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Science-Based Medicine

Exploring issues and controversies in the relationship between science and medicine

Psychological support and breast cancer - againYesterday

Does the degree of efficacy is depend on the time at which it is measured? Apparently so. The case of psychological support and breast cancer longevity again.

After an original 1989 report of positive effects on metastatic breast cancer, by 2006- 7 the majority of RCTs on such effects had settled the issue in the negative. This was only after 20 years of repeated research grants and RCTs based on hunches and feelings that somehow emotional support really affected the course of cancer. Investigations continued despite analyses showing the few original positive studies had been so flawed in design or defective in reported details, that they should have been dismissed and perhaps excluded from systematic reviews. (Spiegel D, Bloom JR, Kraemer H, Gottheil E. Psychological support for cancer patients, Lancet ,1989 Dec 16;2(8677):1447., Fawzy FI, Fawzy NW, et al. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence an survival 6 years later. Arch Gen Psychiatry. 1993 Sep;50(9):681-9.)

But to advocates, conflicting results served as motive to prove the claims by repeating the studies for 20 years, “doing them right this time.” As of mid-2008, consensus was the issue was still “negative.” Now another study, claimed to be positive, makes the news.

Here is the part of the abstract of the latest study, published in the December 15 issue of the journal Cancer:

METHODS. A total of 22

Open-Access Peer Review: Increasing the Noise To Signal RatioYesterday

Readers of Science Based Medicine are quite familiar with the distressingly common logical leap made by disgruntled healthcare consumers into alternative medicine. It goes something like this: I had a terrible experience with a doctor who [ignored/patronized/misdiagnosed] me and I also heard something horrible in the media about a pharmaceutical company’s misbehavior [hiding negative results/overstating efficacy/overcharging for medications], therefore alternative treatments [homeopathy/acupuncture/energy healing, etc.] must be more effective than traditional medicine.

Much to my dismay, a similar logical leap is being made about online health information. It goes something like this: Peer reviewing is biased and often keeps innovative research hidden to the world at large, therefore the best kind of peer review is open-access where anyone in the world can contribute.

You may feel free to slap your forehead now.

While I have absolutely no doubt that doctors have their shortcomings, and that some have created less than pleasant healthcare experiences for their patients – the solution to these shortcomings is not to dive headlong into snake oil. Moreover, I agree that the current peer-review process has its flaws and limitations – the solution is not to ask Aunt Enid in Omaha what she thinks of the recent meta-analysis of perioperative beta blockers in patients having n

Dr. Jay Gordon – “Anti-Vaccination”December 3

Dr. Jay Gordon is a pediatrician and one of the stars of the anti-vaccinationist movement. (Dr. Gorski wrote an exellent criticism of many of his claims recently on SBM.) He is, in fact, the pediatrician to Jenny McCarthy’s son, Evan (who she claims was injured by vaccines). Several months ago he published an “open letter on vaccinations” which is now making the rounds on anti-vaccine websites. The letter is a work of pure arrogant pseudoscience – a crafted piece of anti-vaccine propaganda. He begins:

I don’t give a lot of vaccines.

I still give DPT vaccinations to some children, chicken pox shots to kids who haven’t been able to acquire natural immunity by age ten years or so, and I give polio vaccines very infrequently. The polio vaccines are given for what I call “emotional” reasons because my exposition of the “numbers” (2000 cases of polio out of six or seven billion people) doesn’t counteract the very strong memory of a beloved aunt or uncle who had polio in fifties or sixties. And many parents feel much more comfortable traveling to India or parts of Africa with updated polio immunity for their children and themselves. By the way, 2007-2008 statistics don’t support that discomfort, but I don’t argue much.
In 2007, there were 1314 cases of p

Does TV Cause Teen Pregnancy?December 2

I’ll be the first to admit that the quality of TV programming, especially network programs, leaves much to be desired. Critics of television have blamed TV for everything from violence to obesity. Now studies have shown that teens who watch sexy programs are more likely to become sexually active and to get pregnant. I’m not so sure that these studies really show what TV critics think they show. My local newspaper was equally skeptical.

We frequently criticize media coverage of scientific issues, so for once I’d like to offers kudos to the Tacoma News Tribune for publishing this editorial:

TV and teen pregnancy: A lot else is also at work
THE NEWS TRIBUNE
Published: November 5th, 2008 12:30 AM

For parents, the headline was ominous: “Study links TV, teen pregnancy.”
The article that appeared in The News Tribune Tuesday reported on a Rand Corp. study published in this month’s issue of Pediatrics magazine. Researchers say they found a link between higher teen pregnancy rates and watching television shows that have lots of sexual dialogue and behavior – ones like “Sex in the

Do over one in five breast cancers detected by mammography alone really spontaneously regress?December 1

It figures.

Last Wednesday, right before the four-day Thanksgiving holiday weekend, as I was far more interested in preparing to have family over the next day than in what was going on in the medical news or the blogs, the results of a most fascinating study hit the news. In Medscape, the title of the news report was Mammography Study Suggests Some Breast Cancer May Spontaneously Regress; on WebMD, the story ran under the title Can Breast Cancer Disappear?; on Medical News Today, Mammograms May Identify Cancers That Would Otherwise Just Regress by Drs. Per-Henrik Zahl, Jan Maehlen, and H. Gilbert Welch. Not surprisingly, the study found its way out of the medical news and into