World's cutest mammal critically endangered because of Traditional Chinese Medicine


A pangolin. Photo (c) Christian Boix.
Pangolins, timid little anteaters that are covered with scales, are being hunted to extinction. Why? Because some humans think their scales can be used as medicine. Pangolin scales are made of keratin, the same stuff that makes fingernails and claws, and they have no more medicinal value than any other fingernails–which is to say, none at all.

Pangolins are gentle, toothless mammals that eat ants with their long, sticky tongues. They are covered with scales (sort of like a walking artichoke) which protect them from predators but not from humans, who simply pick them up to harvest them. Baby pangolins ride, adorably on their mothers' tails or backs, as shown in the picture here.
Photo by Firdia Lisnawati.

How could someone look at these creatures and want to kill them? And yet pangolins are being slaughtered in large numbers because some practitioners of traditional Chinese medicine (TCM) think (wrongly!) that pangolin scales can treat nervousness or palsy. They are also being killed for meat: regrettably, pangolin meat and fetuses are considered a delicacy by some people in China.

Just a few months ago, the CITES organization (Convention on International Trade in Endangered Species) banned trade in all eight species of pangolins. We can only hope that this blanket ban is not too late. Previously CITES had declared that Asian pangolins were endangered, but had allowed trade in African pangolins, but because the meat is indistinguishable, the limited ban did little to stop the widespread killing of Asian pangolins. Just before the CITES meeting, Annamiticus (@annamiticus) reported that in the first nine months of 2016, 18,670 tons of pangolin scales from 19 countries had been seized from smugglers, mostly in Hong Kong. And that's just the amount that was stopped; many more tons doubtless slipped through.

Despite the new CITES restrictions, trade in pangolins continues. In December, customs officials in Shanghai arrested 3 people who were attempting to smuggle over 3 tons of pangolin scales into China. That shipment alone represents 5,000 to 7,500 pangolins that were killed for their scales.

Next Saturday (18 February) is World Pangolin Day. Let's hope that the new CITES restrictions, and greater public awareness of the endangered pangolin, can save these gentle animals from extinction.

*note: perhaps it's not the "world's cutest mammal," but the pangolin is still worth saving.

Government scientists go rogue. What a great idea!

Government scientists are very worried, apparently with good reason, that their new boss wants to muzzle them. They've just come up with a brilliant strategy to circumvent this attempt at censorship.

Donald Trump and his minions have already made moves to suppress science within the government, with word going out that government employees cannot say anything to the public without the prior approval of political appointees. This has the marks of Stalinist (or should I say Putinist?) repression of free speech, not the sort of thing any of us ever expected to see in the United States. However, after running a campaign marked by outrageous anti-science claims on climate change and vaccine safety, Trump appears on track to use the enormous power of the federal government to suppress basic scientific facts.

Vladimir Putin has done the same thing. Most Russians think that Malaysia Airlines Flight 17, which was shot down in Ukraine in 2014, killing all 298 passengers, was shot down by Ukraine–despite the overwhelming evidence that the plane was shot down by a Russian missile provided to Russian-backed separatists by Russia. Putin had a record of suppressing, threatening, and even murdering those who speak out against him. Yet Donald Trump seems to find him the most admirable of all world leaders. And one of his closest advisors, Newt Gingrich, has said that he wants to fire all federal workers who didn't vote for Trump.

In just the past few days, though, government scientists have come up with a devilishly clever–and entirely legal–strategy to oppose the Trump administration's efforts to suppress their speech. Using Twitter, the same vehicle that Trump himself used so effectively throughout his campaign, they have created a set of "rogue" and "alt" accounts that have already started tweeting the real news about science, medicine, and the environment.

All of these accounts are run by non-government employees with no government sponsorship, but government scientists, in their off-hours time, can't be prevented from sending them information. In just a few days, these accounts have over 3.3 million followers, a number that is rising fast. Here's are some of the account with their total followers as of January 29:
Here are just a few of the tweets from these accounts so far:








As one tweet already pointed out, quoting the ACLU, "the First Amendment still protects workers' ability to speak in their own private capacities, on their own time, about matters that concern the public."

We might not be able to trust any official statements from the government for the next few years, but perhaps we'll still be able to find accurate science through the alt-gov Twitter accounts. So when you hear the Secretary of Health and Human Services (far right Congressman Tom Price, if he's confirmed) making claims about health care, check out @AltHHS to find out the real story. And when you hear Secretary of Big Oil Energy Rick Perry claim that global warming is a hoax, go to @NotAltWorld or @RogueNasa to find out the real story.

Trump's lovefest with anti-vaxxer RFK Jr.


Robert F. Kennedy Jr., liberal activist
and Donald Trump's new best friend.
Anti-vaccine conspiracy theories make for strange bedfellows. Witness this past week's widely reported meeting between Donald Trump and liberal activist Robert F. Kennedy, Jr. to discuss vaccines and vaccine policy. RFK Jr. emerged from the meeting to claim that Trump had invited him to chair a new commission on vaccines, specifically to discuss the thoroughly discredited claim that vaccines cause autism.

Talk about the blind leading the blind. Trump has been an anti-vaxxer for years (as I've pointed out before), but for him it seems more like an afterthought–yet another of the many false claims he likes to throw out at random moments. RFK Jr., in contrast, has made anti-vaccine conspiracy mongering his raison d'etre for many years, most recently when he published an entire book to promote the bogus theory that thimerosal causes autism.

Just to get this out of the way: vaccines don't cause autism. (If you want details, here's a nearly book-length article that explains more.) The thimerosal used as a preservative in vaccines was removed a decade ago (in an excess of caution), but that never caused autism either. Because of one bogus, now-retracted study published by Andrew Wakefield in 1998, millions of dollars have been spent investigating–and ultimately disproving–any possible link between vaccines and autism. All that money could have been better spent trying to find the real causes of autism, but it was wasted instead in an effort to undo the damage caused by one fraudulent doctor, Wakefield, who eventually was found to have committed fraud and lost his medical license.

Autism is a complex disease with a strong genetic component, and thousands of devoted scientists are trying to understand it better. RFK Jr. is not one of those scientists. He's a lawyer who previously devoted himself to environmental causes. He's also a ideologue who is all too willing to distort the facts and simply make things up if it suits his agenda. He and Trump share that particular style of discussion.

(Aside: it's hard to ignore the irony of a devoted liberal such as RFK Jr. joining forces with Donald Trump. For example, on the issue of global warming, in 2007 RFK Jr. said about Exxon and other companies that denied global warming, "This is treason and we need to start treating them now as traitors." Apparently he doesn't feel that way any longer.)

So back to this "vaccine commission" that RFK Jr. wants to lead. Besides the blindingly obvious fact that RFK Jr. is completely, utterly incompetent to lead such a commission, he and Trump also seem unaware that the U.S. already has a vaccine commission. It's called the Advisory Committee on Immunization Practices, and it's filled with medical experts who have spent their lives studying vaccines and vaccine safety. It also includes a consumer representative, and it is completely open, despite the conspiracy-mongering protestations of RFK Jr. If you want to see who's on it, just look here. The ACIP meets three times a year, its meeting schedule is also posted on the website, and the meetings are open to the public.

Cleary RFK Jr. loves the attention he's getting from Trump. And Trump seems to have found a soulmate in his fellow anti-vaxxer, despite RFK's strongly liberal political views. After the private meeting and RFK's announcement that Trump had invited him to chair a vaccine commission, Trump's representatives denied it. But a day later, RFK Jr. announced that he was leaving his environmental group in order to chair this hypothetical "vaccine safety" commission, and he also claimed that he and Trump had been discussing it for a month.

Putting Robert F. Kennedy Jr. in charge of a commission on vaccines is akin to putting Josef Stalin in charge of prison reform. By insisting that vaccines cause autism, both Trump and RFK Jr. have already ignored a vast body of science that shows vaccines to be not only safe, but perhaps the single greatest benefit to public health in the history of medicine. If Trump gives RFK Jr. a platform to spout his anti-vaccine nonsense, the two of them will set back healthcare by decades. Infectious diseases such as measles will return with a vengeance, and children will die. That will be an awful outcome, and no one–not even Trump or RFK Jr.–can possibly want that. Let's hope that someone in Trump's inner circle stops him before this goes any further.

Calling out fake medical journals that exist to promote acupuncture

Comic strip by Rudis Muiznecks, cectic.com
Fake news has been in the news a lot lately. Fake news proliferated wildly during the 2016 U.S. election, much of it completely fabricated, usually with an extreme partisan bias. Fake news is corrosive. It mis-informs the public, divides people against one another, leads to bad policy decisions, and can even induce people to take action against imaginary threats.

One might think that medical literature is immune from this kind of fakery, but it's not. Recent years have seen the appearance of journals from mainstream publishers that are based entirely on pseudoscience. On the surface, these publications look and act just like real scientific journals, but it's all just pretend. The publishers of these journals presumably care more about their bottom line than about scientific integrity. They know (or seem to know) that journals about pseudoscience will create a never-ending demand for fake breakthroughs and science-y sounding studies that are built on a house of cards.

I've decided to start out the new year by calling out these fake medical journals for what they are: complete and utter nonsense. First, a bit of background.

Imagine for a moment that a publisher created a Journal of Magical Medicine under the rubric of a large, respectable publisher–for example, Elsevier. After assembling an editorial board of academics from legitimate universities who believed in magical medicine, the journal started soliciting and reviewing papers. The editors would send any submissions for review to other academics who believed in magic, and over time a steady stream of peer-reviewed papers would emerge. A large network of magical medicine "experts" would develop, reviewing and citing each others' papers, and occasionally writing review articles about the state of the art in magical medicine.

Dr. Harriet Hall has accurately called this "tooth fairy science." I prefer to call it "cargo cult science," because its practitioners mimic the behavior of real scientists without actually understanding science itself.

Of course, no self-respecting scientist would want to waste his or her time reading garbage, so most scientists would simply ignore the Journal of Magical Medicine. But it would persist anyway.

This is exactly the situation we're in now, but as you might guess, the Journal of Magical Medicine doesn't exist. Instead, we have multiple journals devoted entirely to something just as fanciful and just as unbelievable: acupuncture. Here are three examples:
These aren't the only ones, but they'll do for an illustration. I can't help pointing out that the Elsevier journal has a bonus bit of magic in its name: "meridians" are a completely imaginary concept, referring to invisible lines of energy that supposedly flow through the body. This is a perfect (if unintentional) example of magical medicine. How nice that Elsevier provides a journal for people who want to study it.

Prof. Edzard Ernst has pointed out that these journals, and others like them, are a farce:
"Potential authors ... are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job.... As a result, most (I estimate around 80%) of the articles that currently get published on alternative medicine are useless rubbish."
If anything, Prof. Ernst is being overly generous.

Looking over the articles published in the latest issues of these journals is painful (if you care about good science, that is). For example, the BMJ acupuncture journal features "Needling depth at BL52 in 13 cadavers," an article about inserting needles into dead bodies. Why study this? Because (as the paper explains) acupuncture needles can damage the kidneys if they are inserted too deeply. Here's another example, from Elsevier's acupuncture journal: "Effect of Manual Acupuncture Stimulation at `Bai-Hui' (GV 20) or `Yintáng' (Ex-HN3) on Depressed Rats," a study that concludes that acupuncture helps alleviate depression (in rats, mind you!) but only if you use two acupuncture points simultaneously. Right.

There are thousands more articles like these. It's an entire ecosystem of pseudoscience.

Let's be clear: acupuncture is "a pre-scientific superstition" that has no basis in medicine, physiology, or biology, and has never had any good scientific evidence to support it. It wasn't even popular in China until Chairman Mao re-invented it as part of "traditional Chinese medicine." Mao did this because China didn't have enough real doctors to treat its large population, and he wanted to convince the masses that their local herbalist was offering something just as good. China is still pushing this today, for the same unscientific reasons.

I've been advised that I should treat acupuncturists and acupuncture believers with respect, and that I should accept that they have some legitimate claims because some patients like them. I've tried this approach, and it doesn't work: acupuncture continues to spread, in part because of very badly-done studies that often misrepresent their findings. I've read enough acupuncture studies for one lifetime, and acupuncture doesn't work for anything. It's nothing more than an elaborate, theatrical placebo, performed by quacks to convince unwitting victims patients that the acupuncturists have something real to offer. They don't.

Trying to refute the claims of acupuncture (see here and here, and again here, for example) is like playing whack-a-mole. Proponents claim it cures dozens (or hundreds) of different conditions, and each time a claim falls flat, they simply make up a new one. Acupuncture also carries small but real risks to patients, who can suffer infections and sometimes much worse, such as punctured lungs.

Elsevier, BMJ, and Biomed Central should be embarrassed to publish these fake medical journals, which serve only to promote pseudoscience. Their very existence can confuse medical students, who assume (as they've told me themselves) that if legitimate-looking journals are publishing this stuff, there must be something to it.

Despite their appearances, the Journal of Acupuncture and Meridian Studies, Acupuncture in Medicineand Chinese Medicine are not real medical journals. They are fake journals filled with fake science, and the world would be a better place if they all disappeared.

Anti-vax movement helps create worst year of mumps in a decade

The year isn't quite over yet, but we've already had 4,258 cases of mumps in the U.S., more than any year since 2006, when we also experienced a dramatic spike in cases. As the chart here shows, before 2006 we only saw a couple of hundred cases per year, but the numbers have been trending higher since then. After two years with about 1200 cases each, this year looks to quadruple last year's total when the final numbers come in.
Source: CDC, Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables
Just as in 2005, the outbreaks were centered in a few states, mostly on college campuses in the middle of the country, especially Iowa, Illinois, and Indiana. (The 6500+ cases in 2005 were mostly in or near Iowa and Illinois.)

Why are we seeing this increase?

At least some of the blame, if not all of it, belongs to the anti-vaccine movement. Despite overwhelming evidence that vaccines save lives, and that the risks are miniscule compared to the enormous benefits, the anti-vaxxers remain in denial. They claim that the government–usually the CDC–and pharmaceutical companies have been conspiring for years to hide the so-called harms of vaccines, and they spread misinformation and fear in a continual effort to get parents to withhold vaccines from their children.

The main harm claimed by the anti-vax movement is autism. This belief, though fervently held by many anti-vaxxers, is absolutely false. It was originally proposed in a now-retracted, discredited 1998 study by Andrew Wakefield, who was later shown to have fraudently manipulated data, hidden his secret payments from lawyers who wanted to sue vaccine makers, and treated the children in his own study unethically. In 2010, Wakefield was stripped of his UK medical license. As the BMJ editors wrote in a 2011 editorial:
"Who perpetrated this fraud? There is no doubt that it was Wakefield."
Nonetheless, Wakefield he continues to promote his bogus claims (most recently with an anti-vax movie, which I won't name here to avoid promoting it), and remains a hero to the anti-vax movement, who seem blind to his flaws.

This is reprehensible–and frightening. If all parents followed the anti-vaxxers advice, we would see massive surges in vaccine-preventable illnesses, sometimes leading to permanent harm or even death in helpless children. Fortunately, most children are still getting their vaccines, but the anti-vaxxers have succeeded in reducing vaccination rates in many communities around the country, illustrated most recently by the 19-fold increase in vaccine exemptions in Texas.

Twenty years ago, we had under 200 cases of mumps per year, and it was no longer endemic in the United States. In other words, the only cases in the country were imported by people traveling here from other counties. The same was true for measles, which is much deadlier than mumps. Fortunately, rates of measles are low again this year, after the major outbreak that started in Disneyland in 2015, but if anti-vaxxers have their way, more outbreaks are in our future.

This amazing progress was all thanks to the mumps vaccine, which today is part of the MMR vaccine, which also protects you from measles and rubella. Before the vaccine program started in 1967, we saw about 186,000 cases of mumps annually in the U.S. The vaccine led to a 99% reduction in mumps (and measles). It's not perfect: the mumps vaccine is about 88% effective, but when everyone is vaccinated, "herd immunity" prevents the disease from spreading, even if a few people get sick. As the CDC explains,
"outbreaks are much larger in areas where vaccine coverage rates are lower."
Perhaps more alarming than the surge in mumps cases is that the U.S. has just elected the first anti-vaccine President in history. Others have documented Trump's "long, sordid antivaccine history," so I won't attempt to describe it here. We can only hope that reason will eventually prevail, and Trump's ignorance about vaccines won't lead to thousands of unnecessary cases of measles, mumps, whooping cough, and other diseases that vaccines can prevent.

Does white wine give you skin cancer?

Many studies have shown that drinking wine, especially red wine, seems to have modest benefits for heart health, as long as you drink it in moderate amounts. A study published this week, though, offers a more worrisome message: white wine might increase your risk of skin cancer.

The bottom line: a daily glass of white wine carries a 13% increased risk of melanoma, one of the deadliest forms of skin cancer. Surprisingly, though, red wine did not carry the same risk. In fact, when the authors separated out beer, red wine, white wine, and other forms of alcohol, only white wine carried any risk for melanoma. 

Should you cut back on white wine based on this new finding? I read the study to find out more.

The new study, led by Eunyoung Cho from Brown University, appeared in the most recent issue of a journal published by the American Association for Cancer Research. It's a large, carefully-done analysis of survey information from over 210,000 health professionals, about two-thirds of them nurses, followed over an 18-year period. The 210,000 participants came from 3 studies: 2 studies of nurses and one of male health professionals. About three-quarters of the participants were female, and the vast majority were white (which means the findings might not apply to non-white populations).

One feature I always look for in an analysis like this is a dose-response effect. If the effect is genuine, then higher doses (in this case, more alcohol) should increase the risk. The authors here found that people who drank the most alcohol had the greatest increase in risk. The study also controlled for all the usual confounding factors, such as family history of cancer and smoking. 

In some subgroups–those who drank the most white wine–the increased in relative risk of melanoma was 50% or more. Keep in mind, though, that this is "relative risk." I'll get to that in a minute.

When the researchers looked at where the cancer occurred, they found that the risk of melanoma was "far greater" on areas of the body that don't receive regular sun exposure, such as the stomach and back, compared to the arms or neck where people get the most sun. This result suggests that the effect of alcohol is unrelated to sun exposure.

There are several important caveats about this study. Perhaps the biggest is that the mechanism is unclear: how does white wine cause melanoma? The authors suggest that the effect is due to acetaldehyde, a cancer-causing compound that is present in wine. However, both red and white wine contain this compound, so it's not clear why white wine would carry a greater risk. It's also not clear why acetaldehyde should cause skin cancer more than other cancers, and why it should be associated with skin cancer specifically on areas of the body that are not exposed to the sun. 

Before you panic, let's revisit the actual amount of risk here. The 13% increase in risk does not mean that you have a 13% chance of getting melanoma from drinking white wine. I looked at the raw numbers in the study, and the overall rate of melanoma in non-drinkers (about 71,000 people in this study) was 0.61%. About 26,000 people reported drinking 10-20 grams of alcohol per day (the equivalent of 1 or more glasses of wine), but the study didn't report how many of these people drank white wine. Nonetheless, in this group the rate of melanoma was 0.85%. So in raw numbers, the increased risk for melanoma was 0.24%.

That's a rather small number, but it's still worrisome. The National Cancer Institute warns that alcohol is linked to several types of cancer (although not melanoma), especially for those who drink excessively. The new study reinforces that warning, and suggests that for those who drink wine, red wine might carry fewer risks than white.

I'm still a bit skeptical, because we have no good explanation for why white wine–but not red wine, beer, or alcohol–would cause skin cancer.  But still, when you reach for a glass of wine this holiday season, perhaps you should choose red instead of white.


FTC steps in where FDA fears to tread - on homeopathy

Here's a label that the FDA should require.
The federal government is probably wincing right now from the after-effects of the election, but one agency deserves a robust round of applause: the Federal Trade Commission. This week, the FTC announced, in a strongly-worded report on homeopathic advertising, that homeopathic drugs should "be held to the same truth-in-advertising standards as other products claiming health benefits."

The FTC can't prevent homeopathic marketers from selling their products; only the FDA could do that. But starting very soon, they will require that homeopathic products include statements that:
  • There is no scientific evidence backing homeopathic health claims
  • Homeopathic claims are based only on theories from the 1700s that are not accepted by modern medical experts.
Admittedly, this might not effect sales very much. Over at Slate, Alan Levinovitz argues that these claims might even backfire, because some users of homeopathic drugs don't trust modern medicine, or because they might belief that hey, if it's been around that long, it must work. But old medicine is not good medicine. (And in the FTC's defense, they also recommended that the FDA "subject homeopathic drugs to the same regulatory requirements as other drug products," but they can't force the FDA to act.)

But wait: does this mean homeopathic drug makers didn't have to be truthful in the past? Well, yes. As the FTC report explains, in 1988 the FDA–the agency in charge of regulating drugs in the U.S–basically struck a deal where they agreed that homeopaths could be self-regulating, as long as they included a disclaimer that their claims haven't been evaluated by the FDA. To put this more bluntly: the FDA's agreement with homeopaths (you can read it here) is basically a license to lie.*

For example, the widely-sold homeopathic product Oscillococcinum, which is nothing more than a sugar pill, says on its packaging that it "Temporarily relieves flu-like symptoms such as body aches, headache, fever, chills and fatigue."

Helpful hint to potential victims customers: Oscilloco doesn't do anything of the sort. Oscilloco escapes having to prove their claims by a tiny asterisk, which (after much digging through the website) is attached to a disclaimer that '*these “Uses” have not been evaluated by the Food and Drug Administration.' Interesting how they place the word "uses" in quotation marks.

Homeopathy is the most obviously fake alternative medicine you're likely to see in your local pharmacy. This may seem like a pretty strong statement, but look at what homeopathy claims:
  • That infinite dilutions of a substance, to the point where not a single molecule remains, have a medical benefit
  • That water "remembers" the substances that were in it in the past
  • That a substance that causes a symptom will, when diluted, cure that same symptom. Thus (for example) poison ivy can cure itching.
These claims violate basic principles of physics, chemistry, and biology. The idea that water remembers what was in it is so confused that it's not even wrong–and it also implies that every sip of water you take "remembers" virtually every substance on the planet, although homeopaths appear not to recognize this. Yet homeopathic "drugs" are a multi-billion dollar business today; the FDA estimated that consumers spent $2.9 billion on homeopathic remedies in 2007, the last year for which they reported numbers.

The FDA held a public hearing last March, and the FTC held their public workshop in September. They solicited and received over 500 comments, both pro and con. Most of the pro-homeopathy comments boil down to "it worked for me" or "people have been using this stuff for years"; in other words, anecdotes and testimonials. The con-homeopathy comments described scientific studies showing that homeopathy simply doesn't work. These include a thorough review conducted by the Australian government last year, which concluded:
"There are no health conditions for which there is reliable evidence that homeopathy is effective."
Despite Alan Levinovitz's concerns that warning labels won't help, I'm with the FTC here. If the FDA won't (or can't) stop homeopaths from selling their modern snake oil, at least we can slap labels on them saying they don't work. If consumers want to buy a product that the government says doesn't work, well, it's their money.

*Well, they're not really lying if they include a disclaimer, are they? So I'm not really calling them liars.