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.]

Conclusions
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!]