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HuckleB
HuckleB's Journal
HuckleB's Journal
September 26, 2012
A fine piece that covers a wider swath of the issue from the science standpoint.
http://scienceblogs.com/tomorrowstable/2012/09/24/rachel-carsons-dream-of-a-science-based-agriculture-may-come-as-a-surprise-to-those-who-believe-that-sustainability-and-technology-are-incompatible/
July 8, 2012
"...
In other words, not only did Kaptchuk et al deceive their subjects to trigger placebo effects, whether they realize or will admit that that’s what they did or not, but they might very well have specifically attracted patients more prone to believing in the power of “mind-body” interactions. Yes, patients were informed that they were receiving a placebo, but it must be emphasized again and again that that knowledge was tainted by what the investigators also told them about what the placebo pills could do. After all, investigators told subjects in the placebo group that science says that the placebo pills they would take were capable of activating some sort of woo-ful “mind-body” healing process.
In fact, I would say that what Kaptchuk et al did was no different than what we know about what is required to induce placebo effects. They were also far more suggestive than the explanations that investigators conducting placebo-controlled clinical trials offer subjects during the recruitment process. Consider: In most clinical trials, investigators tell subjects that they will be randomized to receive either the medicine being tested or a sugar pill (i.e., placebo). This, patients are told, means that they have a 50-50 chance of getting a real medicine and a 50-50 chance of receiving the placebo. In explaining this, investigators in general make no claim that that the placebo pill has any effect whatsoever. In fact, in most clinical trials, subjects are explicitly told that it does not. In contrast, Kaptchuk et al explicitly tried to “optimize the placebo response” for purposes of the study by telling their subjects that the sugar pill activated some sort of mind-body response that would make them feel better — but only if they religiously took the sugar pills. Yes, they did tell the subjects that they didn’t have to believe in mind-body interactions to experience the healing response. But did it matter? I doubt it, because people with authority, whom patients tend to believe (namely doctors) also told subjects that there was strong evidence showing that these placebo pills activated some sort of powerful “mind-body” mechanism. This alone makes proclamations about how the investigators triggered placebo effects without deception — shall we say? — not exactly in line with the reality of the situation. A far better design would have included at least one more group, namely a group receiving the placebo but without all the suggestion about how it would activate “powerful mind-body” effects using a neutral script that simply said it was a sugar pill and wasn’t expected to do anything. Lacking that additional group, this study tells us very little that we didn’t already know.
..."
It's worth reading the full thing, IMO.
Placebo effects without deception? Well, not exactly…
http://www.sciencebasedmedicine.org/index.php/placebo-effects-without-deception-well-not-exactly/"...
In other words, not only did Kaptchuk et al deceive their subjects to trigger placebo effects, whether they realize or will admit that that’s what they did or not, but they might very well have specifically attracted patients more prone to believing in the power of “mind-body” interactions. Yes, patients were informed that they were receiving a placebo, but it must be emphasized again and again that that knowledge was tainted by what the investigators also told them about what the placebo pills could do. After all, investigators told subjects in the placebo group that science says that the placebo pills they would take were capable of activating some sort of woo-ful “mind-body” healing process.
In fact, I would say that what Kaptchuk et al did was no different than what we know about what is required to induce placebo effects. They were also far more suggestive than the explanations that investigators conducting placebo-controlled clinical trials offer subjects during the recruitment process. Consider: In most clinical trials, investigators tell subjects that they will be randomized to receive either the medicine being tested or a sugar pill (i.e., placebo). This, patients are told, means that they have a 50-50 chance of getting a real medicine and a 50-50 chance of receiving the placebo. In explaining this, investigators in general make no claim that that the placebo pill has any effect whatsoever. In fact, in most clinical trials, subjects are explicitly told that it does not. In contrast, Kaptchuk et al explicitly tried to “optimize the placebo response” for purposes of the study by telling their subjects that the sugar pill activated some sort of mind-body response that would make them feel better — but only if they religiously took the sugar pills. Yes, they did tell the subjects that they didn’t have to believe in mind-body interactions to experience the healing response. But did it matter? I doubt it, because people with authority, whom patients tend to believe (namely doctors) also told subjects that there was strong evidence showing that these placebo pills activated some sort of powerful “mind-body” mechanism. This alone makes proclamations about how the investigators triggered placebo effects without deception — shall we say? — not exactly in line with the reality of the situation. A far better design would have included at least one more group, namely a group receiving the placebo but without all the suggestion about how it would activate “powerful mind-body” effects using a neutral script that simply said it was a sugar pill and wasn’t expected to do anything. Lacking that additional group, this study tells us very little that we didn’t already know.
..."
It's worth reading the full thing, IMO.
July 6, 2012
"...
So what were the results? Well, as is usual in a study looking at a subjective measure like pain, all patients improved. There was, however, no difference between those who received individualized treatment and a random herbal concoction not expected to have any effect on arthritis. This most likely indicates nothing happening here other than nonspecific effects associated with participating in a trial, including placebo, regression to the mean, the Hawthorne effect, and all the usual suspects that fool us in clinical trials, and in real life.
This study nicely illustrates several of the issues associated with supposed individualization of CAM treatment. First, it shows that such treatment is not, in any meaningful sense, any more individualized than good quality science-based medical treatment. Choosing a selection of herbs based on previous experience, historical use, tradition, and the unscientific theories of Traditional Chinese Medicine, and then selecting which of these herbs to give each patient based on the same prior experience and unscientific theory, is still applying generalizations based on groups to individuals. It simply uses generalizations based on unreliable sources of data.
The study also illustrates that individualizing therapy in this way doesn’t add any efficacy to the treatment. Not surprisingly, the study showed, as the others mentioned early have as well, that tailoring treatment to individuals based on generalizations derived from biased and unreliable sources of information leads to a therapy no more effective than randomly picking herbs out of a hat.
The difference between effective science-based medicine and ineffective medicine of any kind, conventional or alternative, is that the general principles used to guide therapy are derived from formal, controlled research that compensates for the weaknesses in our individual, informal, and unstructured judgment. If individualized medicine is just a code for using informal group observations instead of structured scientific ones to guide therapy, than it is not surprising that it doesn’t work any better than just making up a treatment haphazardly with no guiding principles at all."
------------------------
A good piece worth reading, IMO.
Testing The “Individualization” Of CAM Treatments Shows No Benefits
http://www.sciencebasedmedicine.org/index.php/testing-the-individualization-of-cam-treatments/#more-21725"...
So what were the results? Well, as is usual in a study looking at a subjective measure like pain, all patients improved. There was, however, no difference between those who received individualized treatment and a random herbal concoction not expected to have any effect on arthritis. This most likely indicates nothing happening here other than nonspecific effects associated with participating in a trial, including placebo, regression to the mean, the Hawthorne effect, and all the usual suspects that fool us in clinical trials, and in real life.
This study nicely illustrates several of the issues associated with supposed individualization of CAM treatment. First, it shows that such treatment is not, in any meaningful sense, any more individualized than good quality science-based medical treatment. Choosing a selection of herbs based on previous experience, historical use, tradition, and the unscientific theories of Traditional Chinese Medicine, and then selecting which of these herbs to give each patient based on the same prior experience and unscientific theory, is still applying generalizations based on groups to individuals. It simply uses generalizations based on unreliable sources of data.
The study also illustrates that individualizing therapy in this way doesn’t add any efficacy to the treatment. Not surprisingly, the study showed, as the others mentioned early have as well, that tailoring treatment to individuals based on generalizations derived from biased and unreliable sources of information leads to a therapy no more effective than randomly picking herbs out of a hat.
The difference between effective science-based medicine and ineffective medicine of any kind, conventional or alternative, is that the general principles used to guide therapy are derived from formal, controlled research that compensates for the weaknesses in our individual, informal, and unstructured judgment. If individualized medicine is just a code for using informal group observations instead of structured scientific ones to guide therapy, than it is not surprising that it doesn’t work any better than just making up a treatment haphazardly with no guiding principles at all."
------------------------
A good piece worth reading, IMO.
June 30, 2012
"Even inexperienced physicians like me, still in my residency, have these kinds of stories to tell. They’re tragic. But worse, they’re just so stupid. Notice how, in each instance, the problem still ends up being taken care of, only now it’s emergent, farther along, more risky, and of course, more expensive to treat. This is part of the ludicrous nature of the opposition to health care reform. There is no way to get out of paying for these things. All we do by denying people coverage for necessary medical treatment is guarantee that in a few days, months, or years, they’ll be in the emergency room, only now it will cost ten times as much to fix, at greater risk to the patient. This is also backed up by the international experience of health care. Every other industrialized country has universal coverage, many have far superior care, not to mention superior service (France anyone?) to the United States. Yet every one of the countries pays far less per capita (most less than half) than we do on health care. Data from studies within our own country show it’s cheaper for the state to cover the uninsured than to let them stay uninsured. Because of EMTALA, passed by that notorious socialist Ronald Reagan, everybody gets emergency care whether they are insured or not, and fully 50% of emergency care is uncompensated, costs which get transferred to the insured and the tax payers.
For most of us in the healthcare system we see that universal coverage is necessary (unless you reverse EMTALA which will never happen), although we may disagree on how to accomplish it. If anything, the ACA/Obamacare is more of a free-market reform than many physicians would like. Many in my generation (though certainly not in the older generation) would have preferred single-payer, but for reasons I discussed yesterday this is actually not as important as merely guaranteeing universality. Mixed private/public and government payer/private insurance schemes are, if anything, the norm around the world and they work well while still costing less than 50% of what we pay per capita.
So why so much resistance to what should be obvious? There is no way to avoid paying for this stuff, so why don’t we do it more sensibly? Why don’t we move primary care out of the ER? Why not pay for problems when they’re cheap and not emergent?
...
In order to oppose a reform so obviously needed, so completely supported by the data from international experience and studies from within our own country, and in the face of the obvious gob-smacking experience of every physician in the country, one ultimately must rely on just lying. Politifact, both before and after the Supreme Court decision, has demonstrated this phenomenon. Many of the claims against the ACA have been so rabidly false as to deserve their “pants-on-fire” designation, including the fully debunked death panels nonsense (2009 lie of the year!), that it’s the largest tax increase ever, it’s rationing, or that it is some kind of Obama socialist plot. See the top five lies here. Immediately after the ruling Romney was apparently tripping over his own feet in order to be the first to lie about his own reform package saying it would increase the deficit by trillions, another lie, and Limbaugh reiterated the lie that it was the largest tax increase ever.
..."
This piece contains some great links that support why reform is needed, why it would save everyone money, why it would be positive for the economy, as well as being the right thing to do (even if there are better solutions that we should have pursued). It also offers links debunking GOP BS on ACA.
I offer this up as a hope that we will fight to keep this moving forward.
Fine Piece On The Importance Of Ensuring The Imperfect ACA Moves Forward
http://scienceblogs.com/denialism/2012/06/29/atul-gawande-on-resisting-health-care-reform-he-misses-a-tactic-lying/"Even inexperienced physicians like me, still in my residency, have these kinds of stories to tell. They’re tragic. But worse, they’re just so stupid. Notice how, in each instance, the problem still ends up being taken care of, only now it’s emergent, farther along, more risky, and of course, more expensive to treat. This is part of the ludicrous nature of the opposition to health care reform. There is no way to get out of paying for these things. All we do by denying people coverage for necessary medical treatment is guarantee that in a few days, months, or years, they’ll be in the emergency room, only now it will cost ten times as much to fix, at greater risk to the patient. This is also backed up by the international experience of health care. Every other industrialized country has universal coverage, many have far superior care, not to mention superior service (France anyone?) to the United States. Yet every one of the countries pays far less per capita (most less than half) than we do on health care. Data from studies within our own country show it’s cheaper for the state to cover the uninsured than to let them stay uninsured. Because of EMTALA, passed by that notorious socialist Ronald Reagan, everybody gets emergency care whether they are insured or not, and fully 50% of emergency care is uncompensated, costs which get transferred to the insured and the tax payers.
For most of us in the healthcare system we see that universal coverage is necessary (unless you reverse EMTALA which will never happen), although we may disagree on how to accomplish it. If anything, the ACA/Obamacare is more of a free-market reform than many physicians would like. Many in my generation (though certainly not in the older generation) would have preferred single-payer, but for reasons I discussed yesterday this is actually not as important as merely guaranteeing universality. Mixed private/public and government payer/private insurance schemes are, if anything, the norm around the world and they work well while still costing less than 50% of what we pay per capita.
So why so much resistance to what should be obvious? There is no way to avoid paying for this stuff, so why don’t we do it more sensibly? Why don’t we move primary care out of the ER? Why not pay for problems when they’re cheap and not emergent?
...
In order to oppose a reform so obviously needed, so completely supported by the data from international experience and studies from within our own country, and in the face of the obvious gob-smacking experience of every physician in the country, one ultimately must rely on just lying. Politifact, both before and after the Supreme Court decision, has demonstrated this phenomenon. Many of the claims against the ACA have been so rabidly false as to deserve their “pants-on-fire” designation, including the fully debunked death panels nonsense (2009 lie of the year!), that it’s the largest tax increase ever, it’s rationing, or that it is some kind of Obama socialist plot. See the top five lies here. Immediately after the ruling Romney was apparently tripping over his own feet in order to be the first to lie about his own reform package saying it would increase the deficit by trillions, another lie, and Limbaugh reiterated the lie that it was the largest tax increase ever.
..."
This piece contains some great links that support why reform is needed, why it would save everyone money, why it would be positive for the economy, as well as being the right thing to do (even if there are better solutions that we should have pursued). It also offers links debunking GOP BS on ACA.
I offer this up as a hope that we will fight to keep this moving forward.
June 12, 2012
Anti-Vaccine Rhetoric: When Pro-Safe Is Pro-Misinformation
http://www.science20.com/countering_tackling_woo_and_science_asds/antivaccine_rhetoric_when_prosafe_promisinformation-77038
June 10, 2012
Yes, not directly on topic, but it addresses many of the concerns.
The Problem With Dr Bob's Alternative Vaccine Schedule
http://www.immunize.org/concerns/offit_moser2009.pdfYes, not directly on topic, but it addresses many of the concerns.
June 9, 2012
So your friends add anecdotal evidence to the study's outcomes.
PhDs are meaningless when people can't make an actual risk - benefit analysis.
PS:
Vaccines – Too Few, Too Late
http://theness.com/neurologicablog/index.php/vaccines-too-few-too-late/
June 9, 2012
Unlike you, I actually read ALL of the literature.
And I understand the scientific process develops out of a consensus. I understand the value and the lack of value of a single study. I don't push a ridiculous agendas based on single lines pulled from single studies. That's not how science works. In fact, it's called cherry picking to fit your agenda.
Vaccine studies: Examine the evidence
http://www.aap.org/en-us/advocacy-and-policy/Documents/vaccinestudies.pdf
June 9, 2012
Which, of course, begs the question: Why do the more educated among us seem more likely to fall for baseless fear?
New vaccine-scheduling study deals blow to safety fears
http://arstechnica.com/science/2010/05/new-vaccine-scheduling-study-deals-blow-to-safety-fears/Which, of course, begs the question: Why do the more educated among us seem more likely to fall for baseless fear?
June 9, 2012
"it was more common for alternative vaccinators to indicate that they themselves (41%) or a friend (15%) had developed the schedule. Among the 36% of respondents who endorsed the “other” response to this query, several indicated in the free-text section that they had “worked with their child’s physician” to develop the alternative schedule."
Thus, we see how many people think far too much of themselves.
Alternative Vaccination Schedules
http://www.sciencebasedmedicine.org/index.php/alternative-vaccination-schedules/"it was more common for alternative vaccinators to indicate that they themselves (41%) or a friend (15%) had developed the schedule. Among the 36% of respondents who endorsed the “other” response to this query, several indicated in the free-text section that they had “worked with their child’s physician” to develop the alternative schedule."
Thus, we see how many people think far too much of themselves.
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