Filler – so sue me!

So I know I’ve not posted anything in forever (since my first week of classes, as it turns out), but I just wanted to post a few quick things:

– As it turns out, being a medical student is rather time consuming. It’s not to say it’s quite as bad as some people seem to think it is, but I’m also living by myself, so keeping on top of feeding myself, doing yard work, cleaning house, etc. in addition to studying ends up eating up a lot of my time. So hence my lack of time to compose insightful, brilliant opuses of skepticism. Or you know, even the usual sort of thing I write.

– I don’t have TV anymore and I miss being able to watch Mythbusters. So I followed them all on Twitter. Tory was live-tweeting this Sunday’s episode where they were launching anvils into the air (via explosion, of course). Jealous, I tweeted:

I was maybe a little too excited when he tweeted back.

He made a very good point, and so I didn’t drop out. Yet. Tuition isn’t due until the end of September… so there is still time. Ha ha. Alternatively, I’m hoping they need a doctor on the set. I’d totally do it for free. I love science.

– I spent a lot of time this summer at the St. Norbert Farmer’s Market, and I’ve finally been annoyed enough by the various insane things being peddled there that I decided to blog about it. It’s a work in progress, but here’s some clues: negative ions, biofeedback subluxations, and raw diet. You would not believe how adamantly people buy into it. I actually unintentionally got into an argument about it with one of the customers of these people because they randomly came up to me and tried to convince me, too.

– I also have a lengthy piece on stem cells that I don’t know what to do with for the moment. It’s more educational than controversial – unfortunately but once again science demonstrates that there are no absolutes, and every answer has the caveat “…but it’s not quite that simple.”

– I have a scheduled, testable course lecture on CAM use in cancer coming up in October. It’s being given by the head of the local CAM institute, so I fully expect to have a plethora of blog material from it. It is our only scheduled CAM lecture, but fortunately we have a few vocal skeptics in the class, so it could be an interesting class.

– I am totally procrastinating on studying for my upcoming ominously looming midterm right now. I just thought you should know if you hadn’t figured it out.

Speaking of procrastinating, here's a picture of the grizzlies at the Calgary Zoo. Guess what I did on Saturday...

Skepticamp Winnipeg is coming up forthwith!  September 17th! Aqua Books! Come see all the interesting people give talks on nutrition, fallacies, polyamory, free will, perpetual motion machines… oh, and some pseudonymous blogger is doing a talk about Science in the Media (and how to find out the truth of things). I’m quite excited for it. Let us know that you’re coming here.

This is why we need women in skepticism!

There is a lot of post-Elevatorgate buzz about women in skepticism, including the announcement of a conference to specifically deal with women in secularism, more specifically the lack thereof. A lot of people who think that this is a non-issue have said that women (and other minorities in skepticism) will join the movement when they want to, that women simply aren’t interested in hearing about it. (And if you don’t think people actually believe this, please read the comments on the “Women in Secularism” announcement.) Since secularism is about self-improvement and education, I’m going to call Bullshit! on that. Yes, part of the problem is an environment in secularism that is intimidating to women, a lack of prominence for female skeptics, and so on. But the inverse of that is the amount of woo that is promoted to women.

Manitoba women use the health care system more than men, averaging 5.4 physician visits annually (4.4 for men), and 85% of women see a physician at least annually (79% for men.) Even healthy women of reproductive age receive birth control from their physician, have annual Pap tests, get mammograms, have prenatal consultations, and use health care services before, during and after childbirth. Women who are sick visit their physicians more frequently than men with similar illnesses. Women are more likely to be injured due to domestic violence (1 in 5 Manitoban women have been victimized by their partner in the last five years). Women are more likely to be proactive with their health, seeking screening and taking preventative measures more often than men. Now here’s the scary bit: almost 1 in 5 women in Manitoba consulted a CAM practitioner in 2003 (the most recent data). Only 1 in 10 men did the same! These statistics are in reality even worse, as the analysis excluded chiropractic, which partially covered by the province and therefore “not alternative.” Women are more preoccupied with their health, more concerned with prevention, and therefore more likely to be taken in by quacks.

Here’s a figure from the report I’m getting my data from:

The higher the household income, the more likely the women would seek CAM (here denoted CAHC for "health care"). Men did not seek more care as it became financially feasible.

In other words, as women were able to afford it, likely due to both increased income and increased private insurance coverage with the better paying jobs, more women were using CAM. I certainly would be interested to see if the discrepancy is access in lower income brackets, or a lack of awareness.

Well, maybe, you helpfully offer, chronically ill women are more likely to use CAM, and the wealth changes represent their ability to try unproven treatments for their disease! Nay nay….

The majority of women using CAM are healthy!

So what now? We have a bunch of healthy, wealthy women who are out there spending money on homeopathy and reiki and healing meditation and detox regimens and spiritual communicators. Why is it our problem if women want to waste their money on unproven crap? Well, because it’s not right, and it’s not fair. We don’t teach girls to ask questions, we tell them to trust authority, we tell them that their problems aren’t important, we tell them that they’re not an important part of the skeptical community, and then we proceed to laugh at them for finding a sympathetic ear and falling prey to placebo effects!

Worst of all, thanks to “integrative” “medicine,” woo is pervading our hospitals. While walking through the Women’s Health Centre, I saw a poster for upcoming health workshops being hosted at the Centre that made me do a double take. Yes, sponsored by Alberta Health Services, you can take a $40, 2-hour workshop in Reiki (“massage for your soul!”), a $190, 12-hour class in Feng Shui, or a $48, 3-hour workshop entitled, I kid you not, “Talking to Your Angels and Learning How to Listen,” run by Sandy Day, who claims to be a Reiki Master, Shaman, and Intuitive Healer. This is not some backwoods hand-waving Natural Healing Centre Of Happiness and Puppy Dog Kisses, this is at the biggest teaching hospital in the city, the centre for the high-risk pregnancies, for breast cancer: the medical hub! Or, on Wednesday, September 17th from 7-9 pm, the classroom for “Energy Medicine – The Internal World.” Oh but don’t worry, in tiny text:

Women’s Health Resources does not support, endorse or recommend any method, treatment, product, remedial center, program or person. We do, however, endeavour to inform because we believe in the right to have access to available information in order to make informed individual choices.

Now, call me skeptical, but I’m pretty sure if I wander over to the Urology clinic, I somehow doubt that I will see the same advertisements promising healing touch lessons for prostate problems.

For more than one reason, really. (zpeckler@flikr)

If we don’t teach our girls to question, and if we don’t ask our women to think, stuff like this is only going to get worse. No amount of half-assed disclaimery is going to change the fact that misinforming anyone is the opposite of giving them an informed individual choice. Talking about the dangerous of being teleported to Neptune by devious extraterrestrial cows does not come into discussions of which car you’d like to buy. Yes, you should be aware of the pros and cons of every car, and yes you should be free to make that choice, but having some random loon come in off the street to convince people that our Bovine Neptunian Overlords only abduct people who drive Chevies is pretty much the opposite of informed consent, particularly if the random loon also happens to sell Toyotas. Why is the Women’s Health Centre not bringing in drug companies to give presentations on why everyone should be taking Lipitor? Perhaps because there is a major conflict of interest when you are essentially charging people to sit through a sales pitch? And this is actually a bad example, because at least Lipitor actually has demonstrable, independently reproducible benefits!

So yes, we do need more women in skepticism. We need women standing up for themselves, saying that they are tired of all this bullshit being thrown at them. Without female allies telling Oprah to go stuff herself and Dr. Oz to take his reiki elsewhere, the skepticism movement will never succeed at exposing fraud in CAM. Women’s voices don’t just deserve to be heard in skepticism, they need to be heard, for the sake of everyone’s health.

Integrative and allopathic medicine: a skeptical medical student’s rant

It’s no mystery that I am not a fan of CAM (complementary and alternative medicine), and not because I’m a Big Pharma Shill or been brainwashed by exhaustive campaigns by evil corporations. It’s not that I hate herbs, hate Chinese people, and hate things that are different that I don’t understand. The majority of the time I spent in a research laboratory (5 years, including time as a summer student), I spent it doing research into nutrition and functional foods. I worked with people studying the biochemical effects of exercise on health. I understand the role of preventative medicine and lifestyle interventions more than most people and I strongly advocate them. As part of, you know, medicine.

The term “allopathic medicine” was coined by Samuel Hahnemann, who contrasted it with, unsurprisingly for those of you who recognize the name, homeopathic medicine. It’s a derivative term from the Greek word allos meaning other, implying that the treatment opposes the disease, in contrast to homeos (“like”) cures. That homeopathy continues to persist 168 years after Samuel Hahnemann is a farce – that it is presented to medical students without any iota of explanation or critical thought is a tragedy. Observe:

From the AFMC (Association of Faculties of Medicine of Canada) Primer on Population Health, required reading for my class, with the offending phrases bolded by me:

Contemporary Western medicine is increasingly being challenged to consider how to respond to perspectives and treatments other than those of conventional allopathic medicine. One response has been to propose ‘integrative medicine’ as a collaboration between biomedical approaches and other healing traditions, including herbal remedies, manual interventions such as massage therapy or chiropractic, and mind-body practices such as hypnosis. Similarly, the Canadian College of Naturopathic Medicine trains naturopathic doctors who employ natural therapies as well as using the more standard medical diagnostics of allopathic medicine.

Integrative medicine is about changing the focus in medicine to one of healing rather than disease. This involves an understanding of the influences of mind, spirit, and community as well as of the body…
…Whereas allopathy implies opposing the symptoms of disease, homoepathy implies working with the disease by stimulating the body to produce its natural defensive (e.g., immune) responses.For a time during the mid-nineteenth century, homeopathy (treating like with like) was a serious rival to the allopathic approach, but the development of the germ theory gave allopathy a scientific foundation for many of its remedies. However, by the mid twentieth century disillusionment began when, despite advances in ‘the conquest of infectious disease’ hospitals remained full and waiting lists stayed long. This may have reflected a rising demand for care induced by the perception of its success, but the very success of allopathic medicine (along with improved social conditions) enabled people to live long enough to suffer degenerative diseases for which the allopathic approach is less effective. Moreover, the allopathic approach has some undesired consequences including the rapid increases in costs and the large numbers of people with iatrogenic disorders.2 While allopathic remedies are often highly effective, practitioners are also aware that the best cure may be for the patient to simply restore balance in their life and get adequate sleep, exercise, and good nutrition.

Did you spot all the devious false equivalences and straw men drawn there? Did you notice the bait and switch set up with massage therapy being touted as alternative? Integrative medicine is not a collaboration between biomedical approaches and “other healing traditions” – it’s the infusion of pseudoscience into science. There is no need to worry about traditions when designing a treatment program. You figure out what works best, and you use it. We don’t continue to give people radium for high blood pressure simply because some people in the past thought it was a nifty neat-o idea! Notice also the mention of naturopaths as if they were an equivalent but separate kind of doctor, as if drinking powdered deer horn tea had the same level of efficacy as prescribing a statin.

The idea that “allopathic” medicine is focused on disease rather than healing is a ridiculous notion that I am ashamed to see presented by the people who are overseeing the curricula of this country’s medical schools. In my first week here, the concepts of the spectrum from health to disease, the need for population-based intervention, and the need to treat patients as individuals and not diseases has already come up. We’ve also already talked about treatment – but what is the point of talking about treatment if you don’t understand the disease? I mean, it’s all well and good that Mrs. Johnson comes in vomiting blood all over, but I’m pretty sure that thinking hard about being healthy and taking a nap isn’t going to prevent her form going into hemorrhagic shock! Only once you understand the disease can  you design a treatment. If you think her vomiting blood is from possession by an evil forest spirit, you’re going to proceed quite a bit differently than if you realize that Mrs. Johnson has a ruptured blood vessel in her stomach. The whole purpose of medicine is to achieve wellness! No amount of pre-scientific thinking or feel-good nonsense is going to save Mrs. Johnson’s life!

And of course, the criticisms that because “allopathic” medicine works so well, now people are living long enough to deal with issues that it can’t treat. So, when Mr. Wong comes into your clinic, presenting with symptoms of Alzheimer’s, clearly the only answer is to abandon the system that works really well at everything else, and try some random stuff that has no evidence to support it. This is the same sort of tactic that creationists use in the “God of the gaps” arguments. We don’t know, so God did it. We don’t know, so let’s use reiki. The absence of evidence for something does not mean you get to fill in the blanks with your chosen brand of unsupported beliefs. If there is a gap in our knowledge about what to do with an Alzheimer’s patient, we should research into causes (and subsequently treatments) of Alzheimer’s disease. Plausible, mechanism-based treatments. They don’t need to be drugs; there’s been psychological-behavioural research being done into mental training exercises (most of which has come up short in translating to increased everyday functionality.) Maybe we need to do more to prevent head trauma injures like concussions during sports activities. Maybe we should look at how alcohol and drug abuse can lead to dementia later in life. All of these are well within the realm of medicine, and require no magical thinking. They are testable hypotheses and should be pursued. Until we have an answer, you don’t get to fill the gaps with the nonsense du jour.

Did you also notice that homeopathy is given a one-off vaguely plausible sounding mechanism without any sort of definition as to what it might be? They make it sound like homeopathy is like vaccination, dealing with it not only credulously but dishonestly. How many students are going to read that claim, assume it correct, and go on to think that is is a perfectly legitimate form of medicine?

It’s unsurprising that they also bring up iatrogenic diseases, which can be literally translated to mean “healer-caused” diseases. These diseases range from anemia due to excessive blood draws in the hospital, to hospital-aquired (nosocomial) infections, to potentially lethal drug side effects. They are a major issue in medicine, especially when they are preventable, as in nosocomial infections (which can be prevented by proper cleanliness techniques) or worse, when someone screws up. There are failsafes in place for mistakes, and are why hospitals have adopted a team approach, but they inevitably will happen. However, this is not an argument for throwing the whole system, which we’ve already established works quite well. This is an argument for making the system better, for preventing the mistakes, for increasing communication within a team, for finding more failsafe systems, for being pro-active. The system isn’t broken, it’s just not perfect. You shouldn’t replace something that works but has side effects with something that doesn’t work but has none, especially since the lack of side effects are due to the fact that it doesn’t work. 

This is, of course, also assuming that “traditional” medicine has no side effects, which the anti-vaccine crowd has shown us that it can have. Eschewing modern medicine kills people. If people forsake their family physician for a naturopath, they will cannot be given prescriptions if they need them. If Mr. Sullivan is an overweight, 58-year old pencil pusher with genetic high cholesterol and an impending heart attack, then advocating a healthy diet and more exercise is important. But given his genetic preponderance and his previously sedentary lifestyle, no amount of oatmeal will help. In addition to lifestyle counselling, he desperately needs pharmaceutical intervention, possibly stenting to keep his heart’s blood vessels open, and an intensive monitoring of his blood lipids. If he dies of that heart attack, and the naturopath did not refer him to a physician when first line defences fail, that naturopath is responsible for his death. Just as letting someone get hit by a bus because you don’t want to rumple their suit jacket makes your failure to act lethal, so does dependence on pre-scientific thinking while avoiding science-based medicine cause people to die. Naturopathy, at its core, is based on true principles (that we get drugs from the natural world, there’s a science based on it called pharmacognosy), but in practice is little more than hand-waving, placebo-effecting ridiculousness. On the Canadian Association for Naturopathic Doctors, the website linked to by the AFMC’s primer, they recommend for colds & flus:

To aid the elimination of toxins through the skin induce perspiration by taking long hot baths, using an infra-red sauna or steam room. Increasing perspiration through the skin is one of the safest and most effective ways of eliminating toxins.

You know, unless you get dehydrated and die.  I hear that making people who have a fever sweat even more is really sound medical advice. To get rid of toxins. Right.

So no, Association for the Faculties of Medicine of Canada, I don’t think that we should consider integrative medicine and the “treatment of mind, body and spirit” in our practice. A doctor is not a shaman, nor should they attempt to be. I think physicians should be compassionate, caring, understanding, attentive, and open with their patients. They should be concerned for their patient’s autonomy, their mental health, and their feelings. They should strive to give them the best care, based on the best evidence available.

TL;DNR: I don’t think that there is any room, when people’s lives are at stake, for bullshit.


Update: Somebody famous read this article and liked it enough to link it on their Twitterfeed! Scott Gavura (@PharmacistScott), blogger of Science-Based Pharmacy and occasional writer for Science-Based Medicine.