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.]

GMOs versus antibiotic overuse: which is the greater evil?

People who worry about eating healthy food (and who doesn't?) have recently been very worried about genetically modified organisms, or GMOs.  Meanwhile, industrial livestock producers feed enormous quantities of antibiotics to cows, chickens, and bigs, as a way to make them grow faster.  Which of these practices poses the greater risk?

This one isn't even close. The threat of GMOs pales in comparison to the overuse of antibiotics, which are creating dangerous superbugs that already kill tens of thousands of people each year.

The anti-GMO forces have been making a big push recently to add "GMO" labels to foods. This particularly campaign is based on the hard-to-disagree-with notion that more information is always good. People have a right to know what they're eating, right?

Well, sure. But how many people out there understand what genetic engineering means? How many understand that virtually all the food we eat is genetically modified - including the most wholesome organic foods? Unless you live out in the wilderness eating wild nuts and berries, you're eating plants and animals that have been genetically modified over the centuries by humans, by selecting which ones to plant and breed.  The term GMO is meant to refer to something else:  precise genetic engineering, designed to alter just one or two genes. This creates genetic changes that are far less dramatic than the ones that turned ancient maize into today's modern corn, for example.  Thus the problem with "GMO" label is that it won't inform people unless they have a solid grounding in molecular genetics.

Teosinte is un-modified corn. Not so yummy, is it?

GMO opponents claim that GMOs are bad for you.  So far at least, there's no scientific evidence for this claim.  If GMOs were so bad, people would be dropping like flies every night after dinner.

But in the world of infectious disease, a different, far more deadly scenario is unfolding. Drug-resistant bacteria are spreading fast. Scientists have been warning for years that we are blindly marching towards an era when people start to die of previously treatable bacterial infections. Antibiotics, one of the greatest technological advances in the history of civilization, are losing their effectiveness.

Last week, the Washington Post reported that "nightmare bacteria" are real and on the rise.  In the U.S. alone, over 23,000 people died last year as a result of drug-resistant bacterial infections, according to the CDC. The CDC report implicated the use of antibiotics in animals as one of the primary causes.

Also last week, the Center for a Livable Future at the Johns Hopkins School of Public Health issued a report looking at how we've responded to report 5 years ago that recommended ways "to curb the threats to human health posed by modern industrial agriculture practices." How have we done? According to Dr. Robert Lawrence, director of the Center:

"There has been an appalling lack of progress.  The failure to act by the USDA and FDA, the lack of action or concern by Congress, and continued intransigence of the animal agriculture industry have made all of our problems worse."

Can the FDA regulate antibiotics in livestock? Not really, thanks to intensive lobbying by industry. One of the authors of the Hopkins report commented that the FDA is “almost pleading with industry to make voluntary changes.”

But industry isn't going to do this on their own, and so far the government has been utterly ineffective.  The study points out that:

"Congress has killed every effort to restrict the feeding of farm animals the same antibiotics used in human medicine ...  even as antibiotics have grown less effective in treating infection."

So listen up, GMO alarmists: you're protesting the wrong thing. If you really want people to eat healthier food, start raising Cain over the use of antibiotics in livestock.  If you want labels on our food, insist on labels showing whether our food animals were raised antibiotic-free.  Stop worrying about a hypothetical fear of a few genetic changes in soybeans, and worry instead about the very real rise of superbugs.  You're right to worry about how we raise our food - you're just looking in the wrong place.

Why Can't We Find The Best Surgeons?

Someone finally figured out how to rate surgeons. Don't expect to see a ranking list any time soon, though, the ranking technique was only used for a very small group of specialized surgeons. But boy, does it work well.

The New England Journal of Medicine reported last week on a remarkable new study, by John Birkmeyer and colleagues.  As they wrote:

"Few studies have directly assessed the technical skill of practicing surgeons, and to our knowledge none have linked the level of surgical skill to clinical outcomes."

They then proceeded to do exactly this.  Here's how the study worked: a group of surgeons filmed themselves performing gastric bypass surgery, and submitted one video for review.  A team of other surgeons then viewed the tapes and ranked the skill of the surgeons.  A least 10 evaluators ranked each video.

After doing the rankings, they followed up by looking at actual surgery results of gastric bypass surgeryon 10,343 patients by these same 20 surgeons, between 2006 and 2012.

The differences between the most skilled and least skilled surgeons were remarkable.  Comparing the top 25% to the bottom 25%, Birkmeyer and colleagues found:

• The least-skilled surgeons had nearly triple the rate of complications, 14.5% versus 5.2%.
• The least-skilled surgeons required longer operations, 137 minutes versus 98 minutes.
• Although death is a very rare outcome for gastric bypass surgery, patients had a higher risk of dying if their operation was done by the least-skilled doctors, 0.26% versus 0.05%.

Across the board, the most skilled surgeons had better results.  This shouldn't be surprising, as Birkmeyer and colleagues wrote:

"Few surgeons would be surprised that technical skill is an important determinant of outcomes in patients who have undergone laparoscopic gastric bypass. The procedure is technically complex and performed in patients with morbid obesity, for whom surgical exposure is often challenging."

We know how to rate physical abilities in sports - the top teams and players compete directly against one another. We know that Rafael Nadal and Novak Djokovic are two of the world's best tennis players, even if some people argue about which one deserves to be number 1 (right now it's Nadal).  We can argue about the best soccer team, or American football team, or golfer, but eventually we can see for ourselves by watching them perform.

But in the world of medicine, finding out who is best - or even good - is nearly impossible.  You can find the best hospitals;  U.S. News has a ranking for hospitals, ranked on a published list of criteria (Johns Hopkins Hospital is No. 1).  But not the best doctors.

Not surprisingly, people and institutions have tried to create rankings of top doctors.  The only ones I'm able to find are based on surveys, such as Castle Connolly.  A survey, though, is more a popularity contest than a real measure of how good a doctor is. Many publications offer lists such as the "Top Doctors" lists in New York Magazine or Washingtonian magazine, but these too are just surveys.

One could use outcome measures: shouldn't the best surgeons (and other doctors) have the best results? Yes, of course they should - but we don't know how to measure this, because results depend on how sick the patient was to begin with, whether the patient follows his/her treatment program, etc.  Outcome measures tend to make doctors in educated, affluent areas look better, simply because the patients are healthier.

And just imagine: if we had accurate rankings, then the best surgeons could charge more. The worst surgeons (and someone has to be worst) would face pressure to improve their techniques or find another specialty, which would be good for patients.  I imagine that plenty of patients would be happy to pay more for a better surgeon. Hospitals do charge dramatically different rates, but not necessarily based on the skill of their doctors.

I don't know about you, but if I need surgery, I want one of those surgeons in the top 25% operating on me.  I just don't know how to figure out who they are.  Birkmeyer's study shows how we might change that.

Five vitamins you shouldn't take

I used to take vitamin supplements almost every day. Taking vitamins seems like a good idea: after all, we know that vitamins are essential for life, and vitamin deficiencies can definitely hurt you.  I always thought that vitamins were an inexpensive way to get a little bit healthier.

Millions of Americans apparently agree with me. Close to half of the population in the U.S. takes vitamins, with multi-vitamins being the most popular.*  Vitamins are sold in virtually every grocery store, ranging from mega-markets like Wegmans to the organic Whole Foods chain.

The vitamin and supplements industry, which is immensely profitable, relies on the intuition that if a little bit of something is good for you, a bit more can't hurt.  Right?

Wrong.  If you don't have a serious vitamin deficiency, taking supplemental vitamins doesn't provide any benefit, in almost all cases that have been studied.  What's even more surprising is this: routinely taking mega-doses of vitamins might actually harm you.

So here are the top 5 vitamins that you should not take (unless your doctor recommends it):

1. Vitamin C.  Perhaps the most popular single vitamin supplement, vitamin C occurs in plentiful amounts in many fresh fruits and vegetables.  In the early days of global exploration, sailors often died from scurvy, caused by the lack of vitamin C.  Way back in the 1700's, Scottish doctor James Lind famously conducted an experiment that proved that citrus fruit cured scurvy, although vitamin C itself wasn't discovered until the 1930s.

Vitamin C gained its current popularity through the woefully misguided efforts of Linus Pauling, who published a book in 1970 recommending mega-doses of C to prevent the common cold. Although Pauling was a brilliant chemist (and Nobel laureate), he was completely wrong about vitamin C, as Paul Offit explains in detail in his new book, "Do You Believe in Magic?"

Vitamin C doesn't prevent or cure colds.  This question has been studied exhaustively: a review in 2005 covering 50 years worth of research concluded that

"the lack of effect ... throws doubt on the utility of this wide practice."  

Although Vitamin C is generally safe, megadoses of 2000 mg or more can increase the risk of kidney stones, which can be excruciatingly painful.

2. Vitamin A and beta carotene. Vitamins A, C, and E are all anti-oxidants, which have been promoted for their supposed anti-cancer properties.  The evidence doesn't support this: for example, in a large study supported by the National Cancer Institute*, smokers who took vitamin A were more likely to get lung cancer than those who didn't.

Vitamin A plays an important role in vision, but too much vitamin A can be toxic, causing multiple serious side effects. Perhaps the most famous cases of vitamin A toxicity occurred in early polar explorers, who ate the livers of their sled dogs, not realizing that the livers had excessively high amounts of vitamin A.  Antarctic explorer Douglas Mawson barely survived, and his companions died, probably of vitamin A poisoning.

3. Vitamin E. Long touted as an anti-cancer agent, vitamin E is a very popular supplement.  A large study last year, of 35,533 men, looked at vitamin E and the risk of prostate cancer. The authors found that the risk of cancer increased for men taking vitamin E.  In an even larger review done at Johns Hopkins University, Edgar Miller and Lawrence Appel found that the overall risk of death was higher in people who took vitamin E.  The Mayo Clinic summarizes the evidence this way:

"Evidence suggests that regular use of high-dose vitamin E may increase the risk of death from all causes by a small amount." 

4. Vitamin B6.  The B vitamins, including B6 and B12, are present in many foods, and deficiencies are rare.  But taking B6 supplements for a long time can be harmful, as NIH's website explains*:

"People almost never get too much vitamin B6 from food. But taking high levels of vitamin B6 from supplements for a year or longer can cause severe nerve damage, leading people to lose control of their bodily movements."

5. Multi-vitamins. This is the big one. With nearly 40% of Americans taking a multi-vitamin, they must be good for you, right? But a huge study that I wrote about last year, looking at 38,772 women over 25 years, found that the overall risk of death increased with long-term use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper.  Death, one must admit, is a pretty bad outcome.

On the evidence, supplementing your diet with any of these 5 vitamins carries little or no benefit, and may cause you harm.  This is why we do science, people. Our intuitions aren't always right: just because a little bit of something is good for you does not mean that a lot of it is even better.

Vitamins don't "boost your immune system," they don't promote joint health, they don't reduce stress, and they don't help prevent colds or other common ailments.

So what should one do?  Ignore the marketing, and treat supplements like you would any other medicine: take them with caution.  If you are taking regular vitamin supplements, or thinking about it, ask your doctor before doing so.

And by the way, 100 grams of spinach has healthy amounts of vitamins A, C, E, K, several B vitamins, and essential minerals including iron and calcium.

So ditch the vitamins and eat your spinach.  Or blueberries.  Blueberries are great.

[*The statistics and references used in this article were collected, in part, by the U.S. Centers for Disease Control, the U.S. Department of Agriculture, and the National Institutes of Health, all of which are currently shut down due to the stubborn actions of a minority of Representatives in the U.S. Congress.  Thanks, Congress!]

Cashing in on fears of autism

Autism has been the subject of much controversy in recent years.  Rates of diagnosis are rising, and many parents-to-be are understandably worried.  Despite the efforts of many good scientists, we still don't have an explanation for most cases, although we do know that vaccines have nothing to do with it. Many unscientific claims are out there, some of them designed to take advantage of vulnerable parents who are desperate for answers. In this climate, any new claim to have found "the" cause of autism ought to be stated very, very carefully, and backed up by solid evidence.

Just recently, scientists at the UC Davis Mind Institute published a study that described 6 antibodies found in the blood of some mothers of autistic children, and much less often found in mothers of normally developing children.  They suggested that these antibodies somehow got into the brains of developing fetuses, causing autism in the children.  They even gave a name to this form of autism: maternal autoantibody-related, or MAR autism.

If true, this study suggests that a test for these antibodies might predict whether or not a child will have autism.

The study seems plausible, and it was published in a respectable journal called Translational Psychiatry.  Unfortunately, though, the study and the way it has been promoted are plagued with problems.

Perhaps the biggest red flag is that the two lead authors, Daniel Braunschweig and Judy Van de Water already have a patent on the proteins described in their paper, and Van de Water is involved with a company, Pediatric Biosciences (PBI), that is already marketing a test to predict autism based on this study.  Van de Water is the Chief Scientific Advisor for the company, which has licensed her patent for this specific test.  The company website claims

"To date, the test has demonstrated 100% accuracy - meaning if a mother or prospective mother has developed the antibodies, then her child will later be diagnosed with AU [autism] or ASD [autism spectrum disorder]."

Wow. This sounds incredibly accurate. This test is apparently the sole product of PBI, and they trumpeted the new study with a press release claiming that

"PBI is developing a diagnostic test based on these findings that will provide physicians with a reliable set of biomarkers for pre-conception … diagnosis of this Maternal Autoantibody-Related (MAR) form of autism."  

PBI is marketing the test to all "women over 30 who are at least 2 times more likely to give birth to an autistic child" as well as other women.

So, with all this hype, and despite the major conflicts of interest of the lead authors, did the study show what they are claiming?  Is this a test that mothers should take?

In a word, no.

First, the study doesn't even answer the right question.  The study looked at antibodies found in the blood of mothers some years after their pregnancy, not during or before pregnancy. Therefore it doesn't tell us whether a test of a pregnant mother will predict anything at all.  Post hoc analyses like this are notoriously inaccurate: for example, it's easy to find factors that predict every presidential election for the past 50 years, but many of them will perform poorly at predicting future elections.  Similarly, finding 6 proteins that distinguish some mothers of autistic children from mothers of normal children, all measured after the fact, tells us nothing about whether we can predict autism in advance.

Second, their striking claim of 100% accuracy is false.  (Their press release only claimed 99%: "A positive result would mean that they have a 99 percent likelihood of having a child with autism if they proceed with a pregnancy.")  But the study provides no such evidence.  What it did show was that 56 mothers (out of 246) had antigens to one of 12 combinations of 3 antigens that they selected.  [Aside: there are many other combinations of antigens that they did not report, and no indication that they properly adjusted their statistics to account for this.] But the study failed to say whether these 56 mothers also had non-autistic children.  If they did, then even the mothers in their own study had a much lower chance than 99% of having an autistic child.  Given that many families with autistic children also have other, non-autistic children, touting an accuracy number like this, without proof, is outrageous.

The study isn't completely worthless: it points to a possible link between antibodies in the blood of the mother and autism in a child.  If Van de Water were truly interested in the welfare of autistic families, she would be focusing on the obvious next step: test a large, randomly sampled collection of pregnant women for the same antibodies.  Then follow them up, over the next few years, to see if the test can predict the likelihood of having an autistic child.  Meanwhile, no one should be selling a test before studies can show that it has some predictive value.

But Van de Water and her friends at Pediatric Biosciences seem far more interested in making money off the fears of prospective parents.  PBI is planning to charge about $800 for their test, which they'll begin selling next year. Stanford University biostatistician Steven Goodman says that they are "peddling false hope that giving birth to autistic kids can be avoided."

A news article in Science last week raised many serious questions about Van de Water's study and its claims.  Several scientists quoted in that article questioned the premise of the study: that antibodies from the mother somehow get into the brain of the developing fetus. Yale scientist George Anderson said the data are too preliminary and the statistics too weak to support a clinical test (essentially the same argument I'm making here).

And what about that 99% claim?  In their interview with Science, Van de Water and Jan D'Alvise (president of PBI) said it

"was not meant to convey likelihood in the statistical sense, but rather the 99% accuracy with which the study demonstrated specificity of the biomarkers for ASD."  

This is unadulterated poppycock. As of this writing, the company website still claims that the test has "100% accuracy--meaning if a mother or prospective mother has developed the antibodies, then her child will later be diagnosed with AU or ASD [autism]."  That claim couldn't be any more clear - or any more wrong.

With all the controversy over the causes of autism, and with the medical community still struggling to correct the tremendous damage caused by Andrew Wakefield's fraudulent study linking vaccines to autism, the last thing we need is an erroneous claim that someone has found the cause of autism.  And it's far too soon to start offering moms a test that tells them they're going to have an autistic child.