Quack Medicine and Junk Science

Idle talk, high opinion, low gossip and et cetera.

Postby Colonel Sun » Sun Jul 11, 2010 1:21 pm

kmich wrote:Alright, I will state outright that I have no intention on getting involved in the seemingly endless, pointless pissing contests between Col Sun and Marcus et al. So keep me out of it, please.

Thank you.



Okay, whatever.

kmich wrote:In my world, medical practice is as much of an art as it is a science. Any competent medical practitioner has to keep up on the peer reviewed research to know what the hell he or she is doing and to stay up to date. A respect for science and the findings of solid research and ongoing education is required for any practitioner. So I have reserved at least 2, usually typically dull, days each month to review my journals to keep on top of stuff.


Agreed. CME.

kmich wrote:But the fact that you know your science does not make you a good practitioner. I have known many an academic who knows the research and literature inside out but who pretty much sucks in their clinical and surgical practice. That is because every patient, every situation, every organ, blood vessel, artery, is different, and it typically takes many years of experience to know what to do in an instant of decision with those to save a life, a heart, a brain, or a limb.


Absolutely.

Conversely, I have encountered may clinicians who have no clue on how to perform research, mistaking clinical experience for research skill, but go charge ahead and do it anyways wasting valuable research funds.

So when I read the latest medical research headline the popular press, say that eating too many granola bars may result one's left testicle bursting into flames and dropping off, I more or less dismiss it unless I read the original paper and see that the study was done right.

Not only do such clinicians not have any clue, they often don't have a clue that they don't have a clue.
So a statistician is not consulted in the design of the experiment [often a far more subtle problem than is appreciated esp in the life sciences], the data is not collected in a consistent manner, various biases are introduced mid study, the size of the study is too small, etc.
Instead they think that if they input some numbers into a black box stats package and get an output with p < 0.05, then it's significant [the null hypothesis can be rejected with confidence].

kmich wrote:Medical and surgical practice is an art based upon your experience and the quality of your clinical observations and reasoning. When I work with residents, I often don't give a sh-t about what research studies they cite. I want to know what they heard and understood from the examination of their patients and their review of their radiological and laboratory studies. I want to know what hypotheses and strategies they have devised from those experiences and reviews and why. Tell me what you think and why about this particular person and what needs to be done next, not what "blank blank et al" published in the latest Journal of Vascular Surgery, the NEJM, or whatever.


There's no substitute for practice and experience in mastering a particular skill, be it surgery or golf.

kmich wrote:After observing me in surgery, they ask me sometimes why I did X or Y procedure with a patient, but, to me, it just seemed like the obvious thing to do, but I cannot cite an article to support what I did. How the patient did later proves I was right or wrong, and fortunately for my patients, I am usually right. Some residents never seem to get that line of thinking. Oh well, I am sure they can find some academic post in a medical school somewhere where they can cite Duffus et al or whatever to their wowed medical students.


Well, research is necessary to advance clinical practice, which is why stating the obvious you spend time reviewing new papers. Conversely, feedback from clinical work is essential to determine what questions require further research.

Most medical students and residents are best suited for clinical work. A smaller number are better suited for research. A very small minority are good at both.
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Postby kmich » Sun Jul 11, 2010 11:38 pm

Colonel Sun wrote:Conversely, I have encountered may clinicians who have no clue on how to perform research, mistaking clinical experience for research skill, but go charge ahead and do it anyways wasting valuable research funds.

So when I read the latest medical research headline the popular press, say that eating too many granola bars may result one's left testicle bursting into flames and dropping off, I more or less dismiss it unless I read the original paper and see that the study was done right.

Not only do such clinicians not have any clue, they often don't have a clue that they don't have a clue.

So a statistician is not consulted in the design of the experiment [often a far more subtle problem than is appreciated esp in the life sciences], the data is not collected in a consistent manner, various biases are introduced mid study, the size of the study is too small, etc.
Instead they think that if they input some numbers into a black box stats package and get an output with p < 0.05, then it's significant [the null hypothesis can be rejected with confidence].

I have no idea where you live, but where I live all the clinicians I know are too busy and don't have the time to dick around with research. There may be such characters where you are at, I just don't encounter them where I am.

The popular press comes up with all kinds of goofball stuff, but the only time I look further into it is when the article pertains to my practice or to questions my patients might have.

berzerk savant wrote:kmich, I wish you were my doctor. I don't know how to compliment you more , considering circumstances .

Within the past couple of months , I have known three people with kidney stones severe enough to consider emergency surgery that had a complete change of medical circumstance within six hours after drinking a big glass of half lemon juice, half water . Stones not passed, simply gone, dissolved. The basis for that seems reasonable, but somehow I doubt that's what a doctor would prescribe.

Thanks for the compliment, BS. What and when you intervene with renal calculi depends on the degree of pain and urinary obstruction involved. Most pass on their own, sometimes just drinking plenty of fluids is enough. Interventions like an ESWL are sometimes necessary to relieve excruciating pain and to prevent complications of infections and renal scarring. So, every situation is different.

Yukon Cornelius wrote:kmich:

I don't think there is an inordinate problem in America with medical procedures, as such -- the mechanics of pinning a hip, or heart surgery, or removing an appendix aren't the problem.

The problem, in the case of infant mortality -- or Prozac Nation -- is the needless meddling/intervention that goes on, which brings more and more risk as the interventions increase. I'd argue that with infant mortality, it's simply that -- wanting to schedule C-sections, or make birth a painless "procedure". Once you start doping up the Mom and baby, what was once a relatively straightforward event becomes a funhouse of mirrors.

So here we are in last place. That business with the doc giving my daughter blood thinners (or anticoagulants) without my knowledge belies a much more serious problem. For one, apparently it was so routine it didn't occur to him to tell me, and two -- it was not care that my daughter needed, and three -- he wouldn't have done it, given the choice. Not good.

I never heard about anticoagulants being used routinely on newborns other than for flushing IV's and Heparin Locks when those are placed. Since newborns have blood clotting factors around half of adult values, that would not make any sense. To the contrary, regular vitamin K shots are given routinely in this country as prophylaxis for Hemorrhagic Disease of the Newborn (HDN), but not in most other countries. Whether or not that is a good practice or not is outside my area of expertise. Whatever happened, you should have had the opportunity for informed consent or dissent.

I am not a pediatrician, but my understanding of the research is that the relatively low infant mortality rates in this country are related to factors that have mostly to do with pre and post natal care, diet, parental lifestyle, socio-economic status, and home living conditions, and not so much to do with what the medical community does or what goes on in the hospital. I am not aware of any study on infant mortality factors that indicates that medical practice is a central contributer to infant mortality. If you are aware of such a study, let me know.

The general problems with healthcare in America are complex ones that were beaten to death in other threads. The one element of those issues this thread is considering is quack medicine and science. As I state previously, science is an essential basis for any decent medical practice. However, medical and surgical practice is also an art, there are many unaccounted for variables and intangible elements, and how samples behave in research protocols does not always apply to individual cases. In clinical practice, you simply cannot control variables and exclusions like you can in research, so clinical judgment is much more complex and difficult with many patients who have complex co-morbidities and medication histories.

The problem is that these intangibles become gateways for superstition and credulity in a population that is generally scared about their health and about their ability to pay for their care without going broke. Quacks and medical hucksters prey on these fears using the intangible elements of medical practice as their gateway.
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Postby Marcus » Mon Jul 12, 2010 2:08 am

kmich wrote:. . intangibles become gateways for superstition and credulity in a population that is generally scared about their health and about their ability to pay for their care without going broke. Quacks and medical hucksters prey on these fears using the intangible elements of medical practice as their gateway.

That's well-noted, but, we must add the population's fear of the medical establishment itself. Last I heard, hospital and doc med errors kill more people annually than does breast cancer. And how many Americans annually are forced into bankruptcy by medical bills?

Allopathic medicine has climbed in bed with the government, legislating that only allopaths are able to deliver "medical" care—To whom much is given, much is required, and people are increasingly disillusioned. C-section rates in the US? Allopathic medicine has its share of medical hucksters

Read Part 4 of The China Study and The Social Transformation of American Medicine.

As for the "art" of medical practice or any other, Polanyi describes it nicely in Personal Knowledge.

No easy answers.
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Postby Colonel Sun » Mon Jul 12, 2010 8:29 pm

Marcus wrote:
kmich wrote:. . intangibles become gateways for superstition and credulity in a population that is generally scared about their health and about their ability to pay for their care without going broke. Quacks and medical hucksters prey on these fears using the intangible elements of medical practice as their gateway.

That's well-noted, but, we must add the population's fear of the medical establishment itself. Last I heard, hospital and doc med errors kill more people annually than does breast cancer.


US

Breast cancer incidence: 209,060
Breast cancer deaths: 40,230

Percentage of death: 19%

http://www.cancer.org/acs/groups/conten ... 024113.pdf

Number of patient records: 37, 000, 000
Medical errors resulting in death: 195,000

Percentage of death: 0.5%

http://www.medicalnewstoday.com/articles/11856.php

The percentage that results in death is much lower for medical errors. That's the relevant statistic to compare the two as there are far more hospital visits than breast cancer cases.

Marcus wrote:And how many Americans annually are forced into bankruptcy by medical bills?


I've read numerous sources that medical bills are the leading cause of personal bankruptcy in the US, yet there are pages and pages of threads here arguing about the superiority of the current US insurance system.

And the people most at risk are the ones protesting against any form of public insurance, as is found in other industrialized nations [to mitigate the risk of personal bankruptcy]. Go figure.

Marcus wrote:Allopathic medicine has climbed in bed with the government, legislating that only allopaths are able to deliver "medical" care—To whom much is given, much is required, and people are increasingly disillusioned.


Odd to place "medical" care in quotes:

So what role would an homeopath play in an ER when someone shows up with a gun shot wound?

Diagnosing and treating cancer? Heart disease? Treating infection esp septicemia? Reconnecting a blood vessel? Performing an appendectomy? Surgery to fix a child's heart valve? Etc?

People may be disillusioned, but turning to quackery and expecting magic is not exactly a solution.

Marcus wrote:C-section rates in the US? Allopathic medicine has its share of medical hucksters


Yes, it does. After, all medical doctors are human. It is also very much reflection of how the economics and delivery of medicine is organized in the US.

Also liability. C-sections reduce delivery risk to the fetus and thus reduce the risk of the gynecologist being sued in the litigious US.
A rational individual response to the current system which collectively leads to a proliferation of C-sections.

Anyways, all of this is far removed from the topic of this thread.
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Ad nauseum . .

Postby Marcus » Mon Jul 12, 2010 8:58 pm

Colonel Sun wrote:. . People may be disillusioned, but turning to quackery and expecting magic is not exactly a solution. . .


Yawn . . .
“I consider looseness with words no less of a defect than looseness of the bowels.” —John Calvin
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Postby ethanjin » Mon Jul 12, 2010 9:58 pm

The efficacy of statistical methods is over-estimated most of all by non-mathematicians. They forget that the statistical treatment of data always entails an act of inference - the assumption of an underlying distribution, for instance. The usefulness of the study is limited by the experimental protocol adopted and obviously rigour comes at the price of a restricted scope of application. At the heart of all statistical methodolodgy is correct specification of a distribution or parameter, and this is an entirely subjective procedure, so that the recourse will always be to a rule of thumb, or to clinical experience, ultimately. The number of confounding factors implies clinical experience, supplemented by descriptive statistics, will continue to remain the principal means by which medical knowledge is accumulated, and this is borne out by experience. Any cursory glance at a textbook in internal medicine will confirm this. Those in clinical practice are precisely those who are in the best position to perform research in medicine and even their anecdotal observations will have more validity than statistically-trained people with limited clinical experience. The number of spurious conclusions appearing to be statistically backed and mathematically rigorous is due precisely to the absence of correct experiment design, and correct experiment design depends above all on clinical experience, without which one simply does not even know where to begin and what to look out for. Incorrect specification or the failure to isolate error can lead to wildly inaccurate conclusions. Those who insist on EBM as an infallible rule of medical research and who insist that medicine is not medicine without it, are in fact distrusting modern medicine itself, and should henceforth terminate all visits to their GP.
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Postby ST » Mon Jul 12, 2010 10:25 pm

ethanjin wrote:, and correct experiment design depends above all on clinical experience


With all due respect to clinical experience as a source of research ideas, correct experiment design and clinical experience have very little to do with each other, unless you include "disastrous results of improperly designed experiments in the past" as part of clinical experience. Someone can be a very good doctor and terrible at conducting valid research.
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Postby ethanjin » Mon Jul 12, 2010 10:28 pm

ST wrote:
ethanjin wrote:, and correct experiment design depends above all on clinical experience


With all due respect to clinical experience as a source of research ideas, correct experiment design and clinical experience have very little to do with each other, unless you include "disastrous results of improperly designed experiments in the past" as part of clinical experience. Someone can be a very good doctor and terrible at conducting valid research.


Of course one can be a good doctor and terrible at conducting valid research. But to conduct good medical research, one must also be a good doctor (in the theoretical sense, not bedside manner). How else will one specify a valid hypothesis of sufficiently wide applicability and use? Posing the right questions in a field often requires good background knowledge. One can design completely naive albeit rigorous statistical studies.
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Postby kmich » Tue Jul 13, 2010 2:37 am

Although many of Ethanjin's points are well taken, the supposed dichotomy between clinicians and researchers in Medicine is getting pretty strained here.

Any medical practitioner must be able to evaluate research methodology and results as well as their strengths and limitations, or they cannot effectively understand and evaluate the literature. If they cannot do that, they should not be practicing medicine. Scientific reasoning of causes and effects are central not only in formal research protocols but also in everyday clinical diagnosis and treatment planning. The quality and coherence of reasoning is what is critical in both situations. There are some different skill sets between to two disciplines, but any quality medical researcher and well trained practitioner can have a clear and useful exchange of understandings, ideas, and approaches with each other without anyone talking over someone else's head.

Anyway, in the context of this thread, we are not talking about primary research in biochemistry or genetics, but the effectiveness or quackery of interventions, which suggests the research subset of intervention studies. That kind of research, testing the safety and effectiveness of drugs and devices, while often time and resource intensive, is hardly rocket science in its methodology.
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Postby Doc » Tue Jul 13, 2010 3:14 am

berzerk savant wrote:kmich, I wish you were my doctor. I don't know how to compliment you more , considering circumstances .

Within the past couple of months , I have known three people with kidney stones severe enough to consider emergency surgery that had a complete change of medical circumstance within six hours after drinking a big glass of half lemon juice, half water . Stones not passed, simply gone, dissolved. The basis for that seems reasonable, but somehow I doubt that's what a doctor would prescribe.


I had kidney stones twice. The first time I was force to lay down. It hurt worse than anything I ever experience in my life. Pain killers initially did not work at all. Then they gave me something that did not get rid of the pain but made it so I just did not care about the pain. The whole time I was not allowed to get out of the bed. Finally they took me to get an ex-ray to see if I needed surgery. I took my shot with the guy pushing the wheel chair. I told him I had to go to the bathroom. Lo and behold I did.

The second time I went to the emergency room I walked in and told them at the desk I had a kidney stone and I was going to walk around the outside of the hospital until it passed. Unless I passed out first. That way they would know what is wrong with me. The nurse was telling me I could not do that. I told her she could not stop me. As I was not as yet a patient. So I walked through the pain and the stone passed on its own within 20 minutes. Which was a hell of a lot better than laying on a bed in some real pain for several hours.
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Postby Colonel Sun » Thu Jul 15, 2010 10:26 am

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Postby Colonel Sun » Wed Jul 21, 2010 8:17 am

Slate: The Raw-Milk Deal

Some of the counterclaims in the comments section are priceless.
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Postby thecontributer » Thu Jul 22, 2010 3:03 am

How do you call something a quack.......

When its not even a bird in the first place?
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Postby Sparky » Thu Jul 22, 2010 4:16 am

thecontributer wrote:How do you call something a quack.......

When its not even a bird in the first place?
A set of common characteristics lead you to suspect foul play - the tealeological argument.
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Postby thecontributer » Thu Jul 22, 2010 6:10 am

Sparky wrote:
thecontributer wrote:How do you call something a quack.......

When its not even a bird in the first place?
A set of common characteristics lead you to suspect foul play - the tealeological argument.



Ah yes, but it assume that your looking at a bird in the first place. What if, let's say, its a mammal?
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Postby Sparky » Thu Jul 22, 2010 1:44 pm

thecontributer wrote:
Sparky wrote:
thecontributer wrote:How do you call something a quack.......

When its not even a bird in the first place?
A set of common characteristics lead you to suspect foul play - the tealeological argument.



Ah yes, but it assume that your looking at a bird in the first place. What if, let's say, its a mammal?

Oh, I see - the tits are confusing you. Quack as in "quacksalver"
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Postby Colonel Sun » Tue Aug 10, 2010 12:10 pm

Conservapedia: E=mc^2 Is A Liberal Conspiracy :shock:

RationalWiki: Con Ped deconstructed

[ It's interesting that the Con Ped author, an engineer by training, does not understand the important of Lorentz covariance, a property of special relativity [SR], with respect to the equations of classical electromagnetism [EM].

If the equations of EM did not transform in a covariant manner under SR, then current designs for electric motors and generators, transformers, radio, television, etc would not work. ]

The Con Ped misrepresentations have an all too familiar ring to them:

Aryan Physics
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Postby Endovelico » Tue Aug 10, 2010 6:16 pm

Sorry to pop in on your conversation. In any field of science there is no replacement for simple intelligence. Common sense and a touch of practicality are also very useful. People who are intelligent, practical and have common sense, are usually successful. Those who aren't, no matter how much data they may have in their brains, are of very little use. The problem is more acute in medicine because our lives and well-being may depend on it, but is no different from any other field of science. My number one priority while teaching is to make sure my students use their brains and do not automatically believe anything they hear or read, no matter how apparently authoritative the source. So-called experts say the most idiotic things, especially in the field of economics.
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Postby Colonel Sun » Tue Aug 10, 2010 7:03 pm

Endovelico wrote:Sorry to pop in on your conversation. In any field of science there is no replacement for simple intelligence. Common sense and a touch of practicality are also very useful. People who are intelligent, practical and have common sense, are usually successful. Those who aren't, no matter how much data they may have in their brains, are of very little use.


Perhaps. However, this thread is not about the character requirements for personal success.

On the hand, appeals to so-called common sense are often invoked in ill-informed diatribes against, say, special relativity, general relativity, or quantum mechanics. All of which make testable [and tested] predictions that, at first, seem counterintuitive.

Endovelico wrote:The problem is more acute in medicine because our lives and well-being may depend on it, but is no different from any other field of science. My number one priority while teaching is to make sure my students use their brains and do not automatically believe anything they hear or read, no matter how apparently authoritative the source. So-called experts say the most idiotic things, especially in the field of economics.


Well, my understanding is that in economics it's a challenge to produce a viable quantitative model with predictive properties that can be measured against the real economy.

In other words, although parts of the field make extensive use of advanced mathematics it is still at the stage of "consider the spherical cow . . ."

Given the above situation, people instead invoke preferred political and social ideologies.
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Postby Colonel Sun » Sat Aug 14, 2010 9:43 pm

Colonel Sun wrote:Conservapedia: E=mc^2 Is A Liberal Conspiracy :shock:

RationalWiki: Con Ped deconstructed

[ It's interesting that the Con Ped author, an engineer by training, does not understand the important of Lorentz covariance, a property of special relativity [SR], with respect to the equations of classical electromagnetism [EM].

If the equations of EM did not transform in a covariant manner under SR, then current designs for electric motors and generators, transformers, radio, television, etc would not work. ]

The Con Ped misrepresentations have an all too familiar ring to them:

Aryan Physics


WHAT’S NEW Robert L. Park Friday, 13 Aug 2010 Washington, DC

. . .

2. CONSERVAPEDIA: COUNTERING THE LIBERAL BIAS OF WIKIPEDIA.
An English-language wiki project written from an American conservative-
Christian viewpoint, Conservapedia was started in 2006 by home school
teacher and attorney Andy Schlafly, son of conservative Catholic activist
Phyllis Schlafly, to counter what he calls "the liberal bias of
Wikipedia." The extent of my own liberal bias can be judged by the fact
that I was unaware of Conservapedia until it was pointed out to me by a WN
reader last week. He was calling my attention to conservative hatred of
Einstein and his theory of Relativity. As Conservapedia put it: "The
theory of relativity is a mathematical system that allows no exceptions. It
is heavily promoted by liberals who like its encouragement of relativism
and its tendency to mislead people in how they view the world." This
hopeless confusion of physical theory with Christian-conservative moral
values extends to a list of 28 counterexamples.

. . .

THE UNIVERSITY OF MARYLAND.
Opinions are the author's and not necessarily shared by the
University of Maryland, but they should be.
---
Archives of What's New can be found at http://www.bobpark.org
What's New is moving to a different listserver and our
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