This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.
The flu season is looking particularly bad this year. We already had signs of trouble back in November and December, when it emerged that the flu vaccine was not very effective against the dominant strain that is circulating this year, which is called H3N2.
Until this past Friday, it seemed that the peak of the flu season might have occurred just around the new year, as shown in this chart from the CDC:
The chart shows a peak in the very last week of 2017, and then the number of reported cases seemed to decline. But then on Friday the CDC reported this alarming trend:
That red line spiking upward in the middle of the chart shows the number of flu-like cases reported by the CDC's national network this year. Rather than going down, the trend shows a sharp rise over the past two weeks. We don't know exactly what it is (these are not laboratory-confirmed flu cases), but more people are getting sick.
Even more alarming are the reports of young, healthy people dying of the flu. This past week the Washington Post reported on a healthy 10-year-old boy who caught the flu and died within just a few days. Just before Christmas, a healthy 21-year old young man in Pennsylvania came down with the flu, and went rapidly downhill until he was rushed to the emergency room on Dec. 27. The hospital was unable to save him, and he died the next day. These cases are truly alarming, and even though the CDC hasn't seen a statistically significant increase in deaths among young people (not yet, at least), everyone needs to take the flu very seriously this year.
With the government shut down, a difficult situation becomes worse. Most of the CDC staff will be forced to sit on their hands when they could be working–and many of them want to work, but they won't be allowed to. What's especially frustrating (and wasteful) is that the U.S. will almost certainly pay all federal employees for this forced time off, as it did in previous shutdowns.
We also need a better way to make the flu vaccine. The U.S. still relies on vaccines that are produced by growing the virus in chicken eggs, a decades-old method. This sometimes requires us to use a strain that doesn't match the circulating virus, because some strains just won't grow in eggs. So instead we manufacture a mediocre vaccine, rather than investing in new, modern technology that wouldn't need eggs and could produce more effective vaccines at lower cost. (Why are we stuck with old technology? It's a long story, but essentially it boils down to the fact that we rely completely on private companies to make the flu vaccine. The government doesn't make vaccines and has no plans to do so.)
With the right technology, we should be able to produce a universal flu vaccine, one that we can take once and never need again, like most other vaccines. Scientists are getting closer to that, with much help from the (currently shut down) NIH.
Meanwhile, we are looking at a particularly dangerous flu season, with few weapons to guard against it other than the not-very-good vaccine. (Aside: ineffective doesn't mean useless. Even if the vaccine is only 30% effective, as some estimates have it for this year, it's still a good idea. Everyone in my family got it.)
Oh, and one more thing: the flu shot cannot give you the flu. I only mention this because anti-vaxxers continue to promote this particular myth. 80% of people who have come down with the flu this year did not get vaccinated.
Chairman Mao would be delighted, if he were alive to see it. He now has the U.S. government buying into arguments that he used to hoodwink his own people, decades ago. Never mind that the arguments are all bogus.
This morning, the front page of The Baltimore Sun describes how the U.S. Veterans Administration is using acupuncture to treat chronic pain in veterans. The VA especially likes something called "ear acupuncture," the creation (out of thin air) of a VA doctor who claims that a few needles inserted in your ear will cure pain anywhere in your body. The VA also calls this "battlefield acupuncture," and it is not only fake but also dangerous, so much so that in 2011 I labelled it the worst quackery of the year.
And yet it hasn't gone away, as the Baltimore Sun reports. The VA uses acupuncture "across the country," offering it to veterans who have little choice about their health care provider. A few years ago, the VA argued this could help veterans manage chronic pain from war injuries. Now they're claiming that acupuncture will help solve the opioid epidemic. Whether it works or not seems beside the point: a VA doctor quoted in the story argues that "if patients believe that it’s helping their pain, then it is." Unfortunately for her patients, she seems unaware that science has shown that acupuncture does not work–for anything (as Yale neurologist Steven Novella succinctly put it).
Why is the VA offering quack treatments to veterans? One reason is that these treatments are popular. The same argument appears in countless forms, but it boils down to: "the people want this, so we should give it to them."
I get it: popularity is good news if you're an actor, or a writer, or a singer, or an athlete, or especially a politician. But it means nothing when we're trying to decide if a medical practice is effective. Doctors in medieval Europe used to bleed their patients, often killing them, in the belief that sickness was caused by "ill humors" in the blood. Bleeding was popular, but it was a very bad idea.
It's not just the VA. This past fall, two Colorado Congressmen, Jared Polis (D) and Mike Coffman, (R) announced the creation of a bipartisan Integrative Health and Wellness Caucus, explaining that:
"While at least a third of Americans use complementary or alternative medicines, access is often inconsistent."
It's not surprising that Polis and Coffman believe that we should give people whatever treatments they ask for. Neither of them is a scientist, so they live in a world (politics) where popularity counts for a lot. How ironic that, in the hyper-partisan U.S. political scene today, the parties have come together to support something that is flat-out wrong.
Just stop it already. Stop arguing that just because something is popular, it must be true, or at least worth investigating (at taxpayer expense). For centuries, most humans believed the Earth was flat, but that didn't turn out to be true, though it was popular. We figured it out and moved on.
Today's versions of medieval bleeding include acupuncture, homeopathy, naturopathy, chiropractic, reiki, Ayurveda, healing touch, various "detox" treatments, and more. Science has figured out that all of these are nonsense, and moved on. (And by calling them "nonsense," I am being generous. Some of them are dangerous.) But people who make money off these practices have been waging a decades-long campaign to keep them going.
Acupuncture is a scam foisted on the Chinese people by Mao Tse-Tung, whose country was too poor to provide real medicine to its population. Instead, Chairman Mao launched a marketing campaign to convince them that the old, traditional medicine was just as good. Kimball Atwood wrote a 4-part history of these events; in part 3 he reveals this gem, from Mao's personal physician:
"Publicly, the Chairman was the leading advocate of traditional medicine, but he refused to use it himself."
And now the U.S. government has fallen for the same scam.
Universities are prey to this as well. This fall, we saw the University of California at Irvine announce a $200 million gift to create a new medical center dedicated to integrative medicine, a disturbing intrusion of junk science into the academic mission of the university. One of the donors, Susan Samueli, argued that "The public is not only interested [in integrative medicine], but they are clamoring for it.”
There it is again–the argument from popularity. And even though this might be privately funded, it is based at a public, state-funded university.
"Many Americans—more than 30 percent of adults and about 12 percent of children—use health care approaches developed outside of mainstream Western, or conventional, medicine."
NCCIH's website is careful not to state explicitly that popularity is equivalent to evidence. But then what are they saying? That NIH thinks that 30% of Americans are wrong? (By the way, that 30% number is highly dubious. It includes a wide array of practices, some reasonable and others wacky.)
Why do we even have an NIH center devoted to integrative medicine? It's not because there's any science behind it. On the contrary, NCCIH is a monument to a deep misunderstanding on the part of former Senator Tom Harkin, who created it back in 1991. For an excellent summary of NCCIH's history, see this short video from Reason TV:
or my own talk from a 2015 conference, here. Harkin earmarked a few million dollars to create a small Office of Alternative Medicine in 1991, and with his help it grew over the years into a large, money-wasting administrative behemoth.
NCCIH's website is replete with misleading statements. After pointing out that "millions of Americans use complementary health approaches" (there's that popularity argument again), they offer this sage advice:
"Choose a complementary health practitioner, such as an acupuncturist, as carefully as you would choose a conventional health care provider."
Face, meet palm. No one shouldn't be choosing a "complementary" health provider in the first place, and NIH shouldn't be telling people to do it carefully, whatever the heck that means.
Yes, this stuff is popular. And its popularity has enriched the numerous practitioners of bad medicine, many (most?) of whom may genuinely believe that their snake oil works. But popularity doesn't make something true. Or maybe it does–I hear that the tooth fairy is very popular.
