as deeply religious doctors.

As with most such studies, the two types of questions to ask are – are the results reliable, and if they are reliable what do they mean. To the first point, this is a very weak study. First, it is a self-reporting survey. This is the weakest kind of survey, because it is not strictly scientific – there is a huge effect from self-selection bias. The surveys, in other words, may mostly reflect who is willing to answer the survey, which can overwhelm other factors.

In this survey 8,000 doctors were contacted, and less than four thousand responded. That right there is a massive self-selection factor that renders any results of this survey preliminary at best. Such a survey can be used to generate hypotheses to be confirmed, but not something upon which specific recommendations should be based. Regardless, the authors do just that, recommending:

Greater acknowledgement of the relationship of doctors’ values with clinical decision-making is advocated.

Rather the authors should have concluded: Further testing of the possible relationship between specialty, religious belief, and decision-making is warranted.

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Via YouTube, we can see another case of “foreign accent syndrome (FAS).” This is a rare condition in which a person appears to speak with a foreign accent following a stroke or other brain damage. In this case a woman from Devon who naturally speaks with a “west country lilt” now is said to speak with a Chinese accent. Take a look at the video and decide for yourself.

Essentially this woman has had a migraine stroke – which is the most common cause of stroke in in younger adults. This may have damaged either her language area (specifically Broca’s area or a nearby region that would affect Broca’s function, causing a form of aphasia) or it is also possible that she has damage in another part of the brain causing weakness of certain muscles involved in speech, in which case we would term what she has a dysarthria. I think the former is more likely just from how she sounds, but cannot say definitively without more information.

In any case, the damage has altered her speech, making it more difficult for her to pronounce certain words and also appears to affect the prosody of her speech – her inflection and rhythm. The result is only vaguely reminiscent of a Chinese accent, in my opinion. And you can still hear a bit of her native accent underneath. This is actually an excellent example of what foreign accent syndrome is (as the expert on the video correctly points out) – it is just a coincidence and a heavy helping of pattern recognition that the resulting speech abnormality reminds us of one of the many accents in the world – in this case, Chinese.

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There is yet another dubious diagnosis coming into vogue – adrenal fatigue. This is an entirely made up syndrome invented by naturopath and chiropractor James Wilson. His website begins with the classic solicitation:

Are You Experiencing Adrenal Fatigue?*

* Tired for no reason?
* Having trouble getting up in the morning?
* Need coffee, colas, salty or sweet snacks to keep going?
* Feeling run down and stressed?

If you answered “yes” to one or more of these questions, you may be experiencing adrenal fatigue.*

That’s right – even if you answered “yes” to just one of those questions, which means that you are an average adult, then you may have this fake syndrome. This is beyond satire.

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There is an interesting blog debate going on between PZ Myers and Ray Kurzweil about the complexity of the brain – a topic that I too blog about and so I thought I would offer my thoughts. The “debate” started with a talk by Kurzweil at the Singularity Summit, a press summary of which prompted this response from PZ Myers. Kurzweil then responded here, and Myers responded to his response here.

Futurism

You can read the exchange for all the details. I want to focus on just a couple of points – predicting our efforts to reverse engineer the brain, and the question of how complex the brain is.  Kurzweil has predicted in the past that we will reverse engineer the brain – model its function in a computer, basically – by 2030. It was reported that in his talk he said 2020, but Kurzweil has clarified that this is not correct, he said 2030, sticking to his earlier predictions.

That’s a minor (but interesting) point, and Myers points out that it was not the focus of his original criticism. I agree with Kurzweil on some basic principles. First, we do have an active research program that is using computer modeling to reverse engineer the brain. These efforts are progressing nicely, and I do think that eventually they will succeed. I also agree that some technologies progress at an exponential rate, and they surprise those who were making predictions based upon a linear progression. Kurzweil gives an excellent example of this – the genome project. This project started out very slow, and many thought it was lagging behind predictions, but as technology improved the effort to decode the human genome accelerated geometrically and actually finished years ahead of schedule. Now we can decode the genome of other species in a fraction of the time, and the pace continues to accelerate.

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I have written numerous blogs both here and on SBM about the acupuncture literature, which clearly shows that acupuncture, for any indication, is nothing but an elaborate placebo. Rigorous studies of acupuncture that actually try to isolate variables have shown that it does not matter where you stick the needles or even if you stick the needles – those variable do not have any specific effect. Acupuncture points and meridians are an illusion – nothing but superstition.

But there does appear to be a significant placebo effect, in addition to non-specific effects from relaxation and therapeutic attention, to the ritual of acupuncture. Does this mean “fake acupuncture works?” No – it means acupuncture does not work, but there are known placebo effects from the process of getting treated.

Now we have yet another study that supports the conclusion that acupuncture is just a placebo – but with an added element that is very interesting. Researchers compared traditional Chinese acupuncture (TCA) with sham acupuncture (non acupuncture points, shallow needle insertion) and another control group with no treatment for knee osteoarthritis. The researchers also did one very interesting thing, and one very sloppy and annoying thing (in my opinion). The sloppy thing was to use “electroacupunture” – which isn’t pure acupuncture. It’s acupuncture plus transcutaneous electrical nerve stimulation, which is an already proven modality for pain. In the TCA group they gave full “electroacupuncture” and in the sham group they gave less stimulation – enough to serve as an active placebo but not enough to have any effect.

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The pattern is depressingly common – take a disease that is not currently cured by science-based medicine. Claim that doctors “don’t care”, or are ignoring treatments that do not make them money, or there is a conspiracy of silence headed by “Big Pharma.” Then offer a snake-oil alternative based upon anecdotal evidence. Sometimes faith and God are thrown in for good measure.

Nita Scoggan fits this mold nicely. She is promoting herself as a “health and happiness coach” and using her husband as anecdotal evidence of the power of her nutritional advice. The story is now being promoted by other low-carb gurus, including Jimmy Moore.

The story is a great example of why anecdotes are so problematic. We are told that Nita’s husband, Bill, was diagnosed with Alzheimer’s disease, but she cured him with diet and nutrition, specifically coconut oil and a low carb diet. The problems with this story begin with the diagnosis. Scientific medical trials always include what are called inclusionary and exclusionary criteria – this is to make sure that subjects actually have the disease that is being studied. This is critical because apparent remissions may be due to the fact that the person never had the alleged disease in the first place.

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