Questionable for-profit cancer center profits from alternative therapies

It sounds like a crazy conspiracy theory: a secretive businessman founds a for-profit medical center to treat cancer.  His hospitals offer conventional treatments but also sell highly questionable, unscientific treatments to vulnerable patients. These treatments help to increase profits.  The businessman uses the profits from his cancer hospitals to support his favorite right-wing causes.  Patients have no idea that the fees they pay for treatment help support these causes.

It may sound unbelievable, but it's true.  Most of this story was described in a lengthy exposé just published in the Washington Post on Christmas day.  The Post revealed that Richard Stephenson, the founder of a large for-profit cancer center, is also one of the primary funding sources for Freedom Works, a right-wing Tea Party organization that played a major role in the 2012 elections.  As the Post story described him:
[Stephenson is] "a reclusive Illinois millionaire who has exerted increasing control over one of Washington’s most influential conservative grass-roots organizations."
Among other examples, the Post describes how
"more than $12 million in donations was funneled through two Tennessee corporations to the FreedomWorks super PAC after negotiations with Stephenson over a preelection gift of the same size....  The origin of the money has not previously been reported."
What the Post story didn't explain was the source of Stephenson's millions: Cancer Treatment Centers of America (CTCA), a private, for-profit company with five cancer hospitals scattered around the U.S.  Stephenson is the founder and chairman of CTCA.

For-profit hospitals present a big ethical problem, even when they provide proper care.  The problem is that motivation to increase profits may work against the interest of patients.  I don't want to debate that here, because CTCA has another, more serious problem.  Alongside standard, science-based cancer therapies, CTCA also offers an array of questionable, unscientific therapies, which it proudly labels as part of its "integrative cancer treatment."  CTCA advertises many such treatments, including:

  • Acupuncture
  • Acupressure
  • Chiropractic
  • Naturopathy 
  • Homeopathy
  • Mind-Body medicine (including Reiki and Qi Gong)

None of the treatments in this list has any scientific support showing that they provide a benefit to cancer patients.  Some of them carry a real risk of harm, as I've written about previously.  Acupuncture carries a risk of infection and chiropractic treatment has a risk of stroke - very small risks, admittedly, but no risk is acceptable when the benefit is nonexistent.  (See Science-Based Medicine for a summary of the science behind these and other alternative therapies.)

CTCA makes multiple unsupported, unscientific claims for its alternative treatments, such as:

These are just a few examples. These claims, and CTCA's marketing of the therapies involved, present a huge ethical problem.  Cancer patients are facing some of the most difficult decisions in their lives, often while suffering through painful treatments, not to mention the fear that their cancer will kill them.  When a cancer hospital offers an "integrative" treatment with the promise that it may help, the patient is highly likely to try it, regardless of the cost.  These are extremely vulnerable patients, and CTCA is taking advantage of them to sell ineffective therapies.  CTCA and its owners, including Richard Stephenson, are profiting from their unsuspecting patients.

Offering treatments that are little more than snake oil to cancer patients is ethically indefensible.  Believers in acupuncture, naturopathy, Reiki, and homeopathy will argue that they are not unethical, because the treatments work.  This argument, though, flies in the face of overwhelming evidence to the contrary.  Those who argue that these therapies really work only demonstrate that they are unqualified to offer medical care.

Cancer Treatment Centers of America presents a very welcoming, positive picture of itself through its website, and much of what it describes is accurate.  However, its errors of omission are huge: nowhere does its website say that CTCA is a for-profit center, nor does it tell you that its founder is a major donor to right-wing political organizations.  And most critically for patients, CTCA offers a palette of pseudoscientific treatments, making medical claims that are not supported by any evidence and that in some cases violate basic principles of physiology and biology - although the website claims that its integrative treatments are "scientifically-based supportive therapies."

Let's put aside the right-wing propensities of its owners and simply focus on the science and the ethics of CTCA's "integrative" therapies.  Even if the treatments were free, there is no justification for offering treatments based on pseudoscience.  In the context of a for-profit hospital, where every treatment provided adds to the bottom line, the practice of pushing illegitimate treatments onto cancer patients is even more reprehensible.

[Note: the publisher of Forbes magazine, Steve Forbes, is a board member for Freedom Works.  In case it's not obvious, I don't speak for Forbes and they don't endorse the content of my blog, which appears both here and on the Forbes site.]
[Note 2: for a more detailed, critical look at some of CTCA's offerings and its claims, see this post by Orac at Respectful Insolence from mid-2010.]

Have another cup o' joe, it's good for you

My favorite science studies are the ones that tell us that what we're already doing is good for us. This story fits the bill. In the American Journal of Epidemiology this month, Janet Hildebrand and colleagues reported on a large study looking at the effects of coffee on throat cancers.

Let's get right to the good news: drinking coffee seems to reduce your risk of death from oral or pharyngeal cancer by about 50%. Drinking more coffee is better than drinking less, and drinking caffeinated (normal) coffee is better than decaf.

I knew there was something wrong with decaf.

Now for some details. This study is part of an enormous project, the Cancer Prevention Study II, with over 1 million participants who've been followed for 30 years. The participants regularly fill out questionnaires answering a variety of questions, including how much coffee and tea they drink. After excluding people with missing information about coffee drinking and those who already had cancer in 1982, the researchers still had over 950,000 people. Coffee drinking was categorized based on daily consumption: less than a cup (or none), 1-2 cups, 3-4 cups, and more than 4 cups. They asked about decaf coffee and tea drinking as well.

A study like this is hard to do well, because there are so many confounding variables, especially smoking. Smokers have a dramatically higher risk of throat cancer, and smokers also drink a lot of coffee. Hildebrand and colleagues did a good job at separating out this effect, looking at the risk of cancer in nonsmokers separately and adjusting the statistics accordingly.

Perhaps the most encouraging finding is this: in people who have been nonsmokers for at least 20 years, 1-2 cups of coffee per day corresponds to a 32% decrease in the risk of death from throat cancer.  More than 2 cups per day corresponds to a 64% decrease. And among all participants (including former smokers), more than 4 cups a day seemed to provide the greatest benefit.

Decaf coffee also seems to reduce the risk of fatal throat cancer, though not quite as much. Tea drinkers, in contrast, don't seem to get any benefit, not for this type of cancer.

All this comes with some very big caveats.  First, despite the very large size of the study, the number of deaths oral or pharyngeal cancer was very small, only a few hundred. (Oral/pharyngeal cancer is very common worldwide, but less common in the U.S., where this study was conducted, with about 7850 deaths per year. This includes cancers of the tongue, mouth, and pharynx.)  So the absolute risk is very small.  Another big caveat is that this study only looked at cancer deaths - it did not measure the risk of getting cancer in the first place.

But skepticism aside, drinking coffee seems to reduce the risk of oral cancer.  This confirms my long-held view that the three major food groups - coffee, chocolate, and red wine - are all good for you.  So the next time you feel like a second cup, or a third: drink up!

Congress holds an anti-vaccine hearing

I was in my car yesterday listening to C-SPAN (yes, I do that sometimes), when to my stunned surprise I heard Congressman Dan Burton launch into a diatribe on how mercury in vaccines causes autism.  No, this was not a replay of a recording from a decade ago.  The hearing was held just a few days ago by the Committee on Oversight and Government Reform.

Congressman Burton used this hearing to rehash a series of some of the most thoroughly discredited anti-vaccine positions of the past decade.  Burton is a firm believer in the myth that vaccines cause autism, and he arrogantly holds the position that he knows the truth better than the thousands of scientists who have spent much of the past decade doing real science that proves him wrong.  

In a classic political move, the committee called on scientists Alan Guttmacher from the NIH and Colleen Boyle from the CDC to testify, but in fact the committee just wanted to bully the scientists.  Committee members lectured the scientists, throwing out bad science claims, often disguised as questions, thick and fast.  Alas, Guttmacher and Boyle weren't prepared for this kind of rapid-fire assault by pseudoscience.

Burton himself was the worst offender, offering anecdotes and bad science with an air of authority.  He stated bluntly: 
“I’m convinced that the mercury in vaccinations is a contributing factor to neurological diseases such as autism."
No, it isn't.  Dozens of studies, involving hundreds of thousands of children, have found the same thing: there is no link whatsoever between thimerosal and autism, or between vaccines and autism.  And Burton went off the deep end with this: 
"It wasn’t so bad when a child gets one or two or three vaccines… Mercury accumulates in the brain until it has to be chelated.” 
Bang bang, two false claims in 10 seconds.  First he claims that mercury from vaccines "accumulates in the brain", a statement with no scientific support at all. Then he claims that chelation therapy is the solution - a radical, potentially very harmful treatment that no sensible parent would ever force on their child.  Unfortunately, some quack doctors have experimented with chelation therapy on autistic children, despite that fact that it can cause deadly liver and kidney damage, and one of them caused the death of a 5-year-old boy in 2005.

Burton also claimed that single-shot vials would "eliminate the possibilty of neurological damage from vaccines" - a claim that was invented out of thin air by the discredited anti-vax doctor Andrew Wakefield, whose fraudulent 1998 study was the spark that started the current wave of anti-vax hysteria.

Congressman Bill Posey from Florida was just as bad as Burton, demanding a study of vaccinated versus unvaccinated children, a standard talking point of the anti-vax movement.  (Congressman Posey: do you even realize that your question is almost identical to what Jenny McCarthy asked five years ago, on the Larry King Live show?)  Here's his question to the CDC's Boyle:
"I wonder if the CDC has conducted or facilitated a study comparing vaccinated children with unvaccinated children yet - have you done that?"
Dr. Boyle wasn't prepared for this.  She tried to point out that many studies have been done looking at the relation between vaccines and autism, but she didn't get very far before interrupted, thus: 
Rep. Posey: “So clearly, definitely, unequivocally, you have studied vaccinated versus unvaccinated?” 
Dr. Boyle: “We have not studied vaccinated versus unvaccinated." 
Posey: “Never mind. Stop there. That was the meaning of my question. You wasted two minutes of my time."
Dr. Boyle simply wasn't prepared for a Congressman who was parroting anti-vax activists.  It's too late now, but her response should have been this:
Congressman Posey, only an extremely unethical scientist would consider conducting such a study.  To compare vaccinated versus unvaccinated children in the manner you suggest, one would have to withhold vaccines from young children.  We know from decades of evidence, involving tens of millions of children, that vaccines save lives.  Few if any medical interventions are more effective than vaccines. 
But Congressman, the scientific community has done observational studies of vaccinated versus unvaccinated children, comparing autism rates in children whose parents chose not to vaccinate.  Those studies show that autism rates were slightly higher in unvaccinated children.  That's right, vaccinated children had autism at a lower rate. 
So no, Congressman Posey, the CDC hasn't done a study of vaccinated versus unvaccinated children.  Only a corrupt dictatorship could impose a study like that on its people.  Is that what you want?
To make matters worse, the House committee invited Mark Blaxill to testify.  Blaxill is a well-known anti-vaccine activist whose organization, SafeMinds, seems to revolve around the bogus claim that mercury in vaccines causes autism.  His organization urges parents not to vaccinate their children, and giving him such a prominent platform only serves to spread misinformation among parents of young children.  

Blaxill's central claim is that that we're in the midst of an autism epidemic: 
"For a long time, reported U.S. autism rates were low, estimated at about 1 in 10,000. Then around 1990 something new and terrible happened to a generation of children. Autism rates didn’t just rise, they multiplied," claimed Blaxill in his written testimony.
His entire argument builds on this.  Yet multiple studies, looking carefully and objectively at the data, indicate that all or nearly all of the rise in autism cases is due to increasing diagnoses, which in turn is due to multiple factors: a dramatically broading of the definition of autism in the early 1990s, a greater awareness of the condition, and a greater willingness of doctors and parents to accept the diagnosis.  For an objective summary of the evidence, see the articles by neurologist Steven Novella here and here, which summarize a dozen epidemiological studies.  The weight of the evidence shows that the actual incidence of autism is either stable or possibly rising very slowly.  There is no "autism epidemic."

It's also worth pointing out that Blaxill is a conspiracy theorist who claims that the "CDC has actively covered up the evidence surrounding autism’s environmental causes."  

Congress has every right to conduct oversight into medical research at the NIH and the CDC.  But when Dan Burton, Bob Posey, and others decide in advance what the science says, and abuse their power to demand "answers" that validate their badly mistaken beliefs, people can be harmed. Over the past decade, the anti-vaccine movement has successfully convinced millions of parents to leave their kids unvaccinated, and the result has been serious outbreaks of whooping cough, haemophilus, measles, chicken pox, and mumps around the U.S. and Europe.  

Some anti-vax parents claim that these childhood illnesses aren't so bad.  I wish they would talk to the parents of young children who have died in recent whooping cough outbreaks.  These illnesses can be deadly.

Message to Congress: science isn't easy, and autism is complicated.  Don't criticize science when it doesn't give you the answer you thought you knew.  That's not how science works.  Thousands of scientists are now trying to identify the causes of autism, and they've made progress, especially on the genetic front.  The answer might not be simple, but we will find it.  

Maryland puts football ahead of academics - again

It's holiday season, and here in the U.S. that means one thing: football!  Right?  I mean, what could be more important than football? 

At least that's what the president and regents of the University of Maryland seem to think.  This week, they announced that after 60 years, UMD is leaving the Atlantic Coast Conference, to join the Big Ten.  (Note to non-football fans: the Big Ten has 12 teams.  Yes, I know.)

The president of UMD, Wallace Loh, announced the deal just after the Board of Regents approved it a few days ago, in a secret meeting.  "Today is a watershed moment for the University of Maryland," he said.

Wallace Loh is an accomplished academic, but he is turning out to be a disaster for the University of Maryland.  His first action, just a month after joining the University in 2010, was to announce a wasteful $2 million buyout of the football coach, who had another year left in his contract. Eager football boosters couldn't wait to replace him, so Loh went along with that deal, spending over $2 million to bring in a new coach who, I should mention, has had two lousy seasons so far.  Not that it should matter.

Then, less than a year later, President Loh announced that he was eliminating 8 other sports teams to save money for football, basically doubling down on his big-time football bet.  Well, there goes any pretense that he's doing this for the student-athletes.

To see how deeply confused UMD's Loh is, consider what he said in his press release announcing the move to the Big Ten:
"We wanted to join this athletic conference because we also wanted to join its associated academic consortium. The extensive opportunities ... for collaborations with our peer AAU and flagship universities in education, research, and innovation will boost the University of Maryland's ascendancy in academic excellence."
Oh really?  Let's look at the evidence, shall we?  The ACC has 12 schools including UMD, and has just added 3 more.  Using the U.S. News rankings of national universities, we can calculate that the average ACC school is ranked 48th in the country.  The average Big Ten school is ranked 58th.  (UMD is tied for 58th nationally.)  So although the Big Ten isn't bad, a move to the Big Ten from the ACC is clearly a move down academically.

Dr. Loh is a smart man, and I doubt he truly believes that joining the Big Ten will help Maryland academically.  But he does claim it will help the athletes.  He claimed that:
 "We will have the capability to support better our student-athletes -- in the classroom and on the field -- and compete successfully at the highest levels."
Never mind that the Big Ten schools are, on average, much further away from Maryland than the ACC schools, which will require more travel from the athletes. But travel is educational, right?  

Obviously this is all about the money.  USA Today's headline got it just right: "Maryland leaves ACC for more money."

Here's a question for Dr. Loh: since Maryland will make more money in the Big Ten, will you pay your athletes higher salaries?  Oh right, these are "student-athletes": they mustn't get paid!  Never mind that their coaches make the highest salaries in the university. 

Why does no one seem surprised that a university president, a highly educated scholar with both a Ph.D. and a law degree, is spending so much time on football?  Why is a university spending any time at all running a big-time sports entertainment system?  As I wrote last year:
The football-industrial complex has too much power over our universities. Nothing else can explain how we spend so much money and time on football, which contributes almost nothing to students' education, while academic departments are cutting faculty and staff. The culture of football worship has gotten so out of control that I think the only solution is to get rid of it entirely.
It's not just UMD.  For instance, just last spring the University of Florida proposed to eliminate its Computer Science department to save $1.4 million, while simultaneously increasing its athletic budget by $2 million.  After my article about this plan went viral, UF's president reversed that decision.

Stated simply, football has corrupted America's universities.  Top administrators have completely lost sight of their academic mission, and instead seem to believe that their primary job is to provide sports entertainment for the TV-watching public.  There is only one way to fix this: get rid of football.

But wait!  Football fans don't have to lose their beloved teams.  I have a better proposal.  Each university can spin off its football program as a for-profit, separate enterprise.  The team can pay license fees for the use of the university's name and pay to rent the stadium.  Then it can pay its coaches whatever it wants; after all, they won't be university employees.  More important, these minor-league professional teams (which is what they already are) will have to pay their athletes.  We should get rid of the current system, where the athletes are basically indentured servants. (For more on this problem, see Taylor Branch's remarkable piece, "The Shame of College Sports", which sportswriter Frank DeFord called "the most important article ever written about college sports".)  

Let's remind university presidents, and boards of regents, and everyone else involved in running a university that their mission is to provide education, research, and training for their students and the world. They should get out of the business of providing television entertainment.  And they should most certainly put an end to the practice of profiting off the labor of unpaid student athletes while neglecting their education.

How to predict an election? Ask the math geeks.

Mark Newman's rendering of the 2012 U.S. election,
 weighted by population

It's time for a bit of gloating.  No, not for Democrats over Republicans, though I'm sure that's going on.  It's time for the math geeks to throw a bit of scorn at those insufferable, over-confident frat boys who call themselves political prognosticators, and who spent most of the past two years telling us that they knew how the election would turn out.  They bloviated endlessly on talk shows, explaining why their favored candidate would win, and how he would do it.  

Politicos behave just like promoters of quack treatments when things go wrong: they always have a ready answer, and somehow their "theories" can never be proven wrong.  It seems that the only thing these guys are really expert at is getting themselves onto talk shows. Now that the election is over, let's hope that happens a bit less often.

Instead, pay attention to the math geeks.  The statisticians and analysts who build mathematical models based on multiple polls and other data absolutely nailed this election.  Nailed it!  Nate Silver at FiveThirtyEight blog predicted the winner of the presidential election in all 50 states.  So did Sam Wang , a biophysics professor at Princeton, over at the Princeton Election Consortium blog.  And so did Simon Jackman, a political science professor at Stanford who writes for HuffPo.  Nate Silver first drew everyone's attention in the 2008 election, when he correctly predicted 49 out of 50 states.  Last week's success shows that this is not an anomaly, although it has the mathematically challenged pundits in a tizzy.

Hopkins statistics professor Jeff Leek wrote a nice explanation of how these models work over at Simply Statistics, so I won't explain it here.  Suffice it to say that mathematical models don't work by chattering with their buddies at political rallies.

Mathematics delivered the goods.  And make no mistake, this is the way of the future.

That hasn't stopped the punditocracy yet.   On election night, Republican hatchet man Karl Rove was sputtering on Fox News that Romney could still win, after Fox News itself - which is little more than a media arm of the Republican party -called Ohio and the election for Obama.  Rove, who predicted that Romney would win with 285 electoral voites, also orchestrated the spending of over $127 million on Romney, not to mention his spending on 12 Senate candidates, 10 of whom lost.  Has he admitted he did anything wrong?  Nope.

Rove wasn't the only one wrong.  As Techcrunch pointed out
"every single major pundit was wrong - some comically wrong."  
The Atlantic created a detailed score sheet listing all the pundits and their predictions of the overall winner, the electoral college total, and the winner in all the swing states.  And indeed, even those who predicted correctly that Obama would win got most of the swing states wrong.

Here's what needs to happen.  The television networks need to realize that political expertise is meaningless when it comes to making statistical predictions.  Let's treat political forecasting just like weather forecasting, using models that are demonstrably accurate (such as Silver's).  Television stations can hire attractive political "forecasters" (because physical appearance matters on TV, like it or not) who will describe the latest forecasts just like today's weather forecasters do.  Now that I think of it, why not let the weather forecasters do both jobs?  We already have them in place at every local TV station in the country.  Think of all the money the networks will save.

But what about all that air time they need to fill with talking heads arguing about who will win elections?  Well, this makes about as much sense as having two self-proclaimed experts arguing about whether it's going to snow this weekend.  Maybe they can find real experts who will argue about issues rather than about who's ahead in the polls.

Ha ha, just kidding!  Who wants to hear about issues?  But if you must know how the race is going, ask the math geeks.

Why we want to believe chocolate makes us smarter

Eat chocolate, win Nobel Prize?

The New England Journal of Medicine published a study two weeks ago showing, amazingly, that eating chocolate might make you smarter.  To be precise, the author, Franz Messerli, was wondering if chocolate consumption might be correlated with the overall cognitive function of a population.  He couldn't find any data on national intelligence, so instead he used the total number of Nobel prize winners per capita.  The correlation between chocolate consumption and Nobels is remarkably strong, with a p-value less than 0.0001, meaning that the odds that this is due to chance are less than 1 in 10,000.

Ha ha! Dr. Messerli was just kidding.  Or was he?

The article itself reads like almost any science paper.  It includes a straight-faced presentation of the data and scholarly references suggesting that the brain-enhancing effect of chocolate might be due to flavanols, which may be "effective in slowing down or even reversing the reductions in cognitive performance that occur with aging."

In fact the entire article appears to be dead serious until the end, where Messerli makes the wry comment that
"The cumulative dose of chocolate that is needed to sufficiently increase the odds of being asked to travel to Stockholm [where the Nobels are awarded] is uncertain."
And then, in his disclosure of conflicts of interest, he reports "daily chocolate consumption, mostly but not exclusively in the form of Lindt's dark varieties."  Hmmm, this doesn't seem like a serious science paper after all.

Word of this article swept through the halls of academia the day after it was published.  I heard it being discussed among my colleagues, who were concerned that NEJM had published yet another example of misleading statistics.  It took a couple of days for us to realize that it was a joke - based on real data, but a joke nonetheless.

The media reported the story widely, and a few reporters figured out the ruse, but the parody was just too subtle for most.  Reuters wasn't fooled, as reported on their own site and on Fox News. They reached Messerli by phone, who confessed that
"the whole idea is absurd, although the data are legitimate and contain a few lessons about the fallibility of science."
The Associated Press reporters were slightly suspicious, opening with "take this with a grain of salt." But they went on to report it as straight news, and their story appeared on CBS News, the Huffington Post, and elsewhere.

Larry Husten, my fellow columnist at at Forbes, reported it as straight news with the headline "Chocolate and Nobel Prizes Linked in Study." Time magazine fell for it too.

Two medical websites, Medical News Today and WebMD, not only took the story seriously, but also bought into the explanation that the effect is caused by flavanols, which are found not just in cocoa, but also in red wine and green tea.  Sounds like an ideal diet to me.

Slate's Brian Palmer had an interesting angle. He reported the story as straight news, but then investigated why the Swiss eat so much chocolate.  (Answer: innovation in chocolate-making, and wealth.)

Why do we want to believe chocolate makes us smarter?  Well, obviously because we'd love for it to be true.  And as Messerli points out, there have been some serious studies linking flavonoids to better health and cognitive function.  But the notion that chocolate leads to Nobel prizes is a little too good to be true.  I'm reminded of the study that I wrote about back in April that claimed chocolate would help you lose weight - which was little more than wishful thinking masquerading as science.

Still, with Halloween just past, many parents are probably wondering how much to let their kids eat.  Those Nobel-champion Swiss consume about 11 kilograms per year, about 30 g (1 ounce) per day.  That's 3 of those little mini-chocolate bars.  And parents, maybe you should have a few too - just in case Messerli is right.

Multivitamins and cancer: a mixed bag

A major new study published this week in the Journal of the American Medical Association (JAMA)  came to the surprising conclusion that
"daily multivitamin supplementation modestly but significantly reduced the risk of total cancer."
The report included some caveats, such as the fact that all 14,641 participants were healthy male physicians.

But the result is still surprising, because other recent studies, some of them even larger, have concluded that vitamin supplements do not provide any significant health benefits.  On the contrary, some studies found that supplements could actually be harmful.  As I wrote last year, a very large study of 38,772 older women, who were followed for 25 years, showed that the risk of death INCREASED with long-term use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper.  That's death, not just cancer.  The authors of that study, Jaakko Mursu and colleagues, concluded that there is
"little justification for the general and widespread use of dietary supplements."
The new study, PHS II (Physicians' Health Study II) looked at overall death rates as well as cancer, and found that men on a daily multivitamin had fewer deaths, but too few to be statistically significant.

So we have a large study in men showing that multivitamins seem to reduce overall cancer, and maybe even death, but an even larger study in women showing the opposite effect.

A second study from last year, in 35,533 men, looked at vitamin E and selenium supplements. That study, also published in JAMA, found that risk of cancer INCREASED for men taking vitamin E, selenium, or both.

The media reports aren't helping to clarify things.  The NY Times proclaimed "Multivitamin use linked to lowered cancer risk, and the Wall St. Journal reported that "Multivitamin cuts cancer risk, large study finds."  Bloomberg News went right for the business angle, announcing that "Pfizer multivitamin reduces cancer 8% in men, study finds."

Compared to Bloomberg news, Pfizer's own website was remarkably restrained, saying only
"Centrum Silver was part of the recently published landmark study evaluating the long-term benefits of multivitamins."  
No claims about reducing the risk of cancer - surprisingly, the independent media made far stronger statements than Pfizer.  Not true of supplement manufacturer GNC, which was flashing a pop-up headline that "Taking a daily multivitamin could cut cancer risk", linking to a news article at the Boston Herald.

So what do we make of this new study?  Are multivitamins good for you after all?

The new JAMA study appears to be very well done.  It's a double-blind, placebo-controlled study in which half of the physicians received a daily multivitamin, Centrum Silver, and half received a placebo.  The participants didn't know if the pill they were taking was a vitamin or a sugar pill.  The authors report some minor conflicts of interest, but none of them work for or received major funding from Pfizer (PFE, the manufacturer of Centrum).  So how to explain the seeming contradiction with two larger studies published only a year ago?

To answer this question, we must look at the details of the study itself.  This study looked at 21 different types of cancer risk.  For most cancers - colon cancer, prostate cancer, lung cancer, pancreatic cancer, lymphoma, leukemia, melanoma, and others - multivitamins did not provide a benefit.  But when all the numbers were added up, the effect was just large enough to be "significant", at a level of p=0.04.  More on that in a moment.

Here are the raw numbers: among the 7,317 men who took a daily multivitamin, there were 1,290 cases of cancer over the 11-year study.  Among the 7,324 men who took a placebo pill, there were 1,379 cases.  That's about 1.2% more - far less than the 8% reported by Bloomberg News. The statistical analysis showed that this difference had a p-value of 0.04, a result the authors considered significant. When the authors looked only at men with no history of cancer, the effect was smaller, and not statistically significant.

One explanation of the new finding is that the effects were indeed due to chance. Let's look at that p-value of 0.04. In much of the scientific literature, any p-value below 0.05 is considered "significant," but this has been widely criticized, in part because it encourages binary "true, false" thinking that is not the way scientists actually think. Also, the "0.05 threshold actually represents evidence much weaker than the number "0.05" suggests. A back-of-the-envelope Bayesian calculation shows that if the cancer-preventing power of multivitamins was a 50:50 proposition before this study, then after this study there is still a 10-26% chance that the cancer prevention claim is wrong. If we thought that prior evidence made this effect less than 50:50, (say 25:75), then the study has roughly a 25-50% chance of being wrong.* Either way, I won't be stocking up on Centrum Silver anytime soon.

Looking at this small effect, and at the contradictory results from other studies, neurologist Steven Novella writes in his blog that
"About the only thing we can say with a high degree of confidence is that there is no large risk or benefit from taking a multivitamin. There may be a small benefit, no benefit, or even a small harm."
That's a good summary.  So should men take a multivitamin?  Well, it's your money, but if you don't have a vitamin deficiency, it's probably not worth it.  Should women?  The evidence still says no.

*Thanks to Stanford biostatistician Steven Goodman (formerly of Johns Hopkins University) for crunching some numbers to produce Bayes factors.

What do the Presidential candidates think about science? recently posed 14 questions to President Obama and Republican presidential nominee Mitt Romney, and just a few days ago, the candidates answered all 14.  Can we learn what they actually think about science from these answers?  Well, maybe just a little bit.  

My first inclination, on going to the ScienceDebate2012 website, was to look for the candidates' positions on the two biggest scientific topics in the political arena today: evolution and global warming.  Somehow, ScienceDebate2012 only asked about one of these, which I'll get to in a minute.

The ScienceDebate2012 organization calls its list "the top American science questions: 2012", but the questions themselves are a disappointment.  They're what you'd expect from a committee: lots of nice-sounding, polite questions, but nothing that really challenges the candidates.  I guess SD2012 was afraid that the candidates might get all offended, or maybe that fewer scientists would sign their petition.  But if you read the answers, you'll see that the candidates just answered the question they wanted to hear, as politicians love to do.  Most of the answers describe policies we already know (for those who are paying attention to the campaigns), but an interesting surprise popped up: Mitt Romney has no fondness for NASA.  Jump to the bottom to learn more.

Most of the questions are big fat softballs, starting with the first one: "What policies will best ensure that America remains a world leader in innovation?"   Good tough question, guys!  We only have 14 questions, and you waste one on this?  Unsurprisingly, the answers to this one just repeated campaign talking points.

Before looking at some real answers, let's start with the howlingly obvious question that ScienceDebate2012 failed to ask.  
The Un-asked Question: do you believe that evolution should be taught in public schools, and that it should be presented as the only explanation for how species arose?  
This question has only one right answer, as any biologist worthy of the name knows.  Evolution is the foundation of all of modern biology, genetics, infectious disease research, you name it.  And the U.S. is one of the few advanced countries where a significant number of its citizens don't accept evolution, opting instead for an archaic religious position that claims Earth is only a few thousand years old.  

We should know the candidates' answers.  In 2008, ten Republican presidential candidates were asked if they believe in the theory of evolution.  Only 7 said yes--but one was Governor Romney.  Back in 2007, he told the New York Times that "the science class is where to teach evolution," and that intelligent design was "for the religion class or philosophy class."  President Obama also supports evolution, and opposes teaching creationism in the science classroom. 

So the candidates agree on this one - at least they did in the past.  But Romney's fellow Republicans don't all agree. In particular, we need to ask Governor Romney: do you support the crazy religious extremism of your fellow Republican, Congressman Paul Broun from Georgia, who just announced that evolution, embryology, and the Big Bang theory are
 "lies straight from the pit of hell"?  
And Broun also stated that the Bible - and his wacko interpretation of it - should be used to run our government.  Any candidate for president should denounce this call for theocratic rule.

And by the way, if a Democratic Congressman said anything like this, I'd throw the same question at President Obama.

Now on to one of the real questions, on global warming. ScienceDebate2012 posed the question this way:
"The Earth’s climate is changing and there is concern about the potentially adverse effects of these changes on life on the planet. What is your position on cap-and-trade, carbon taxes, and other policies proposed to address global climate change—and what steps can we take to improve our ability to tackle challenges like climate change that cross national boundaries?"  
Obama's short answer acknowledges that "climate change is one of the biggest issues of this generation," and goes on to say he will "continue efforts to reduce our dependence on oil and lower our greenhouse gas emissions."  Vague generalities, and nothing he hasn't said before, but consistent at least.

Romney's answer, though, tries to have it both ways.  He first says that global warming is indeed happening and then says, basically, we need more research because it's controversial.  Here's how his lengthy answer begins: 
"My best assessment of the data is that the world is getting warmer, that human activity contributes to that warming, and that policymakers should therefore consider the risk of negative consequences."  
But then he pivots in the very next sentence and claims 
"there remains a lack of scientific consensus on the issue ... and I believe we must supported continued debate and investigation within the scientific community."  
So there you go: yes, global warming is a problem, but let's study it rather than do something.  At the end of his answer, Romney recovers a bit by saying he supports "robust government funding for research on efficient, low-emissions technologies."  So it appears he would support some action on global warming.  But his answer offers a troubling false claim about a lack of scientific consensus: the consensus is rock solid.

Now, I promised one surprise: a bit of new information.  Question 12 covers space exploration and is another softball: 
"What should America's space exploration and utilization goals be in the 21st century and what steps should the government take to help achieve them?" 
I expected some vague answers about how great America is (and both candidates did indeed deliver on that), but Romney surprised me with his answer.

Here's the surprise: Romney comes right out and says he will probably cut the NASA budget.  What he actually said in his answer was: 
"A strong and successful NASA does not require more funding, it needs clearer priorities."
In Washington-speak, this means "NASA has too much money and I will probably cut it."

So at least we know where Romney stands on space exploration.  He wants to downsize it and, apparently, outsource it to other countries.  Here's how he puts it later in his answer: 
"Part of leadership is also engaging and working with our allies and the international community. I will be clear about the nation’s space objectives and will invite friends and allies to cooperate with America in achieving mutually beneficial goals."  
If I worked for NASA, I'd be worried.  

GM corn causes cancer in rats: a study in bad science

Last week a scientific paper appeared that reported that eating genetically modified (GM) corn causes cancer in rats.  Specifically, the scientists fed Roundup Ready® corn, or maize, to rats for two years, and reported that both females and males developed cancer and died at higher rates than controls.  

This is very surprising.  If GM corn causes cancer, why aren't Americans "dropping like flies," as one scientist asked?  We've been eating Monsanto's Roundup Ready® corn for over a decade, even if most of us aren't aware of it.  But our rates of cancer haven't increased more than Europeans, who eat far less GM corn.  Maybe the effect is limited to rats - in which case we should also have seen dramatic increases in cancer in lab rats.  But we haven't seen that either.

So what's wrong?  The best way to find out is to read the paper, which I did.  It turns out to be a very badly designed study, and the report itself omits many crucial details that may (and probably do) completely invalidate the findings.  The scientists leading the study have a strongly biases agenda and a conflict of interest, which they failed to reveal. I'll explain below, but meanwhile this study has already been taken up by politicians as proof (proof!) that GMO crops are harmful.  As Forbes blogger Tim Worstall explained, this paper is more politics than science.

Let's look at the study itself, which was led by Gilles-Eric Seralini (more on him below) and published last week in Food and Chemical Toxicology.  (A copy of the full paper is here.)

The authors studied 200 rats for 2 years, dividing them into 20 group of 10 rats each.  The test rats were fed a variety of diets:
  1. Non-GM corn comprising 33% of the diet (this was the control group).
  2. Roundup Ready corn comprising 11%, 22%, or 33% of the food.
  3. Roundup Ready corn that had been treated with Roundup during cultivation.
  4. Non-GM corn but with Roundup itself added to the rats' water.
So what happened?  Well, in some groups, the rats got more cancer than controls.  But not always.  In fact, the authors had to cherry-pick their own data to support their conclusions.

One major problem is that only 10% of the rats were controls - 10 male, 10 female. The study's main claim is that rates of cancer were significantly higher in the rats fed GM corn.  Martina Newell-McGloughlin from UC Davis, in an interview with Discovery News, said 
"The type of statistical analysis they used is really a type of fishing expedition.  One individual referred to it as 'fantasy statistics.' "
Another major problem is that there's no dosage effect.  In other words, if Seralini is right and GM food is bad for you, then more of it should be worse.  But the study's results actually contradict this hypothesis: rats fed the highest levels of GM corn lived longer than rats fed the lowest level.

A third problem, as Discovery News and other sources reported, is that the rats used in this study are a special laboratory strain that is highly prone to cancer.

Perhaps most damning, though, is the fact that rats fed Roundup directly had the longest survival times.  As Seralini's own Figure 1 shows, the longest-living rats in the entire study, out of all the conditions, where those that drank Roundup in their water.  These rats outlived the control rats.

Yum!  Maybe Perrier should start selling Roundup-enhanced spring water?

Seralini and colleagues struggle to explain the internal contradictions in their study.  They write, 
"Interestingly, in the groups of animals fed with the NK603 [Roundup Ready corn] without R[oundup] application, similar effects with respect to enhanced tumor incidence and mortality rates were observed."  
This tortured English is their way of admitting that rats did worse ("similar effects") when fed GM corn that was grown without Roundup.  They don't want to admit that this result contradicts their central hypothesis.

The study was designed to fail: the sample sizes (10 rats in each group) are so small that all the results are likely just due to chance, and none of the differences are meaningful.  It's exceedingly unlikely that the Roundup in the rats' water made them live longer, just as it's unlikely that Roundup Ready corn had any effect on the incidence of cancer.

I know that ad hominem attacks aren't valid, but I can't resist pointing out that Seralini's co-author, Joel de Vendomois, is a homeopath, with a "Homeopathy and Acupuncture Diploma", a double dose of quackery in a single degree.  Seralini has also published a book about the supposed dangers of GMOs, and he and de Vendomois are the lead scientists at CRIIGEN, an organization devoted to lobbying against GMOs. Of course, even if Seralini and de Vendomois are bad scientists, and even if they have a strong bias, their paper isn't necessarily wrong.  It's wrong simply because the science is wrong.

Not surprisingly, an anti-GMO group in California has gleefully embraced the claims of this dreadful paper to argue in favor of Proposition 37, a ballot initiative that will require labelling of genetically modified foods.  And Jose Bove of the European Parliament has used it to claim that all GM crops are harmful to human health.

Let's be clear about the science here.  Genetic modification of foods is a powerful technology that can be incredibly beneficial.  The recent development of salmon that can grow faster is an example: these salmon (developed by a company called AquaBounty) will make fish farming more efficient, and thereby help preserve the perilously endangered wild fish species in our oceans.  On the other hand, GM technology can be used, as Monsanto has done, simply to allow farmers to use more pesticides, which doesn't seem to benefit anyone other than the pesticide producers.  It's unfortunate that Monsanto's behavior has been used as an excuse to give all GMOs a bad name.

Now we have a bad study done by anti-GMO scientists who have allowed their political agenda to trump their scientific judgment.  What a mess.

Stabbing kids with needles: malpractice, or just a very bad idea?

Yesterday's Washington Post featured a terribly researched article titled "Kids and needles is sometimes a good match: Acupuncture can help with pain."

Imagine: a one-year-old boy arrives at an emergency room in New York at 3 a.m. with an asthma attack.  He is slow to respond to a nebulizer treatment.  Enter Dr. Stephen Cowan, who decides to use acupuncture.  That's right, he stabs a one-year-old baby with multiple needles to treat asthma.  According to Dr. Cowan, the boy "reacted calmly" and improved.  The article doesn't provide any more details.

This is appalling.  Sticking needles into a baby has never been shown to have any effectiveness at treating asthma, and we do have treatments that work.  In all likelihood, the nebulizer did work, in the case that Dr. Cowan related to the reporter, but Dr. Cowan mistakenly credits his acupuncture treatment.

Stephen Cowan is a aggressively self-promoting doctor, who claims on his website that he can treat both autism and ADHD with acupuncture and other forms of Chinese Medicine.  He also describes how he convinces children to let him stick needles into them.  He states his belief in mystical "vital energy" or qi, one of the wacky pseudoscientific notions at the core of acupuncture beliefs.  His claims are little more than a modern, mystical version of the claims made by 19th-century snake oil salesman.

The Washington Post story also revealed that Children's National Medical Center in Washington, D.C. recently treated a 17-year-old girl with pancreatitis by stabbing needles into her stomach and other places.  There is no evidence that this works, but the girl's doctor believes it does.  The girl reportedly wasn't harmed, fortunately.

The doctor at Children's Hospital, Jennifer Anderson, is an anesthesiologist who is also an acupuncturist.  In the story, she said "I often treat patients with chronic issues" with acupuncture.  This is frightening: a doctor at a major medical center is telling children, most of whom are too young to even think of questioning the wisdom of a doctor, that sticking them with needles will help their pain.  Dr. Anderson admitted that "she often does two to three treatments a week at first on a child."  So she admits to stabbing many sharp needles into children and telling them that the treatments will help their pain.  She argues that the children report that this is "helpful."

This is perilously close to child abuse.  Children want to please adults, and if an adult tells them something is good for them, especially if an authority figure tells them, they are extremely unlikely to disagree. They'll just swallow the medicine, or endure the treatment, and then tell the adult what she wants to hear.  Dr. Anderson seems unaware of this.  And Children's National Medical Center, a generally outstanding hospital, should be seriously concerned that one of its anesthesiologists is practicing quack medicine on children, who are perhaps the most vulnerable of all patients.

Let's be clear: acupuncture is based on nonsense.  Scientists have gone to great pains to study it, and the conclusion can be stated simply: acupuncture does not work.  (And yes, I know about the latest meta-analysis claiming that acupuncture works.  Dr. Steven Novella has already explained why that analysis is "completely useless.")  If acupuncture were a drug being tested by a pharmaceutical company, it would have been abandoned long ago.  Its proponents are no better than any big pharma company that pushes a drug that it knows to be ineffective.

Acupuncture is worse than ineffective: because it's an invasive procedure, there is a small but real risk of harm.  As I wrote last year in The Atlantic, acupuncturist sometimes cause infections, which can lead to rare but serious complications.  Acupuncturists protest (often) that they use sterile needles, but this very protest reveals their ignorance: most infections are caused by bacteria already present on the skin, which enter through the puncture wound.

Parents: don't let an acupuncturist stick needles into your kids.  Read the science first, and avoid - no, run screaming from - any practitioner who claims that he can adjust the "qi" in your child.

British Health Minister believes in magic water

Well, this is one way to save money on health care.  The new British Minister of Health, Jeremy Hunt, is a firm believer in homeopathy, which treats disease using magic water solutions that contain - well, only water.

Just a few days ago, British prime minister David Cameron shuffled his cabinet, moving Hunt from Minister of Culture to his new position in charge of health.  Within hours, Tom Chivers, a science editor at the Telegraph, reported on Hunt's belief in homeopathy:
"The man put in charge of the nation's health policy is on record as supporting spending public money on magic water to cure disease." 
He went on to add:
"This is not unlike putting someone who thinks the Second World War began in 1986 in charge of the Department of Education."
Not surprisingly, Chivers' blog post was flooded with hundreds of comments, many of them from upset defenders of homeopathy.  Most of their arguments boiled down to "I think it works for me, so there."

Homeopathy is one of the most absurd, wildly implausible forms of quack medicine. I've written about it many times (for example, about the bogus flu pills sold as oscillococcinum,
about NCCAM's embarrassing funding of studies of homeopathy, and about how homeopaths offer strychnine to cure children's colds), so I'll try not to repeat myself.  Homeopathy is founded on two basic notinos, both of them dead wrong:

  1. Infinitely diluted substances are more potent than substances at higher concentrations, and
  2. "Like cures like," meaning that if a substance causes a symptom, you can use that substance to cure the symptom.  

Thus caffeine can be used to help you sleep, and poison ivy can cure itching.  No, I'm not making this up; homeopaths really believe this stuff.

Homeopathy is simply magical thinking.  There has never been a shred of scientific evidence to support it, and the British Medical Association declared in 2010 that homeopathy is witchcraft.  After pressure from science bloggers, NIH's NCCAM has corrected its website to state that
"it is not possible to explain in scientific terms how a remedy containing little or no active ingredient can have any effect."
But homeopaths make a lot of money selling homeopathic potions, and through clever marketing they keep themselves in business.  Now they have a new ally, the UK Minister of Health. Andy Coghlan, writing in The New Scientist, called him "the new minister for magic."  Brilliant!  As Coghlan pointed out, magic is much cheaper than real medicine:
"Think of the savings if all those expensive proven treatments and drugs are phased out, and patients are offered cheap little vials of water instead."
We're desperately looking for ways to control health care costs here in the U.S. as well.  The UK Minister of Magic may have a solution for us.  I wonder, though, if it works for muggles?

What did the ENCODE project discover about the genome? A quick shout-out.

Does top-down science work as well as bottom-up science?

This is just a quick link-over to my friends at Simply Statistics, who interviewed me on their blog (and vodcast) about the just-published set of papers on the human genome known as the ENCODE project.  Check it out here, and then follow the discussion and comments further on their follow-up post here.

UC Davis muzzles professor for speaking out about excessive PSA testing

When UC Davis announced a seminar on men's health back in October 2010, it sounded like a typical educational event.  But UC David professor Michael Wilkes investigated and learned that the seminar was primarily a sales pitch about the prostate specific antigen (PSA) test, and that its main message was that men should get tested regularly beginning at age 40.  However, the weight of scientific evidence suggests that regular PSA testing is not a good idea, and it may do more harm than good, as I wrote recently.  In a major report issued earlier this year, the U.S. Preventive Services Task Force recommended that men should not get routine PSA screening for prostate cancer, stating explicitly that
"the benefits of PSA-based screening for prostate cancer do not outweigh the harms." 
Prof. Wilkes, an expert on prostate cancer screening, came to the same conclusion almost two years ago.  In response to the UC Davis seminar, he and USC professor Jerome Hoffman wrote an opinion article for the San Francisco Chronicle.  They made basically the same argument that the USPSTF made in their lengthy, thoroughly researched report: that the PSA test often does more harm than good.

The story would end there, if not for what UC Davis then did to Prof. Wilkes.  Within a few hours of the publication of the newspaper article, the Executive Associate Dean at the UC Davis medical school informed Wilkes that he would be punished in two ways.  First, he would lose his position in the doctoring program, and second, he would lose the funding support for a Hungarian student exchange program that he organized.  Dr. Wilkes, it is worth noting, was recruited to UC Davis from UCLA because of the innovative program in doctoring (how to be a doctor) that he developed.

Apparently the Executive Associate Dean (where do they get these titles?) was angry over what Dr. Wilkes wrote in the newspaper.  He later admitted that he read Dr. Wilkes' article just before he wrote his threatening email.  All of this is documented in a report issued this past May by the UC Davis faculty Committee on Academic Freedom and Responsibility (CAFR).  Many additional details were reported on UC Davis Professor Jonathan Eisen's blog in June.

When challenged about these threats, the university lawyer David Levine said, in essence, what threats?  My goodness, he said in a letter to Wilkes, I'm just giving you a few helpful facts:
"I am simply pointing out that there are numerous errors of fact in your article, that they were injurious to the University interests and reputation and thus potentially actionable under the law of defamation."
But heavens no, we're not threatening to sue you or anything like that.  Just pointing out some things that we're sure you will want to know.  The university's lawyer's explained further, in a letter to CAFR this past February, that
"The administrative action … was simply to provide information to Dr. Wilkes regarding … the potential legal exposure for broadcasting false information that is injurious to reputation."
I'm sure that Dr. Wilkes found all of this information very helpful.

This summer, the UC Davis faculty senate voted 52-0 that the university had violated Prof. Wilkes' academic freedom, and called for the university to apologize and withdraw its threats, which UC Davis has not yet done.  An academic freedom watchdog group, FIRE, wrote to UC Davis chancellor Linda Katehi with the same requests.  Chancellor Katehi replied in a letter, dated July 17, that she and Provost Ralph Hexter have "assembled a small team of independent subject-matter experts" to review the case, and that they will have more to say by August 31.

What the heck do you need a committee of experts for?  Even if Prof. Wilkes' article was wrong (and it's not - he is spot-on accurate), he has every right to express his opinions.  So it doesn't really matter if PSA testing is good for you or not.  Yet after almost two years, UC Davis still has not withdrawn the threats made by its lawyers and by its Executive Associate Dean against Prof. Wilkes, and by extension against any other professor who might disagree with something the university is doing.

At this point, merely withdrawing the threats is not enough.  Chancellor Katehi should clearly and unambiguously affirm Prof. Wilkes' right to speak his mind, and she should also punish the Executive Associate Dean, the university counsel, and any other administrators who have been involved in this outrageous assault on free speech and academic freedom.  Otherwise they or others might very well just do it again, the next time they read an Op-Ed piece that annoys them.

The perfect hamburger, spoiled

20 years ago, we cooked hamburgers the way we liked them.  If you wanted your burger medium rare, well, good for you.  A thick, juicy burger, seared on the outside and just a bit pink on the inside, was the centerpiece of any good summer cookout. That was a more innocent time.

In 1993, a deadly outbreak of E. coli infections hit the northwestern U.S., sickening hundreds of people and killing four children.  The outbreak was traced to undercooked ground beef from a hamburger chain called Jack in the Box.

Fortunately, we live in a highly educated, advanced society, where the citizenry understands that its health depends on having bacteria-free food.  The unsanitary conditions that allowed E. coli to enter the food supply, including assembly-line slaughterhouse practices, were quickly halted.  New government regulations assured that any factory that shipped contaminated beef would be shut down.  Inexpensive, accurate DNA testing now detects almost all bacteria at a neglible cost.  Food-borne outbreaks of bacterial infections have been rare ever since.

Ha ha ha ha ha!  Just kidding!  Of course we can't have government regulators getting in the way of efficient food manufacturing!  Consumers ought to know that it's their fault if they get sick.  We must cook our burgers until they're as sterile as a Martian landscape.  That's simply the trade-off we must make to have such cheap food these days.

It's not that we don't check for any bacteria at all.  In fact, the U.S. Department of Agriculture recently announced that it would begin testing beef for six different deadly strains of E. coli.  Until now, it has only tested for the O157:H7 strain, which was behind the 1993 outbreak.  I guess this is progress.  However, the USDA will not be testing for salmonella bacteria or for any other nasty microbes.

The beef industry is opposed to any efforts by the government to test its products for bacteria.  For many years now, it has been remarkably successful, through lobbying efforts in Congress and through lawsuits, at rendering the USDA powerless.  As one example: twelve years ago the USDA tried to shut down a beef plant in Texas that failed its salmonella tests.  The beef industry challenged the USDA in court and won, and the USDA still doesn't have the power to shut down a plant for salmonella contamination.

We have the technology to detect all the bacteria that keep turning up in beef and chicken.  DNA testing technology has gotten much faster, cheaper, and more accurate in the 20 years since the Jack-in-the-Box outbreak, but we still don't use it on our food.  The meat industry won't say why it opposes DNA tests for contamination, but no one knows how consumers might react if they knew how much bacteria was really in their meat.

The USDA does test for E. coli O157:H7.  In the first half of this year, it tested 6,427 beef samples.  Out of those, 470 (7%) tested positive, which is pretty startling, considering that this is just one strain out of six known to be deadly to humans, and considering that we've known about this one since 1993.

(Chicken, by the way, has similar problems, with most raw chicken (organic or not) being contaminated by salmonella or campylobacter bacteria.  It helps that no one likes chicken cooked rare.)

Where does all this bacteria comes from, anyway? You may already know the answer: poo.  Beef and chicken production facilities aren't very good at keeping the (ahem) waste material separated from the meat.  Changing the way our beef is produced would cost more, undoubtedly. But is it unreasonable to ask a food producer to deliver safe food?

Luckily, if you cook meat long enough, it can't hurt you.  It might not taste as good, but hey, we all make compromises.  So broil those burgers through and through, and if they're a bit dry, well, that's what ketchup is for.

Anti-vaccination propagandists help create the worst whooping cough epidemic in 70 years

The great northwest of the U.S. is known for its natural beauty.  It's also a high-tech region with a highly educated public - not exactly the kind of place one would expect to fall for the anti-science rhetoric of the anti-vaccine movement.

But it has.  The anti-vaxxers have convinced a frighteningly high number of parents in Washington State to withhold vaccines from their children.  A story in The Seattle Times last year reported that 
"Washington [state] parents are choosing not to vaccinate their kindergartners at a rate higher than anywhere else in the country."  
This despite the fact that the Bill & Melinda Gates Foundation (formed by the founder of Microsoft, which is headquartered in Seattle) is one of the world's leading sponsors of vaccine research.  

When the vaccination rates drop, everyone becomes more vulnerable to infectious diseases.  When more than 90% of the population is vaccinated, we have "herd immunity" - this means the disease can't spread because there aren't enough susceptible people in the community.  So the high rate of vaccine refusal in Washington makes it easier for whooping cough (and other diseases) to spread.

The media has been complicit in spreading some of the anti-vaccine misinformation.  Sometimes it comes straight from the media itself, such as the credulous, anti-science, anti-vax CBS reporter Sharyl Attkisson. Other times it comes from talk shows, magazines, or even airline advertisements that provide a platform for anti-vax celebrity doctors such as Jay Gordon (who gained fame as Jenny McCarthy's son's doctor) and "Dr. Bob" Sears, who has published his own "alternative" vaccine schedule in a book filled with anti-vaccine nonsense.  These characters continue to claim, at every chance they get, that vaccines cause autism (as Gordon has said, repeatedly), or that they cause other harms, despite overwhelming evidence to the contrary.  They use their medical degrees and their faux concern "for the children" to frighten parents into keeping their kids unvaccinated.

And now we learn that the U.S. is in the midst of the worst whooping cough epidemic in 70 years.  One of the most hard-hit states is Washington, which the CDC just announced (on 20 July) has suffered 2,520 cases so far this year, a 1300% increase over last year.  This is the highest number of cases reported in Washington since 1942.  This plot of the number of cases this year compared to last year shows the dramatic rise in infections:
The figure above shows the number of confirmed and probable pertussis cases reported, by week of onset in Washington, during January 1, 2011-June 16, 2012.  Source: Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention.
Making things worse, it seems, is an increase in cases among children aged 13-14.  Children get a booster shot at age 11-12, but the new outbreak indicates that the effectiveness of the booster may not last very long.  The dramatic increase in whooping cough this year also suggests that the bacterium that causes it, Bordetella pertussis, is mutating to make the vaccine less effective.  Nevertheless, the CDC emphasizes: 
"Vaccination continues to be the single most effective strategy to reduce morbidity and mortality caused by pertussis. Vaccination of pregnant women and contacts of infants is recommended to protect infants too young to be vaccinated."
This good advice is seriously undermined when misinformed doctors such as "Dr. Bob" Sears directly advise pregnant women not to get the whooping cough vaccine, as he did in the Huffington Post. (Hint: it's a good rule to be very skeptical of celebrity doctors who go by their first name.)

I should also point out that whooping cough is a national problem, not just Washington State's.  The U.S. has had over 17,000 cases this year, putting it on track for the worst year since 1959.  The highest rate of infection in the nation is in Wisconsin (which has also been hit hard by anti-vaccine effects), followed by Washington and Montana. 10 deaths have been reported, mostly in infants who were too young to be vaccinated.  For all this, we can thank the anti-vaccination movement.

Zinc for the common cold: the industry responds

In my recent articles about zinc treatments for the common cold (in March and May), I expressed skepticism that zinc has any effect on the duration of colds.

The maker of Cold-EEZE, ProPhase Labs (PRPH), sent me a detailed response from their Chairman and CEO, which I'm posting here for my readers. Because the document is rather long, I've only included a portion of it below, with my commentary interspersed.  The full text, with references, can be found here.  Now on to the response.

Response from the makers of Cold-EEZE
The objective of this document is to respond to your original article in Forbes titled “Zinc Versus Chicken Soup, Round Two.”

The following information will provide a clearer picture as to what the Common cold is and how it progresses in your body.  Also discussed is how certain zinc formulations are clinically proven to reduce the severity of cold symptoms and the duration of the common cold by nearly half. Finally, we provide some clarity as to why some zinc formulations are more effective than others, and thus, some studies on zinc formulations demonstrate significant efficacy while other studies fail to do so.

We would like to start by correcting some misinformation in your article. Contrary to your claim, ProPhase Labs, Inc. (former The Quigley Corp.) did not sponsor the two clinical studies supporting the effectiveness of Cold-EEZE zinc lozenges.  ProPhase Labs, Inc. only provided the zinc gluconate lozenges for these studies.

The first study at The Dartmouth College was sponsored by Godfrey Science & Design, Inc., Huntingdon Valley, PA and by a grant from the Rorer Pharmaceutical Corp., Fort Washington, PA. The second study conducted by Cleveland Institute was granted by the General Pediatrics Research Fund and the Departments of Infectious Diseases and General Pediatrics of the Cleveland Clinic Foundation.

[COMMENT: I didn't claim that at all.  I stated, correctly, that all 17 studies in a recent review article were funded by industry.  The review article lists the funding sources in Table 1.]

Another criticism in your article related to the fact that some of the clinical studies had been conducted 10 to 20 years ago and that the results from these studies were therefore no longer valid. This is simply not a valid conclusion. The science to conduct such studies, the metrics to measure the response, and the statistical tools utilized for analyzing the results has not been modified or changed significantly during this time.  One should bear in mind that there are plenty of drug products on the market today which are approved by FDA based on clinical studies conducted more than 20-30 years ago.

[COMMENT: I did not state that these studies were "no longer valid."  Here's what I wrote 
"… their website points to three studies from 10-20 years ago.  They conveniently ignore the more recent studies that showed far less (possibly no) benefit."  
As any good scientist knows, scientific conclusions that don't hold up under further examination must be revised or thrown out entirely.  The follow-up studies of zinc didn't support these early results.  This happens all the time in science, and what we usually do is conclude that the early results were incorrect.] 

The Common Cold and Zinc
For the past decenniums, scientists have studied the effect of Zinc on the common cold caused by the Rhinovirus and have tried to understand the science behind it. The exact mechanism of action of Zinc in the common cold has not been fully identified yet; however, there is strong scientific evidence, based on several ex-vivo and in-vitro studies, supporting the two main mechanism hypotheses:

  1. The zinc ion, based on its specific property and electrical charge, has an affinity for a specific intracellular adhesion molecule called ICAM-1 receptor present in the nasal epithelium cells. The Zinc ion has an ability to form a complex with the receptor and thereby prevent the binding of the Rhinovirus to nasal epithelial cells.  
  2. The Zinc ion has an ability to prevent the formation of viral capsid proteins and thereby inhibits the replication of several viruses, including Rhinovirus.  

There are several peer reviewed scientific publications which provide a better understanding regarding the effect of Zinc on the common cold caused by Rhinovirus and the possible mechanism of actions to inhibit the progress of Rhinovirus infection. 

[COMMENT: the makers of Cold-Eeze point to a list of 9 "peer reviewed" papers that they say support their point. Few of us (certainly not me) have time to read all these papers, but I did look at them briefly.  Two papers are in the journal Medical Hypotheses, which is not only not peer reviewed, but is well known as a trash bin full of crank theories without any scientific support or plausibility.  See the excellent discussion by Photon in the Darkness about why Medical Hypotheses is a bogus source.
Citing bogus sources is never a good idea.  However, some of the other cited articles are legitimate, and the most recent one, from 2009, does show that zinc is a plausible agent for inhibiting the cold virus.]

The different outcomes from different Zinc studies
The inconsistency in the clinical results between different studies may be explained by the fact that: (i) the type of virus causing the common cold may have varied in each study and; (ii) the type of zinc formulation that was studied also varied. Different formulations use different types of additives such as flavoring agents and sugars which are commonly used to help improve the palatability of the zinc ions.  In some formulations, these additives form highly bound complexes with the zinc ions.  This results in poor ionic zinc availability.  Given the link between ionic zinc availability and prevention of cold virus replication, it is only logical that decreased ionic Zinc availability may lead to decreased efficacy observed in some particular clinical studies. Effective delivery of the Zinc ions in the oral cavity is critical to the success of zinc formulations reducing the duration of the common cold caused by rhinovirus. There are many forms of Zinc supplements which do not release the Zinc ions in the oral cavity. This is likely to be a major reason for the inconsistent results in some zinc studies.

[COMMENT: This is what is known as "special pleading", a common logical fallacy.  The many studies showing no effect are a big problem for zinc.  It just doesn't seem to work, and no amount of special pleading will change that.]

Based on the strong, statistically significant results obtained from the two double blinded, randomized, placebo controlled studies conducted by Cleveland Institute and The Dartmouth College, we are convinced that our Cold-EEZE product releases and effectively delivers the right amount of Zinc ions in the oral cavity to fight the Common Cold caused by rhinoviruses.  Furthermore, two other studies were conducted by the Heritage School in which teenage students were provided with one Cold-EEZE lozenge daily.  The reduction in the number of instances of upper respiratory infections was dramatic.  Moreover, for those students who did catch a cold, the duration was reduced significantly relative to the prior year.  Unfortunately, these were not placebo controlled studies so our technical conclusions are a bit more limited but the results are highly convincing and supportive of the other two statistically significant studies that we refer to.

[COMMENT: These are the older studies that have not held up upon further study.  The conclusions might be "highly convincing" to the makers of Cold-Eeze, but not to me.]

Finally, we include an insert in every package of Cold-EEZE, asking consumers for feedback.  Well over 90% of consumer feedback is directly positive toward efficacy and incredibly, only approximately 1% is negative regarding efficacy.  (The rest of the consumer feedback primarily relates to packaging and flavor comments and suggestions.)  These real life results in the field powerfully confirm the supportive clinical studies.

[COMMENT: Do you really believe that feedback from your own biased sample of consumers, who already bought your product on the assumption that it would work, is confirmatory evidence?  Sorry, but this claim gets a failing grade.]

An understanding of the different zinc formulations including their zinc ion availability and delivery is critical to drawing the appropriate conclusions with regard to zinc efficacy. Our intention in this response has not been to undermine the nutritional value of chicken soup which most probably has a complimentary function in shortening the duration of the common cold.

[COMMENT: We agree on chicken soup!]