Revenge is sweet

About 6 months ago, I commented on a medical blog that possibly - just possibly - we were overtreating for breast cancer. After all, it was possible that some tumors came and went without us even knowing about it. I suggested that we needed some negative controls for breast cancer, and that it wasn't a bad idea to let some patients opt out of masectomies and see what happens.

I was laughed off the blog. My scientific credentials and ethical values were challenged. The comments were very reactionary, not very scientific.

Six months later, and my how things have changed. The phenomenon I predicted was borne out in major studies. I heard doctors talking about it on NPR. Now, in recognition of these new findings, it looks like the recommended age for mammography may soon change from 40 to 50.

A lot of bloggers call themselves "skeptics" because they dare to mock other peoples' beliefs. But that's not what science is about. Science is about creativity and challenge, not biology-textbook dogma. It's about thinking outside of the box. From that perspective, I daresay some of these science bloggers could learn a thing or two from the people they are mocking.

Did Michael Jackson's doctor KILL him?

What's clear is that Mikey's personal physician gave him a heavy anesthetic the night before he died. What isn't clear is whether he ever woke up in the morning. The drug in question (propofol) is quite dangerous and is usually only administered in hospitals, because it can cause breathing problems.

Granted, Mikey had issues. But he was not overweight or diabetic, and appeared in decent shape compared to other big stars. His sudden heart attack at 50 was unexpected, and now we know why. He might have lived another 20 years at least - had this douchebag with an MD not poisoned him!

(And don't even get me started on the cosmetic surgery that made him look like an alien. Some doctor did that to him, too.)

The physician's rule is "First, do no harm," and I wish every vocation had such noble priorities. But I find it strange to hear physician-scientists on the web constantly criticizing alternative medicine but never thinking to question the dangers of their own profession. Jackson's death is a reminder that medical technology is a double-edged sword. Physician, heal thyself!

Funny Science

(c) The Onion, America's Finest News Source... Enjoy these links as well, courtesy of my laugh-happy brother:

Researchers Quietly Chuckling at Placebo Group

Studies Show Alternative Medicine Ineffective (American Voices)

Nice lead-in to our discussion about clinical trials!

The Science of Qigong

בן זומא אומר, איזה הוא חכם--הלמד מכל אדם

Ben Zoma says: Who is wise? He who learns from every man. (Avot 4:1)

Many American science bloggers are obsessed with disproving Chinese medicine, but good science is about data, not ideology. The jury is still out on Chinese medicine, as well as many conventional Western medical therapies, simply because experiments on people are prohibitively expensive and as a society we prefer to spend our money elsewhere (mostly guns). In fact, studies have vindicated certain alternative therapies, such as acupuncture for back pain, which is why they are covered by health insurance plans here in CA.

I've learned to keep an open mind about what's possible in the physical world. For this week's Fun Science Friday, I'll introduce you to John Chang, a master of the ancient Chinese art of Qigong. While I am dubious about his ability to light fires with his hands, I am intrigued by the possibility of sending electric shocks through the body. Brain and nerve cells throughout the body are inherently electric, and signal through instantaneous changes in voltage. With enough practice, it seems possible that a human being could focus these voltages to release energy or heat, like an electric eel.

I'm Not One of Those Fancy College-Educated Doctors (Fun Science Friday)

I totally get this guy.

Needles for needles? (Response to Orac comments)

I don't know when this Orac fellow sleeps, but he is not only a research scientist and surgeon but also writes a well-researched blog on medicine/biology. Recently he wrote a post criticizing a Baltimore prison program sponsoring acupuncture as a drug addiction therapy for inmates, saying it's a waste of $40,000 since acupuncture has been discredited as an addiction therapy in most studies.

Here is what I commented:

An interesting post. I agree in some ways, disagree in others. Have you ever tried acupuncture, Orac? Some people swear by it.

I doubt acupuncture will have much of an effect on drug addiction, we agree there. But then what does? There is no cure for addiction, just like there's no magic bullet for cancer. We spend plenty more than $40,000 treating addiction with all kinds of therapies that might also not work. We also spend trillions making wars that don't make any sense. Are you as critical of those programs as you are of this one?

As a research scientist, I think it's not a terrible idea to try some "high risk" therapies - ones that might not work, but if they do there's a big payoff.

I got a lot of responses. I will reply to a few of these here so my readers can benefit from the discussion.

@Techskeptic,
oh sigh... There is a reason that randomized double-blind studies are used to determine the efficacy of therapies – personal experience is unreliable.

Although double-blind studies are perhaps our most rigorous test of therapies, they are not infallible. They provide no mechanism and often use small sample sizes. Human society is very diverse and it's difficult to control for different variables.

Personal experience is subjective, certainly, but it is still data. It's a valuable way of gaining insight into what is actually going on. I wouldn't be so quick to dismiss it. In fact, I'll bet most doctors use "personal experience" as their #1 diagnostic tool.

Please don’t tell us that your woo therapy worked because you felt better just after you were treated, unless you can explain why the improvement you experienced could not possibly be due to one of the following:

1. Placebo
2. Temporary mood improvements due to the personal nature of the treatment
3. Psychological investment of the patient in the success of the therapy...

I agree with your idea that we should try some high risk therapies. Its just that acupuncture is not one of them. Not only is it not an unknown, its been tested and tested for 30 years, and after initial confusion with placebo, its pretty damn clear that there is nothing else to support it.

First off, there was that Yale study that Orac mentioned in his post that suggested that acupuncture helps with cocaine addiction.

Second off, so what if it is placebo? We're talking about inmate drug addiction here. Even if it works by providing the inmates a little personal contact and love - shouldn't we take advantage of that? Maybe placebos work.

As for being critical of other things, like wars...total non-sequitur. Superman could come here and wipe out everyone in the state of Virginia and if Orac didn't bother to comment on that, it still wouldn't make acupuncture any more effective or useful.

The question is about our priorities in spending public funds. How can you talk about the ants if you ignore the elephant in the room? (sigh)

@Becca,
It's funny, I think a lot of Orac's previous acupuncture posts start with the mention that once upon a time, he thought there might be something to the whole 'acupuncture thing'. Not the business with energy flow and meridians, but that there might be some science behind 'being poked with needles makes one's head hurt less'.

Then he did some reading on it, looked at studies that compared acupuncture with being poked with non-needles in the wrong places, and noticed that they show the exact same result. That's a very good sign that the needles aren't doing much, and it's mostly in the heads of the people being poked (maybe not consciously in there, but in there).

Hey, a few years ago I'd have been totally dismissive of acupuncture. But after 6 years in California, well... there's something in the water out here :) 

FYI, acupuncture and Chinese medical treatments are covered in your health insurance out here. They are practiced by licensed professionals. One of my housemates just passed her boards, she works side-by-side with a very successful MD.

As for the therapy being "mostly in the heads of the people being poked" -- see my reply to TechSkeptic above.

@Pareidolius,
I tried acupuncture when I was a believer in such things. I swore it up and down that it worked. It had to, it was expensive. Once I had awakened to what a gullible slave to woo I had become, I saw that acupuncture was really not any more effective than a good nap... The same was true for bodywork, reiki, and other assorted woo I used to swear by. Now I just go lie down or talk to someone I love or pet the dog or, well, you get the picture. Science works. Woo is wishful thinking.

I loved your story. This personal experience may be subjective, but it's still data.

I think some of these inmates might not have a dog to pet, or a loved one to talk to. Acupuncture may be beneficial for their health, possibly to help them relax, possibly as a placebo. I don't think it will cure their drug addiction. But who knows, maybe it couldn't hurt.

That's all the comments I feel like replying to right now. I got work to do. Science, y'know.