Skepticism

In a world ridden with woo, it can be hard to discern between something that is of genuine concern and something harmless that people oppose due to a faulty understanding of the world. However, to disregard any criticisms of any given thing just because the woo-minded oppose it is to endorse a stubbornly contrary sort of dogma.

One example of something that is often criticized for unscientific (or, at least, not verified) reasons is Monsanto, the global agricultural corporation.

Most of the fuss that we tend to hear about Monsanto relates to their foods derived from GMO, or genetically modified organisms. In other words, people tend to be most upset by the idea of food whose genetic code has been altered in a lab as opposed to selective breeding, an older genetic modification technique.

While there seems to be quite a bit of fear surrounding genetically modified foods, most of the evidence does not indicate that is particularly unhealthy or toxic. As is the case with anything other technological advancement, there might be issues with it, but the most measured and methodical approach would be to take each issue on a case-by-case basis. In the case of genetically modified foods, there have been some early issues with allergic reactions, but those were pulled from the market when the issues were discovered.

Reactions over GMO aside, though, Monsanto is problematic in many, many ways. In fact, even in the case of groups who oppose Monsanto based on their perception of food safety issues, of their top ten list of “Things Monsanto Doesn’t Want You to Know“, four of the list items have little to do with food safety, and one is particularly disturbing: Monsanto’s litigiousness against small farmers. Between 1997 and 2010, 144 cases filed by Monsanto have made it to litigation, while 700 were settled out-of-court. Monsanto is opposed to the common farming practice of saving seeds, and while this could be argued to be their choice and right in business practice, the fact is that it is quite difficult to buy non-GMO seeds (i.e. non-Monsanto seeds). The inability to save seeds has made farming far more expensive both domestically and abroad.

Aside from the seed issue, Monsanto had targeted dairy producers who advertise their milk as rBGH free. Whether or not rGBH is controversial due to legitimate reasons, for them to target other companies for truthfully advertising their products is somewhat disingenuous given that they falsely advertised Roundup as “biodegradable.”

In addition to current issues, Monsanto has a history of creating toxic waste dumps, over 50 of which have been targeted by the United States government for clean up, not to mention the toxic waste issues it has created in other countries.

To reverse a proverb, the enemy of my enemy is not automatically my friend. Just because Monsanto is opposed by some people who are afraid of genetic modification does not mean that all people who dislike the company and its practices do so for the same reasons. To assume that any company that is targeted by pro-woo crowds must be just fine as a business is to engage in an odd reversal of the contrarian fallacy.

Main image via.

When I first heard about studies using smartphones to treat anxiety with cognitive therapy I was intrigued, to say the least. However, I had a misconception about what that actually meant. My assumption was that the smartphone app would be automating some basic cognitive therapy, a virtual therapist that could give some reflective feedback and also give basic cognitive tools to deal with anxiety. That sounded like it might be useful, at least for mild cases, and I hoped that the app was designed to refer severe cases to an actual therapist.

I had already been very interested in the concept of online, virtual, or computer-based therapy. It seems like this is coming, but of course it needs to be researched to see how it works and for which patients.

But that is not what the smartphone app is at all. Rather it has to do with a treatment technique called cognitive bias modification (CBM). This therapy is based on research that finds that those with social anxiety have a cognitive bias which makes them attend more than others to signs of threat or to negative emotions. Further, they have a cognitive bias to interpret ambiguous social cues as hostile or negative. This raises a cause and effect question – are they anxious because they have these cognitive biases, or does the anxiety make them attend to negative emotions and interpret emotions negatively. Perhaps it is both, in a reinforcing feedback loop.

There is some evidence from prospective studies that cognitive biases predict future anxiety, suggesting (but not proving) a cause and effect. Another way to address this question, and perhaps to develop a treatment for social anxiety, is to target these cognitive biases directly, rather than addressing possible underlying causes of the biases. That is where the smartphone app comes in. There are two computer-based treatments designed to directly treat these cognitive biases: CBM-Attentional and CBM-Interpretive (CBM-A and CBM-I respectively).

For CBM-A subjects are made to look at a computer screen (or now a smartphone screen) with two faces displayed, one neutral and one disgusted or angry. They are told to note and remember the letters that appear on the screen. A letter than appears where the neutral face was located, drawing their attention toward the neutral face and away from the face displaying a negative emotion. This is supposed to train their brain away from attending to negative emotions – modifying their cognitive bias for attention.

For CBM-I subjects are asked to interpret word-sentence associations, and are given positive feedback for benign interpretations and negative feedback for negative interpretations. Again this is supposed to modify their bias away from negative interpretations.

As always, we like to evaluate any new treatment paradigm on two basic criteria – is it plausible, and does it work better than placebo. Plausibility is a little challenging to assess. There are certainly no laws of physics, chemistry, or basic biology involved. Plausibility depends on whether or not you think this top-down approach to brain training can have a significant and lasting effect on our thinking and emotions. Personally I am not convinced that this approach has much value. It all seems like the “magic wand” approach to therapy – rather than addressing a complex behavior with an approach that reasonably addresses that complexity, it focuses on one perhaps superficial aspect of something as complex as social anxiety.

I have not been impressed with the whole “brain training” approach to cognitive therapy, such as EMDR (eye movement desensitization and reprocessing). At best it seems like treating the symptom of a disease rather than the disease itself. But I could be wrong. Sometimes the symptoms are the disease. In some chronic pain conditions, for example, the pain is the problem, and treating the symptom of the pain may be a reasonable and effective approach. Perhaps at its core social anxiety is being driven by some flaw or bias in brain function that can be tweaked by simple training.

My personal bias, therefore, is that this kind of approach has low (but not very low) plausibility but I am willing to be convinced by reasonable clinical evidence. So what does the clinical evidence show?

There are many pilot studies of CBM (both CBM-A and CBM-I and a couple with combined treatments). A review published in February 2011 concluded:

Although the potential clinical utility of CBM is quite exciting, the existing data do not address a number of limitations. First, the majority of the evidence of CBM’s effect on cognitive bias and anxiety relies on analogue samples and brief (one session) experiments. The field is in need of RCTs to test treatment protocols in clinical samples. A related issue is that all existing RCTs represent researchers’ initial pilot studies rather than large-scale RCTs. Therefore, they comprise of relatively small samples (subject numbers ranging from 29 to 44). Effect sizes from small studies are unreliable [93]; thus we await the results of larger, definitive trials.

While positive, the evidence is still preliminary and there needs to be more rigorous trial design before we can conclude that there is a real specific effect here. My concern with the research to far is that we are just seeing the non-specific effects of treatment intervention, rather than specific effects of CBM.

In a recent New York Times article on the topic, one specifically discussing the smartphone app for administering CBM, the results of perhaps the largest study to date are discussed. The study is yet to be published, but the researchers reported their results so far as:

Participants who got the treatment improved their scores on a questionnaire measuring anxiety, dropping by an average of 22 points, compared with an 8-point drop among people in a “waiting list” group, who got no computer games to play. However, a placebo group in the study practiced with a two-face video program not intended to shift the eyes from one face or the other, and their anxiety levels as measured on questionnaires also fell by about 22 points, just as they had for those who got the treatment.

The comparison to a waiting group showed a significant difference, but to a more rigorous and blinded control showed no difference at all. While the article indicated that these results were “confusing” I don’t find them confusing at all – they are dead negative. The only comparison that matters is the blinded one to a reasonable placebo treatment.

Further the article refers to a review from the University of Pennsylvania that found evidence of publication bias:

The authors noted that there was evidence of what scientists call a “file drawer” problem — in which studies finding no effect are filed away or ignored, while encouraging ones are published. “I think in this field the standards for publishing positive studies are lower than for negative ones,” Dr. Van der Does said in an e-mail.

To summarize: preliminary evidence is mixed but tending toward the positive, but has acknowledged serious limitations and evidence of publication bias. Preliminary results from a large and well-controlled study are negative.

I agree with various reviewers who conclude that this treatment is interesting and deserves more research. I would like to see some rigorous large studies – the kind that are really definitive. I sense a great deal of excitement among researchers. For example, from a recent pilot study the authors write:

Excitingly, these procedures have been shown to reduce bias in attention to threat (CBM-A), and to promote a positive interpretive bias (CBM-I) in anxious populations; furthermore, these modifications are associated with reductions in anxiety. We believe that these techniques have the potential to create a real clinical impact for people with anxiety.

The excitement may be premature, however. I hope this therapy is found to have potential, because it can result in a cheap and convenient treatment method. All the more reason to move beyond pilot studies are perform some rigorous studies that can really answer the question as to whether or not the specific elements of CBM-I and CBM-A, alone or in combination, can have long lasting benefits for social or other forms of anxiety.

Did you see that popular Internet video that allegedly showed a mammoth crossing a river in Siberia? You probably figured it was a hoax—and we did too—but we decided to get to the bottom of the matter. Join us as we discuss the methods and motives for Internet hoax videos. This episode also includes interviews with documentary film maker Ludovic Petho and Alan Melikdjanian (aka Captain Disillusion). Was there really something fishy about that video? Listen to see if you can bear the truth!

READ episode notes

I’ve done a terrible thing. I’ve turned my son into a Pluto apologist, one who’s not happy with Neil deGrasse Tyson. And the thing is, my son is only four. He never knew of a planet named Pluto until this past weekend. I’m working on remedying the situation, but trying to explain to a young and angry child that Tyson did not lose Pluto is no small feat.

But in moments like these, it’s hard not to stop and take note of how different the world is for him than it was when I was a kid. And I’m still young enough to be of a generation that was afforded the luxury of one uphill trip and one downhill trip when commuting to school, and that path was mostly cleared of snow. 

I remember being in grade school, hearing about how one day touch screen computers would exist, and that blew my mind. Now I can’t go five minutes without using one. And I keep it in my pocket.

And when I was growing up, we had shuttles that took people to space! That’s not really a thing anymore.

There were two Germanys… in fact, Eastern Europe and most of Asia were completely different maps.

It was amazing that we could control the TV from across the room. Now I can control my TV from anywhere in the world… even though I don’t even need a TV to watch TV.

Hell, I can even watch news for 24 hours straight… and never hear anything that’s actually news. And I can stay current on the state of the world by watching Twitter.

Just two months ago, my daughter saw a pay phone for the first time… and thought it was an electric razor.

We can change the world without leaving our homes and without ever putting on pants.

I can Facetime with my mom’s poodles. And I have. Because I refuse to live in a future where I can’t talk to dogs on the phone.

I know it’s pretty cliche at this point to talk about how much times have changed, but really… really… our world is amazing.

And even though we may have lost Pluto as a planet, we gained a new perspective on the universe.

What is your favorite thing about living in the future? What is your favorite advancement over the last century? What are you still waiting to see happen? How do you feel about the state of our world? Are you nostalgic for your good ol’ days? Do you ever pine for a world with less technology? Can you admit that you still struggle to list the planets without ending with Pluto?

T-shirts with the featured and Pluto images can be purchased at Snorg Tees.

The Afternoon Inquisition (or AI) is a question posed to you, the Skepchick community. Look for it to appear Tuesdays and Thursdays at 3pm ET.

I’ve mostly taken the past month or so off from traveling in order to spend more quality time with my cats, but yesterday, as I was cutting out paper glasses to stick to Fry’s face, I realized that I should probably head back out on the road. Here’s my upcoming schedule!

Washington, DC
March 24
I actually haven’t solidified plans for Reason Rally yet, but I wanted to mention it just in case I do end up going. If I do go, I’ll be working on a story for radio, but not speaking.

New York City
April 21-22
As always, I’ll be at NECSS with my Skeptics’ Guide to the Universe co-hosts as well as PZ Myers, Seth Shostak, Julia Galef, George Hrab, and more!

Arlington, VA
May 18
The Women in Secularism Conference is super exciting! I’ll be there with fellow Skepchick Debbie Goddard, plus Greta Christina, Jen McCreight, Susan Jacoby, Sikivu Hutichinson, Jamila Bey, Ophelia Benson, and many more amazing women. Be there!

Berlin, Germany
May 20
Then I’m immediately off to the 6th World Skeptics Congress, my first time ever in Germany! Also at the con will be Simon Singh, Harriet Hall, James Randi, Massimo Polidoro, and many more.

Cologne, Germany
May 25-27
The following weekend I’ll be in Cologne for the 2012 European Atheist Convention with PZ Myers, Taslima Nasrin, Annie Laurie Gaylor, Leo Igwe, Tanya Smith, and (you guessed it) many more! By the 25th I expect to be speaking fluent German so that’s probably how I’ll deliver my talk.

Minneapolis, MN
July 5-8
In July it’s time for SkepchickCon, which occurs every year during CONvergence! More info on that coming soon but you can still pick up your tickets in the meantime.

There’s a lot more planned for the rest of the year but most of the details are still being hammered out, so I’ll do another post once we get there. Hope to see some of you soon!

• Chinese retiree leads crusade against fake products – “Here’s a bottle of walnut oil. The label says it fights against aging, it will help you lose weight, it will protect you against radiation and it will cure cancer. Bulls**t.” Transcript and audio of the Marketplace piece at the link, audio’s only ~4 minutes long so take a listen.
• Indiana lawmaker calls Girl Scouts a “radicalized organization” – “A lawmaker has sent a letter to fellow Republican members of the Indiana House saying he will not support a resolution celebrating the 100th anniversary of the Girl Scouts because he believes it is a “radicalized organization” that supports abortion and promotes homosexuality.” From Elaine (a proud former Girl Scout).
• The 8 stupidest defenses against accusations of sexism – My personal favorite is the dictionary defense. Thanks to all the readers who sent this in.
• Boyfriend went vegan PETA ad – Don’t all headdesk at once, we’ll cause an earthquake. (No gore, but a couple people in their underwear.) From Ashley.

Please note: the following refers to routine physicals and screening tests in healthy, asymptomatic adults. It does not apply to people who have been diagnosed with diseases, who have any kind of symptoms or signs, or who are at particularly high risk of certain specific diseases.

Throughout most of human history, people have consulted doctors (or shamans or other supposed providers of medical care) only when they were sick.  Not too long ago, the “if it ain’t broke don’t fix it” mindset changed. It became customary for everyone to have a yearly checkup with a doctor even if they were feeling perfectly well. The doctor would look in your eyes, ears and mouth, listen to your heart and lungs with a stethoscope and poke and prod other parts of your anatomy. He would do several routine tests, perhaps a blood count, urinalysis, EKG, chest-x-ray and TB tine test. There was even an “executive physical” based on the concept that more is better if you can afford it. Perhaps the need for maintenance of cars had an influence: the annual physical was analogous to the 30,000 mile checkup on your vehicle. The assumption was that this process would find and fix any problems and insure that any disease process would be detected at an early stage where earlier treatment would improve final outcomes. It would keep your body running like a well-tuned engine and possibly save your life.

We have gradually come to realize that the routine physical did little or nothing to improve health outcomes and was largely a waste of time and money. Today the emphasis is on identifying factors that can be altered to improve outcomes. We are even seeing articles in the popular press telling the public that no medical group advises annual checkups for healthy adults. If patients see their doctor only when they have symptoms, the doctor can take advantage of those visits to update vaccinations and any indicated screening tests.

The Physical Exam Itself

The physical exam of a healthy, asymptomatic adult is unlikely to reveal any significant abnormality (1) that would not have been detected eventually when symptoms developed and (2) whose earlier detection and treatment would reduce morbidity and mortality in the long run.

A directed physical exam is sometimes indicated in patients with risk factors for specific conditions. A Pap smear is indicated in most women, but not every year, and the accompanying pelvic exam is likely a waste of time.

For healthy adults between the ages of 18 and 65, The American Academy of Family Physicians (AAFP) recommends only these components of the traditional physical exam:

• For men, a blood pressure measurement.
• For women, a blood pressure measurement and a periodic Pap smear.

They have other recommendations including vaccinations, counseling, and screening tests; but none of those require a physical exam.

Because they are so unproductive, routine physical exams are very boring to most physicians. My least favorite chore as an Air Force physician and flight surgeon was doing the required physicals. The system had some really idiotic requirements: for instance, the flight physical required a measurement of pulse rate after exercise, but there was nothing in the regulations that said what readings were considered abnormal or what actions to take if they were!

I heard about one doctor who had to do a lot of exams of healthy young men at a recruiting center and dreamed up a way to make it more interesting. He challenged himself to identify patients with situs inversus. This is a condition where the internal organs are on the wrong side (i.e. heart on the right, appendix on the left). It’s disqualifying for military service, probably because of the implications for battlefield trauma care. He soon held a record for the most diagnoses of situs inversus and was asked how he did it. He explained that he simply looked for men whose right testicle hung lower than the left and subjected those patients to a more intensive evaluation!

Screening Tests

We are increasingly questioning screening tests that were formerly recommended. The annual chest x-ray, tine test, and urinalysis are long gone. The recommended age limits for mammography have changed. Routine PSA testing is being discouraged. A recent study suggested that a woman whose DEXA scan shows normal bone density or mild osteopenia need not be rescreened for 15 years.

We don’t need to examine all the published literature on screening tests, because the U.S. Preventive Services Task Force (USPSTF) has done all the work for us.  They continually update recommended screening tests for different age and risk groups based on the latest studies. There are other organizations in the US and elsewhere that make similar recommendations but that may differ to some degree in different countries. In general, a specialty organization is likely to recommend more screening in its particular area of interest, based on a different focus in interpreting the same published evidence. The American Academy of Family Physicians, with a broader perspective, generally follows USPSTF recommendations.

The Early Detection Myth

There is a general perception, among the public and among doctors, that there’s no such thing as a bad screening test, that early detection is important, that knowing is always better than not knowing. If something is wrong with you, you need to know because, if you find a problem in time, it can be treated effectively to prevent morbidity and mortality. If you get a checkup and everything looks OK, you can breathe a sigh of relief and relax. Unfortunately this is all wrong.

A recent book explains why: Overdiagnosed: Making People Sick in the Pursuit of Health, by Drs. H. Gilbert Welch, Lisa M. Schwartz, and Steven Woloshin. It’s a comprehensive explanation of how test results make people sick and why visiting a doctor can be hazardous to your health. I reviewed it in an earlier article here on ScienceBasedMedicine.org. Please read that link and then come back.

Welch et al. commented

…some people may feel safer having their potential problems diagnosed and treated. For some, that may make the treatment side effects and hassle factors seem worth it… [but] the sense of being safer is likely an exaggerated view of the reality.

For a healthy, asymptomatic patient, the physical exam with the laying on of hands and stethoscope and other rituals is pretty much meaningless. If nothing is found, it can produce false reassurance. If something is found, it is not likely to prolong the patient’s life and it has a significant likelihood of leading to harm from unnecessary treatment or from a diagnostic cascade of tests, unnecessary surgeries, unnecessary expense, and unnecessary worry.

Re-inventing the Check-up

Doctors are not punished for overdiagnosis, but they are punished for failing to diagnose. We mustn’t let fear of lawyers interfere with our good judgment. The annual physical is obsolete.

On the other hand, there is a good argument for a periodic visit with a healthcare provider without the ritual of the physical exam. It’s helpful to have a systematic way of ensuring that the screening tests recommended by the USPSTF get done. An annual visit would be an opportunity for a preventive medicine interview and advice about a healthy diet, exercise, and other lifestyle factors. While an objective benefit has not been proven by any controlled studies, it can only be helpful for a doctor to get to know his patients before they get sick, for a patient’s history to be documented in a chart, and for patients to develop a relationship with a doctor they can trust. Instead of just rejecting the annual physical, maybe we ought to reinvent it.

Anyway, what’s so special about “annual?” The human body can’t read the calendar. A year is only a convenient way to jog the memory. Who’s to say that 365 days is better than 340 or 390 for any given purpose? In the absence of solid data, a range of suggested intervals might be more appropriate.

Welch et al. point out that health is more than absence of disease; it’s also a state of mind. They recommend health promotion efforts that lead people to feel more resilient, both physically and emotionally. Ironically, pursuing health requires not paying too much attention to it.

This is huge news, you guys. Huge! It was announced back in September but somehow I completely missed it. You see, one scientist by the name of fernieboy100, published his research in the venerable journal YouTube, showing without a doubt that the Bible is true and science is false because the Earth is most definitely not rotating.

OK, I know that it’s 30 minutes long and you have better things to do with your time like figuring out who you’re going to vote for in the Prezoodential elections at Franklin Park Zoo (um Stella the Red Panda, no duh), but this is important! Oh fine, I’ll try my best to sum up the entire video in one sentence:

“The Earth isn’t rotating because if it was, we’d all be motion sick from moving at 1,000 miles an hour.”

That is the argument, re-stated again and again, through all 30 minutes of the video. Go on, have a look. If you must skip most of it, at least don’t you dare miss the part around the 23-minute mark where it’s just a string of videos showing people falling off things.

fernieboy100 maintains that the Earth’s atmosphere is not a solid – it is a gas (note: this has been confirmed by godless heathen scientists). When a hot air balloon is hanging in the air, the Earth isn’t spinning beneath it. “Scientists” would tell you that this is because the Earth’s atmosphere moves along with the rotation of the Earth, but fernieboy100 proves conclusively that the gas around a solid does not move with the solid.

He demonstrates this using a remote control helicopter he procured from his local Sharper Image Scientific Supply Outlet. When the helicopter lifts off his non-moving pick-up truck, it moves (mostly) straight up into the air. When his pick-up is moving, the helicopter does not lift straight up. Because his pick-up’s atmosphere is remarkably similar to that of Earth’s, this proves that Earth is not moving. Get it? The gas around an object (which we apparently always call an “atmosphere”) does not move with the object.

Checkmate, science!

This research is not without it’s controversies, though. When reached for comment, a 12-year old astronomy enthusiast named Kaitlyn said, “What about Jupiter?”

In response, fernieboy100 issued a press release that read in full:

FOR IMMEDIATE RELEASE

What?

At a press conference held several days later in Mr. Andrews’ 4th period physics class, Kaitlyn clarified with the following statement:

Jupiter might have a small rocky core but it’s made of mostly hydrogen and helium, and we can see it rotating even though it’s pretty much all gas. Also, Jessica took my hairband and won’t give it back.

fernieboy100 took several months to consider this new information and run more RC helicopter-based calculations before finally issuing one final press release:

FOR IMMEDIATE RELEASE

I, fernieboy100, am now an atheist who renounces my lord and savior Jesus Christ and his Holy word the Bible.

Ah, well. It was a great theory while it lasted.

Thanks to Angel for sending in this tip!

The rumors are true. Teen Skepchick is looking for writers. Are you interested? We can’t pay you, unless you consider good times and being surrounded by lots of smart young people to be pay. WHICH I DO. In that case, you’ll be a metaphorical bajillionaire in no time.

Are you still interested? Excellent. There are, however, a few requirements:

• You must know how to write concisely.
• You must be able to handle quite a bit of email, mostly from other TS writers, but also occasionally from readers.
• You must have a sense of humor.
• You don’t have to have a willingness to engage in in depth discussions of Doctor Who…but it helps.

If you meet those qualifications, you might be a good fit for Teen Skepchick. We also try to represent the under-represented in the skeptic movement, so if you think you have a perspective that is lacking in organized skepticism, you are especially encouraged to apply.

You’re still interested after all that? Sa-weet. To apply, send a short introductory email to admin@teenskepchick.org with “Help Wanted” in the subject line. Please include your real name, background, areas of interest, links to your previous writing (if you have any), and any skills (e.g. photo or video editing) you may have. Or, if you know any young people who fit the bill, please pass this post along.

Thanks, and we look forward to hearing from you!

Dear Surly Amy,

i met this guy over the internet about 2 months ago. we have gotten very serious. iv’e sent him photos. he has sent me photos. we have fallen so much in-love. i guess i should cut to the chase. that’s not me in the photo. ive been dishonest about what i look like. he wants to see me. we have always discussed that looks don’t matter. i don’t know how to break it to him. also, he has mentioned me to his family and has showed the photos to them as well. so that’s a huge problem. ill not only be a fake to him, but to his family as well, making him look like a fool. i don’t know what to do or what to say i think about it all the time. i cry about it all the time. it hurts so bad. i really don’t know how to break it to him. i don’t like the way i look, and that’s why i was dishonest. i need help in letting him know that, that is not me. anything you can do to help me, would be greatly appreciated. thanks for your time. please help.

~karen

Dear Karen,

I’m going to cut to the chase here.

You are going to have to come clean and tell the truth.

I have been asked similar questions before about online relationships and the answer is always the same. If you ever hope to have an actual relationship in the meatspace you have to be honest about who you are online. You are going to have to tell him the truth.

I understand that temptation is strong to exaggerate who you. Some people go so far as to create a fake persona online but it is never a good idea. The truth as they say, always comes back and bites you on the ass.

Self Esteem

If you are having serious self esteem problems like you say you are then I highly recommend seeking out professional therapy. Few of us are ever completely satisfied with who we are and society creates often unattainable ideals, especially with beauty standards for women. It is something many of us are upset by and have to learn to deal with. However, if your self-esteem problems are causing you to lie about yourself and to spend hours crying about it then that is abnormal behavior and I think you would truly benefit from some professional help. It’s ok, to be unhappy at times but know that you can find help. You may be suffering from a form of depression. You can learn to love and accept yourself. There is help out there.

None of us are perfect and beauty is subjective.

Part of what love is, is appreciating the imperfections we each have and accepting them as part of the whole package. What one person finds average another may find exquisite. You haven’t even given this person a chance to love your flaws.

If the person does not accept you for who you actually are then it was never an honest love to begin with. It was just an idea of love. If you are going to be in a healthy loving relationship you have to come from a place of honesty and you have to learn to accept and love yourself before anyone else ever can.

He will have a right to be hurt and upset.

You lied to him and that’s not ok. You are going to have to accept that. It’s time to tell the truth and deal with the consequences. If he really cares for you he will want to work through this and remain friends. If his love was based only on what he thought you looked like, then it wasn’t a healthy relationship to begin with.

Attraction

You can not really say that you are in love with a person that you have never met in real life. You can love the idea of that someone but if you are expecting to have a physical relationship you will have to spend time together to see if there is physical chemistry between the two of you.

Other Fish

Remember that if this relationship doesn’t work out, it’s not the end of the world. There are many people out there you have yet to meet that I am sure are capable of loving you for who you really are. You just have to give them a chance to do so.

Again, I recommend finding a professional therapist in your area and the practice of honesty. Hope things work out for you.

Got a question you would like some Surly-Skepchick advice on? Send it in! We won’t publish your real name, unless you want us to and creative pseudonyms get bonus points! Just use the contact link on the top left of the page.

*Photos by Johnny Skaare. Each photo was taken via the reflection of a beveled mirror with an ordinary phone camera.

Hello! It’s time for another edition of In Case You Missed It! Are you as excited as I am. Yeah, I know you are…

Teen Skepchick

ScienceSunday: Darwin Day!
Ali Marie celebrates Darwin Day by explaining natural selection.

Medical Madness: Blood Letting Edition
Beccy discusses medical cures of old. This week: blood letting.

Aphrodisiacs: Do They Work? Do We Want Them To?
For Valentine’s Day, Melanie debunks some common aphrodisiac myths.

Mad Art Lab

Tales from Pareidolia
A guest post from Stuart F. Taylor on his book of skeptical fairy tales.

The Drake Equation
Amy creates art based on the Drake Equation.

This is Why Art People Don’t Like Science
Smashley rips apart journalists who try explain why Adele’s “Someone Like You” is so magnificent.

Skepchick SE

Soul Chemistry (på svenska)
Is it brain chemistry, or do humans have a soul? Technicolor explains why it’s the former.

Valentine’s Day. Stop the Cupidity! (på svenska)
Amygdala encourages us to appreciate the people we love every day.

H13 Still Impresses (på svenska)
Felicia brings skepticism to a beekeeping conference.

Escéptica

Of Love and Other Hormones (en español)
The chemistry of falling and staying in love.

Doing Your Part (en español)
There are plenty of young skeptics doing great work. You should be doing something too.

Technicolor Poop (en español)
Introducing the Scatalog, a new colorful diagnostic tool.

Queereka

Sunday School: On Pegging
Rachel answers a reader question about anal sex.

AI: Pride Events
Aretha wants your opinions on LGBTQ Pride events.

AI: Newbies
Will wonders what advice you would give people who want to become involved in online communities.

Featured image credit: stevendepolo

• The 8 stupidest defenses against accusations of sexism. (From just about all of you.)
• Why patriarchal men are utterly petrified of birth control – and why we’ll still be fighting about it 100 years from now.
• The scale of the universe. (From Rosaire.)
• Booth babes: iCandy or iScream?

One of the hallmarks of science as it has been practiced for the last century or so is that scientists share their discoveries in the peer-reviewed literature, where their fellow scientists can evaluate them, decide if they’re interesting, and then replicate them, usually as a prelude to building upon them. While the system of publication and peer review in science is anything but perfect (and, indeed, we have discussed many of its shortcomings right here on this very blog), I tend to like to view it in much the same way Winston Churchill characterized democracy:

Many forms of Government have been tried and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time.

I would rephrase this as:

Many forms of evaluating science have been tried and will be tried in this world of sin and woe. No one pretends that peer review is perfect or all-wise. Indeed, it has been said (by me) that peer review is the worst form of evaluating science except all those other forms that have been tried from time to time.

As mainstream medicine has become more scientific over the last century in the wake of the Flexner Report, physicians and medical researchers have similarly come to view publication in the peer-reviewed literature to be a very important component of communicating and evaluating medical discoveries. It’s not as though this is even a particularly high bar to pass, either. After all, many are the absolutely execrable papers that I (and my partners in crime here at SBM) have discussed over the last four years, nearly all of which were in peer-reviewed journals, some very prestigious. After all, if papers on “energy chelation” can find their way into decent journals and the likes of Mark and David Geier can publish in the peer-reviewed literature, while someone like Christopher Shaw can get cringe-worthy confusions of correlation with causation published, I don’t take seriously the whines of cranks who claim that they can’t publish in the peer-reviewed literature for one reason or another.

That’s why I view being published in the peer-reviewed literature as a minimum, but by no means sufficient, requirement good science. It’s also why, whenever I see a new claim, my first reaction is to see if (1) the person making the claim has published on it and (2) there are publications in the peer reviewed literature that support the claim. The first criterion helps me judge whether the person is a serious scientist; the second, whether there is any plausibility to his ideas. Sure, it’s not a foolproof scheme, but it is helpful.

I only wish antivaccinationists would do the same. That they don’t explains why they seem to be embracing someone named Dr. Hanan Polansky.

Fear and loathing of DNA among the antivaccine crowd

Back in September, I employed what I like to call science-based ridicule to deconstruct the overwhelmingly silly fear mongering by a group known as SANE Vax over the alleged discovery of HPV DNA in the HPV vaccine. SANE Vax, as you may recall, is a group founded by a woman named Norma Erickson dedicated to spreading misinformation about the HPV vaccine. If you peruse the SANE Vax website, you’ll see that the common antivaccine tropes are all there; they’re just directed mainly at the HPV vaccine. The hysterial fear mongering over the alleged discovery of DNA fragments of HPV in Gardasil was, as I described, massively overblown. The full explanation is in my post from September. The CliffsNotes version follows.

Basically, a pathologist by the name of Dr. Sin Hang Lee, who appears to have drunk at least a little of the antivaccine Kool-Aid, was hired by SANE Vax to test Gardasil for the presence of HPV DNA. Dr. Lee apparently made his name by developing exceedingly sensitive nested PCR assays to detect various DNA sequences. It was impossible to tell if his methods were valid, if Dr. Lee controlled adequately for the potential of false positives (which increase rapidly with the sensitivity of a test), and if his analysis was convincing because in September he had not published his results in the peer-reviewed literature. A quick search of PubMed on Saturday failed to find any publications on the topic since September. In any case, even if Dr. Lee’s analysis was correct and his new, allegedly more sensitive methodology had picked up previously undetected traces of HPV DNA from the plasmids used to make the HPV vaccine, it is still incredibly unlikely that such tiny amounts of DNA could cause problems because, as I explained, it’s incredibly difficult to get naked DNA into cells and making the proteins it normally makes, and, even if Dr. Lee were 100% correct about there being undetected HPV DNA in Gardasil, the quantities involved are many orders of magnitude less than what would be needed to have even a whiff of a wisp of a hope of the DNA getting into cells and making its protein. That’s even assuming it could pass the blood-brain barrier or that the DNA fragments were large enough to contain whole coding regions of genes with a proper promoter in front of them to drive their expression.

In other words, the fear mongering about the potential for minute quantities of HPV DNA being in Gardasil was nonsensical and not based on science.

On some level, I rather suspect that even Dr. Lee, Norma Erickson, and Leslie Carol Botha, host of a radio show known as Holy Hormones and, judging by her prominent association with SANE Vax, apparently also a die-hard antivaccinationist, have some inkling how utterly implausible their fear mongering about HPV DNA fragments in Gardasil was. The reason I suspect this is that they’ve latched on to Dr. Hanan Polansky and his “microcompetition” idea as a means of salvaging their fear of the evil HPV DNA that’s supposedly in Gardasil, waiting to make your little girls sick.

With the Oil of Aphrodite and the Dust of the Grand Wazoo

Dr. Hanan Polansky’s apparent coming to the rescue of SANE Vax began two weeks ago, when his Center for the Biology of Chronic Disease issued a press release:

Dr. Hanan Polansky, Director of the Center for the Biology of Chronic Disease, will discuss his discovery of Microcompetition with Norma Erickson, President of SANE Vax Inc. Dr. Polansky will use Microcompetition to explain the biological mechanism underlying the Gardasil adverse events. Leslie Carol Botha will host the event on the Holy Hormones Radio Show. The show will be broadcast on the community radio station KRFC FM in Fort Collins, CO, Monday, February 6, from 6 to 7pm MST.

Dr. Hanan Polansky is the author of the highly acclaimed “Purple” book, entitled Microcompetition with Foreign DNA and the Origin of Chronic Disease. In his book he explains how foreign DNA fragments can cause many major diseases without damaging (mutating) the human DNA. The book has been read by more than 5,000 scientists around the world, and has been reviewed in more than 20 leading scientific journals.

I’ll get to Dr. Polansky’s radio interview and “purple book” a little later. In the meantime, let’s take a look at Dr. Polansky’s background and what he might mean by “microcompetition.” To do this, it doesn’t help to go to the medical literature. A quick search of PubMed this weekend for works by Dr. Polansky reveals only one publication in Acta Oncologica entitled Gene-Eden, a broad range, natural antiviral supplement, may shrink tumors and strengthen the immune system. Remember what I said about how low a bar it is to get a paper published somewhere in the peer-reviewed literature? Let’s just say that this paper is evidence of that. It’s a case report of the use of a supplement called Gene-Eden published as what appears to be a letter to the editor describing how Gene-Eden plus chemotherapy shrank a pancreatic cancer. (Obviously, it must have been the Gene-Eden that worked.) But what is Gene-Eden? According to the Gene-Eden website, Dr. Polansky’s Gene-Eden-VIR supplement contains “five natural ingredients” (Camellia Sinensis Extract, Quercetin, Licorice Extract, Cinnamomum Extract, and Selenium) identified thusly:

Gene-Eden-VIR the the first product of our Science-Based approach. To identify the Gene-Eden ingredients, the scientists at polyDNA used the scientific method developed by Dr. Hanan Polansky. We scanned the scientific literature, analyzed thousands of papers using our proprietary bioinformatics-based computer program, and identified the most effective and safe natural ingredients. Some of the laboratory and clinical studies, which were published in scientific journals, and show that these natural ingredients have a strong antiviral effect, are described here.

The studies listed are, as you might expect, a bunch of cell culture and animal studies. Amusingly, on the Gene-Eden website there is also a table boasting between 913 and 6,753 publications for each ingredient, depending on the specific ingredient. (Take that, skeptics!) There’s that, and, in addition to Dr. Polansky’s single publication listed in PubMed, lots of press releases, for instance about how Gene-Eden-VIR can treat cervical cancer, prevent swine flu, and treat a whole host of viruses.

And ya might not believe this, little fella, but it’ll cure your asthma, too.

In any case, besides apparently shrinking pancreatic cancer, according to Dr. Polansky his Gene-Eden supplement can also help insomnia (which Polansky attributes to “latent viruses”), chronic fatigue syndrome, and a host of other diseases. In fact, Polansky attributes many diseases to “latent viruses,” reminding me of how many supplement hawkers justify the ingredients in their supplements. They cherry pick the literature to find suggestive preclinical or correlative studies for each ingredient that might indicate usefulness for the purpose claimed, with nary a convincing clinical trial to justify the combination of ingredients used at the dose used, because, well, latent viruses cause every chronic health problem known to humans, apparently.

And the rationale for Gene-Eden is based on something that Dr. Polansky refers to as “microcompetition” or the “starved gene hypothesis.” This brings us to how Polansky’s ideas can serve the agenda of a crank organization like SANE Vax. But what is “microcompetition”?

Microcompetition? More like a microhypothesis!

Now here’s where things start to get all “sciencey.” A trip back to the website of Dr. Polansky’s Center for the Biology of Chronic Disease soon leads one to a link to his free book, Microcompetition with Foreign DNA and the Origin of Chronic Disease. It even has an ISBN and everything! But what about Dr. Polansky’s Center? Its address is listed on the website; so I did a bit of Google Maps fun. Here’s where the institute maps to (click to enlarge):

Even though it’s on a major road, it sure looks like a private residence to me. Shades of Mark and David Geier doing their antivaccine research in the basement of Mark Geier’s house as part of their “Institute for Chronic Illnesses” (which sounds eerily similar to the Center for the Biology of Chronic Disease)!

Still, just because Dr. Polansky isn’t affiliated with a university or research institute doesn’t necessarily mean his ideas aren’t worth considering. After all, Albert Einstein did some of his best work when he was still a patent clerk. True, Polansky’s selling of a dubious supplement and his apparent belief that latent viral infections are the cause of most chronic illnesses suggest he might be a few bases short of a full coding sequence, but let’s see what he says. Back to the press release about his appearance on Holy Hormones:

The FDA and Merck admit that Gardasil contains foreign DNA fragments. However, the FDA asserts that these foreign DNA fragments pose no risk. In contrast, Dr. Hanan Polansky, in his highly acclaimed “Purple” book explains how certain foreign DNA fragments, at high concentrations, cause major diseases, such as, cancer, heart disease, diabetes, autoimmune diseases, and even obesity even when the DNA is broken and not functioning.

Note: “…at high concentrations.” (Emphasis mine.) It’s half tempting to stop right here, point out that, even if there is a tiny amount of HPV DNA left in each Gardasil vaccine vial, it isn’t “at high concentrations” and couldn’t possibly get into any cell in the human body at high enough concentrations to induce microcompetition, thus making Dr. Polansky’s ideas about “microcompetition,” right or wrong, completely irrelevant to SANE Vax’s fear mongering, and leave it at that. However, by agreeing to be interviewed it was Dr. Polansky who voluntarily offered up his idea as tactical air support for the SANE Vax campaign of fear mongering about the HPV vaccine. Besides, you come to SBM for more than that; so more than that I will try to deliver. To do that, let’s head to the source:

Dr. Hanan Polansky discovered that fragments of DNA, called N-boxes, can be very dangerous. When foreign N-boxes enter the body (naturally, or artificially, like through an injection of some treatment), they end up in the nucleus, where they attract scarce genetic resources. It is interesting that many common dormant (latent) viruses have strong N-boxes in their DNA. They include the Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Herpes Simplex virus (HSV), Varicella Zoster virus (VZV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Papillomavirus (HPV), and others. In fact, the CMV virus has the strongest N-box known to science. This N-box is so strong that human genes cannot compete with its power to attract the scarce genetic resources.

Sometimes Dr. Polansky compares these fragments of DNA to magnets. Imagine introducing a powerful magnet into the nucleus. What will be the effect of this powerful magnet on the allocation of genetic resources in the nucleus? The weak human N-boxes have no chance. Poor human genes. Poor host.

In the nucleus, “microcompetition” between the foreign N-boxes and the human N-boxes in the human genes can lead to disease. When the foreign N-boxes belong to a virus, microcompetition between the viral DNA and the human DNA can lead to disease even when the virus is dormant (latent), or the viral DNA is broken into pieces and cannot express proteins. As predicted by Dr. Hanan Polansky, many studies found fragments of DNA that belong to these viruses in tumors, clogged arteries (arterial plaque), arthritic joints, and other diseased tissues.

What might come as a surprise to SBM readers is that this is not an entirely implausible hypothesis, at least for some viral infections. What makes it implausible is how Dr. Polansky links it to latent viral infections. Be that as it may, back in the day, way, way back when I used to do a lot of plasmid transfections, we knew about microcompetition, only we didn’t call it that. Plasmids, for those not familiar with them, are DNA circles in which scientists can place whatever genes they want under the control of whatever promoter (DNA sequences that control how much a gene is transcribed into RNA) they want. “Transfection” is a process by which scientists can introduce this foreign DNA into mammalian cells and thereby drive expression of an exogenous gene. For purposes of this discussion, it’s not really that important how the plasmid DNA gets into the cell, only that it gets into the cell.

In the cell, the transcriptional machinery is made up of a number of proteins, among which is a class of proteins known as transcription factors. Transcription factors bind to specific DNA sequences on promoters and activate the transcription of the gene into messenger RNA, which is then used as a template to make protein. The key concept to understand here is that the supply of transcription factors and their protein co-factors in the cell can be limited, which means that there are only so many binding sites that the cell can accommodate. It is possible to “sop up” all of the cell’s supply of a specific transcription factor (or set of transcription factors) by flooding the cell with short length oligonucleotides that contain the correct sequence of nucleotides to bind to the transcription factor. When this happens, the transcription factor supply is tied up and these transcription factors can’t activate transcription of the cell’s DNA. It’s all a matter of chemical equilibrium; if the amount of exogenous DNA binding sequence introduced into the cell is very large relative to the amount of endogenous DNA binding sequences in the genome and the sum total is much larger than what the cell’s transcriptional machinery can accommodate, the transcription of the cell’s genes controlled by that sequence will plummet. This concept is illustrated in a figure from a paper published 12 years ago (click to enlarge).

Note that in this figure a specific sequence of DNA is acting as a “decoy” to tie up the E2F transcription factor. This oligonucleotide decoy strategy is a strategy that’s been studied for at least a couple of decades for shutting down gene activity, with mixed results. It is, however, not a new idea. Nor is it a new idea that certain viruses can do exactly the same thing by flooding the cell with copies of themselves, including sequences that can “sop up” specific transcription factors. This appears to form the basis of Dr. Polansky’s “microcompetition” idea. Indeed, in his book, Dr. Polansky goes way back to the very beginnings of molecular biology and gene transcription assays and points out well-known observations that I was taught in graduate school 20 years ago showing how investigators using pSV2CAT in 1984 showed that two plasmids could compete with each other for the cell’s transcriptional machinery: “taken together, our data indicate that a limited amount of the cellular factors required for the function of the SV40 72-bp repeats is present in CV-1 cells. Increasing the number of functional SV40 enhancer elements successfully competes for these factors, whereas other elements necessary for stable transcription did not show such an effect” (quoted from Scholer et al, 1984). My PhD thesis advisor did studies of this type studying transcription in muscle in the late 1980s.

Right here I should admit that I didn’t read all—or even most—of Dr. Polansky’s book. It is, after all, 427 pages long, not counting indices and the list of references (the latter of which numbers well over 1,000, demonstrating that the number of references doesn’t necessarily correlate with the quality of the science). Much of it is also painfully tedious reading. I’ll do a lot of things for a blog post, but even I have my limits, and trying to slog through 427+ pages of snore-inducing prose prose about a mildly interesting but outdated idea is beyond my limits. That’s why I found this review of Dr. Polansky’s book rather useful, coupled with some careful “cherry picking” of chapters discussing topics about which I’m knowledgeable. Basically, Dr. Polansky zeros in on a DNA sequence known as an N-box, which is also known as the ETS binding site and has a motif that looks like this: (A/C)GGA(A/T)(G/A). This is the core binding sequence of a transcription factor known as GA-binding protein transcription factor (GABP), which is involved in the regulation of transcription of a lot of important genes that regulate important cellular processes. It turns out that some viruses, including the HPV virus, have N-box sequences. Dr. Polansky claims that these N-box sequences in latent viruses compete for GABP and cause disease.

There are, as you might imagine, a lot of problems with this concept, and that’s even before we get to discussing whether this concept has any relevency whatsoever to HPV and its vaccine. For one thing, dormant viruses are by definition dormant. That means they are not replicating. Remember, the concept of “microcompetition” means that the N-box DNA must be present in high concentrations in order to compete with the N-boxes in the cellular DNA. Yet Dr. Polansky seems to think that this N-box in some viruses has some sort of magical powers to attract all the transcription factors in the cell to them. He uses terms like “magnet” and in his interview with Leslie Carol Botha approves of Norma Erickson’s referring to them as “vampires.” In fact, he more than just approves of the term, he even says, “I love the word ‘vampire’; it adds a lot of flavor to it.” Erickson then carries the analogy one step beyond into the ether when she then refers to the cells as functioning like “zombies.”

He analogizes to sucking the nutrients out of cells (hence the “starved gene hypothesis.” In reality, even if it occurs in reality, microcompetition is nothing more than a chemical equilibrium. For “microcompetition” to be the cause of disease, these latent viruses would have to be churning out N-box sequence at prodigious levels, which latent viruses don’t do because, well, if they were replicating themselves they wouldn’t be latent anymore.

None of this stops Dr. Polansky from saying this about N-box sequences in his interview:

At the end of the five years, we had found something pretty amazing, that many of the major diseases originate from the same source, and the source is basically foreign fragments of DNA and specifically one segment of DNA that’s causing all the trouble. This fragment of DNA is called an N-box, that is basically operating as a magnet and competing with human genes for scarce genetic resources available in the nucleus. Once these foreign DNA fragments are found in the nucleus, then as they arrive in high concentrations [difficult to understand], a disease will start and we see all the symptoms that today are recognized for all these major diseases.

Erickson helpfully chimes in later that this is “starvation at a cellular level,” and Dr. Polansky agrees. If this guy can’t even understand the difference between transcription factors and nutrients, I have a hard time taking him seriously. Even as a metaphor, Polansky’s analogy fails. It gets worse than that, though. Later in the interview, Polansky goes on and on about how regular drugs are “synthesized from scratch” and biologicals (like vaccines) are not, but are rather made using plasmids and recombinant genetic technology. This leads Botha and Erickson to gasp in terror at “genetically modified” treatments. Scary! This is followed by an anti-pharma rant about how much money drug companies make selling…drugs! And they’re shocked—shocked, I say!—that Gardasil, being a vaccine, is classified as a “biological.” Run for the hills!

But how does all of this relate to HPV and Gardasil? I think you know. I’ve already alluded to it, but just for the heck of it, let’s take a look at what Dr. Polansky has to say:

In my book, these DNA fragments are dangerous. They are the cause potentially—it has to be investigated further. But potentially, they can be the source of all the adverse effects, side effects, or diseases that we see with the injection… after the the injection, with the woman being vaccinated.

After Botha expresses her gratitude at having “found” Dr. Polansky (the two deserve each other from where I stand), she rants a bit about how many girls are allegedly sick from Gardasil, regurgitating various antivaccine tropes. The discussion (such as it is) then continues and goes beyond Gardasil, with Dr. Polansky opining:

All the modern vaccines are basically sharing the same process and therefore all of them will have DNA or fragments of DNA that are being injected into the people getting the vaccines. Autism, for instance, was linked recently with the MMR and a lot of debate about it, meaning you can read opinions on this issue. I read somewhere recently that MMR was also discovered to have foreign DNA fragments in it. So that’s the way it’s being done. That’s the manufacturing process and the purification pricess. And the limits of the purification process result in DNA residuals in the vaccines. As I said, the dispute is not whether there are DNA fragments in the vaccine, because nobody will argue that. You go online, you check on Google, and you’ll see that the debate is whether these DNA fragments cause disease. And if you ask the maintream scientist or doctor or pharmaceutical officer whether these DNA fragments cause any harm, they’ll say no. My book argues otherwise. So in a way my book is flying in the face of the entire traditional mainstream biology.

Except that it’s not. As I’ve described before, microcompetition is not a new concept, nor is the concept that viruses can cause chronic diseases. All Dr. Polansky has done with respect to this is to repackage old ideas in a not particularly exciting way. Hilariously, even the die-hard antivaccine Australian Vera Schreiber stated this in the comments of one of the SANE Vax posts about Dr. Polansky. He’s also way behind the times when it comes to genomics and molecular biology in that he doesn’t even consider microRNAs as a mechanism that could explain some of the “anomalous” observations he describes in his book about BRCA1 and breast cancer linked to low BRCA1 in women without BRCA1 mutations.

In fact, as Abbie Smith describes, there are a lot of things that Dr. Polansky apparently doesn’t understand about virology and biology, among other things.

Now I understand where microcompetition came from!

Microcompetition as a concept has a modicum of plausibility in a limited fashion for some aspects of cellular behavior. It has not to my knowledge been directly linked to any specific diseases in the 9 years since Dr. Polansky first wrote his book. Certainly Dr. Polansky hasn’t published anything supporting his idea, nor has anyone else as far as I’ve been able to ascertain in my multiple searches of PubMed. As speculation, Dr. Polansky’s concepts are somewhat interesting, but he takes their potential implications far beyond what the evidence can support. Normally, this wouldn’t necessarily be such a horrible thing if it were done as an intellectual exercise. After all, I didn’t mind, for example, the speculative fiction that was Medical Hypotheses until it started providing a platform for quacks to give their ideas a patina of seeming scientific respectability, as it did for Mark and David Geier and their ideas that led to their use of chemical castration with Lupron as a treatment for autism. Besides, sometimes outlandish ideas actually go somewhere.

I consider it higly unlikely that Dr. Polansky’s idea will.

The reasons are numerous. First, his idea isn’t all that new, as much as he tries to labor to represent it as some radical new breakthrough. Yes, I know he’s managed to impress a few doctors and scientists, but that was eight years ago, back when his idea actually seemed mildly innovative. Science has moved on, particularly virology and genomics, the two most relevant scientific disciplines to Dr. Polansky’s ideas. Second, nine years after he proposed it, it hasn’t really gone anywhere. Neither Dr. Polansky himself nor any other scientist that I’ve been able to locate has published any reports linking the concept of microcompetition definitively to a human disease.

Worse, however, instead of doing research to determine whether his idea has experimental evidence to back it up and, more importantly, whether that experimental evidence can suggest strategies to use the concept of microcompetition to intervene in the pathophysiology of any disease, instead Dr. Polansky has devoted himself to selling a supplement that he made up by cherry picking some natural compounds for which he could find a bit of in vitro and animal data supporting antiviral effect and using them to make a supplement that he sells to treat “chronic viral infection.” There’s no clinically acceptable evidence that his supplement works in humans as advertised or that it impacts microcompetition in any way. Not only that, but he’s been warned by the FDA about at least one of his claims for his supplement.

Worst of all, though, now Dr. Polansky appears to have hitched his horse to the antivaccine movement. I don’t know who contacted whom first, SANE Vax or Dr. Polansky. It might have been either. Perhaps the brain trust at SANE Vax saw Dr. Polansky’s website and thought it a perfect way to slap a veneer of plausibility on their utterly ridiculous fear mongering about minuscule bits of DNA in the HPV vaccine, or maybe Dr. Polansky sought out SANE Vax because of their recent “revelation.” Who knows? Does it really matter? Either way, what we have is a crank organization teaming up with a crank to link their respective crank ideas in the service of spreading fear, uncertainty, and doubt about vaccines. They’re two nasty crank ideas that taste cranky together.

There’s still one final question, though: Where did he get this idea? The answer to that question, my friends, is perhaps the silliest aspect of this entire sordid story. Although Dr. Polansky explains how he came up with his idea in his interview, it’s easier to go to another of Dr. Polansky’s websites for the skinny:

Wouldn’t you wish to have Einstein working on your medical problem? Imagine someone with his ability to choose the right direction to work on, his talent to recognize meaningful findings, his genius to leap from old concepts to new and more promising ideas. Think how much you would accomplish with Einstein on your team.

Einstein and other great scientists had one overwhelming talent, their superb intuition. This talent led them to discover pathways not charted on any map, and ensured that these pathways would become highways traveled by generations of scientists in their expeditions to uncover the secrets of nature.

We believe that the above proposition is not merely wishful thinking. Our sophisticated computer program, called Computer Intuition, was modeled to show the characteristics of genius intuition, and therefore, to turns us into “Einsteins.”

The basic premise of the Computer Intuition program is that every future event is preceded by hints, and that the key to realizing these events is recognizing the future significance of these hints.

In 1996, Dr. Hanan Polansky completed a prototype of a computer program that analyzes scientific text and assigns a rating to all ideas found in the text. The rating can be interpreted as intuitive intensity, (or psychological intensity, hence, psytensity). The higher the intuitive intensity, or psytensity, of an idea, the more it hints on future discoveries or future treatments. Dr. Polansky modeled the program after the intuition of the greatest minds in science such as Einstein, Newton, Edison and Tesla, and called it Computer Intuition.

Yes indeed, you read it right. Dr. Polansky wrote a “computer intuition program” and used it to scan the medical literature. In his interview with SANE Vax, he stated that he had used his computer program to scan 500,000 publications. This microcompetition idea is what he came up with. I kid you not. You’d think such a seemingly awesome algorithm could come up with something better, but apparently you’d be wrong.

As a consolation prize, at least Dr. Polansky should be proud that he made it in the alt-med world. He now has his own entry on Whale.to. Now, that‘s an accomplishment!

This Day in Skepticism; News Items: The Science of Pony Tails, Online Surveys, Structural Batteries, Quickie with Bob - Alien Matter; Who's That Noisy; Questions and E-mails: Evolution Falsifiable, Headgear; Science or Fiction

0:00:00
Introduction
Richard Saunders

0:06:20
Artist and Nurse - Paul O'Brien Paul shares his thoughts on skeptical podcasts and insights gained in over 40 years of nursing. What 'woo' concerns him and what can be done about it.

0:29:40
We chat to Ian Bryce from Australian Skeptics about the latest moves in the ongoing 'cold fusion' story, Andrea Rossi's E-Cat. Will Rossi pick up an easy $1,000,000 from Dick Smith?

The Religious Right’s war on women continues apace in state legislatures like New Hampshire, where congress is chock full of idiots. Here’s some recent footage of Rep. Jeanine Notter arguing that the government shouldn’t concern themselves with making birth control pills affordable because they (the pills, not the government) cause prostate cancer:

Rep Jeanine Notter (R-Merrimack): …As a man, would it interest you to know that Dr Brownstein just published an article that links the pill to prostate cancer?

Rep Andrew Manuse (R-Derry): In the children that are born from these women?

Rep Jeanine Notter:…women take the pill and it’s in their body (and I’m very anti-chemical) and uh the men are (garbled) it up.

Birth control causes prostate cancer! Science says so, apparently.

Notter is apparently referring to this article in which one Dr. David Brownstein answers a question that I assume he asked himself: Do birth control pills somehow play a role in prostate cancer?

Previously, Dr. Brownstein cautioned his audience to avoid the flu shot because it contains mercury and isn’t very effective, so we already know that he’s full of shit because thimerosal is a safe preservative used in some vaccines but not in single-shot seasonal flu vaccines and the flu vaccine is very effective at preventing the spread of a deadly disease.

But anyway, let’s get back to how women controlling their cycles and preventing pregnancy is murdering the menz.

Brownstein references this study (Oral contraceptive use is associated with prostate cancer: an ecological study) published in the British Medical Journal last November that looked at countries with a high rate of women using birth control pills and found a correlation with rates of prostate cancer. They found no such correlation with the use of other types of birth control. The researchers attributed this correlation to the potentially dangerous impact of hormonal birth control going through women’s bodies and out into the environment.

There have been many studies that suggest that the various pills we end up flushing down the toilet have a serious environmental impact, so this doesn’t really come out of left field. However, there were many other researchers who took issue with the way this study in particular was conducted and the conclusions that were drawn.

First let’s put the usual disclaimer out there: correlation does not equal causation. But that doesn’t mean that we shouldn’t take a strong correlation seriously. So, what went wrong with this study?

For starters, the researchers failed to take into consideration any other known risk factors for prostate cancer, such as diet or the existence of a certain allele (ApoE4).

They also failed to take into account that improved testing for prostate cancer might lead to higher rates of detection in more affluent countries where more women also happen to have access to birth control pills. The authors attempted to control for affluence but admitted that accurate reporting in developing countries was difficult to come by.

Most damning of all, John W. Cherrie and Laura MacCalman of the Institute of Occupational Medicine found a multitude of statistical errors in the paper, particularly a difference between numbers reported in original sources and the numbers that appear in the final charts. When Cherrie and MacCalman used the original source figures, they found that the correlation between birth control pills and prostate cancer disappeared while a positive correlation with condom use and a negative association with intrauterine device use suddenly appeared.

Interestingly, Cherrie and MacCalman suggest that a better way to test the hypothesis of whether or not birth control pills cause prostate cancer is to look at male-to-female transsexuals. These women receive high doses of estrogen and anti-androgens, yet apparently there is no apparent increase in prostate cancer in that group.

Over on the BMJ’s reply page you can read the detailed criticism presented by Cherrie and MacCalman as well as the reply from David Marge and Neil Fleshner, the original authors, who admit that they did make several statistical errors but maintain that the new data still supports their hypothesis enough to merit ongoing study.

At the end of the day, though, I don’t even think Margel and Fleshner would support Rep. Notter’s use of their study as a way to argue that the government shouldn’t care about insurance coverage for the millions of women who use birth control pills to prevent pregnancy and/or safeguard their health. That’s just bad science and bad politics.

Lest you think that Rep. Notter is an otherwise sensible legislator, let it be known that she is as anti-vaccine as the aforementioned Dr. Brownstein. Last year she argued against vaccines by pointing out that the Black Plague eventually wound down without the need of vaccines:

“The Black death was a terrible disease, there was never a shot for the black death and yet it declined naturally. Have you heard of that, the Black Death?” (01:17:10)
-Rep. Notter on HB416
3/15/11 AM Session

So we only need to kill several millions of people before we finally get rid of things like polio, whooping cough, or measles. Good to know.

And lest you think that Notter is the only embarrassment currently in the New Hampshire congress, here’s Rep. Blankenbeker insisting that people don’t need access to affordable birth control pills because people, including married couples, can just be abstinent:

Note everyone laughing when it is rightfully pointed out to them that condoms are not 100% effective and abstinence does not work. No one, at least in the clip, points out that birth control pills are also used to help women who have otherwise unmanageable and excruciating periods.

New Hampshire residents: you have a bunch of clowns running your state. Do something about it, please.

There has been much ado about drug resistant bacteria in the news. As a researcher in the field, I thought it would be valuable to outline some of the biochemical background that explains some of the challenges in this field.

Benzylpenicillin, a beta-lactam antibiotic. The beta-lactam ring (red) is the commonality in this antibiotic class.

Most bacteria require a cell wall to live. Enzymes named D-alanyl-D-alanine carboxypeptidases (peptidases) are responsible for forming the bacterial cell wall. Beta-lactam antibiotics (i.e. penicllins, cephalosporins, carbapenams, and monobactams)  are useful because they inhibit the mechanism peptidases use for bacterial cell wall formation.

However, in response to environmental factors, bacteria have been evolving for millions of years to circumvent these problems. One resistance mechanism is the development of a competing enzyme known as a beta-lactamase. They have a similar binding site therefore compete with peptidases to bind beta-lactam antibiotics. When a beta-lactamase binds a beta-lactam antibiotic it is rendered useless against their intended target, peptidases.

Streptomyces R61, a DD-peptidase, bound to benzylpenicillin

One of the main problems surrounding research today is that beta-lactamases have become better at binding most antibiotics than peptidases. However, this is not the only method of drug resistance, similarly, beta-lactams are not the only class of antibiotics encountering resistance. For example, bacterial mutations can occur making drug resistance a multifaceted problem. This has resulted in a world wide health crisis. Researchers are scrambling to design new antibiotics to overcome the propagating issue.

The term ‘superbug’ is being used to denote multi-drug resistant (MDR) bacteria. MRSA (methicillin-resistant Staphylococcus aureus), a well known super bug, is common in densely populated areas particularly hospitals, prisons, and athletic locker rooms. A great deal of research is underway to develop effective antibiotics for MRSA, a gram-positive bacteria. In the last two decades, only two new classes of antibiotics (daptomycin and linezolid) have been introduced and are gram-positive specific. Despite this development, MRSA is still a prevalent problem.

This leads to another issue, not all bacteria are gram-positive, additionally, some are gram-negative. In general, there has been less research focused on gram-negative bacterial infections. In 2008, a new beta-lactamase was identified in Klebsiella pneumoniae in India now named the New Delhi metallo-beta-lactamase (NDM-1). This enzyme is able to inhibit all beta-lactams except aztreonam, however its mechanisms make it resistant to nearly all antibiotics. NDM-1 is becoming prevalent in a variety of bacterial strains creating significant complications and a new target for researchers.

We are basically in a ‘keeping up with the Joneses’ relationship with bacteria. We develop new drugs and they evolve.

Some hope… 

Research is consistently being done to help solve these problems. A common strategy is to combine a beta-lactamase inhibitor with a beta-lactam antibiotic. Therefore the inhibitor prevents the beta-lactamase from interfering with the antibiotic activity of the beta-lactam in peptidases.

Just this week, I have read a couple promising papers about beta-lactamase inhibitors. The group of Christian Melander at NC State University published a study in Medicinal Chemistry Letters that resulted in a promising drug that acts as a partner to an antibiotic. Their drug binds to  NDM-1 and allows the antibiotic to inhibit K. pneumoniae growth. At University of South Florida, Yu Chen’s group published in the Journal of Medicinal Chemistry another beta-lactamase inhibitor for the CTX-M class.

Multi-drug resistant bacteria is a world wide problem and nothing short of consistent, collaborative research will allow us to ‘keep up’.

• Jessica Ahlquist is victorious! – The Cranston school will not appeal the ruling to take down the school prayer banner.
• Bodies as property – From Zebra, whose description I’m stealing, “I read this amazing, eye-opening, and heart-breaking post this morning on the negative effects of normalized but unwanted male behavior.”
• NH’s Rep. Notter claims birth control causes prostate cancer – The delightful Kammy utilized the internets and found the original study and the replies and challenges to the study. Proof once again that politicians don’t understand Google.
• Alphanail – I’ll just leave this here. Felicia found it, blame it on her.
• Cute Animal Friday! Let’s start with a tiny Madagascarian lizard from Donnie and Paul. A cat suddenly falls asleep, from Brian. From nowoo, the nerdily hilarious cats as fonts. And an entire tumblr devoted to animals doing people things.

This is yet another response to the recent “Integrative Medicine in America” report published by the Bravewell Collaborative. Drs. Novella and Gorski have already given that report its due, so I won’t repeat the background information. Inevitably, I’ll cover some of the same points, but I’ll also try to emphasize a few that stand out to me. Most of these have been discussed on SBM over the years, but bear repeating from time to time. Let’s begin with:

If it Ducks like a Quack…

Misleading language is the sine qua non of ‘integrative medicine’ (IM) and its various synonyms. The term itself is a euphemism, intended to distract the reader from first noticing the quackery that is its distinguishing characteristic. As previously explained, Bravewell darlings Andrew Weil and Ralph Snyderman, quack pitchmen extraordinaires, recognized nearly 10 years ago that if you really want to sell the product, you should dress it up in ways that appeal to a broad market.

Let’s see how this is done in the latest report. Here is the very first sentence:

The impetus for developing and implementing integrative medicine strategies is rooted in the desire to improve patient care.

Who would disagree with improving patient care? (Try not to notice the begged question). Here’s the next paragraph (emphasis added):

The Bravewell Collaborative, a philanthropic organization that works to improve healthcare, defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.”

Who would dare to disagree with those points? Other than biting off more than it can chew (see below), the definition applies to modern medicine, which tries to be patient-centered, holistic (in the honest sense of the term), “personalized,” scientific, etc. You have to be pretty savvy to recognize the misleading hype in that paragraph:

• “The Bravewell Collaborative…works to improve healthcare.” That would require that highly implausible medical claims—the only things that distinguish IM from real medicine—actually do what their proponents claim. They don’t, as we at SBM have been explaining for years.
• “…puts the patient at the center.” That implies “patient-centered care,” which requires that practitioners provide honest, comprehensive information about the methods in question. IM practitioners are universally dishonest about such matters. They have to be, because otherwise they’d have to tell patients the truth: that the methods are worthless. In a subsequent post I’ll provide examples pertinent to this report.
• “…an array of scientific disciplines.” This is standard quackspeak for “an array of pseudoscientific disciplines.” Here’s an example from that Mother of All IM centers, Andrew Weil’s Arizona Center for Integrative Medicine:

[Iris Bell, MD, PhD] is a clinical researcher with an emphasis on systems theory as a conceptual framework and the use of psychophysiological methodologies (EEG, cardiovascular) to study the linear and nonlinear effects of homeopathic remedies and low level environmental chemicals.

•  ”…to heal illness and disease.” The standard muddling of everything that might bother anyone, whether medical or not, other than being strapped for cash. This effortlessly leads to offering anything that might make someone feel better, whether medical or not, other than money. See how easy IM is?
• “…maintain optimum health.” Another standard IM gambit: its special and specious claim to preventive medicine.

Making Promises they can’t Keep

A recurrent theme is that IM can do, well, everything. We saw evidence of that above:

…an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health.

In the very next paragraph, the Bravewell Report makes it explicit (emphasis added):

…very little information had been collected regarding the actual practice of integrative medicine, which by definition treats the whole person.

It may not immediately occur to many readers, in this Era of Hype, but such a claim is ridiculous. Philosophers Clark Glymour and Douglas Stalker recognized this nearly 30 years ago in their essay about ‘holistic medicine,’ previously discussed on SBM here and here:

Another doctrine said to be holistic is that one’s state of health is affected by everything. Whatever this means, it has nothing to do with any possible practice of medicine, for no one can attend to everything. If physicians cannot distinguish relevant from irrelevant factors, important from unimportant causes, then they can do nothing.

Glymour and Stalker’s next few sentences, by the way, were these:

A variation of this doctrine is not vacuous but merely vapid: ‘Fundamental to holistic medicine is the recognition that each state of health and disease requires a consideration of all contributing factors: psychological, psychosocial, environmental, and spiritual.’ [Pelletier 1979] This is not a new revelation about medicine. Insofar as such multiple factors are known and believed to be important, they are routinely addressed in conventional medicine practice.

It would seem not to be a new revelation about ‘integrative medicine,’ either; just a repackaging of the same old stuff by a different label. Even the authors are the same.

An Established Part of Healthcare?

From the Bravewell report’s conclusion:

The strong affiliations to hospitals, healthcare systems, and medical and nursing schools as well as the centers’ collaborative work with and growing referrals from their own health systems reveal that integrative medicine is now an established part of healthcare in the United States.

Being “an established part of healthcare” is not the same as being accepted as valid in any important medical sense. I suppose one would be technically correct to write, “chiropractic is now an established part of healthcare,” but that would ignore the only interesting question about chiropractic.

There is no question that some of the centers looked at in this report are affiliated with hospitals and healthcare systems. Some that claim to be so affiliated are not, however. The Marino Center for Integrative Health in Cambridge and Wellesley, Massachusetts, is identified in the report as having a “hospital affiliation” with the Newton-Wellesley Hospital, which is where I work. In fact, some but not all of the Marino Center physicians have been granted staff privileges at my hospital—a mistake, in my opinion—but there is no institutional affiliation whatsoever. In two weeks I’ll look at the Marino Center in some detail.

More from the Bravewell conclusions:

…high levels of concordance of interventions for specific conditions suggests that integrative medicine practice is informed by a common knowledge base.

The naive reader might assume that a “common knowledge base” suggests something about medical validity. It does not. It suggests something about faddism.

The data from the survey reveals that integrative medicine centers embrace a group of core values that inform and radiate through their practice and interactions with their patients.

Ah, ‘embrace,’ ‘inform and radiate’: you don’t need a baloney detection kit to notice that such metaphors inform and radiate through quack treatises everywhere.

Ultimately, Bravewell Quacks

Here’s the final paragraph of the conclusion in the Executive Summary:

One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with nonconventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community.

Don’t you just love how spin doctors occasionally slip, and admit to what you knew was the case all along? I’ve been referring to what Bravewell calls “nonconventional or non-Western therapies; ancient healing wisdom” by the useful and accurate shorthand, “quackery.” For a somewhat broader treatment, let’s go to Glymour and Stalker:

The therapies described and recommended in a typical book of the genre include biofeedback, hypnosis, psychic healing, chiropractic, tai chi, iridology, homeopathy, acupuncture, clairvoyant diagnosis, human auras, and Rolfing. One of the larger books of this kind was even subsidized by the National Institute of Mental Health.

What ties together the diverse practices…? In part, a banal rhetoric about the physician as consoler;… In part, familiar and rather useless admonitions about not overlooking the abundance of circumstances that may contribute to one condition or another. Such banalities are often true and no doubt sometimes ignored, with disastrous consequences, but they scarcely amount to a distinctive conception of medicine. Holist therapies can be divided into those that are adaptations of traditional medical practices in other societies—Chinese, Navajo, and so forth—and those that were invented, so to speak, the week before last by some relatively successful crank.

Insofar as it extends beyond banality, the holistic medical movement constitutes both a deliberate attempt to substitute a magical for an engineering conception of the physician and an attack on scientific understanding and reasoning. Although the holistic movement does not contain a conception of medicine distinct from those we have discussed, it does contain a reactionary impetus to return the practice of medicine to the practice of magic and to replace logic and method with occultism and obfuscation.

“Welfare for the Rich”

The two philosophers warned of what Bravewell calls “integrative medicine” becoming “an established part of healthcare”:

If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason. Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign. At times, physicians may find themselves in sympathy with the holistic movement, because some fragment of the rhetoric rings true, because of certain practices and attitudes they encounter in their daily work with colleagues and patients, or because of dissatisfaction with the economic and social organization of medicine. One hopes they will speak bluntly, but it does no good to join forces with cranks and quacks, magicians and madmen.

Bravewell is what can happen when ditzy rich people who know little about medicine or science get it into their heads that they know something—some crucial secret or secrets, little known to most in medicine except for a few cranks who themselves have found the secret to easy money. That would be maddening enough, although we must expect it as part of living in a free, democratic society. What we shouldn’t have to accept is that those rich people haven’t been using their own money. They’ve been using ours.

 

A brief reference on the web site The Quackometer recently drew my attention to a very short book (really more of a pamphlet, in the historical sense) by Dr. Worthington Hooker, Lessons from the History of Medical Delusions, which I thought might be of interest to readers of this blog. Though published in 1850, the book contains many eloquent observations that are just as relevant to understanding how pseudoscience and quackery persist and even flourish in what we otherwise assume to be an age of scientific medicine. The book is available online as a Google eBook, and relatively cheap printed facsimiles are available as well.

Dr. Hooker was a physician, a professor at Yale, and an outspoken critic of homeopathy in it’s early days. His critique of homeopathy still resonates today, and has long drawn the ire of Hahneman loyalists, such as this one who makes reference to Dr. Hooker’s, “periodical fulminations for the destruction of Homoeopathy that have appeared like locusts or cholera at certain dates.” Though Dr. Hooker wrote an entire book discussing homeopathy, Homeopathy: An Examination of its Doctrines and Evidences, he does spare a few words here for this less-than-venerated practice:

The error I have been illustrating is carried to an extreme by the Homeopathist. He attributes palpable results to doses of medicine which are so small that they cannot produce any perceptible effect except by miracle.

He also includes a lengthy and preposterous example of a homeopathic proving, taken from a homeopathic text of the time, illustrating the absurdity of simply listing every imaginable (and imagined) experience following the taking of a substance and then attributing the entire list to that substance in order to guide the selection and use of homeopathic remedies. However, the focus of this booklet is to illustrate more generally the sorts of errors in thinking that lead even otherwise intelligent and reasonable people to believe such nonsense.

And Hooker makes a specific point of reminding us that belief in medical absurdities is not by any means a characteristic only of the unintelligent, the uneducated or the past.

The history of medical delusions most copiously illustrates the truth, that folly is very far from being confined to fools.

The present generation laugh at the follies of the past but have quite as great follies of their own, an follies too of a similar character, and products of the same fundamental errors.

The majority [of believers in quackery] is made up of those who are more or less intelligent and rational on most subjects, but who…are especially deluded on the subject of medicine…The exposition I make is not a partial one. It is not a one-sided argument-a plea for the doctors against the people. But it is an attempt to show how both doctors and people have ever been liable to error, and how they have been alike in the common elements, if not in the forms and modes and fashions of their delusions.

The medical profession, like the community at large, is made up of fallible men, and the elements of delusion are the same in the one class as in the other [though] the error of the physician would be refined, and would have the pomp and circumstance of erudition.

Error gilded with the pomp and circumstance of erudition….That certainly brings a few names to mind, eh?

Some of the specific examples he uses are fine tidbits of historical minutia. Apparently, one of the founding fathers of chemistry, Boyle”>Robert Boyle, a man who distinguished between alchemy and chemistry in a book called The Sceptical Chymist, also expressed his belief that dysentery could be cured through use of the thighbone of an executed criminal. And according to Hooker, Bacon”>Francis Bacon, that luminary of critical thinking and scientific philosophy, advocated for applying healing salves to the weapon that made a wound rather than the wound itself (though given the loathsome nature of many therapeutic unguents of the time, this may not have been a bad idea since apply them to wounds doesn’t sound wise).

So what are the common “elements of delusion” that Hooker wishes to warn us of? He begins with the post hoc ergo propter hoc fallacy.

The first [element] which I shall notice is the too ready disposition to consider whatever follows as a cause as being the result of that cause.

He then points out the most obvious reason why this sort of reasoning so often misleads us in medicine:

The most important of the confounding causes is “vis medicatrix naturae, or the tendency there is in the system to remove disease and cure itself….there is in the system a tendency to spontaneous restoration in case of injury and disease…This tendency is the chief agency in most cases in curing disease. Sometimes it is the only one; and very often it effects a cure in spite of the mistaken and officious interference of art.

And yet quacks, and even physicians, and the public generally, are very prone to leave this agency out of view, and to attribute cures, as a matter of course, entirely to some favorite remedy which has been used. This disposition is the chief source of medical errors of all classes of men.

Hooker also touches on several other key sources of erroneous conclusions in evaluating medical theories, including confirmation bias, availability bias, anchoring, premature closure, sloppy use of analogous reasoning, passionate commitment to theories without empirical evidence, and medical fads, though all describe in a language rather more poetic than we would ordinarily use today.

He then goes on to talk about the issue of the commercial and political success of medical nonsense, which are certainly still relevant issues often discussed here.

So extensive is the popular delusion in regard to quack medicines, that the nostrum system has become an organized system, with an enormous machinery of certificates and advertisements. It has become a monstrous business interest, and is linked in with a thousand ties with other business interests. So powerful is it in this respect, that it has almost entirely subsidized the press, forcing it to be silent except when it speaks in it’s favor. The same may be substantially said when speaking of the action of legislatures on this subject.

Similarly, Hooker touches on the unfortunate aura of legitimacy that attaches to quack therapies when they are embraced by what he calls “medical men in good standing,” which could certainly be applied to the quackademic medicine phenomenon and the endorsement of medical nonsense by the likes of Dr. Oz and others.

Despite the eloquent expression of many issues associated with medical nonsense that are as relevant today as they were in 1850, not all of Dr. Hooker’s book will resonate with a modern audience. Apart from the florid prose style of the time, and the unabashedly sexist language, he scoffs a bit “the skeptic,” who he describes as sitting in “his ‘doubting castle’ well-fortified against all the shafts of truth.” He also was a fan of bloodletting as a remedy, and sneered at the research of Pierre Charles Alexandre Louis and others who demonstrated its lack of effect. In general, he was no fan of the “numerical” methods which have since developed into epidemiology, and he was overly respectful of the experience and judgment on individual doctors. Citing the same sloppy reasoning as is often used by modern proponents of alternative therapies, he argues that such “numerical observations…can be of no practical use to the physician in deciding in regard to any individual case…”

However, as a whole this little historical gem is strikingly applicable to the issues this blog deals with today. And it ends with a nice description of the gradual and imperfect process of vetting ideas through scientific inquiry, from initial unjustified enthusiasm to a gradual withering of bad ideas and a fitting of good ones into their appropriate but limited places.

While many remedies, once potent to cure in the public estimation, have….been wholly discarded, others, which have more real merit, while they have lost the extravagant reputation of their nascent state, have, under the watchful eye of experience, gradually obtained very nearly their right valuation, and the circumstances which should regulate their use have been ascertained with considerable accuracy. Others, in great numbers, are now going through this searching process; and others still are just now wearing the brilliant honors of an enthusiastic reception.

He also suggests, mistakenly I hope, that direct attacks on medical nonsense rarely have a salutary impact on the popularity of such practices. However, he also describes with some hopefulness the goal of his book, which I think to some extent describes the purpose of this blog as well.

No delusion however fiercely it may have been attacked was ever killed. Each after having withstood all assaults, has laid itself down o die in the most quiet manner, benumbed into the sleep of death by the chill of popular neglect, while the warm breeze of popular favor which it once enjoyed are now bestowed upon some other delusion…

And such exposition as this essay presents, of the common causes of medical delusion, both in the profession and in the community, will, I believe, commend itself to the reason and common sense of such persons, and will therefore have some influence, in connection with other kindred efforts, in deterring them from giving heir patronage to quackery in any form…