Glucosamine Update: A New Study and a New Product

When I recently wrote about glucosamine, I discussed the evidence up through the New England Journal of Medicine study of 2006, which I thought was a pretty definitive study showing that neither glucosamine, chondroitin or a combination of the two was more effective than placebo.  Subsequent studies have continued to fuel the controversy. One 2007 study showed that glucosamine sulfate was better than placebo for knee osteoarthritis.  Another 2007 study showed...

/ February 26, 2008

When the popularity of new surgical procedures outpaces science

In science- and evidence-based medicine, the evaluation of surgical procedures represents a unique challenge that is truly qualitatively different from the challenges in medical specialties. Perhaps the most daunting of these challenges is that it is often either ethically unacceptable or logistically impossible to do the gold-standard clinical trial, a double-blind, randomized placebo trial for an operation. After all, the “placebo” in...

/ February 25, 2008

Prior Probability: the Dirty Little Secret of “Evidence-Based Alternative Medicine”—Continued

This is an addendum to my previous entry on Bayesian statistics for clinical research.† After that posting, a few comments made it clear that I needed to add some words about estimating prior probabilities of therapeutic hypotheses. This is a huge topic that I will discuss briefly. In that, happily, I am abetted by my own ignorance. Thus I apologize in advance for simplistic or incomplete...

/ February 22, 2008

Iraq civilian deaths II: Summing up

Call me naive, but I did not expect the volume or the emotional depth of the responses to the Iraqi civilian death post. I thought many would respond to the new NEJMed survey as I did; wondering about the validity of the previous surveys and recognizing that they have a validity problem. And, that there is a question about what is printed...

/ February 21, 2008

Proposed Changes to FDA Regulation Present a Dilemma

The Food and Drug Administration (FDA) is proposing a very interesting loosening of their regulations of pharmaceutical company marketing. The pros and cons of the proposed changes present an interesting dilemma, with legitimate points on both sides. When the FDA approves a drug it is approved for a very specific medical indication. I have long thought that FDA approved indications for drugs...

/ February 20, 2008

Antibiotics for Sinusitis

You’re a patient. That cold just isn’t getting better and you have purulent drainage from your nose, and your face hurts and your teeth hurt. You probably have sinusitis, right? You go to a doctor to get an antibiotic. You’re a doctor. Deep down, you know there’s a good chance the patient has a self-resolving condition.  You’d rather not do x-rays on every patient who...

/ February 19, 2008

Toxic myths about vaccines

Antivaccine activists would have you believe that vaccines are loaded with "toxins" and are therefore dangerous. While there are some chemicals that sound scary in some vaccines, they dose makes the poison, and at the tiny amounts used in vaccines none of these "toxins" are harmful.

/ February 18, 2008

Prior Probability: The Dirty Little Secret of “Evidence-Based Alternative Medicine”

This is actually the second entry in this series;† the first was Part V of the Homeopathy and Evidence-Based Medicine series, which began the discussion of why Evidence-Based Medicine (EBM) is not up to the task of evaluating highly implausible claims. That discussion made the point that EBM favors equivocal clinical trial data over basic science, even if the latter is both...

/ February 15, 2008

Alternative Medicine, and the Internet

When I think back to my own ‘discovery’ of the skeptical movement, it grew out of my experience watching the James Randi Secrets of the Psychics NOVA special. After being enthralled with the special (and with several Randi books already in my library) I sought Mr. Randi out on the Internet. In chat rooms, blogs, forums and skeptical conferences such as TAM...

/ February 14, 2008

Super Fruit Juices – The New Snake Oil

The core principle of science-based medicine is that health care decisions should be based upon our best current scientific evidence and understanding. When applied to the regulation of health products this means that health claims should first be required to meet some reasonable threshold of scientific evidence before they are allowed. Admittedly this is not a purely scientific question but the application...

/ February 13, 2008