Why is a university hosting a conference on a practice that may be an abuse of human rights?

Sometimes you think you've settled an issue, and you can move on. Demonstrating that a health practice is useless and sometimes harmful should be enough to squash it–but not always.

A few days from now, the University of Northern Iowa will host a conference on "facilitated communcation," a thoroughly debunked practice that harms patients and their families and that has been called unethical by leading medical societies.

For those who haven't heard of it, facilitated communication, or FC, is a method where a person (the "facilitator") sits next to someone and guides their hand over a keyboard. For example, a facilitator will hold the hand of a nonspeaking autistic child and guide her as she types out messages.

The problem is, scientific evidence going back 25 years shows that it doesn't work at all. All of the messages come from the facilitator–who might not even be aware that s/he is doing the actual communicating. Even worse, there are multiple documented instances where FC led to false charges of sexual abuse, invented by the facilitator, that severely damaged families and even led to imprisonment of innocent parents. Nonetheless, FC is still used today, and it is easy to find websites claiming that it can help parents communicate with their autistic children.

The American Speech-Language-Hearing Association has recently written that

"FC is not an effective form of communication and does not provide access to communication... [it] has been associated with significant preventable harms arising through false allegations of sexual abuse and mistreatment. (Boynton, 2012; Chan & Nankervis, 2014; Wombles, 2014)"

Others have been even more blunt, writing that "FC is an abuse of human rights." And yet it has not disappeared.

Why do people still practice facilitated communication? Are they even aware that what they're doing is deeply harmful? A compelling case is made in this lengthy expose, published in 2012 by a former facilitator, Janyce Boynton, who admits that she was responsible for "graphic depictions of rape and sexual assault that had no bearing in reality." Her actions led to a family being split apart and the parents being charged with child abuse. 

Yet Boynton believed at the time that what she was doing was real–as she puts it, she simply "did not want to believe that FC was a hoax." She also makes it clear that many of the people she learned from sincerely believed that FC was real. Boynton herself was crushed when she realized that she–and not the severely autistic child who had been entrusted to her care–was typing all the messages. As Boynton eventually discovered: 

"By the mid-1990s, the scientific community had proved over and over again that it was the facilitator—not the disabled communication partner—who was typing the messages. Every time. Full stop."

Ms. Boynton is now leading the effort to try to convince the University of Northern Iowa to cancel its workshop promoting Facilitated Communication. She helped put together a letter, signed by dozens of doctors, scientists, and speech pathologists, urging the dean of the UNI's School of Education not to host the conference.

I wrote to the UNI dean as well, and she forwarded my questions to Christine Ashby, a faculty member at Syracuse University which is co-sponsoring the conference. Prof. Ashby declined to answer my questions, and instead sent me a document that "provides additional information about the method and the research pertaining to its use," as she wrote. I read the document and looked at the references, but I could find nothing that refuted the earlier double-blind studies (or other, more recent studies such as this one) that have shown that FC is ineffective.

The fight against dangerous pseudoscience never ends. As five professors of speech pathology and psychology wrote just a few weeks ago:

"It's time to stop exposing people to the dangers of Facilitated Communication."

And yet it is nearly certain that the University of Northern Iowa will proceed with its workshop on June 18-19, where attendees will not only get college credit, but they may emerge with the mistaken belief that they can unlock hidden thoughts in children who are unable to communicate. This can only cause harm.

No, Google didn't just create AI that could "build your genome"

Most scientists don't have their own PR machine to hype their work. After reading the announcement last week from Google's genomics group, I realized that's probably a good thing.

A Wired article last Friday reported that "Google is giving away AI that can build your genome sequence." Sounds impressive–two high-tech innovations (AI and genomes) in the same title! Unfortunately, the truth is somewhat different. It turns out that Google's new "AI" software is little more than an incremental improvement over existing software, and it might be even less than that.

I'm going to have to get into the (technical) weeds a bit to explain this, but it's the only way to set the record straight. The Wired piece opens with this intriguing challenge:

"Today, a teaspoon of spit and a hundred bucks is all you need to get a snapshot of your DNA. But getting the full picture—all 3 billion base pairs of your genome—requires a much more laborious process."

Interesting, I thought. The writer (Megan Molteni) seems to be talking about genome assembly–the process of taking billions of tiny pieces of DNA sequence and putting them together to reconstruct whole chromosomes. This is something I've been working on for nearly 20 years, and it's a fascinating but very complex problem. (See our recent paper on the wheat genome, as one of dozens of examples I could cite.)

So does Google have a new genome assembly program, and is it based on some gee-whiz AI algorithm?

No. Not even close. Let's look at some of the ways that the Google announcement and the Wired article are misleading, over-hyped, or both.

1. The Google program doesn't assemble genomes. That's right: even though the Wired piece opens with the promise of "getting the full picture" of your genome, the new Google program, DeepVariant, doesn't do anything of the sort. DeepVariant is a program for identifying small mutations, mostly changes of a single letter (called SNPs). (It can find slightly larger changes too.) This is known as variant calling, or SNP calling, and it's been around for more than a decade. Lots of programs can do this, and most of them do it very well, with accuracy exceeding 99.9%.

How could Wired get this so wrong? Well, the Wired piece is based on a Google news release from a few days earlier, called "DeepVariant: Highly Accurate Genomes With Deep Neural Networks," written by the authors of the software itself. Those authors, who obviously know what their own software does, make the misleading statement that DeepVariant is

"a deep learning technology to reconstruct the true genome sequence from HTS sequencer data with significantly greater accuracy than previous classical methods."

If you read on, though, you quickly learn that DeepVariant is just a variant caller (as the name implies). This software does not "reconstruct the true genome sequence." That's just wrong. To reconstruct the sequence, you would need to use a program called a genome assembler, a far more complex algorithm. (I should add that many genome assemblers have been developed, and it's an active and thriving area of research. But I digress.)

The Wired article also points out that

"the data produced by today’s [sequencing] machines still only produce incomplete, patchy, and glitch-riddled genomes."

Yes, that's true. Again, though, DeepVariant does nothing to fix this problem. It can't assemble a genome, and it can't improve the assembly of an "incomplete, patchy" genome.

2. Wild hyperbole: the caption on the lead image in the Wired piece says "Deep Variant is more accurate than all the existing methods out there."  The Google press release, presumably the source for that caption, claims that DeepVariant has "significantly greater accuracy than previous classical methods."

No, it does not. This is the kind of claim you'd never get away with in a scientific paper, not unless you rigorously demonstrated your method was truly better than everything else. The Google team hasn't done that.

How good is it? First, let me remind you that variant calling programs have been around a long time, and they work very well. An incremental improvements would be nice, but not "transformative" or a "breakthrough"–words that the Google team didn't hesitate to use in their press release. They also used the word "significant," which they'd never get away with in a scientific paper, not without statistics to back it up. Press releases can throw around dramatic claims like these without anyone to check them. That's not a good thing.

About a year ago, the Google team released a preprint on bioRxiv that shows that their method is more accurate (on a limited data set) than an earlier method called GATK, which was developed by the same author, Mark DePristo, in his former job at MIT, which he left to join Google. GATK is quite good, and is very widely used, but other, newer methods are much faster and (at least sometimes) more accurate. The Google team basically ignored all of the other variant calling programs, so we just don't know if DeepVariant is better or worse than all of them. If they want to get this preprint published in a peer-reviewed journal, they're going to have to make a much better case.

(As an aside: a much-less hyped method called 16GT, published earlier this year by a former member of my lab, Ruibang Luo, is far faster than DeepVariant, just as accurate, and runs on commodity hardware, unlike DeepVariant which requires special resources only available in the Google Cloud. And it does all this with math and statistics–no AI required. But I digress.)

(Another aside: if we really wanted to get into the weeds, I would explain here that the "AI" solution in DeepVariant is transformation of the variant calling problem into an image recognition problem. The program then uses a method called deep neural networks to solve it. I have serious reservations about this approach, but suffice it to say that there's no particular reason why treating the problem as an image recognition task would provide a large boost over existing methods.)

3. More wild hyperbole. The Google news release opens with a sentence containing this:

"in the field of genomics, major breakthroughs have often resulted from new technologies."

It then goes on to describe several true breakthroughs in DNA sequencing technology, such as Sanger sequencing and microarrays, none of which had any contribution from the Google team. Then–pause for a deep breath and a paragraph break–we learn that "today, we announce the open source release of DeepVariant." Ta-da!

I can only shake my head in wonder. Does the Google team truly believe that DeepVariant is a breakthrough on a par with Sanger sequencing, which won Fred Sanger the 1980 Nobel Prize in Chemistry? This is breathtakingly arrogant.

4. DeepVariant is computationally inefficient. Even if it is better than earlier programs (and I'm not convinced of that), DeepVariant is far slower. While other programs run on commodity hardware, it appears that Google's DeepVariant requires a large, dedicated grid of computers working in parallel. The Wired article explains that two companies (DNAnexus and DNAStack) had to invest in new GPU-based computer hardware in order to run DeepVariant. An independent evaluation found that DeepVariant was 10 to 15 times slower than the competition. Coincidentally, perhaps, Google's press release also announces the availability of the Google Cloud Platform for those who want to run DeepVariant.

No thanks. My lab will continue to use 16GT, or Samtools, or other variant callers that do the job much faster, and just as well, without the need for the Google Cloud. As a colleague remarked on Twitter, the "magic pixie dust of 'deep learning' and 'google'" doesn't necessarily make something better.

Genomics is indeed making great progress, and although I applaud Google for dedicating some of its own scientific efforts to genomics, it's not helpful to exaggerate what they've done so far, especially when they take it to this level. Both the Google news release and the Wired article contain the sort of over-statements that make the public distrust science reporting. We don't need to do that to get people excited about science.

No, Wi-Fi exposure is not killing your kids

Last week a blog post at Forbes on Wi-Fi devices went viral. That post, by fellow Forbes contributor Robert Szczerba, claimed that Wi-Fi exposures from cell phones, iPads, microwave ovens, and other mobile devices are "more dangerous to kids than previously thought."

Szczerba claimed that Wi-Fi devices might be causing cancer, especially in children." It was illustrated with a photo of a toddler playing with a tablet PC, possibly an iPad.

Well, that got some attention.

The problem is, it's all wrong. Even the premise is wrong: there was no "previous" evidence of danger from Wi-Fi devices, except from conspiracy theorists. Let's start where Szczerba started: he based his article on a newpaper published in the Journal of Microscopy and Ultrastructure, titled "Why children absorb more microwave radiation than adults: The consequences."

I read the article, painful though it was, to see what it actually claims. The first red flag is that it appeared in a very obscure journal that does not focus on radiation or environmental health. The second red flag is that two of the authors, Lloyd Morgan and Devra Davis, work for a private organization whose sole purpose seems to be to promote claims that cellphones and other wi-fi devices cause cancer. The remaining author, Santosh Kesari, seems to be a respectable neuroscientist at UC San Diego. I wrote to Kesari to ask for comment, but he did not respond.

Now to the article itself I have to say that this is perhaps the worst scientific paper I have read in years–and I read a lot. It purports to be a review of some sort on microwave radiation (MWR) exposure in children. It is nothing of the sort. It's not even written like a scientific paper.

Essentially, the article is a series of claims, most of them unrelated to one another, about the effects of MWR and other topics. The authors have cherry-picked several dozen studies that they believe support their hypothesis, which they cite without any explanatory details, while ignoring hundreds of studies that contradict their claims. For example, they write:

"In 2008 Joe Wiart, a senior researcher for French telecom and Orange reported that the brain tissue of children absorbed about two times more MWR than adults' brain tissue."

That's it: just one sentence, with no explanation of what the study was about (nor of what "Orange" is here). It turns out to be a simulation study with little or no relevance to the health risks of MWR on actual people.

Other cherry-picked examples in this so-called review include a 1972 study of myelin degeneration in guinea pigs and a 1977 study in rats, neither of which tell us anything about the risks of wi-fi devices. This paper is a dreadful mess.

The paper also includes many stunning non sequiturs, such as this:

"The Australian study reported, "an overall significant increase in primary malignant brain tumors was observed over the study period from 2000 to 2008." 

This study does indeed exist, but it has nothing to do with wi-fi or microwaves! It's a study of changing cancer rates in Australia, and the authors don't even mention wi-fi, much less suggest that it causes cancer. In a real journal, peer reviewers would have insisted that the studies cited have some relevance to the main topic of the paper. Not here, apparently.

I don't have time to debunk all the nonsense in this truly awful paper - nor should you want to read about it. My guess is that the Journal of Microscopy and Ultrastructure will publish anything as long as the authors pay the publication fees. In its entire history, the journal has only published 6 issues.

So what is the evidence for Wi-Fi and cancer? Just a few months ago I wrote an article explaining that high-voltage power lines do not cause cancer. But how about Wi-Fi devices like cell phones and iPads? It only took me a few minutes to find a recent review of the literature, published just a year ago in the journal Health Physics. Note that this is a journal that's actually about human health, unlike the microscopy journal that Szczerba relied upon. That study concluded:

"The overwhelming consensus of health agencies around the world is that RF [radio frequency] exposures below international exposure limits have not been shown to produce any health hazard (Verschaeve 2012). That conclusion would not be changed by the Wi-Fi–related studies reviewed here, some of which indeed were already considered in these expert reviews."

Or to put it in simpler terms: Wi-Fi is not more dangerous than previously thought, and your iPad is not going to give your kids cancer. That's what Robert Szczerba should have written, if he'd looked at the real science instead of one really bad paper.

But that wouldn't have gone viral, would it?

New York governor must decide today about law that protects doctors offering bogus treatments for Chronic Lyme Disease

Lyme disease is carried by tiny ticks; lower right above.

On Monday, the day this article appears, New York will get a new law that protects doctors who offer illegitimate therapies for a non-existent disease—unless Governor Andrew Cuomo vetoes it. The law is written to protect doctors who offer expensive treatments that provide no benefit, and it is being supported by advocacy groups who are thoroughly convinced that these treatments work.

What is this about? Lyme disease. A cadre of doctors has emerged in recent years who specialize in treating something they call Chronic Lyme Disease. They call themselves “Lyme literate,” and some of them have built their entire practices around CLD. Unfortunately for them, and sadly for their patients, this disease does not exist. 

First, I should be clear that Lyme disease is a real illness. It’s caused by a bacterium known as Borrelia burgdorferi, a small spirochete carried by ticks. (Aside: I was part of the scientific team that first sequenced this bacterium.) In most cases, Lyme disease responds well to a short treatment with antibiotics, and patients are fully cured. (See this excellent short video from Dr. Paul Auwaerter of Johns Hopkins School of Medicine.) Lyme disease ticks are really tiny, about the size of a poppy seed, and many people get bitten without realizing it. The ticks are carried by deer, and the disease has become more common as deer populations have exploded in suburban areas of the northeastern U.S.

Claims about "chronic" Lyme aren't new. As reported by Patricia Callahan and Trine Tsouderos in the Chicago Tribune back in 2010, 

“doctors around the country are telling patients with common medical problems such as back pain, poor concentration and fatigue that their ailments stem from a chronic form of Lyme disease that can evade standard treatment and wreak havoc for years. To fight what they believe is a persistent infection, the doctors often order months or years of intravenous antibiotics, which can cost tens of thousands of dollars.”

Long-term antibiotic usage doesn’t help, as multiple studies have shown (for example, Klempner et al. here and here). Even worse, it can create drug-resistant bacteria and other very serious, even fatal, complications.

But let’s not get distracted. The NY law is emphatically not providing support for Lyme disease patients, or funding new research into Lyme disease treatments. This law has one purpose: to protect doctors who want to use unproven, possibly dangerous therapies on unsuspecting or confused patients. Callahan and Tsouderos documented multiple cases where doctors told patients with other diseases—such as Lou Gehrig’s disease—that they had Lyme, and then treated them with expensive, unapproved drugs.

The New York legislature, apparently convinced by advocacy groups that chronic Lyme disease is real, passed a law whose sole purpose is to protect ill-informed doctors who want to use unproven (often expensive) therapies on sick patients. These groups are lobbying like crazy to convince Governor Cuomo to sign the law, claiming that it will protect Lyme patients. If anything, it will do the opposite. The law itself

“prohibits the investigation of any claim of medical professional misconduct based solely on treatment that is not universally accepted by the medical profession… including, but not limited to, the treatment of Lyme disease.”

So there it is: no funding for Lyme disease research or treatment. And the language is so broad that it protects almost any treatment, no matter how crazy—all the practitioner has to do is point out that the treatment is “not universally accepted.” An accurate name for this law might be the "freedom to experiment on unsuspecting patients act.”

Let's hope Cuomo rejects this law today. Otherwise, New York may become a haven for illicit, unscientific, and possibly harmful medical practices.

Raw milk enthusiasts want you to drink a bacterial stew. Yum.

Sometimes it is astonishing how ignorant people can be. Now it's the turn of fans of "raw milk," a new fad that is sweeping the U.S.

I still remember reading milk cartons as a kid, and asking my parents what "pasteurized" meant. While I don't remember exactly what they said, I'm sure they told me that it made the milk safe by killing bacteria. Even as a kid, I understood that bacteria in my milk were probably a bad thing.

Louis Pasteur is one of the most famous scientists in history, and rightly so. In 1862, he invented the process of heating milk to kill the bacteria in it. Pasteurization, as we now call it, has saved millions of lives in the 150 years since. Pasteur also created the first vaccine for rabies. He was a true giant.

Fans of raw milk appear to be stunningly unaware of Pasteur's achievements, and equally ignorant of the dangers of bacterial infections. Many of the health and safety claims for raw milk can be found on sites such as RealMilk.com, a site that is chock full of

• Conspiracy theories: the Government is hiding the truth from you.
• Denialism: raw milk never hurt anyone, and even protects you against bacteria.
• Shifting the blame: infections are caused by other contaminated foods, not raw milk.

One of the more chilling facts about RealMilk.com is their emphasis on feeding raw milk to infants, who are at the greatest risk of dying from infections.  Their "Campaign for Real Milk" advocates

"universal access to clean raw whole milk from pasture-fed cows, especially access for pregnant and nursing mothers and for babies and growing children."

We have plenty of good science about raw milk. CDC review of infectious disease outbreaks across the U.S. from 1993-2006 found that

Langer et al., Emerging Infectious Diseases 18:3 (2012).

Among other findings, a

"The rate of outbreaks caused by unpasteurized milk (often called raw milk) and products made from it was 150 times greater than outbreaks linked to pasteurized milk."

Dr. Robert Tauxe, an infectious disease specialist at the CDC, debunks some of the myths about raw milk in an article freely available on Medscape. John Snyder and Mark Crislip have both written compellingly about the dangers of raw milk at sciencebasedmedicine.org.

If I were being cynical, I might say that the wild-eyed proponents of raw milk deserve whatever infections they get. But their children don't. 3-year-old Kylee Young, who the Washington Post wrote about this past Sunday, didn't deserve to suffer kidney failure and a stroke after her mother fed her raw milk that was infected with E. coli O157:H7. Kylee can no longer walk or talk and needs constant care. Her mother now says

"If I had known what I know now, I would never have fed [raw milk] to my daughter." 

Louis Pasteur and his wife had five children, three of whom died of childhood infections. These tragedies were Pasteur's motivation for studying infectious disease. Thanks to his work 150 years ago, no one today needs to die from drinking unpasteurized milk. The raw milk movement insists, despite the evidence, that they know better.

So go ahead, drink your raw milk and eat a paleo diet too, while you're at it. But don't ask our modern medical system to pay for your treatment when you get sick. And most of all, don't subject innocent children to the unnecessary risks of raw milk.

Deepak Chopra's pseudoscience is called out by Jerry Coyne

Deepak Chopra is upset.

Why? Well, it all goes back to statements like this one, from Chopra himself:

“Consciousness may exist in photons, which seem to be the carrier of all information in the universe.”

Chopra is upset that evolutionary biologist Jerry Coyne pointed out how absurd this statement is. More specifically, Coyne wrote that:

“[Chopra's] lucrative brand of woo is finally exposed as a lot of scientifically-sounding psychobabble.”

Prof. Coyne’s main topic was another pseudoscientist, Rupert Sheldrake, but he also criticized Chopra, whom he called “Sheldrake’s American counterpart.” As a result, Deepak Chopra is very unhappy, as he makes clear in his very touchy response published last week in the New Republic. I didn’t know Deepak Chopra had such thin skin.

So how did he respond? Well, his entire indignant riposte is essentially a list of his credentials:

“I regularly write articles and books co-authored by full professors … at Harvard,” Chopra protests. 

And he tells us that he is regularly invited to give talks by conferences sponsored by Harvard Medical School, and he’s an Adjunct Professor in the business schools at both Northwestern and Columbia. And more!

With such impressive credentials, how can anything Chopra says can be wrong? But hang on a minute: Jerry Coyne is a Professor at the University of Chicago, and he got his Ph.D. in evolutionary biology at Harvard, under renowned biologist Richard Lewontin. So he must be right too!

What’s wrong with Chopra’s defense is that it’s a classic argument from authority, a logical fallacy that amounts to little more than saying “I have impressive credentials, so I must be right.” As Coyne explains in his rebuttal at the New Republic,

“Science doesn’t work that way. Scientists don’t defer to authority and credentials. We defer to the quality of one’s arguments and the evidence that backs them up.”

Chopra's claim that photons have consciousness, I have to say, is the purest nonsense. Does Chopra even know what a photon is? (Doubtful: he’s been throwing around the term “quantum” for decades with apparently no understanding of what it means.)  Chopra says this sort of stuff all the time; Coyne also gives us this example:

“The gaia hypothesis says nature does have a mind, that the globe is conscious.”

So both photons and the entire planet are conscious. I can see why Coyne called this psychobabble. If Chopra doesn’t want to be ridiculed, he shouldn’t make ridiculous claims. (He also claims that telepathy is a serious research topic. Right.)

Chopra has become very wealthy spouting this kind of nonsense. His website heavily promotes his line of nutritional supplements, books, videos, and seminars (which he calls “meditation experiences”). He's particularly fond of Ayurvedic supplements, which he claims provide a wide range of vague health benefits. One example: $35 for a 25-ounce bottle of fruit juice called Zrii (or 2 ounces for $4.75). This is little more than modern snake oil.

Visiting Chopra's website is a deep dive into the world of pseudoscience. Jerry Coyne got this one exactly right - which is not surprising, because he went to Harvard.

Guys: no more invasive prostate cancer exams!

Good news for all the over-40 men out there: we don't need routine screening for prostate cancer. More to the point, we don't need to subject ourselves to the dreaded "digital rectal exam" that has been a standard procedure for decades.  (Sorry for the ick factor, but that's what it's called, and yes, "digital" does mean "finger", not "computer.")   Most guys don't need any encouragement to avoid this particular invasive procedure, but now there's good scientific evidence saying we don't need it.

One of the most widely used screens for prostate cancer is the PSA test. I wrote about this last year, after several studies and a thorough review concluded that

“there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.” (USPSTF, Annals of Internal Medicine, 22 May 2012)

Now, the Choosing Wisely campaign and the American Academy of Family Physicians (AAFP) have included not only PSA testing, but also digital rectal exams as procedures that are usually unnecessary. Their advice to physicians is very clear:

Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

So guys, the next time you go to the doctor, don't let him (or her) give you the PSA test (it's expensive too! even if insurance pays for it) or the dreaded "digital rectal exam." If your physician hesitates (though I imagine most doctors will be glad to skip these tests), print this list and hand it to him. If you or your doctor want to know more, the list includes references to long, detailed summaries of the evidence.

It's not just prostate cancer screening that is wasteful and unncessary. After a review of the latest evidence, the AAFP, as part of the Choosing Wisely campaign, has identified 15 tests and procedures that most of us should just say "no" to.

Choosing Wisely, which was created by the American Board of Internal Medicine Foundation, is a great idea: a campaign to educate patients and physicians about what practices are:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

The AAFP has identified their first set of 15 unnecessary procedures. Widespread attention to this list may save a huge amount of time and expense, and it should improve public health. Choosing Wisely and the American College of Medical Toxicology have also looked at homeopathy and other quack-y "complementary" or "integrative" treatments. Not surprisingly, their advice is simple: don't use them. (See Respectful Insolence for much more on that topic.)

Brevia: Critical thinking prize for this blog

Last week at CSICON 2013 in Seattle, this blog was the recipient of the

2012 Robert P. Balles Prize in Critical Thinking

which was awarded jointly to Joe Nickell and myself, by the Committee for Skeptical Inquiry.  The announcement reads, in part:

In his column for Forbes, "Fighting Pseudoscience," Steven Salzberg regularly shines the light of reason on the false or dubious claims made by those hawking homeopathy, demonizing vaccines, deifying celebrity gurus, or generally denying science and reality, often at the expense of public health. He has done so with a clear and accessible voice, and with a healthy dose of humor.

Recipients in past years include Richard Wiseman, Steven Novella, Michael Specter, Leonard Mlodinow, and Ben Goldacre. I feel privileged to join this select group of writers and skeptics.

[Note: this blog and my Forbes column contain identical content, with a few exceptions.]

Dr. Oz tries to do science again, this time with green coffee bean extract

Dr. Mehmet Oz hosts a popular TV show in which he promotes all sorts of medical treatments, some good and some - well, not so good.  And once in a while, he tries to do a science experiment, as he did in 2011 with a badly flawed experiment on arsenic in apple juice.

Well, Dr. Oz has done it again.  This time he wanted to re-examine a claim that he himself had made on an earlier show about green coffee bean extract.

In April 2012, Oz aired a segment on his TV show called "Green Coffee Bean Extract: The Fat Burner That Works!"  On it he "this miracle pill can burn fat fast, for anyone who wants to lose weight." Not surprisingly, sales of green coffee bean extract skyrocketed in response.

"A marketing apocalypse was ignited!" Dr. Oz pointed out in his show in September of 2012.  "I was surprised by the firestorm," he said.

Dr. Oz loves this topic, by the way. He's run dozens of shows on weight-loss gimmicks, such as "The New Silver Bullet for Weight Loss" in which he promoted a new diet pill called Qnexa, and "Ancient Ayurvedic Secrets to Lose Weight".  But let's leave those for another day.

One problem with Oz's first green coffee bean show was that he based it on a study that has some serious problems.  That study claimed that a particular brand of green coffee bean extract called GCA led to significant weight loss.  Subjects lost a lot of weight, too: 8 kilograms (over 17 pounds) on average.    Dr. Oz called it "a staggering, newly released study."  Wow, must be good, right?

Let's look at that study, shall we?  First, it only involved 16 people, a tiny sample.  There were 3 treatments: high dose GCA, low dose GCA, and placebo.  The subjects were divided into 3 even smaller groups, but not by treatment: instead, each group took all 3 treatments, for 6 weeks at a time, with a 2-week rest period in between.  The only difference between groups was the order of the treatments (high-dose/low-dose/placebo).  Subjects in all 3 groups lost about the same amount of weight.  What was the difference?  Well, the authors claimed that the amount of weight loss during the periods when the subjects were taking GCA was greater than when they weren't, even though they lost weight even during placebo treatment.

One critique of the study is there was no proper placebo control.  Looking at the paper, it is impossible to tell how much weight loss is being attributed to the green coffee beans rather than the daily monitoring of diet, which is known to help with weight loss.  And it's a really, really small study.

Perhaps a larger problem is that the trial was carried out in India, and then written up by a U.S. researcher, Joe Vinson from the University of Scranton, as revealed by a story in The Globe and Mail (Canada) last December.  That's right: the subjects were recruited in India, all data was collected there, and the data was emailed to Vinson so he could write it up.

Even more troubling was that Vinson was paid by the makers of GCA to write the study.  Worse yet, the paper states that "The authors report no conflicts of interest in this work." When asked about this by The Globe and Mail:

"Vinson said that he doesn’t gain financially if the company sells a lot of product and that the journal didn’t require him to disclose the relationship."

This small, badly run study was anything but "staggering", as Dr. Oz called it.  I have little confidence that the data sent to Vinson from India was even correct.

Maybe Dr. Oz might was worried too, because a few months after his original show, he ran another show in which he looked at green coffee bean extract again.  He said he was responding to criticism of his earlier show, and he wanted to set the record straight.  For his second show, "Green Coffee Bean Extract: The Answer to Weight Loss?" he ran his own experiment:

"For the first time, we are doing an unprecedented experiment," he said. "We're doing our own study, right here on this show.... the first of its kind EVER on television!"  

Oz's experiment involved 100 women - all of them in the studio audience for his show - who took either green coffee bean extract or a placebo pill for two weeks.  And the result?  I won't make you watch the video; here is the entire statement of results, from Oz's website:

"In two weeks, the group of women who took the green coffee bean extract lost, on average, two pounds. However, the group of women who took the placebo lost an average of one pound – possibly because they were more aware of their diet for that two weeks because of the required food journal."

On the show, Oz stated proudly: "green coffee bean worked for us."

Maybe Dr. Oz's science experiment was better than the Vinson study.  But that doesn't mean it was any good.  First off, Oz seems to have ignored some critical rules on how to run a experiment involving humans.  As Scott Gavura pointed out at the Science-Based Medicine blog, Oz's study "makes a mockery of good research methodology."  Oz failed to explain how the women were recruited for the experiment, and Gavura points out that apparently did not obtain the ethics board approval that all experiments on human subjects require.

Oz also seems willfully ignorant of the notion that 2 weeks is far too short a time to assess the value of a weight-loss treatment.  Will he go back to those same women a few months later to see if the effect lasted? Somehow I doubt it.

But what about that result?  The women who took the coffee bean extract lost 2 pounds, versus just 1 pound for the other group.  (Actually, thanks to Scott Gavura, we know that the difference was even smaller, just 0.76 pounds.) Oz provides no statistical analysis to demonstrate that is even marginally significant. Nor does he provide the raw data that would allow others to replicate his analysis, as he might have to do if he were actually to try to publish his study. But for Oz, what he described on his show seems to be proof enough.  That's is a poor excuse for science.

Meanwhile, sales of green coffee bean extract continue to climb.  My advice: save your money.  And the next time Dr. Oz runs a science experiment, be skeptical.

Alternative medicine quacks show their greedy side

Congress is on holiday this month, but the lobbyists are baiting their hooks, planning their strategies for how to get more money for themselves.

A growing lobby is Complementary and Alternative Medicine (CAM) providers, who have discovered a new opportunity to extract even more money from patients than they do already. They want the government to force insurance providers to pay for quack treatments, regardless of whether or not the treatments work. Any attempt to require evidence, they argue, amounts to discrimination.

Discrimination? Yes! We must not allow the government to exclude health care providers just because those providers don't cure anything.  The CAMmers argument boils down to this: we have patients who want our services.  The patients like us. In some cases, thanks to lobbying at the state level, we even have state-approved licenses. Therefore insurance companies must pay for our services.

Neat.

To be specific, the CAMmers are lobbying furiously to try to protect a special clause in the Affordable Care Act (Obamacare) that promises them a fertile new ground for making money from vulnerable patients.

The strategy is simple: require the government to fund any treatment that a patient wants, and dress this up as "patient choice."  Then if insurance companies resist paying for ineffective treatments, accuse them of discriminating against the poor, hapless "integrative medicine" providers.

Thus through a diabolical twist of illogic, if Obamacare doesn't cover homeopathy, or naturopathy, or acupuncture, or magnetic energy healing, or any other so-called alternative therapy, it's discrimination.

The mind boggles.

Why is this an issue now?  Because, unbeknownst to most people outside the Washington beltway, two pro-CAM lobbying groups slipped a clause into the ACA, section 2706, that attempts to force insurance providers to cover a wide range of quack practices.  This section requires that insurers

"shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law."

Sounds harmless, right?  Well, no.  This language was added to the ACA by Senator Tom Harkin, after heavy lobbying by the American Chiropractic Association and the Integrative Healthcare Policy Consortium.  In fact, it is virtually certain that lobbyists wrote the section, and Harkin simply inserted it into the law. The IHPC is a lobbying group dedicated to obtaining more government money for homeopathy, naturopathy, chiropractic, acupuncture, and a raft of other ineffective medical practices.

Section 2706 opens the door to anyone who provides what they claim is health care - no matter how ridiculous the claim - to file a lawsuit claiming discrimination if an insurance company won't pay for their services.  You could start offering dried bird poop for arthritis, call it "avian nature therapy," and if an insurer won't pay for it, you can sue.

Some in Congress have realized how truly bad an idea this is, and just a few weeks ago, a new bill was introduced to get rid of it, HR 2817.  The American Medical Association supports the new bill. This has some CAM proponents alarmed.

Over at the Huffington Post, John Weeks, an outspoken apologist for questionable medical practices, offers the predictable, whining claim that this is all about "discrimination" by legitimate health care providers (the big, bad AMA) against poor, defenseless integrative medicine providers.

Make no mistake: this is all about greed.  The CAM industry sees Obamacare as a chance to reap huge profits, by forcing insurance companies to pay for ineffective treatments, including many that are wildly implausible.

Homeopaths, naturopaths, acupuncturists, reiki practitioners, energy healers, and other CAM practitioners don't want to subject their methods to rigorous tests of effectiveness.  They know that their methods have failed scientific scrutiny, time and time again.  So now they want to force health care providers to pay for anything the patient wants. "Our patients believe us," they argue, "so pay us."

Forcing health care providers to pay for anything a patient wants, even if it doesn't work, is guaranteed to drive up costs, without any benefit to patients.  Let's ditch this bogus "discrimination" clause in the ACA, and insist that all medical care be held to the same high, scientifically rigorous standards.

What Works for Knee Pain? Good Medicine, Bad Medicine, and Wasted Money

Knee pain is a very common problem, affecting young and old alike.  Among athletes, knees take a beating, particularly in sports that involve running and twisting.  Among older people, the cartilage that provides a cushion in our knees often just wears out, producing chronic stiffness and pain.

I've had knee problems myself, so I was interested to see an article posted on CNN, with content from Harvard Medical School called "Alternative Treatments for Knee Pain."  Would it describe "alternative" medicine, as in "complementary and alternative medicine," or would it present real medicine for knee pain?

A little of both, as it turns out.  But it does more: it inadvertently illustrates one of the major flaws with the U.S. health system.  We don't discriminate between effective and ineffective treatments, and some doctors seem content to let patients try anything, regardless of efficacy or cost.

The article describes several treatments for knee pain, and for each one it turns to Eric Berkson, M.D., for an opinion on how well the treatment works.  Berkson is an orthopaedic surgeon at Massachusetts General Hospital and an Instructor in Orthopaedic Surgery at Harvard Medical School.

Despite these excellent credentials, Dr. Berkson doesn't seem to have a firm command of science-based medicine. The article starts out strong, recommending the most effective therapies, but then wanders into unproven therapies, and concludes with Berkson making an unscientific recommendation for the most wildly ineffective treatment of all: acupuncture.  Let's look quickly at each "alternative."

The most effective treatments, according to Dr. Berkson, are physical therapy and weight loss.  Berkson is on solid scientific ground here: physical therapy strengthens the muscles around the knee, relieving some stress on the joint, and weight loss does the same thing by reducing the load directly.  If you stopped reading at this point, you'd be in great shape.

Next is a discussion of chondroitin and glucosamine, two very popular supplements that are often used to treat joint pain.  After many years of competing claims about these supplements, NIH conducted a large, $12.5 million study called GAIT to test whether these supplements worked for knee pain. The researchers looked at glucosamine and chondroitin separately and together, and compared them to a standard pain reliever (celecoxib, brand name Celebrex®, an NSAID) and to a placebo.

The conclusion: celecoxib worked, but the supplements did not.  In a small subset of patients with moderate to severe pain, there was a hint of a benefit for glucosamine-condroitin, but it wasn't significant.  For patients with mild pain, though, only celecoxib was better than a placebo.

Despite this large and compelling study, Berkson says

"there's a lot of evidence that they [glucosamine and chondroitin] work, but only in a certain percentage of patients." 

Perhaps he's referring to patients with moderate to severe pain from the GAIT study, but the article doesn't explain if that's what he means.  And then Berkson recommends them anyway, saying "there's little downside to trying the supplements."  Especially if it makes the patient think the doctor is helping.

The article then describes three different treatments that involve injections of various substances into the knee.  To keep this brief, I'll just consider the first: viscosupplementation, a fancy name which means that hyaluronic acid is injected into the knee. It's supposed to help lubricate the joint, which sounds plausible: after all, we lubricate machines to keep them running smoothly.  Shouldn't some "grease" help our knees?

For hyalonuric acid, the answer is simply no.  A large review just last year, involving over 12,000 patients (Rutjes et al. 2012) shows that hyaluronic acid has little or no benefit, and possibly causes harm.  Their conclusion:

"In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events."

Berkson's own colleagues, the American Academy of Orthopaedic Surgeons, just issued a 1200-page report on treatments for knee osteoarthritis, and they found strong evidence against the use of hyalonuric acid.  To be specific, the AAOS says "We cannot recommend using hyaluronic acid for patients with osteoarthritis of the knee."  They label this a "strong" recommendation.

Despite the the advice of his own professional organization, Dr. Berkson says

"I have some patients who think [hyalonuric acid is] a miracle drug that keeps their symptoms at bay.  Given that the risks of injection are very low, it makes sense to try it if insurance will pay."

Oh my.  Here we have a medical expert recommending an expensive treatment - he estimates the cost is about $1500 - despite the evidence, apparently because he has patients who think it works.  Paying for expensive, ineffective procedures is a poor way to treat patients and a great way to run up costs.

(Aside: I might seem to be picking on Dr. Berkson here, but I think his responses are probably typical of many practicing doctors.  Not to excuse him, but it's easy to follow your instincts and to rely on anecdotes from patients.)

After briefly discussing two other injection therapies, the CNN/Harvard article addresses one last alternative: acupuncture.  It quotes Berkson again, this time saying:

"Acupuncture works in some patients, although I don't think science knows exactly why it works. It's worth trying if other things aren't working for you."

Despite Dr. Berkson's comment, the science doesn't support him.  Acupuncture for knee pain, and for other pain, simply doesn't work.  (See this article for a lengthy discussion, with citations.)  Just to pretend for a second: in order for acupuncture to work, there would have to be lines of force (called "meridians") through which a mystical, apparently unmeasurable life force ("qi") flows, and furthermore you'd have to be able to manipulate this life force by plunging needles into the skin.  There is no support whatsoever for these ideas in human biology and physiology.

The American Academy of Orthopaedic Surgeon's report addresses acupuncture too, stating that "We cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee."

Dr. Berkson's recommendation is akin to a shrug: while admitting that he doesn't know why it might work, he just says to give it a try.  His own professional organization, after an extensive review of the scientific evidence, disagrees.

The CNN Health article, with "content provided by the faculty of the Harvard Medical School," demonstrates in a microcosm how health care dollars are wasted in the U.S.  First it recommends the most effective and least expensive treatments: weight loss and exercise.  Both of these involve lifestyle changes that are difficult for many people.  The article then suggests alternative treatments for knee pain that include:

1. Glucosamine and chondroitin supplements - ineffective but cheap. 
2. Knee injections of hyalonuric acid - ineffective and very expensive.
3. Acupuncture - ineffective, wildly implausible, and sort of cheap.

Despite the evidence against them, the doctor quoted throughout the article recommends trying all three, especially if (as is common) the patient doesn't have to pay the bills.

Science only supports three treatments for knee pain, as physician Harriet Hall summarized in her recent blog post: exercise, weight loss, and NSAIDs.  The "alternatives" described by CNN, no matter how appealing they sound, are a waste of time and money.

Poison for pain, the homeopathic way

At my local mega-grocery store last weekend, I happened to stroll down the aisle dedicated to homeopathic treatments.  I saw shelf after shelf of brightly colored packages, all claiming health benefits.  Most of these "medicines" were not cheap.

Amazing.  To an average shopper, all of these products look like real medicine.  The packaging is similar, the claims are similar, and it's all on display at a respectable grocery store.  The difference, though, is that none of these products do what they claim to do.  Thanks to a special exception for homeopathy created all the way back in 1938, none of the claims on these medicines need to be tested.  The homeopathy aisle is an organized, state-sanctioned scam.

The 1938 law was the brain child of a U.S. senator, Royal Copeland, who happened to be a homeopath.  Sen. Copeland inserted language into a major food and drug law that declared homeopathic preparations to be drugs.  It also allowed homeopaths themselves to maintain the official list of these drugs, called the Homeopathic Pharmacopeia.  Talk about the fox guarding the henhouse!  Thanks to aggressive lobbying by homeopaths, homeopathic ingredients are not subject to the normal review required of real drugs.  Most importantly, homeopathic drug makers do not have to prove their products are effective.

Homeopathy is based on the long-discredited beliefs of Samuel Hahnemann 200 years ago.  Hahnemann thought that "like cures like," as long as you dilute the substance sufficiently.  Thus caffeine will cure sleeplessness, poison ivy extract will cure an itch, and paralyzing plant toxins will cure pain.  None of this is true.

The other key principle of homeopathy is that the more you dilute something, the stronger its effect.  This is not only wrong, but it is exactly the opposite of what really happens.  Greater dosage levels, unsurprisingly, have stronger effects.  In Hahnemann's defense, science wasn't very far along when he came up with these notions.

Real medicine moved on long ago.  But homeopathy persists, because there is money to be made - lots of money.

Back to my grocery store.  Several shelves were filled with something called Topricin(R), which claims to relieve pain. Sounds like a medicine, right? Real drugs often use "cin" or "in" in their names because the word "medicine" itself ends with that sound.  Clever!  In front of me I saw Topricin for pain, Topricin foot cream, even Topricin for children. The Topricin packages and the company's website proclaim, in big letters, "Ideal Pain Relief", and in slightly less big letters: "Safe.  Effective. Free of Side Effects."  It also claims:

"Topricin's 11 homeopathic medicines are proven to be safe and effective for the elderly, pregnant, children, pregnant women and all skin types.  Experience Topricin's relief for damaged muscle, tendon, ligament, and nerve tissue."

This is simply not true.  It even seems to go beyond the bounds of what the (very weak) FDA regulations allow.  The website specifically claims that Topricin is effective for arthritis, back pain, bruises, bursitis, fibromyalgia, minor burns, tendinitis, and more.

Well, what is it?  Let's look at just two of the homeopathic ingredients in Topricin:

• Belladonna 6X................. Treats muscles spasms, night leg cramps
• Heloderma 8X................. Relief of burning pain in the hands and feet

Belladonna for pain?  Belladonna is one of the most toxic plants known to man.  Eating just a few small berries is lethal.  And the one study I could find showed that it has no clinical effect when used in a homeopathic preparation.  That's lucky for unwitting consumers: if it wasn't so diluted, Belladonna would make them very sick indeed.

Heloderma?  That's the venom from a gila monster.  Although rarely fatal, it causes severe pain, bleeding, nausea, and vomiting.  This is not something I would take for pain - and I certainly would never give it to children.

I know that Big Pharma is often guilty of deceptive marketing, and I've criticized Pharma many times.  But CAM ("complementary and alternative") pharma is every bit as bad.  Big CAM takes advantage of generous laws to make medical claims with impunity, often skirting as close as possible to what the law permits.  And the Big CAM companies profit handsomely in the process.  Everything on the Topricin package - the name, the packaging, the claims - is designed to make the consumer think that it is an effective pain treatment.  It's not.  It's a modern package of snake oil.

Everything in this journal is wrong

Moxibustion at work.

In real science, we agonize over every detail.  When we publish a paper, we strive to get everything just right.  We qualify our findings, always allowing for the possibility that we might have missed something.

Oh, to be freed of the constraints of reality.  But fiction, alas, doesn't work in the real world.  Fantasy medicine is, well, a fantasy.  Or is it?  Let's enter the world of Complementary and Alternative Medicine.

Imagine a scientific journal in which every single article was wrong.  Not just an occasional mistake, as happens with many journals.  No, I'm talking about a publication where every single article has at least one fundamental flaw.

No, it's a real journal, published by BMJ, the publishers of the well-known journal by the same name (the British Medical Journal).  "Helping doctors make better decisions since 1840", they proclaim.  Then why, among their 40+ journals, do they publish Acupuncture in Medicine?

It appears - I can't prove this, but it seems to be so - that every single article in this journal is wrong.  Not just a little bit wrong, either.  Let's look at the "Editor's choice" article from the latest issue, which must be one of their best.  It's called "Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial".

In this study, a group of Spanish doctors looked at the use of moxibustion to correct a common problem in pregnancy known as a breech position - that's a baby that is turned the wrong way round in the mother, head up instead of down.  What, you may ask, is moxibustion?  Well, let me use the authors' explanation:

"The application of heat from the combustion of Artemisia vulgaris (moxibustion) for therapeutic purposes has long been used in China. Among other effects, it is believed to contribute to correcting the non-vertex presentation of the fetus when applied at a specific acupuncture point (BL67 Zhiyin) located at the outer corner of the little toenail."

That's right: you burn an herb (Artemisia) next to the little toenail of the pregnant mother, right next to an acupuncture point, and that's supposed to make baby flip right around so its head comes out first.

You can't make this stuff up.

These guys are serious.  They ran a study where they divided pregnant women into 3 groups, with about 135 women in each.  One group got moxibustion, another got "fake" moxibustion, where they burned the herb next to a different toe (really!), and the last group got standard care.

Amazingly, the doctors found that it works!  More of the women with moxibustion had babies born the right way round, head down, than in either of the other two groups.  To be precise, 79 babies in the moxibustion group came out the right way, versus 60 and 59 in the other two.  By the authors' own analysis, this difference was statistically significant.

Wow.  Maybe this stuff really does work.  And moxibustion is cheap and easy to administer.  Maybe this is the solution to our rising health care costs.

How to explain this result?  I see several possibilities:

1. The small effect was just a random variation, not due to the treatment.  Previous studies of exactly the same treatment (such as this one) showed that moxibustion did not work.  So either those studies are wrong, or this one is.
2. There was bias in how the women were assigned to treatment, and the effect can be explained by that.
3. The authors manipulated the data to make the numbers come out better.  (Quelle surprise! Not in a BMJ journal!)  Of course we can't prove this without much more investigation.
4. Burning an herb next to the little toe at just the right place - and nowhere else - stimulates a mystical "qi" pathway, and zaps that little baby back around the way he's supposed to be.

Hmmm, which seems the most likely?

OK, I admit it: I haven't read every single article in BMJ's acupuncture journal.  So I don't really know that they are all wrong.  But who has time to read all this bad science?  The latest issue has a disturbing number of articles about acupuncture for cancer, which I find particularly upsetting because that practice takes advantage of highly vulnerable patients.  It also includes an article on ear acupuncture, a practice invented out of whole cloth by an Army doctor in the U.S., who has been inflicting it on injured service members, as I've written about before.

Actually there is one article that seems plausible.  It reports a case of arterial hemorrhage caused by an acupuncture needle.  But we don't need to dwell on that.

Acupuncture in Medicine has all the trappings of a real journal, including an editorial board whose members work at respectable medical schools.  I know that BMJ wants us to believe it; after all, they make money on this stuff.  As for the journal itself: I can't bear to read any more.  It is just too painful.  Perhaps acupuncture would help.

Naturopathic shenanigans in the Maryland state legislature

Quacks never give up.  In their never-ending quest to make money from bogus treatments, they try all kinds of strategies to convince people that what they're selling really, really works, despite the evidence to the contrary.

One strategy is creating a legal licensing system.  If the government licenses your profession, it must be legitimate, right?  Legislators wouldn't approve a licensing system for nonsense, would they?  Of course not!

So it's strange that the Maryland legislature is considering a bill in its upcoming session to allow naturopaths to practice medicine in the state of Maryland.  

Some of you might be wondering, what the heck is a naturopath?  As Peter Lipson explained recently in his Forbes column, naturopaths are little more than fake doctors, whose practices are a modern-day version of folk medicine.  When naturopaths got licensed in Minnesota, PZ Myers suggested they be called "witch doctors."  Too harsh?  Well, one thing is clear: naturopaths are trying to get licensed in multiple states (Lipson described their efforts in Michigan) as a route towards legitimacy.

There's an easy way to become legitimate: practice science-based medicine.  This would be awfully difficult for naturopaths, whose practices include homeopathy, colloidal silver treatments, and chelation therapy, to name but a few.

When the naturopaths tried this in Massachusetts 10 years ago, my colleague Kimball Atwood put together detailed testimony describing many of the unscientific and downright dangerous practices of naturopaths.  I encourage anyone to read his full testimony or his series of blog articles.  Here, though, is a brief sample of the erroneous claims made by naturopaths, courtesy of Dr. Atwood:

• "... that hydrogen peroxide dissolved in a bath can provide vital oxygen through the skin of a patient suffering from an acute asthma attack [5]; 
• that balloons inflated inside the nose can cure learning disorders [8];
• that strokes in progress can be reversed by cold compresses applied over the carotid arteries [9]; 
• that vitamin C is an effective treatment for approximately 100 conditions, including glaucoma, male infertility, and AIDS [12]; 
• that high blood pressure and coronary heart disease should be treated with unproven herbs and chelation therapy [17]."

The numbers refer to citations that Dr. Atwood provides for each of his points.

Among other things, the proposed new law (House bill 1029 and its companion Senate bill 783) specifically authorizes hydrotherapy, stating: 

"A license authorizes a licensee to ... administer or perform hot or cold hydrotherapy, naturopathic physical therapy, electromagnetic energy, colon hydrotherapy ... for the purpose of providing basic therapeutic care."

[Aside: I have no idea what it means to "administer electromagnetic energy"; perhaps you simply shine a light on the patient?  I suspect the legislators who are sponsoring this bill haven't a clue either.]

Hydrotherapy doesn't sound so bad until you learn what naturopaths do with it.  According to the naturopathic organization's own experts, 

"One technique is to lower your body temperature, with a cold bath for example, as much as possible without inducing shivering as soon as possible after a stroke has occurred, or is suspected to have occured.... Another hydrotherapy technique with a similar rationale is to soak the feet in a hot foot bath, as soon as possible after the stroke has occurred, while applying a cold compress to the neck, face and scalp. If this technique can be applied as a stroke is happening, it may even abort the stroke."

Again, quoting Dr. Atwood: "All strokes are potentially life-threatening, and are considered to be medical emergencies that require prompt and expert evaluation and supportive care. The treatments described above will do nothing to improve the outcomes of strokes, but are certain to delay competent diagnosis and treatment. 

Most disturbing, perhaps, is that the new Maryland bill would require physicians to violate medical ethics.  The AMA code of ethics states that

"It is unethical to engage in or to aid and abet in treatment which has no scientific basis and is dangerous, is calculated to deceive the patient by giving false hope, or which may cause the patient to delay in seeking proper care."

By adding a naturopath to the Maryland State Board of Physicians, and by requiring them to license naturopaths to practice medicine, the legislature is forcing physicians to act unethically.

So if you live in Maryland, take a few minutes and write to your state representative telling him or her not to support this quack bill.  Heck, contact them even if you don't live in Maryland, and tell them you were thinking of moving but now you want to move to Virginia instead. 

Bad medicine infiltrates M.D. Anderson Cancer Center

M.D. Anderson Cancer Center in Texas is usually considered one of the country's top cancer centers, but that hasn't stopped it from promoting bad science.   In Friday's Huffington Post, Dr. Lorenzo Cohen, Director of MD Anderson's Integrative Medicine program, writes that it is "time for acupuncture to become part of standard care" for cancer.  He claims that acupuncture is "an appropriate treatment alongside conventional care for chemotherapy-induced nausea/vomiting."

As evidence, Dr. Cohen cites a newly published review article.  There are many problems with Cohen's arguments. Let's start with what he fails to tell us.

First, he states that he is reporting on the results of "a recent systematic review conducted by researchers in the Integrative Medicine Program at the MD Anderson Cancer center."  He conveniently neglects to say that he is the senior author of that review!  He should have made it clear that he's writing about his own report.  Unless his readers look up the original article, they may not realize that he is is merely promoting his own work, in a highly biased way.  He also fails to point out that his article doesn't provide any new evidence itself; it only reviews other, earlier studies.

Second, Cohen tells us that his group found 41 studies evaluating the use of acupuncture for treating the symptoms of cancer therapy.  (To be precise, he writes that "41 studies were found," still disguising the fact that he's the one who found them.)  He neglects to mention that out of 41 studies, all but one were highly biased, by his own review's judgment (and therefore scientifically worthless).  Rather than concluding that "it's time for acupuncture to become part of standard care," Cohen should be lamenting the fact that nearly all studies of acupuncture are badly done.

Third, Cohen does mention that his review article considered 8 symptoms of cancer treatment: pain, nausea, hot flashes, fatigue, dry mouth, constipation, anxiety, and sleep disturbance, but he doesn't explain that the only study out of 41 that wasn't excessively biased (according to his own criteria) looked at nausea.  Thus Cohen should have told us that acupuncture is not effective for any of these other conditions.  At best, if he insists on putting a positive spin on it, he should have explained that the evidence is insufficient to recommend acupuncture for any of these symptoms.

Let's look at that one positive study, published in 2000 by Joannie Shen and colleagues.  It's a small study, with about 33 patients in each of 3 groups, where the treatment group got electroacupuncture, which means an electric current is run through the needles.  This isn't the same as traditional acupuncture, and the study didn't compare identical groups with and without the electrical stimulation.  So we can't know whether the electrical current was the real reason the treatment showed a benefit.  The study also failed (and this is a huge problem) to "blind" either the patients or those providing treatment: obviously the patients knew they were getting electroacupuncture.  Despite this, Cohen claimed in his review article that the 12-year-old study had a low risk of bias for blinding.

The patients that received electrical stimulation plus acupuncture had fewer episodes of vomiting.  This suggests that something in the treatment - maybe the acupuncture, maybe the electricity - somehow reduced this particular symptom.  Or maybe not: the study had a possibly serious flaw in the assignment of patients to groups: in the electroacupuncture group, only 51% had vomited during previous chemotherapy sessions, significantly fewer than in the other two groups.

Despite the methodological flaws, if acupuncture works, surely that 12-year-old study would be replicated by now, yes?  Well, no.  Cohen neglects to mention a much more recent study on acupuncture for nausea, published just last year, which his own reviewed graded as unbiased for 5 out of 6 criteria, including blinding.  That study was negative: acupuncture was no better than sham acupuncture.  When a small, problematic study fails to replicate, good scientists conclude that the treatment simply doesn't work.  Cohen, though, ignores this larger (twice as many patients), better-done study in his HuffPo piece.

So based on one mediocre study from 12 years ago, involving only a small number of patients, for only one condition, Cohen is calling for acupuncture to become standard treatment for all cancer patients.  Could this be because he is currently running his own clinical trial on acupuncture for the treatment of cancer patients?  Could he be biased by the $777,886 he is currently receiving from NIH to study acupuncture?

Given that Cohen is its Director of Integrative Medicine, it's not surprising that MD Anderson has been using acupuncture on its patients since 2003:  they even list a fee schedule, $80 on the first visit and $65 for each follow-up, and they recommend at least 8-10 treatments.  MD Anderson's website offers up this gem of an explanation:

"A block in the meridians can deny the muscles and surrounding tissues of Qi, creating an imbalance of health. However, the flow of Qi can be restored by inserting needles at specific acupuncture points."  

This pseudoscientific babble does not belong in one the nation's best cancer centers.  What's worse is that MD Anderson is offering ineffective treatments to cancer patients - a highly vulnerable population - accompanied by claims that they should know are false.  This is inexcusable.

MD Anderson's many outstanding scientists surely know that acupuncture is wildly implausible, and many of them (although not Dr. Cohen) must know that it has repeatedly failed to stand up to scientific scrutiny.  US News ranks MD Anderson as the country's top cancer hospital, followed by Memorial Sloan-Kettering and Johns Hopkins Hospital. After reading Dr. Cohen's article, and looking at MD Anderson's promotion of unproven pseudoscientific treatments, I would argue that MD Anderson should be dropped many, many notches down in those rankings.