Wednesday, December 24, 2008

Quack medicine making inroads

Below is an excerpt, without links, from a recent Sandy Szwarc article. Sandy is too polite to use the term "quack medicine" but that is what it is. Read the whole article for the full depressing story. I suppose quack medicine could be regarded as a self-administered placebo, though

This month, the American Academy of Pediatrics issued a new Guidance for the Clinician in Rendering Pediatric Care on using alternative modalities. This professional society supported pediatricians complementing their medical practices and the advice they give with alternative modalities (called CAM, holistic or integrative), incorrectly claiming that CAM use is increasing and more than a third of adults have used alternative modalities.

CAM was described as caring for the whole patient and considering their biological, psychological, family and social needs - all of which has been part of medical assessments and nursing care plans as long as I can remember. The real "distinction between CAM and mainstream medicine," said the AAP guideline, is that mainstream medicine includes practices that have undergone rigorous research. It reported that many alternative modalities have proven effective, lessening "the distinction between CAM and mainstream medicine," and that clinicians have an ethical responsibility to know about evidence-based CAM, and be open and respectful of CAM use.

This is an example of a term no longer meaning what we think it does: `evidence-based' no longer means sound and scientific evidence.

Readers who weren't reading the AAP guideline closely might have come away believing that CAM had been soundly shown to be effective in clinical research. "More than 1400 randomized clinical trials and 47 systematic reviews of pediatric CAM [have been identified]. Formal evaluation has suggested that the quality of RCTs of CAM is as good as that of RCTs of conventional medicine," it said - neglecting to report that the findings of those reviews have been notably negative.

The AAP guidance, published in its journal Pediatrics, presented the Kemper Model of Holistic Care and uncritically reviewed the efficacy and popularity of everything from biofield modalities "intended to affect energy fields," to acupuncture, therapeutic touch ("healing is promoted when the body's energies are in balance"), reiki, spiritual healing, healing massage, supplements, functional foods, magnets, and homeopathy (used by an estimated 3,000 clinicians in the U.S.) for babies and children.

Medscape offered an accompanying continuing medical education course, giving doctors and nurses credit for answering (incorrectly) just two questions - the most popular CAM used in children and how doctors should address the use of CAM in children.

How did we go from treatments that would once have been deemed patent medicines and been treated to careful scientific analyses of effectiveness and safety in medical literature - to these same practices being advocated by a professional medical society using innuendos and ad populum?

This isn't a trivial concern, nor is it just about what is traditionally considered alternative modalities. We've increasingly been seeing unsound medical information being unquestionably accepted by healthcare professionals, and published in peer-reviewed journals, that neglects basic principles of research, fact checking, or statistics - surrounding everything from weight management, preventive health, lifestyle and anti-aging medicine, misuse of risk factors and epidemiology, and food as medicine dietary ideologies. What explains the growing departure of science and the scientific process from medicine? As major academic medical and nursing schools across the country adopt core CAM curriculums, are medical professionals who are trained to believe in alternative modalities losing the ability to recognize sound scientific research and evidence-based medicine?

More here

'Sex chip' will have us wired, Oxford University researcher says

Forget Viagra: scientists are working on an electronic "sex chip" that will be able to stimulate pleasure centres in the brain, The Australian reports. The prospect of the chip is emerging from progress in deep brain stimulation, in which tiny shocks from implanted electrodes are given to the brain. It has already been used to treat symptoms of Parkinson's disease.

In recent months, scientists have been focusing on an area of the brain just behind the eyes known as the orbitofrontal cortex. This is associated with feelings of pleasure derived from eating and sex. A research survey conducted by Morten Kringelbach, senior fellow at Oxford University's department of psychiatry, and reported in the Nature Reviews Neuroscience journal, found the orbitofrontal cortex could be a "new stimulation target" to help people suffering from anhedonia, an inability to experience pleasure from such activities. Stimulating this area can produce pleasure as intense as "devouring a delicious pastry", he said.

His colleague Tipu Aziz, a professor of neurosurgery at the John Radcliffe hospital in Oxford, predicted a significant breakthrough in the science behind a "sex chip" within 10 years. "There is evidence that this chip will work," Dr Aziz said. "A few years ago, a scientist implanted such a device into the brain of a woman with a low sex drive and turned her into a very sexually active woman. She didn't like the sudden change, so the wiring in her head was removed."

The wiring remains a hurdle: Dr Aziz says current technology, which requires surgery to connect a wire from a heart pacemaker into the brain, causes bleeding in some patients and is "intrusive and crude". By 2015, he predicts, micro-computers in the brain with a range of applications could be self-powered and controlled by hand-held transmitters.


No comments: