Week in review 13/11/2012

Here it is guys, some more tidbits from the world of science and skepticism;

More Than a Quarter of St. Louis EMTs Don’t Get Flu Vaccines, Saint Louis University Study Finds

http://www.newswise.com/articles/more-than-a-quarter-of-st-louis-emts-don-t-get-flu-vaccines-saint-louis-university-study-finds

A Saint Louis University study reveals that more than 25 percent of St. Louis area Emergency Medical Technicians (EMTs) do not get vaccinated against the flu.
Published in the American Journal of Infection Control, the study indicates that the seasonal influenza vaccine compliance for St. Louis EMTs still remains far below the 90 percent target outlined by the U.S. Department of Health and Human Services’ Healthy People 2020 program…

…The study, funded by the Saint Louis County Department of Health, gauged the seasonal and H1N1 influenza vaccine compliance and whether or not St. Louis EMTs planned to get vaccinated. It also measured the attitudes and beliefs of EMTs about the seasonal influenza vaccine. Sixty percent of EMTs who did not get vaccinated said they do not trust the public health authorities when they say the influenza vaccine is safe, and about a third said that flu vaccine has a lot of side effects and reported being afraid of them. More than half in this group also said they do not believe they can play a role in transmitting influenza to their patients if they are not vaccinated.

There are a few points from this that are very worrying indeed. I don’t think it would be speculating too wildly to think that you could generalise from this study to other regions, and nations. EMTs are on the front line and as such interact with more patients than nearly any other health professional, especially the elderly who are most at risk from influenza. For health professionals the flu vaccine is not just to protect the immunised, but also to protect the people they come into contact with. Previous studies have shown that at risk groups like the elderly are not nearly as likely to receive the flu vaccine than is necessary, which means the will be depending on the vaccination status of others to prevent catching the flu, which can be fatal. Which is why it’s all the more important that healthcare professionals get the vaccinations they require, vaccines like the flu and whooping cough boosters.
What is more surprising to me is the distrust that 60% of the non-vaccinated have for their own profession. It really demonstrates the up-hill battle we are facing as skeptics and activists to prove that modern medical establishments aren’t part of some money making conspiracy, with peoples lives caught in the middle. The fact of the matter is that pharmaceutical companies are already hesitant to produce vaccine due to the risk of legal action over vaccine injury, vaccines aren’t hugely profitable either.
Perhaps the most disappointing finding though is the clear lack of education that lead more than half of the non-vaccinated to believe that they were not capable of transmitting the flu to their patients. Working in the health industry myself I have all too often been witness to shocking gaps in what should be common knowledge to any health professional, especially in matter where patients lives are literally on the line. Clearly more resources are needed to keep members of our healthcare systems up to date.

Mike Lacelle Passed Away

http://www.facebook.com/theskepticsguide

Last night around midnight our friend Mike Lacelle passed away. We will be talking about him on the next show and his silent contributions to skepticism.

The sad news came last week that friend and contributor to the podcast Skeptics Guide to the Universe Mike Lacelle passed away. This is the second death to rock the show after the great Perry DeAngelis passed away several years ago. Mike was an enthusiastic fan of the show creating the SGU fan site as well as countless hours of behind the scenes contributions to skepticism’s most popular podcast; The Skeptics Guide to the Universe. His work ethic was a real inspiration to me, he showed that we can all make a difference, even if we don’t get the glory we feel we might deserve. Condolences to Mike’s family and friends, he will be missed but not forgotten.

New Study Updates Statistics on CAM use in Autism

http://pediatrics.aappublications.org/content/130/Supplement_2/S77.full.pdf+html

Children with ASD use more CAM when they have coexisting

gastrointestinal symptoms, seizure disorders, and behavior

problems. This study suggests the importance of asking about CAM

use in children with ASD, especially those with complex symptoms.

The journal Pediatrics recently published a study about complementary and alternative medicine use in paediatric patients with autism with some interesting results. 28% of the 3173 patients sample reported use of CAM therapies. For all the publicity CAM gets, especially with autism this result is actually surprisingly low, though admittedly still too high. There was a correlation between increasing severity of disease and increased likelihood to use CAM therapies. There was also a correlation between increased wealth and increased likelihood to use CAM. This is not really that surprising, I would speculate that the more severe the disease, the more distressing for the parents and therefore the more likely the parents would be to seek alternative therapies and wealthier parents are more likely to be able to afford the sometimes expensive CAM treatments.

In the good news category Chelation therapy, a dangerous and thoroughly unsupported treatment according to the evidence was reported by only 0.6% of the 3173 respondents, this is down from as much as 7% in previous studies. Perhaps all the work of skeptics and scientists has been paying off when it comes to these kinds of treatments?

For more information the original article is available in full for free and doesn’t contain too much scientific jargon.

http://pediatrics.aappublications.org/content/130/Supplement_2/S77.full.pdf+html

For a great review of CAM therapies used by autism patients and the evidence behind the claims I highly recommend this article.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597185/

Natural is not the same as safe

Herbal remedies linked to drug side effects

http://www.telegraph.co.uk/health/healthnews/9636982/Herbal-remedies-linked-to-drug-side-effects.html

Interactions between prescription drugs and herbal or dietary supplements can cause complications including heart problems, chest and abdominal pain and headache, according to a review of existing evidence.

Remedies and supplements including ingredients like St John’s wort, magnesium, calcium, iron and ginkgo caused the greatest issues, researchers reported in the International Journal of Clinical Practice.

Experts from the China Medical School in Taiwan studied data from 54 review articles and 31 independent studies involving 213 herbal and dietary supplements and 509 prescribed drugs.

A total of 882 linked effects were observed, with warfarin, insulin, aspirin digoxin and ticlopidine among the drugs which were most affected.

Flaxseed, echinacea and yohimbe, a stimulant and aphrodisiac found in Africa, were the herbal ingredients which were found to cause the greatest number of drug interactions.

It seems these days that one of the most common logical pitfalls I come across is the naturalistic fallacy. It’s everywhere you go, from those natural herbal supplements, natural milk, pretty much everything is marketed as natural at the moment, it’s the big buzz word, probably surpassing organic.

For those that aren’t aware of the naturalistic fallacy it is the flaw in logic that describes that because something is natural it must be beneficial, or at least not harmful. It doesn’t take much to dispel this particular fallacy. I like to point out that arsenic, cyanide, snake venom and crude oil are natural, and I sure wouldn’t want to ingest those.

So let’s talk about this recent literature review, it highlights what the medical profession and Skeptics have been trying to put across for years. News Flash! Herbs are drugs! That’s right folks, they are not inert, and they actually have physiological effects on your body. Unfortunately they are not normally the effects that are claimed on the bottle.

The biggest problem is that patients rarely report to their doctors what supplements they are taking because they don’t consider them to be drugs, it doesn’t even occur to most people. The fact is that most of our potent pharmaceuticals were found in nature, the difference between a pharma drug and a “natural” remedy is that pharmaceuticals are refined and defined. This means you take a pure form of the drug and you know how much you are taking. The same cannot be said for herbal remedies.

Why is this an issue? It’s because of the aforementioned non inertness of herbal remedies. While a lot of herbal remedies don’t really have a big effect by themselves (with the exception of some quite toxic remedies) they can react with real drugs that you are taking at the time. St Johns Wart is just one example, and probably the most well-known, this study also identified flaxseed and Echinacea. These are all commonly taken supplements that could be harming unknowing patients who are taking prescription meds. Heart problems are serious and potentially life threatening, whilst headaches, chest and abdominal pain are nothing to be sniffed at.

The moral to this story is that tell you doctor EVERYTHING, honestly you just don’t know how useful and even potentially lifesaving this could turn out to be.

Acupuncture and poor science… again.

A study published in the Journal of Clinical Oncology this week has concluded that acupuncture can decrease cancer related fatigue in breast cancer patients. However concluding something and finding something are two separate beasts.

In this study, 227 breast cancer patients were treated with acupuncture alongside the usual care they receive, 75 patients did not receive acupuncture but continued to receive their normal care. In order to asses fatigue levels, anxiety, depression and quality of life, established 20 point scales determined by questionnaires were performed and the results show that on average the acupuncture patients improved on all assessments compared to the non-acupuncture group.

That sounds promising doesn’t it? Surely the only thing you might conclude from this study is that acupuncture can reduce fatigue in breast cancer patients? Well not exactly no; what we can conclude from these results is that acupuncture might reduce fatigue in breast cancer patients and here’s why.

Clinical science is a funny old thing, this is mostly because human beings are a fairly odd sort with complicated psychology and what some may call intelligence. This means that studying the effects of health care interventions is a lot different from studying say physics. The laws of physics are immutable and constant, if you were to drop a ball with the exact same weight and dimensions from the same height with the same force and the exact same environmental conditions, the ball would take exactly the same amount of time to hit the ground, every time. Humans though, not so much.

How do you feel right now? It seems like an easy question but I’m willing to bet that you had to think quite hard about it, chances are if I asked you tomorrow you might not give me the same response, even though little will have changed. This is because human emotions and perception is affected by the experiences and expectations you gain from your existence. This is what makes clinical trials quite tricky, if you are told that you are getting a treatment, you might expect to get better, then when you are asked if you feel better you think that you do, because it’s what you expect. This is called the placebo effect.

So let’s get back to why the conclusion from this study is not congruent with the results they obtained. The author described this study as a “Pragmatic Study”, what this means is that is a real world study. Usually a pragmatic study is used to make an observation and then form a hypothesis. In order to reach a conclusion you must do a controlled trial that accounts for all the variables that are reasonable to control. Concluding that an effect exists from a pragmatic study is just plain poor science.

In the study there were two groups, one that did not receive acupuncture and a group that did. As stated earlier the group that received acupuncture improved on all measured levels of wellbeing by a small amount, which might suggest that acupuncture is useful as a treatment, however that is all you can surmise from those results, it might be useful. This is because the study did not control for the other variables that might account for these results.

Let’s talk about blinding, this is a tool used by scientists to remove variables such as the placebo effect. Blinding means that the patients do not know whether they are receiving the treatment or not. This is important because if the patient doesn’t receive a treatment but still reports an improvement the effect can’t be due to the treatment, but more likely because they expected to improve. If the effect from the treatment group isn’t stronger than the placebo group, it is safe to assume that the treatment is no more effective than no treatment at all.

What this trial needed then was a third group, this group would have received a placebo type of treatment, this involves using fake needles that retract rather like a stage knife, or the acupuncture is done in none-acupuncture points (although this makes the assumption acupuncture must be done on certain points on the body and isn’t just the process of inserting the needles) my preference would be the fake needles because these don’t actually pierce the skin. Importantly the subjects would not know whether they were receiving “real” acupuncture or the placebo acupuncture.

If the results of this trial had then shown that the real acupuncture group had a bigger effect than both the non-treatment and placebo acupuncture group, that would have been more interesting and the conclusion that acupuncture is effective rather than might be effective is much more valid.

At the least this trial should have included a group that received another form of alternative treatment such as massage or aroma therapy. While this still doesn’t allow us to make firm conclusions about the effectiveness of acupuncture it would at least indicate whether the effect was specific to acupuncture or not.

The fact is that a non-blinded, non-placebo controlled study is almost worthless to our understanding of whether something works or not. For the author of this study to make such a definitive conclusion shows a poor lack of knowledge about the scientific method and at worst an agenda to promote acupuncture. That this article was published in a reputable journal is all the more disappointing.

doi:10.1200/JCO.2012.41.6222

#006 Sciencism: Critical Eye – 24/11/2011

This week in Sciencism: Critical Eye, Ross Balch is joined by Natalie McKirdy, Dan Abrahmsen and David Balch. We discuss exorcism, gecko trade for traditional medicine, measels outbreak in the UK, hypothes.is new website, 7 year old girl who is “crying” stones and a multiple UFO event over Seattle.

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#005 Sciencism: Critical Eye – 18/11/2011

In Sciencism: Critical Eye this week; host Ross Balch is joined by Dan Abrahmsen. In science news we discuss why people with sickle-cell anaemia get increased resistance to malaria, a computerised pathologist, magentic cows, the official extinctions of the western black rhino and a new “albino spider”. We talk about the issues of censorship and ideological bias affecting science jouralism. There is an urban legend about “seeing” a nuclear blast even if you are blind. We also have the skeptical news including spontaneous human combustion, strange objects seen on google earth in China, more Jesus pareidolia and strange numerology rituals surrounding 11/11/11. We round off the show by analysing the “evidence” for why powerade improves your performance.

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#004 Sciencism: Critical Eye – 10/11/2011

This week in Sciencism: Critical Eye, Ross Balch is joined by Dan Abrahmsen. We discuss a couple of lion sightings, Dr Melba Ketchum’s statement regarding big foot evidence, a psychic accepts an award on behalf of Kurt Cobain, the White House answers UFO petition and sneaky anti-vaccination campaigns.

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