Internet quack Joe Mercola is worried. Dr. Oz to the rescue!

Dr. Oz interviews Joe Mercola on his show.

After a series of studies showing that vitamins and supplements are usually a waste of money, including my recent article on the top 6 vitamins you shouldn’t take, internet supplement salesman Joe Mercola is worried.  He should be: his Internet-driven empire is largely based on sales of vitamins and supplements, for which his claims range from merely implausible to dangerously untrue, including:

• Himalayan salt is far better for you than regular salt. Coincidentally, Mercola sells the good salt.
• Vitamin D is "the new silver bullet for cancer." No, it's not.  Not even a little bit.
• Homeopathy cured a boy of autism. Of course Mercola doesn't provide any proof of this, only a testimonial.  This is not even remotely plausible, since homeopathic preparations are just sugar pills.

I could provide many more examples, but this should be enough to demonstrate that I'm not making this stuff up.

Mercola is also one of the loudest voices and worst offenders in the anti-vaccine movement. Among other misinformation, he claims that the hepatitis vaccine causes autism, and his website urges people to use his supplements instead of getting vaccinated.

So how do I know Mercola is worried? He's appearing on the Dr. Oz Show on Monday, February 10 (the day after I'm writing this) to talk about multivitamins. Apparently his 10 minute segment wasn't enough, so he posted an article on his website with the "Information I couldn't share" on Dr. Oz's show.

Does the article explain why multivitamins are actually good for you?  Well, no. Most of the article is a big red herring, in which he argues that supplements should not be regulated as drugs, because "we have all the regulations we need." Then he contradicts himself and says that the FDA already regulates supplements. (It doesn't - or to be more precise, the FDA does not require supplement makers to prove their products work. It can only step in if the products start to kill people. This is what Mercola calls regulation.) Besides, he says, supplements are harmless. As evidence, he cites a press release from a pseudoscientific organization that claims "no deaths from supplements in 27 years."

Not surprisingly, Mercola doesn't cite any actual science to support his claims. In contrast, several very large studies in major medical journals, cited in my own columns last month and last October, show that routine supplementation with multivitamins, especially with the megadoses that many people take, can indeed cause genuine harm. Those same studies showed that if you don't have a deficiency, there's simply no benefit to taking most vitamins.  Mercola's response is to cite opinion pieces from his own website that simply assert, without any evidence, that the studies are wrong.

In other words, Mercola's response is "Oh yeah?" He then goes off on a tangent and launches an irrelevant ad hominem attack on noted vaccine expert Dr. Paul Offit.

Why has Dr. Oz repeatedly had Joe Mercola on his show? This is a tough one. Does Oz believe that autism is caused by vaccines, something Mercola has claimed repeatedly over the years?  Does he understand that Mercola's anti-vaccination campaign leads to genuine harm? Does he know that the FDA has repeatedly issued warnings to Mercola to demand that he stop making false claims about his vitamins and supplements, as Chicago Magazine reported?

Or does Dr. Oz keep inviting Mercola back because he knows Mercola has a big audience that will increase his own viewership?

Despite my past criticism of Dr. Oz, I still think he has a better grasp of science than Joe Mercola. He also reassures viewers constantly that he doesn't sell the products that appear on his show. And yet Oz is giving a platform to someone who makes huge profits selling products based on unproven claims. By having Mercola on his show, Oz is giving him free publicity and helping him sell those same products. And whether or not Oz agrees with Mercola, he is helping to give credibility to Mercola's wildly inaccurate and dangerous anti-vaccine claims.

Brief note: a new vaccine mythbuster site appears

Vaccines are probably the single greatest advance in public health ever invented. Despite their enormous benefits, and the overwhelming evidence in their favor (we've wiped out smallpox and nearly wiped out polio), anti-vaccine activists continue to spread rumors and wildly inaccurate, but scary tales about the potential harms of vaccines.

Today a new website was published, a collection of 100 other sites that provide good information on the benefits of vaccines, and that bust many of the most damaging anti-vaccine myths.  This site is on the list, but you'll find many other excellent sources of good science about vaccines.  We need every bit of help we can get to counter the mis-information about vaccines promoted by groups such as Generation Rescue and Age of Autism.

What's up with the magic tape that athletes are wearing?

Li Na with kinesio tape on her knee, playing on clay.

When Chinese tennis star Li Na won the Australian open final this weekend, she had two long, wide strips of black tape criss-crossing her right knee. And in the semifinals, Poland’s Agnieszka Radwanska had two similar pieces of tape criss-crossed over her right shoulder.  Sports fans have been seeing this sight for a few years now: we saw these big pieces of tape slathered across the legs of many Olympic swimmers in the 2008 and 2012 Olympics. 

So what is this tape on the knees, shoulders, and thighs of top athletes? And more important, does it work?

Why is it so popular? After all, with so many world-class athletes using it, it must help somehow, right? Nope. Athetic tape has become hugely popular thanks to clever marketing: during the 2008 Olympic games in Beijing, tape manufacturer KT tape donated its “kinesio tape” to 58 countries for their athletes to use. Many athletes gave it a try, and millions of viewers saw it on television.

Athletes are notoriously superstitious. If they have a good performance, they will obsessively try to repeat everything they wore, ate, or otherwise did that might have led to that performance. Obviously, with so many athletes wearing elastic tape in 2008 games, some of them performed well. This merely reinforces the superstition that somehow the tape helped.

Tape man! (From the KT website.)

Fortunately, this claim is pretty easy to study, and multiple studies were done after the 2008 Olympics, looking at the possible benefits of athletic tape. A review of ten scientific studies published in the journal Sports Medicine in 2012 found little benefit. They reported that 

“The efficacy of KT [kinesio tape] in pain relief was trivial given there were no clinically important results.” 

Other studies looked at other effects, and for these the authors reported “KT had some substantial effects on muscle activity, but it was unclear whether these changes were beneficial or harmful.” Not a slam dunk for the benefits of kinesio tape, apparently.  

Tennis player Li Na was wearing the tape on her knee. What does the science say about tape for knee pain in particular? Here the evidence is not so clear. A small study last year by Marc Campolo and colleagues compared at Kinesio Tape® to another taping method called the McConnell Taping (MT) and to no tape at all. The difference between the tapes is that KT is elastic, while the MT technique uses rigid tape. This study found a small benefit for both types of tape on pain while climbing stairs or doing knee squats. This result is interesting, but the study only had 20 subjects, far too few to say anything conclusive. And it wasn't "blinded" - the subjects obviously knew they had tape on their knees. So they might have been telling the scientists what they wanted to hear, a common phenomenon in these types of studies.

Of course, the company that sells KT tape is not nearly so careful in their claims. Their website says:

“KT TAPE is lightweight, comfortable to wear, and can be used for hundreds of common injuries such as lower back pain, knee pain, shin splints, carpal tunnel syndrome, and tennis elbow, just to name a few.”

This is, to put it mildly, a bit of overstatement.  As the recent review article stated, when it comes to pain relief, the evidence shows “no clinically important results.”

There are a remarkable number of studies looking at various kinds of taping for joint or muscle problems, but the evidence is, on the whole, weak at best. My reading is that elastic tape probably has no more than a placebo benefit. But in sports, a placebo benefit can be significant: if you think it helps, it might really help.  

And think of the other benefits: KT tape comes in lots of cool colors, and for just a few bucks, you’ll look like a pro. A women's pro, that is: I didn't see any tape on Rafael Nadal or Stanislas Wawrinka in the men's final. Maybe that's because removing a big piece of tape from a hairy leg has got to hurt.

The top 6 vitamins and supplements you shouldn’t take

The evidence against supplements continues to pile up.

Recently I created a list of The Top 5 Vitamins You Shouldn’t Take. Now I’m expanding that list to include vitamin D, which is taken by almost half of older adults. Now, two new studies in latest issue of The Lancet show that most of these people are wasting their money.

The first study is a large review by Philippe Autier and colleagues, who found that taking supplemental vitamin D has no effect on a wide range of diseases and conditions. After looking at over 450 studies, the authors conclude:

“The absence of an effect of vitamin D supplementation on disease occurrence, severity, and clinical course leads to the hypothesis that variations [in vitamin D levels] would essentially be a result, and not a cause, of ill health.”

So it appears that we’ve been getting cause and effect backwards, at least as far as vitamin D is concerned. Autier looked at non-skeletal disorders, including heart disease, weight gain, mood disorders, multiple sclerosis, and metabolic disorders, all of which have been linked to lower vitamin D. In trial after trial, supplemental vitamin D had no beneficial effect on any of these conditions. Autier et al concluded that:

“associations between 25(OH)D and health disorders … are not causal. Low 25(OH)D [vitamin D] could be the result of inflammatory processes involved in disease.”

Instead, the researchers found, in study after study, that low vitamin D was the result of poor health, not the cause.

The Autier study didn’t look at the biggest supposed benefit of vitamin D: protection against osteoporosis. We’ve long known that vitamin D is associated with bone health. Fortunately, in the same issue of The Lancet, Ian Reid and colleagues looked closely at this question. They reviewed 23 studies with 4082 participants, all designed to determine at whether supplemental vitamin D improves bone density. Their findings? It doesn’t help. They concluded:

“Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.”

Vitamin D supplements, to put it plainly, are a waste of money.

(For those concerned about osteoporosis, the widely used drug alendronate (Fosamax®), has been shown to increase bone density by about 5%, as explained in a 2011 article by Dr. Sundeep Khosia. But Fosamax has side effects.)

It’s pretty easy to get enough vitamin D in a normal diet. Or, as Dr. Mark Gillinov explained in the Huffington Post last week, just 10 minutes of sunlight gives you about 4 times your daily recommended vitamin D requirement.

So here's my expanded list of the Top Six Vitamins You Shouldn’t Take, with the newest entrant at the end:

1. Vitamin C
2. Vitamin A and beta carotene
3. Vitamin E
4. Vitamin B6
5. Multi-vitamins
6. Vitamin D

You can read more about the first five in the original list.

What’s left? Well, if you don’t have a deficiency, there’s no reason to take any supplemental vitamins at all.  As my Hopkins colleagues Eliseo Guallar, Lawrence Appel, and Edgar Miller wrote last month in the Annals of Internal Medicine : “Enough is enough: stop wasting money on vitamin and mineral supplements.”  As they wrote, after looking at three more large studies just published last month,

"most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided."

Save your money. Or better yet, if you must spend it, buy a bit more fresh fruit. You'll be healthier for it.

Which is more urgent: military drones or a cure for cancer?

A Global Hawk drone

The U.S. government has an answer: drones. Drones and other weapons of destruction are vastly more important than healing people - or at least that’s what one might think, based on our government’s spending priorities. In the most recent federal budget, we spent $821.6 billion on defense, which includes $636.2 billion for the Defense Department, $138.9 billion for veterans, and another $46 billion on foreign military aid. We spent just $29.1 billion for the National Institutes of Health, the epicenter of all our research on new cures for disease. That’s a decline of $1.7 billion from 2012 (thanks to the sequester). In the big picture, then, we spent 28 times as much on defense as we spent on curing disease.

Does anyone in the federal government ever step back and think seriously about what our overall priorities are? Or do they just think about whether to adjust a particular agency’s budget a few percent up or down? Congress returns from recess next week, and they’ll make lots of noise about the budget decisions, and then they'll pass something that makes at most a few incremental changes.

A big problem with our short-term approach to governing is that the forces that want to keep everything the same are always more powerful than the forces for change. The people and institutions that benefit from the current budget are already in place, and always at the ready to lobby against change. We desperately need to review our priorities, at least once in a while, and make a rational decision about how much to invest in the things that government does. Do I expect this to happen? No. But that doesn’t mean we shouldn’t try to make the argument.

Here are just a couple of examples of how current spending plans just can’t be stopped, even if they have gone wildly out of control. First let’s consider the Global Hawk drone program, which the Defense Department itself would like to terminate: the Air Force says it has better equipment for the same job. Ending the program would save $2.5 billion over four years. (That’s $2,500,000,000. It helps to write these numbers out.) How did Congress respond to the Air Force proposal? The head of the Armed Services Committee, Howard McKeon (R-Calif.) rejected the proposal and added $443 million to purchase three more Global Hawks. Not coincidentally, the manufacturer of these drones, Northrop, builds them in the district represented by McKeon.

A bigger example is the Joint Strike Fighter program, the most expensive plane in history, which is now estimated to cost $400 billion by the time it starts flying in 2018 - if it’s not delayed further. This is more than triple its estimated cost in 2001, when it was first approved for $119 billion. Just recently, the Pentagon itself reported 147 “major” quality issues with the program. 

We won’t even have these planes for another 5 years, so obviously this hasn’t improved our security yet. And once it starts flying, the Pentagon estimates this fighter plane will cost another $850 billion to keep going. Who decided this was worth it? Is anyone seriously considering scrapping the whole project, before we spend another trillion dollars on it?

There are many more examples, such as the $436,000,000 we’ve spent building new Abrams tanks that the Army does not want. The Army may not want it, but it’s built in Ohio, and the Ohio members of Congress (both Democrats and Republicans) have fiercely defended it. 

It’s not just Defense, of course - we are still funding the 1925 federal helium program, which Congress seems unable to kill. The helium program was started after World War I, when the U.S. was worried that it wouldn’t have enough blimps. Lobbyists are keeping the program alive.

Let’s go back to the big picture. The leading causes of death in the U.S., according to the CDC’s latest figures, are:

1. Heart disease (597,689 deaths)
2. Cancer (574,743 deaths)
3. Chronic lower respiratory disease (129,476 deaths)
4. Stroke (120,859 deaths)

You might expect that we would be pouring money into research on the biggest causes of death in the country - at least as much as, say, a new fighter plane. But you’d be sorely disappointed: the entire U.S. budget for cancer research at NIH's National Cancer Institute is $4.78 billion. That’s for every type of cancer (and there are hundreds). This budget covers clinical research on new treatments, long-term research on understanding cancer, and everything in between. The budget for heart, lung and blood disease (the number 1 and 4 causes of death) is even smaller, just $2.90 billion. 

These numbers are little more than round-off errors when compared to the entire U.S. budget, which for 2013 is $3,454 billion.  The NCI budget is just 0.14% of the total.

How much should we invest in cures for all disease each year? How about 5% of our budget? Or maybe just 2%? That doesn’t seem like too much. Ask anyone who has cancer, or who knows someone with cancer, if 2% of the budget is too much to invest in cures. I suspect that most of them will say it’s not nearly enough. 

2% of the federal budget is $69 billion. Let’s put that on the table as next year’s budget for NIH. Rather than building weapons, let's use our tax dollars to build new things and make new discoveries. Rather than destroying infrastructure in other countries, let’s invest in our future, and create new treatments that make our lives longer and healthier. 

In the current issue of The Atlantic, James Fallows interviewed Eric Lander, one of the world's leading genome scientists, and asked him when genomics would lead to a cure for cancer. Lander responded:

“If we invest vigorously in this and we attract the best young people into this field, we get it done in a generation. If we don’t, it takes two generations. That’s a very big difference.”

Think about it. If we invest more now, you might see a cure for most forms of cancer in your lifetime. Two generations, though, will be far too late for most of us. How many more people need to die from cancers that we’ll eventually be able to cure?

Government ranking of U.S. universities: a truly bad idea

The U.S. Secretary of Education, Arne Duncan, has come up with a plan to produce official government rankings of our universities.

The plan was announced this past August, and over the past month, the Obama administration has been holding public forums around the country to get input about its plan.  But it seems like they’ve already made up their minds.

I hope not.  This is such a bad idea I don’t know where to start.  But I’ll start.

First of all, we have multiple rankings systems already, including the highly regarded U.S. News college rankings, which millions of students, faculty, and administrators use every year.  Even though everyone loves to complain about it, U.S. News is pretty darned good: they rank colleges in many categories, by region, by specialty, and more. They also rank graduate programs and professional schools such as law and medicine.

If you don’t like U.S. News, there are several other rankings, including the more recently established World Rankings from Shanghai and The Times Higher Education rankings. These are excellent rankings, well-documented using multiple criteria, and not nearly so US-centric. All these websites are chock-full of useful data about hundreds of universities.

I know, I know: “ratings aren’t rankings” as Ben Miller wrote recently at the Inside Higher Ed site. But I’m not at all confident that the proposed ratings won’t turn into a ranking system, especially with the weight of the federal government behind them.

So we don’t need a federal ranking of universities. That’s the first problem.

Second, this push to create official ratings will inevitably lead to a new bureaucracy within the Education Department, which will then create a constituency that will fight to keep itself in existence. How many staff will Secretary Duncan hire to create these rankings? Dozens? Hundreds?  And how many university employees around the country will then have to be hired to answer whatever questions the government asks?  This seems like it could quickly become a very expensive proposition, running in the tens of millions of dollars annually, or perhaps even more. I haven't seen any estimate of how much this new system would cost, but I'm betting on a lot. What will we cut from the federal budget to create this new system?

Third, a ranking system will likely spawn a host of new requirements that universities will have to satisfy. Why? Well, primarily because federal financial aid to universities will be tied to their ratings. Thus it’s pretty clear that universities will do whatever they can to keep the feds happy. And I’ve no doubt that with a full-time bureaucracy in place, the federal raters will keep moving the goalpost - coming up with new measures that in turn will spur new costs throughout academia. I’m highly skeptical that any of these government metrics will lead to better education.

We’ve already seen what government scorecards do in our public education system. Thanks to the No Child Left Behind program, we now have incessant testing of students, beginning in elementary school, and thousands of hours devoted to teaching students how to take tests rather than learn new material. Schools have not improved as a result. Do we want this trend to creep into colleges too?

I’m not the only one who thinks this a bad idea. Janet Napolitano, the president the University of California system and former Secretary of Homeland Security under President Obama, told the Washington Post that she is “deeply skeptical” of the criteria that a federal ratings bureau would develop.

“It’s not like you’re buying a car or a boat,” said Napolitano.

Secretary of Education Arne Duncan has already criticized the critics of the new rankings system, calling the criticism “premature and a little silly.”  Duncan emphasizes the need to address the alarming number of college students who default on their student loans. This is certainly a problem, but a college ranking (or rating) system is not the solution.

Perhaps the biggest problems with student debt is the rapid rise in mediocre, for-profit online colleges. If the feds want to get the loan problem under control, they should stop funneling money to these Yugos of higher education. As the PBS show Frontline pointed out in 2010, for-profit universities are

 “churning out worthless degrees that leave students with a mountain of debt.”  

And they’re not cheap, either - the GAO found that

“tuition in 14 out of 15 cases, regardless of degree, was more expensive at the for-profit college than at the closest public colleges.”

So yes, we do have a problem with student debt. One solution would be to exclude truly bad colleges, which are responsible for a disproportionate share of student debt, from federal aid. But that would mean naming the bad apples, who in turn will claim that the government is somehow being unfair. Perhaps the new ratings are an attempt to be fair, but it just makes no sense to rate everyone in order to identify the worst universities. Having a federal government agency produce college rankings is just a bad idea.

Controversial GMO corn study being retracted over the authors' objections

Retractions are always interesting. When a scientific paper is retracted, it usually means the authors have found a serious error, and that the major conclusions are no longer valid. The error can be unintentional, but in some high-profile cases, the story is far more interesting.

Reading about a retraction is, for a scientist, kind of like reading about a celebrity divorce. You know something went wrong, and it just might be a bit scandalous.

Last year, I wrote a detailed takedown ("Does genetically modified corn cause cancer?") of a very poorly done scientific study by Gilles-Eric Seralini and colleagues, in which they claimed that genetically modified corn, Roundup Ready® corn, caused cancer in rats.  The study had many egregious flaws, and I explained a few of them after reading the paper.  Hundreds of other scientists criticized the study at the time, and six French science academies took the unusual step of issuing a joint statement that rejected the study's conclusions.

Among the many flaws, the study used far too few rats to make statistically valid conclusions, and it contained self-contradictory results, such as data showing that rats fed the highest amount of GMO corn lived longer than rats fed the lowest amounts.  They also used a strain of rats that is highly prone to cancer.  Basically, it was unconvincing junk science.

Last week, Retraction Watch reported that this paper is being retracted. Particularly interesting was the news that the retraction is being made by the editors of the journal, not by Seralini and his co-authors, who are pretty darned upset about it. The journal conducted a lengthy investigation (much too lengthy, I might add - they should have been able to act more quickly) and decided that the many flaws in the paper mean that its major findings are not valid.  It is very unusual for editors to force a retraction like this, especially when fraud is not involved. The journal, Food and Chemical Toxicology, issued a statement that said:

"A more in-depth look at the raw data revealed that no definitive conclusions can be reached with this small sample size regarding the role of either NK603 [RoundupReady corn] or glyphosate [Roundup] in regards to overall mortality or tumor incidence. Given the known high incidence of tumors in the Sprague-Dawley rat, normal variability cannot be excluded as the cause of the higher mortality and incidence observed in the treated groups."

In other words, the editors concluded that Seralini's results were not supported by the data. Together with the rest of their statement, it seems pretty clear the editors are admitting that they screwed up during the peer review process, and they never should have published the article.

Seralini is very unhappy.  So unhappy, in fact, that he's threatening a lawsuit, as Forbes contributor Jon Entine reported.

But is this grounds for retraction? Lots of bad science gets published, often due to sloppy peer review, and most of these papers aren't retracted. In this case, it's pretty clear that the high-profile nature of the paper played a role.  Seralini is part of an anti-GMO organization, CRIIGEN, which has used this paper as justification for an aggressive campaign to ban GMO crops in Europe and elsewhere.

As bad as this study is, and as much as I'd like to see it retracted, I'm not sure that the justification given by the editors of Food and Chemical Toxicology is sufficient for retraction. Maybe it's because their statement is too carefully worded - wimpy, in fact. If they just came out and stated clearly that the study's conclusions are erroneous, then they would have a much better case for forcing the retraction. But they don't quite say that.

Here's what they are trying to say: "we screwed up and did a shoddy job in the peer review process, and now we realize that we never should have published this piece of dreck. Now we want to retract it so that no one will associate our journal with this bad science."

I know some very good scientists who have retracted papers merely because they couldn't replicate the results, and they grew worried that something was wrong. That's how science should work: rather than publish something erroneous, most scientists will admit their errors and retract their findings, or at least issue a correction. Obviously, Seralini has no plans to do this. His intent on publishing this paper was to make a political point, not a scientific one, and he distorted his findings in the paper itself, overstating his results with insufficient statistical evidence, and more so in statements to the press.

Retractions are indeed interesting. I'm still not sure the journal did the right thing to retract this paper, but I know they never should have published it in the first place.

(And for those who don't have time to look at the controversy after the original study: no, genetically modified corn does not cause cancer. Not even a little bit.)