Great Idea

http://blogs.forbes.com/sciencebiz/2010/06/save-taxpayer-eliminate-alternative-medicine-research/

From Steven Salzberg:

This past week, President Obama called on all federal agencies to voluntarily propose budget cuts of 5%. Well, Mr. President, you might be surprised to learn that there's a way for you that cut the National Institutes of Health budget without hurting biomedical research. In fact, it will help.

Here's my proposal: save over $240 million per year in the NIH budget by cutting all funding for the two centers that fund alternative medicine research--the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Cancer Complementary and Alternative Medicine (OCCAM). Both of them exist primarily to promote pseudoscience. For the current year, NCCAM’s budget is $128.8 million, an amount that has rapidly grown from $2 million in 1992, despite the fact that not a single “alternative” therapy supported by NCCAM has proven beneficial to health. OCCAM’s budget was $121 million in 2008 (the latest I could find) and presumably higher in 2010. That’s over $240M, not counting money these programs got from the stimulus package (and yes, they did get some stimulus funding).

These two organizations use our tax dollars – and take money away from real biomedical research – to support some of the most laughable pseudoscience that you can find. To take just one example, NCCAM has spent $3.1 million supporting studies of Reiki, an “energy healing” method. Energy healing is based on the unsupported claim that the human body is surrounded by an energy field, and that Reiki practitioners can manipulate this field to improve someone's health. Not surprisingly, the $3.1 million has so far failed to produce any evidence that Reiki works. But because there was never any evidence in the first place, we should never have spent precious research dollars looking into it.

In addition to funding pseudoscience, NCCAM also “educates” the public about alternative medicine. I put “educate” in quotes because much of what NCCAM has on its website is misinformation, which serves to mis-educate rather than to inform. For one example (and there are many), under homeopathy the website states that

“homeopathy is used for wellness and prevention and to treat many diseases and conditions.”

Note how carefully this is worded: homeopathy is "used for prevention", from which one might easily infer that homeopathy is effective. It is not.

NCCAM’s homeopathy page goes on to state that

“most analyses have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition; although, some studies have reported positive findings.”

Again, note the careful wording of that last phrase: strictly speaking, it is true, but let me state it a bit more accurately: “some poorly designed, poorly controlled studies with small patient groups, published in low-quality journals, have reported positive findings.”

Homeopathy is based on principals that scientists know to be false: for example, homeopaths believe that an active ingredient is stronger if there is less of it in a solution. In fact, the opposite is true. They also believe that solutions can be diluted infinitely and still retain their effectiveness. Even NCCAM admits that “its [homeopathy's] key concepts are not consistent with the current understanding of science, particularly chemistry and physics.” So why does NCCAM insist on maintaining misleading information on its website?

Getting rid of NCCAM and OCCAM won’t be easy. These “alt.med” agencies have grown at the direct behest of the U.S. Congress, particularly Sen. Tom Harkin, who is woefully misguided where science is concerned. (This despite the fact that he's a big supporter of NIH. But this doesn't mean he should get a pass when he promotes pseudoscience.) Back in 1998, when previous NIH Director Harold Varmus tried to impose more scientific standards on the Office of Alternative Medicine, Harkin retaliated by elevating it to a Center (thus creating NCCAM) and dramatically increasing its budget. And just a year ago he scolded NCCAM because too many of the studies it funded were “disproving things rather than seeking out and approving” them. As Kimball Atwood pointed out, this comment illustrates rather starkly how that Sen. Harkin doesn't care what the science shows. Sen. Harkin, if the evidence says it doesn’t work, then it doesn’t.

I proposed eliminating NCCAM in Obama’s “Citizen’s Briefing Book” in early 2009, and it received thousands of positive votes, thanks in part to a boost from fellow blogger P.Z. Myers. My proposal was reported by the Washington Post too. But it was also subject to a broad attack by proponents of the supplement industry, who sent out a web alert to their minions and did their best to vote it down. Despite their efforts, the net vote was strongly positive. But like most (or all) of the suggestions in the Briefing Book, my proposal went nowhere.

For more details, see one of my previous blog posts on this proposal, or take a look at Steven Novella’s comments, or at David Gorski’s excellent argument against NCCAM here and here. I also liked the recent blog post by Barbara Drescher.

So, to Francis Collins (Director of NIH) and Kathleen Sibelius (Secretary of Health and Human Services, in which NIH resides), there you have it: an easy way to cut $250 million from the NIH budget. I know the total NIH budget is $30 billion, and this is only about 1%, but if you need suggestions for the other 4%, let me know.

9/11 Truthers Go Away

http://www.desmoinesregister.com/article/20100617/NEWS03/6170360/1012/NEWS11/Hansen-For-9/11-skeptics-case-is-far-from-settled


From Marc Hansen:

On Tuesday night, Sean Michalek drove from Victor to Adel for the monthly 911 Truth of Central Iowa meeting.

The trek west took 105 minutes, but so what? Michalek, 64, would have driven nine hours to commune and commiserate with other Iowans who believe the official story of Sept. 11, 2001, is a big fat lie.

"It's the only game in Iowa," he said.

The only game, he meant, for people who think 9/11 is the least examined tragedy in American history.

According to 911truth.org, the Adel group has company. Grass-roots organizers also exist in Cedar Falls, Davenport and Indianola.

That said, going on nine years after the attack on the United States, the 9/11 truthers are still playing small ball. The group, for the most part, is still more sect than mainline denomination.

Though 15 people showed up for the June meeting at the Adel Public Library, the attendees are convinced the movement is gaining strength and that someday the conspiracy theory will become an accepted fact.

James Hufferd, a former junior college teacher with a Ph.D., has been calling these monthly meetings for almost three years. When they have a speaker, they draw a decent crowd. In April, theologian and author David Ray Griffin filled a 300-seat auditorium at Drake.

On this night, Dennis Scar, 60, rolled in from his farm near Earlham. Lin Cornelison, 59, traveled from Creston. Angela Bassett, 38, came from Urbandale. Scott Hartung, 51, Kent Harkrader, 45, and John Frankling, 35, are from Des Moines.

Spread out on a table was a small video library. Dave Scar, 58, of Woodward, said he's made 11,000 copies of various titles. Simply ask and ye shall receive.

Beginners, Scar said, might want to begin with "Loose Change" then work their way to "Zero: 9/11" or "911 in Plane Site" or "Blueprint for Truth" or "9/11 Mysteries."

Most members of the group seem to believe the attack was an inside job that gave the United States an excuse to go to war. And if you disagree, it's only because you haven't taken the time to study the evidence or you've fallen under the sway of the lazy, corrupt corporate media.

If you want to debate the truthers, come prepared. Right or wrong, they've looked into this a lot more than the rest of us.

Michalek, a retired teacher, probation officer, truck driver, farmer and military veteran, said he lies in bed wondering how he can make people understand that, whatever happened, 9/11 cries out for further investigation.

"I wake up at 3 in the morning," he said, "asking myself: How can I better reach people? How can I change minds? For me it was easy. I knew the government lied to me about Vietnam, because I was there."

In Tuesday's session, the truthers ate pizza and watched a film of scientist Kevin Ryan speaking at a college in Vermont. Ryan was fired from his lab director job after challenging government findings that burning jet fuel weakened the steel beams supporting the World Trade Center towers.

Ryan's laboratory said he was axed for making his opinions sound like those of his employer. The Adel crowd believes he was fired for telling the truth.

Before they watched the video, "The Emerging Science Around the 9/11 WTC Destruction," Hufferd warned the group. It's a little technical.

A little technical? Ryan stood behind the lectern and talked about nanothermite and red/gray chips and methyl ketone something or other.

The video was less about juicy tidbits and dark scenarios and more about science and how the collapse of the Trade Center showed all the characteristics of a staged demolition event.

The truthers watched the film as if it were the final episode of "Law & Order." In Ryan's Q&A session, there was some sexy stuff about gangsters and FBI moles and how the conspiracy might go back further than people think.

When the film was over, the group members talked about what they'd learned: "I hadn't heard two people were killed in the clean-up," one person said.

Another wondered how John O'Neal really died. John O'Neal? I looked it up later. He was a counterterrorism guru who got fed up, quit the FBI and became head of security at the World Trade Center. Two weeks later, he died in the attack.

All their curiosity doesn't make the truthers popular. In fact, it rubs a lot of people the wrong way.

Even loved ones sometimes wonder what went wrong. Frankling, a carpenter, said his mother isn't buying what he's selling. "She told me, 'I raised you better than that,' " he said with a smile.

Most people, somebody else added, don't want to believe the United States would murder 3,000 of its own citizens. Truthwise, there definitely is that.

Homeopaths Without Borders

I was doing research into homeopathy when I came across Homeopaths Without Borders. (http://www.homeopathswithoutborders-na.org/). An organization who's stated goal is to:

Provide humanitarian aid, homeopathic treatment and education by serving as partners with communities in need.

The organization's mission would be wonderful, if it weren't for their use of the quack science of homeopathy. In insisting that such treatment is given to those indeed they may be interfering in the work of real medical professionals. An individual who has been convinced that he has been cured thanks to a homeopathic remedy may not seek needed treatment from a doctor.

The organization is currently in Haiti. The country needs aid, no doubt. However, aid should not come with false hope and woo.

Vaccines and Autism

http://www.thisisleicestershire.co.uk/news/great-MMR-autism-hoax/article-2258599-detail/article.html

From Simon Perry:

If you've not vaccinated your child against MMR as a result of the media outcry, read on.

It started with a class action lawsuit.

A number of parents, convinced that their children's autism had been caused by the MMR vaccine, decided to sue the vaccine's manufacturer.

But the parents had one problem: their claim of a link between MMR and autism was based upon nothing but intuition. The lawyers needed scientific research that demonstrated a link.

And who better to provide that research than Dr Andrew Wakefield?

Wakefield wouldn't seem to be an obvious choice, given that he did not have the necessary paediatric qualifications, but one thing Wakefield did possess was bias in their favour.

After all, he was the inventor of an alternative vaccine for the measles virus.

In total, Wakefield was paid more than £435,000 by Legal Aid to provide evidence to the court, according to the results of a Freedom of Information request.

Wakefield's team dealt with 12 children between the ages of three and 10.

His research involved sedating them and subjecting them to ileocolonoscopy, an endoscopic examination of the large bowel and part of the small bowel, which included taking a biopsy from their small intestine.

It also involved lumbar puncture, commonly known as a spinal tap.

To discover if the symptoms found were correlated with the MMR vaccine, Wakefield's team simply asked the parents and physicians if the onset of the symptoms occurred soon after the child was given the vaccine.

But the first stage was to find children to assess. This can be one of the trickiest bits of getting the science right, because the way that your sample group is selected can easily introduce bias in your results, even if you are extremely careful to avoid it.

By looking for children whose parents already blamed their child's symptoms on the MMR vaccine, it appears Wakefield was guaranteed an outcome that would please the legal team.

Wakefield's paper claimed that the children had been consecutively referred to the Department of Paediatric Gastroenterology with a history of a pervasive developmental disorder and intestinal symptoms.

We later found out that Wakefield had been actively involved in getting these children referred.

In fact, some of the children had been actively recruited through anti-MMR campaign groups, and most of the parents were clients and contacts of the very lawyer who commissioned Wakefield with an aim to "produce unassailable evidence in court so as to convince a court that these vaccines are dangerous".

One parent was even the managing director of the company set up to sell Wakefield's alternative vaccine.

The results were as predictable as an election poll that only polled members of, say, the Green Party, and equally inaccurate in describing reality.

Now you can criticise me for being judgemental if you like, but if you wish to stick a needle into a three-year-old's spine and then force something large and uncomfortable into their anus then you'd better have a very good reason for doing so.

Producing dodgy research for a lawsuit is not, in my opinion, reason enough.

While the risks involved in colonoscopy are small, they certainly exist.

In December, 2007, the Daily Mail reported that in a similar procedure that followed the initial "research", a 14-year-old boy had a similar unnecessary procedure and endured multiple organ failure after his bowel was perforated in 12 places.

Wakefield managed to get his paper published in The Lancet in February, 1998.

However, the paper had certain critical elements missing.

It didn't mention the conflicts of interest that would have caused his paper to be rejected. It didn't mention how the children had been selected. After suggestions that the process had been biased, Wakefield responded in a published letter that the children had been referred through the normal channels – a statement described by the GMC as "dishonest and irresponsible".

At the time the paper was published, nobody knew about what was going on behind the scenes. Even if this research had been conducted honestly, it still would not tell us anything useful about the MMR vaccine.

If you take 12 patients who were referred to a ward for specific symptoms, then you really shouldn't be surprised if you find out that many of them have those symptoms.

You also shouldn't be too surprised if they'd also had the MMR vaccine when, in 1996, 96% of children had received it.

The evidence consisted of no more than eight anecdotes from a possible 12. This paper was effectively worthless.

There was never, at any point in this hoax, a single point in time where it would have been reasonable to believe it to be likely that there was a connection between MMR and autism, yet this did not stop newspapers repeating the story and misinterpreting the evidence.

Possibly as a direct result of the media outcry following Wakefield's flawed research, other scientists were motivated to find out if there was a genuine link.

And in contrast to Wakefield, they managed to do it without putting a single piece of medical equipment up a child's bottom.

In November, 2002, Madsen, Hviid, Vestergaard et al compared levels of autism in children who had received the MMR jab against those who hadn't.

Instead of Wakefield's 12 children, this study used 537,303.

And instead of selecting them specifically to prove the outcome they hoped for, they used every child born in Denmark from 1991 through 1998.

There was no difference in the rates of autism in the two groups.

The authors quite reasonably concluded "This study provides strong evidence against the hypothesis that MMR vaccination causes autism".

This was by no means the only study. In 2008, a Cochrane review looked at 31 separate studies and concluded that "no credible evidence of an involvement of MMR with either autism or Crohn's disease was found."

In 1996, 92% of children were vaccinated with MMR. In 2002, it was down to just 84%. And in 2006 – more than three years after the Danish study of 537,303 children was published and two years after Brian Deer uncovered the flaws at the heart of Wakefield's 12 case studies – MMR coverage at 24 months was just 85%.

In 2006, measles came back to the UK.

In 2005, we had just 77 cases. In 2006, there were 449 before April. One child died. The mumps epidemic of 2005 infected 56,390 people.

There is only one way to prevent future epidemics. Vaccinate your children.

Brian Deer, the investigative journalist who exposed Wakefield's research, will be speaking at Leicester Skeptics in the Pub on July 15.

It starts at 7:30pm in Square Bar on Hotel Street, Leicester.

Testosterone Replacement Therapy

http://www.nationalpost.com/life/health/fast+with+quick+treatments+testosterone+skeptics+urge/3127523/story.html

Middle-aged men sit around looking forlorn, while their shadows appear to be having all the fun. The men are moody, they have low libido, and they lack energy.

The scene is from an ad running during the US National Basketball Association playoffs sponsored by Solvay Pharmaceuticals, which makes AndroGel, a prescription ointment for men with low testosterone. The ads direct viewers to a Web site called "Is It Low T?" -- isitlowt.com -- and urge them to discuss the symptoms and others with their doctors.

But is that good advice?

While experts welcome a public discussion of the ailments of middle-aged men with "Low T," they say that testosterone replacement therapy isn't necessarily the solution for these problems. The symptoms described in the ads occur in other diseases, they note, and could also be chalked up to plain old aging, or "male menopause."

According to a review in the June issue of the Drug and Therapeutics Bulletin, testosterone replacement therapy is questionable because it has risks, its efficacy is uncertain, and there's no strong agreement about whether low testosterone is really a disease in older age.

"We're skeptical about this," said Dr. Ike Iheanacho, the journal's editor. "You may have men who have symptoms who have low testosterone levels, but in our view it doesn't add up convincingly to an undoubted medical condition."

Iheanacho said that men do tend to produce less testosterone as they age, but it's not inevitable, and even if it does happen it doesn't necessarily produce symptoms. Half of all men 80 years and older produce normal levels of testosterone, he said.

University of Washington professor Dr. Alvin Matsumoto said that the condition does exist, but that the symptoms should be carefully evaluated along with a series of tests for testosterone levels.

"There does need to be an increased awareness of true clinical hypogonadism," he said, using the clinical term for low testosterone. "I think a lot of people are missed."

But the campaign "is casting a wider net than necessarily needs to be cast," added Matsumoto, who co-authored the Endocrine Society's just-revised guidelines on sex hormone treatment. "The thing I'm a little worried about is that there will be a lot of people out there who will be treated inappropriately."

Iheanacho and Matsumoto said separately that the symptoms described in the campaign are "nonspecific," and could be linked to diabetes, circulation problems, or depression, as well as aging. The Low T site does say that the problem is more common in diabetics and the overweight.

"If someone is low in energy and is 65, that might be entirely compatible with his general life and -- let's face it -- decline," Iheanacho said. "It would be entirely normal."

The endocrine group's guidelines, which appear in the June issue of the Journal of Clinical Endocrinology & Metabolism, say doctors should only make a diagnosis of low testosterone "in men with consistent symptoms and signs and unequivocally low serum testosterone levels."

The group recommends against screening the general population. The guidelines do call for the use of testosterone therapy - which comes in patches, pellets, and tablets -- in many cases. It could be prescribed, for instance, for men with erectile dysfunction or loss of libido, provided that other underlying causes and therapies are evaluated.

The treatment isn't without peril. The Endocrine Society said it's not recommended for men with prostate cancer or for African-American men with fathers, brothers, or children with prostate cancer. In 2009, the Food and Drug Administration required that testosterone gels be labeled with a prominent warning after repeated reports that young children showed signs of early puberty after being exposed to it, typically through skin contact with their fathers.

According to Solvay's Web site, a man's level of testosterone is considered low when it goes below 300 nanograms per deciliter of blood. But Matsumoto said that a single test won't suffice, because "30% of the time tests are normal after you repeat them."

Solvay says that low testosterone affects 13 million men in the U.S. over age 45. According to the FDA, prescriptions for testosterone gel nearly doubled between 2002 and 2008. AndroGel is the most popular gel, with 1.7 million prescriptions filled in 2007, according to the FDA. Matsumoto said the gel is expensive, but is covered by insurance more often than not.

The ad campaign isn't meant to drive sales of AndroGel, said Neil Hirsch, a spokesman for Solvay, which coined the phrase "Low T."

"The purpose of the ad is to raise awareness, not any specific treatment option," he said. It helps men "connect the dots between what they may be experiencing themselves so they can have a dialogue with their practitioner."

Iheanacho said a European doctor "would look at you blankly" if you asked about Low T.

"It sounds like a rapper," Matsumoto said.