Tuesday, November 30, 2010

Medical Skepticism and Dr. Oz

I think that it is fair to say that a lot of the New-Agey, hippie, touchy-feely woo-tastic type beliefs in terms of medicine and nutrition either originated in or were propagated by the San Francisco Bay Area. I know a LOT of hippies that live here (my parents are hippies. I'll get to them by and by) that swear by things like healers and parasite cleanses and various other bits of woo.

My parents are hippies. (see? Told ya!) I grew up taking vitamins for everything from colds to cramps. I went to my first chiropractor's appointment by the age of 12. I still feel weird taking analgesics.

I was introduced to the nature of the vitamin industry at a nutritional seminar at Fresno State. The researchers had done nutritional studies on geriatric model mice in order to determine why geriatric animals have a difficult time keeping weight on. After tweaking the genes of the mice to promote obesity, they had supplemented the mice with a particular fatty acid in order to see if it helped improve appetite and weight retention. Unfortunately their results were inconclusive, but it opened the doors for further study.

In the Q&A session, the topic of the vitamin industry came up. Now mind you, this is a group of professional research scientists that basically dumbed down their research in order to make it accessible for the average biology undergrad to understand. I had a brief conversation with the presenter where he basically concluded that vitamins are pretty much a scam if you have a varied diet and that they should not be trusted because manufacturers can and do put anything in there and the FDA has no power to regulate.

Fast forward 7-8 years. I ran into an old friend of mine on Facebook who claimed that her 3 year old son got autism from his vaccines. I didn't know very much about the topic, but I did what any scientist does when presented with a question for which she has no answers: I did some research. I asked the lady how she knew the vaccines caused the condition and she sent me links from Age of Autism, Safe Minds, and some odd independent researchers. I hunted through the data there and concluded that it was mediocre at best and lies at worst (in fact it's all lies, really.) I did my own digging and I came up with the delightfully quirky Respectful Insolence.

Orac was my first glimpse into a world that I hadn't dipped a toe into for quite some time: the world of science based medicine. I jumped in and read everything that I could get my hands on. My brain seemed to like being dusted off and the cobwebs removed. I worked at an incredibly dull job that really required me to turn my brain off to be happy, and I guess it got to be habit. Thanks to him and a few others, I was inspired to go back to school and get my medical degree.

But I digress. There are scads of websites out there that have all the information on vaccines and whatnot that you need to know. Quackwatch is a great one. Respectful Insolence is another. I also like What's The Harm?, Autism News Beat, Code For Life, and The Truth About The Evils of Vaccination.

What is the difference between these people and the idiots I mean folks at Age of Autism and Safe Minds? These people are scientists and practicing medical professionals that base their practices on sound science-based medicine. AoA and SM do not.

What does this mean? It means that they base their conclusions about treatments and medications on sound scientific well-developed research that has been published by reputable scientists with no glaring conflicts of interest in reputable top-tier journals that has passed the vetting process by the scientific community. Science is a process, a long slow arduous one, and conclusions come gradually. Even an excellently developed and well-laid out paper will be met with cautious enthusiasm if there is only one set of data to back it up. One paper does not mean this is true always. Two? Closer. Ten? Much closer. A hundred? It becomes accepted fact. Science is slow for just this reason: it prevents us from jumping to conclusions about how things work until they have been rigorously tested.

Bottom line: Are vaccines safe? Yup. Are they thoroughly tested? Yep. Do they cause neurological conditions such as autism? Nope.

But much like the biological refutation of creationism, it gets discredited, cherry picked, and sneered at by the fundamentalists that have something to profit by propagating these outright lies.

Often what these people do is sell things like autism 'treatments' and 'cures' to credulous and terrified parents. Autistic children can be very difficult to handle, and require a lot of time and money in order to help them gain something close to normal function. What people like Joe Mercola and Mike Adams and other scumbags do is peddle expensive treatments to parents who will try just about anything to 'fix' their 'broken' child. This can include things like putting an industrial chelator into a supplement form (chelators draw out heavy metals and can be used for heavy metal toxicity clinically, but it can be incredibly damaging for a growing child because some heavy metals are necessary for development: magnesium and calcium come to mind)  or using a drug that is used to chemically castrate sex offenders and those suffering from prostate cancer. (I hope I don't have to explain why messing with the hormones in a growing body is a very very bad idea)

And now we move on to the vitamin industry. In 1993 a piece of legislation was passed that prevented the FDA from regulating vitamins, minerals, supplements, and basically allowed the vitamin industry to self-regulate. But because the vitamin industry stands to profit egregiously, and indeed has: (Americans spent $26.9 billion on supplements in 2009 (from the Nutrition Business Journal)) the chances of that happening are slim to none. It is a repeated tale in America: give companies that can become megarich from shady business practices the chance to self-regulate and all kinds of abuses crop up.

What kind of abuses? Well, since the labels are not regulated by the FDA, they can put anything in their vitamins and herbal supplements. They often do. Hormones have been found in vitamins. The potency of vitamins is also dicey. The gram weight on the label can mean anything, but the part that your body can actually use (called bioavailability) varies wildly. In other words, the label may or may not have anything to do with reality. And frankly, the jury is still out on whether you really need supplementation anyway.

A fantastic overview of what might be in supplements can be found here.

The problem is that the FDA can't do anything about these abuses because of this bit of legislation. It took nearly 10 years to get Ephedrine off the market because the burden of proof of harm is on the FDA, not on the supplement company.

Pretty much the only thing the FDA can regulate are the claims made on the label. Even this, though, they seem powerless to do much about, because some of the claims you seen on supplement packages are absurd to say the least. But so long as they have the Quack Miranda Label on the package somewhere, the FDA seems hamstrung.

And so we return to my wonderful family. I love them dearly. But I get slightly concerned about where they are throwing their money if they have a subscription to Joe Mercola's blog and I see them get supplement shipments regularly. I have gently tried to explain why they should be a bit more careful about where they buy their supplements (or if they need them at all) and they pooh-pooh my concerns.

Somehow I doubt that they will pay any more attention to me if I have MD after my name.

I have given up trying to argue the point with them. But in an oddly defensive manner they brought up Dr. Oz as being a real genuine medical professional that they actually agree with. I didn't have an opinion on Dr. Oz because I didn't know much about him. But they were talking about how common sense he was about things like diet and exercise (A little side rant: I hate how alties claim that normal doctors don't care about the whole person. Of course we do! Of course there is nothing wrong with a sensible diet, lots of exercise, and proper hydration. Of course this is advice that normal doctors should be giving their patients. But by claiming that we want to 'medicate away' every ill the alties make themselves sound more caring and speshul. Grrr.) I told them that it sounds reasonable. But I was still skeptical.

But being the scientist I am, you know where that led. Yay for research!

The wonderful thing about Respectful Insolence is that if the person in question is a woomeister, quack, or otherwise has a reality problem, Orac will have written about them. And Dr. Oz has his own category. This doesn't bode well for Dr. Oz. In fact, he has merited multiple helpings of Insolence since the beginning of this year. I like this one in particular since Orac seemed to wrap up everything he has said about Dr. Oz in one nice tidy package of Insolence.

Now the next time my family brings up Dr. Oz, I know what to say: He's a quack.

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