Archive for the 'Science and Medicine' Category

Oct 08 2015

CRISPR and a Hypoallergenic Peanut

Anyone with a child in school is probably aware of the need for peanut free zones. You get a notice when your child returns from school on the first day stating that at least one child in their class has a peanut allergy, which means nothing with peanuts gets sent to school for your child’s lunch. If you are a parent of a child with a peanut allergy you understand how important and serious this is – your child is literally one errant Snickers bar away from death.

The general consensus is that food allergies have been on the rise in developed countries, although studies show a wide range of estimates based upon study techniques. A US review found the prevalence of self-reported peanut allergies ranged from 0-2%. A European review found the average estimate to be 2.2% – around 2% is usually the figure quoted. In a direct challenge study, at age 4, 1.1% of the 1218 children were sensitized to peanuts, and 0.5% had had an allergic reaction to peanuts. That means there are millions of people with peanut allergies.

So far there is no cure for the allergies themselves. Acute attacks can be treated with epinephrine, but there are cases of children dying (through anaphylaxis) even after multiple shots. The only real treatment is to obsessively avoid contact with the food in question. Peanuts, tree nuts, and shellfish are the foods most likely to cause anaphylaxis.

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15 responses so far

Oct 06 2015

The Diabetes Treatment Your Doctor Won’t Tell You About

Because it’s bogus.

It’s unfortunate that it’s so easy to convince many people that there is a vast medical conspiracy, and that a few brave mavericks are willing to bring you “the truth.” I was recently asked to look at this website, claiming that doctors who treat diabetes have all been lying to their patients and the world. They promise to reveal the secret of curing diabetes, but the long video, and the endless website, is all just one long commercial hyping their book which you can get for the “bargain basement reduced price of just $77 for the digital copy or $94.39 for the paperback copy with free worldwide shipping.”

The sales pitch is framed as an “Urgent diabetes health bulletin from the doctors at the International Council for Truth in Medicine.” (Quackwatch lists the ICTM as a “questionable organization.”) To backup their authority they claim they are in partnership with “Natural News.” Given that Natural News is, in my opinion, the most notorious crank, conspiracy mongering, health misinformation site on the web, that is all you need to know about the ICTM to make an informed judgement.

Their narrative is depressingly typical, and not even imaginative. The tropes are so common they are worth addressing in detail.

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12 responses so far

Sep 18 2015

Lobbying for Quackery

The American Association of Naturopathic Physicians is lobbying Congress to pay naturopaths to treat vetarans, specifically for chronic pain. This, of course, goes beyond “health care freedom” (which itself is dubious) and is asking for taxpayer dollars to be spent on unproven and pseudoscientific treatments.

The open letter does not mention specific treatments that naturopaths would offer.  Instead it fearmongers about pharmacological treatments for pain. It is certainly true that opiates are a double-edged sword. They are powerful pain killers, but long term use causes dependence, tolerance, and may complicate pain management. Science-based physicians are well aware of this, and use a variety of approaches to minimize opiate use for chronic pain.

The letter claims that naturopaths have unique “natural” therapies that can effectively treat pain. This is one of the core myths of “alternative” medicine – if there were a treatment that objectively worked, it would be incorporated into mainstream medicine.

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84 responses so far

Sep 17 2015

Trump on Vaccines

I generally don’t cover purely political issues on this blog, but the second Republican primary debate from last night ventured into the area of vaccines and autism. Donald Trump has said in the past that he thinks the current “epidemic” of autism is caused by vaccines. He was challenged on this position during the debate, and face palms ensued.

Orac, perhaps presciently, gave a good recap of Trump’s anti-vaccine nonsense just yesterday. In 2007 Trump said:

“When I was growing up, autism wasn’t really a factor,” Trump said. “And now all of a sudden, it’s an epidemic. Everybody has their theory. My theory, and I study it because I have young children, my theory is the shots. We’ve giving these massive injections at one time, and I really think it does something to the children.”

That is pretty much exactly what Trump said during the second debate, almost word-for-word. This demonstrates several things about Trump, in my opinion. First, he feels comfortable forming his own opinions, based on nothing but casual observation and anecdote, even on complex scientific issues, without adequate information. The fact that the scientific community has come to an opposite opinion does not even seem to give him pause. Finally, he has learned exactly nothing on this issue over the last 8 years – nothing. He has added no depth or nuance to his position, let alone correcting his factual errors.

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23 responses so far

Sep 14 2015

Is Fibromyalgia Real?

The question of whether or not fibromyalgia is a real disease is deceptively complex. The answer, therefore, is not a simple yes or no. A thorough answer requires some background, which makes it challenging to discuss any issue related to fibromyalgia without going on a long tangent about its status as a diagnosis.

What’s In a Name?

Before we get to fibromyalgia specifically, I want to review how diagnostic labels are used in medicine. Health care providers, researchers, and also insurance companies and regulators need a common language to refer to what patients have. As our understanding of disease is incomplete, and also disease entities are often complex and fuzzy around the edges, a coherent and thorough diagnostic system is likewise complex.

For simplicity, however, we can divide diagnostic entities into two broad types. First there are discrete diseases, which are pathophysiological entities. This is a specific problem with a specific tissue or physiological process in the body. A disease diagnosis may refer to a specific genetic mutation, for example, or an alteration in a physiological parameter.

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100 responses so far

Sep 01 2015

Sleep and Health

Getting sufficient sleep is very important to overall health. It is an often overlooked aspect of health. I frequently have patients with multiple complaints who inform me, only when asked, that they have terrible sleep. They did not make the connection between their sleep and their symptoms, however.

Good sleep has been tied to longevity. A review of studies found that getting <6 hours of sleep on average per night was associated with a 12% increased risk of death. The same review found that getting >9 hours of sleep a night was associated with a 30% increased risk of death.

It is difficult to determine cause and effects with these studies. Sleep may simply be a marker for other health variables. People who sleep over 9 hours, for example, may do so because they are unhealthy for other reasons.

Even still, it is plausible that lack of sleep is stressful to the system, especially brain function, and therefore sleep disorders should be identified and treated. Don’t overlook the importance of good sleep.

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19 responses so far

Aug 27 2015

FTC Responds to FDA on Homeopathy

The FDA (Food and Drug Administration) recently asked for public comment on its regulatory policies regarding homeopathy. They probably didn’t figure that a fellow federal agency, the FTC (Federal Trade Commission) would respond.

The FTC also recently asked for public comment on how it can better regulate homeopathic product advertising. While the FDA regulates food and drugs (including supplements), the FTC regulates claims that sellers can make about those foods and drugs. The FTC is now complaining to the FDA that their policies are in inherent conflict. They write:

The staff comment notes that the FDA’s regulatory framework for homeopathic drugs, set forth in a 1988 Compliance Policy Guide, does not require that over-the-counter (OTC) homeopathic drugs be approved by FDA as safe and effective if they satisfy certain conditions, including that the product’s label contains an indication for use. Yet the policy guide does not require sellers to have competent and reliable scientific evidence to support the indication for use.

The comment states that given the FTC’s long-standing advertising substantiation policy that health claims must be substantiated by such evidence the FDA’s current regulatory framework may harm consumers and confuse advertisers.

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7 responses so far

Aug 25 2015

Anti-GMO in the NEJM

A recent commentary published in the New England Journal of Medicine (NEJM) by Philip J. Landrigan and Charles Benbrook has sparked some controversy. Landrigan and Benbrook are publishing in a medical journal because they claim the issue of genetically modified organisms (GMOs) is a public health issue. They use extremely strained logic and misrepresentation to make their point, however.

Equating GMOs with Herbicides.

The primary logical flaw in their argument is their attempt to equate GMOs with the use of herbicides. They write:

Herbicide resistance is the main characteristic that the biotechnology industry has chosen to introduce into plants.


The first of the two developments that raise fresh concerns about the safety of GM crops is a 2014 decision by the Environmental Protection Agency (EPA) to approve Enlist Duo, a new combination herbicide comprising glyphosate plus 2,4-D. Enlist Duo was formulated to combat herbicide resistance.

The authors also acknowledge that:

“ genetically engineered crops can increase yields, thrive when irrigated with salty water, or produce fruits and vegetables resistant to mold and rot.”

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13 responses so far

Aug 24 2015

Antivaxxers Still Flogging Thimerosal

I gave a talk on the vaccine controversy over the weekend. I was not surprised that a couple of audience members had a lot of questions taken directly from anti-vaccine propaganda sites. What was interesting was that they were still pushing the idea that thimerosal, a mercury-based vaccine preservative, is linked to autism.

The reason this is interesting and illuminating is that the thimerosal hypothesis is not just mostly dead, it is most sincerely dead. It is pushing up the proverbial daisies.

A Brief History of Thimerosal

Thimerosal was developed as an organomercurial anti-microbial agent shortly after World War I. It was soon discovered that it has great anti-microbial properties and was well tolerated when injected into rabbits or rats even at high doses. This made it superior to anything else available at the time.

Bacterial contamination was a serious problem for vaccines in the first half of the 20th century. Thimerosal in tiny doses, well below safety limits, proved to be an effective agent for preventing contamination. By the 1940s thimerosal was being added to several vaccines for this purpose.

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38 responses so far

Aug 21 2015

Risk Factors for Alzheimer’s Disease

A new meta-analysis of 323 studies looks at 93 possible factors associated with the risk of developing Alzheimer’s disease (AD). AD is a neurodegenerative disorder affecting the entire brain that causes a slowly progressive dementia over years.

Dementia is a generic term for a chronic disorder of memory and cognition. AD is a specific disease that causes dementia. It is the most common cause of dementia, responsible for about half of all cases. There are 5.2 million people with AD in the US, most over the age of 65. About one-third of people 85 years or older have AD.

AD, therefore, is a significant cause of a common condition that causes extreme disability and death in the older population. There is currently no cure for AD. Available treatments are considered symptomatic – they improve memory and function modestly but do not alter the course of the disease. Preventing AD, therefore, is very important.

The current meta-analysis looked at cohort studies and case-control studies. These are two different types of observational studies, meaning that they are observing what happens or has happened to people but does not randomize people to different groups. It is difficult to draw conclusion about cause and effect from observational studies because of possible confounding factors. The advantage, however, is that they can observe large populations. In the current analysis the researchers looked at 93 factors with >5,000 subjects in the pooled studies.

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23 responses so far

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