Sunday April 10th 2011Rounding the Cape of Good Hope Latitude 34 degrees 32 minutes south Longitude 23 degrees 23 minutes eastSouth Africa is still scarred from apartheid. The people are not very friendly in the big cities and crime is rampant. Many people have come down from other parts of Africa in search of jobs. Unemployment is over 25 and everywhere we saw people sleeping in Parks an
Chianti Day 26 to 30
Hello All Apologies for the lack of postings it feels like we havent stopped all week. Where did I leave you ..ahh yes Day 26 it was times to start tackling all the winter leaves and that meant sweeping collecting and then burning.sounds simple enough right and it would be if there wasnt what felt like little mountains of leaves everywhere. In some areas they had built up to be kne
To Macau and Back
I just returned from Macau I have been quite busy for the last month and have a lot of material now to catch everyone up on. My trip was what foreigners here call a visa run. This is when my legal stay in China is about up and I need to leave and return. My duration of stay is limited to 90 days so I have to take small trips to be here legally. It is inconvenient and a blessing at the same
My Dad in India
Ever since I arrived in India I have been thinking more and more about my heritage and where half of me originates from. My Dad's family are originally from Pakistan in the Punjab region and although he was brought up in Kenya his family are traditional Pakistani Muslims living now in Pakistan Kenya and England. My only involvement with my Dad's side of the family was for large family gathering
Surrounded by Tea
coming soon... technically we were in Valparai but that's not listed here...
Madurai and Bangalore
also coming soon... ish
Lots more to update…
from Rajasthan...
Delhi
Delhi.I feel like a local. I have not been anywhere near as intimidated as I thought I would in Delhi in fact I have felt very relaxed ever since I arrived... apart from the slight issue with the phone topup going a bit skewwhiff. I met a guy called Ajit through a friend a French girl from England I made in Pushkar. We met up a couple of times and as his mother lives in Allahabad he was ta
Pushkar
Lots to say about this place... soon...ish
zooming along I 75
YoSo far so good in the heading home department. Weather hot and muggy when we left both on Fri and the early part of Saturday. No much rain fortunately. Fri nite we stopped just before Atlanta that enabled us to go thru Atlanta early STy am and at that it was busy enough. It gets to be like a parking lot as you progress into Atlanta and we were doing bumper to bumper at 2
Ill
Today i feel like neardeath. I started feeling dodgy yesterday while I was sitting in a hammock outside our bedroom door and writing my blog. I felt a little bit achey and knew I was coming down with what Ed Sarah Will and Maddy had a few days ago. I also had a very bloated uncomfortable feeling in my stomach which wouldn't go away and which I'd put down to eating too much right before bed the
Poker Face
Dear Blog ReadersWe begin this week with news that has reached us from England that the Radio 1 Big Weekend will be held in Carlisle this year Laura is gobsmacked that her hometown should be represented on such a colossal scale with acts such as the Black Eyed Peas Foo Fighters and Boeun Girls High School favourite Lady Gaga will be performing. Lauras coteacher was visibly stunned at t
More updates coming soon…
meeting the family. seeing the sights Taj Mahal The Hanids in Haridwar Rishikesh My Dad and me Amritsar and the Golden Temple The cancelled train scenario Pushkar for Holi Shimla and return to Delhi.
Victorious on Jeopardy!, Watson Heads to Medical School – Medscape
Victorious on Jeopardy!, Watson Heads to Medical School Medscape Fresh from its Jeopardy! victories, Watson -- IBM's new supercomputer -- heads off to medical school to master a set of medical information and processes far more complex than those required to win a game show contest. On Jeopardy! the knowledge that ... |
Humble zebrafish being used to study disease – Boston Herald
 WHDH-TV | Humble zebrafish being used to study disease Boston Herald Professor Craig Ceol of the University of Massachusetts Medical School was among the scientists who studied the zebrafish's dark stripes to single out the gene responsible for promoting melanoma in the fish. Researchers found the same gene at high ... Zebrafish key to cure?Worcester Telegram |
Medical school to launch new grad program – Gwinnettdailypost.com
Medical school to launch new grad program Gwinnettdailypost.com SUWANEE — A master's degree in organizational development and leadership will be the newest program offered at the Georgia campus of the Philadelphia College of Osteopathic Medicine this fall. The college offers only graduate and professional level ... |
Healing breakthroughs at University of Miami Integrative Medicine Symposium – Examiner.com
Healing breakthroughs at University of Miami Integrative Medicine Symposium Examiner.com The University of Miami's 4th annual Integrative Medicine Symposium kicked off Friday April 8th with opening remarks from medical school dean Pascal Goldschmidt, MD Goldschmidt highlighted the increasing recognition of integrative and holistic medicine ... itaminSpice Featured at University of Miami Integrative Medicine SymposiumPR-USA.net (press release) |
Province to look at feasibility of a medical school in Brandon – Winnipeg Free Press
Province to look at feasibility of a medical school in Brandon Winnipeg Free Press The province will spend $350000 on a study to determine how enhancing medical education in Brandon can help increase the number of doctors in the province. Premier Greg Selinger said the study will review the feasibility of a Brandon Medical School, ... Manitoba Government to Invest $350000 for Reforms in Medical Education of BrandonFrench Tribune Brandon gets its med-school studyBrandon Sun |
The World Has Moved On
I do a lot of driving as part of my job. I am the sole Infectious Disease doctor at three hospitals and I can spend an hour or two a day in the car, depending on traffic. What prevents me from going crazy sitting in traffic is listening to podcasts and audible books. I especially like reading (and yes, audio books is reading, pedant) multivolume epics. Currently I am reading Steven King’s Dark Tower series, which occurs in a universe “where the world has moved on.” In Mid-world there was once a world with science and beauty and art, but something changed, what I do not know yet (I am only on the third volume; no spoilers in the comments), and the world moved on, leaving behind some artifacts of science and technology, but it appears to be an increasingly primitive world. Being fantasy, there is, unlike the world I live in, magic as well.
I like that phrase: “the world has moved on.” I have an understanding of the world and medicine, based mostly, but not entirely, on science. My understanding of the natural world is not complete, but mostly consistent and validated by hundreds of years of research. My undergraduate degree was in physics, and, like all premeds and medical school students, have an extensive education in chemistry, biology, biochemist, physiology, anatomy, biochemistry, etc. It all ties together nicely, especially in my specialty , where I have the most knowledge. I consider infections at many levels, from issues of single molecule changes that may confer antibiotic resistance, up through the patient and their family, and sometimes at the level of the entire planet. Truly wholistic, not the pseudo-wholism of SCAM.
The sciences gives a mostly coherent understanding of the world. Mostly coherent. It does give an understanding of the possible, the probable, the improbable and the impossible. Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned. Perpetual motion is not considered seriously by any academic physicist; if perpetual motion were an alternative medicine it would be offered at a Center by a Harvard Professor of Medicine.
Most scientists outside of medicine are aware of how easy it is to fool themselves and, by extension, others. As Richard Feynman said.
“We’ve learned from experience that the truth will come out. Other experimenters will repeat your experiment and find out whether you were wrong or right. Nature’s phenomena will agree or they’ll disagree with your theory. And, although you may gain some temporary fame and excitement, you will not gain a good reputation as a scientist if you haven’t tried to be very careful in this kind of work. And it’s this type of integrity, this kind of care not to fool yourself, that is missing to a large extent in much of the research in cargo cult science.”
My archetype for scientists fooling themselves, and others, is the story of N-rays, which I have discussed before.
For whatever reason, and I do not pretend to understand why, medical people are occasionally unable to incorporate the simple concept that unless they are very careful, they can be fooled. The result is complementary and alternative medicine. It is the place that remains after the world has moved on.
That phase constantly popped into my head as I looked at the Huffington Post sections on Intergratve Medicine. The world of medicine, at least, has moved on and left the Huffington Post behind. So much on the HuffPo Intergrative medicine site is at odds with reality that I will mention only a few of the more egregious examples of medical nonsense. HuffPo is giving Natural News a run for their money in the production of fantasy. Most striking was the homeopathic (the facts being seriously deluded; isn’t that an underlying principle of homeopathy?) article by Dana Ulman entitled Homeopathy for Radiation Poisoning. Water for radiation toxicity. Seriously. And not even heavy water, which might catch the extra neutron. And the reasoning for its use is even more goofy, if possible, than that of oh-so-silly-ococcinum.
“Because one of the basic premises of homeopathic medicine is that small doses of a treatment can help to heal those symptoms that large doses are known to cause, Ludlam suggested to Grubbe that radiation may be a treatment for conditions such as tumors because it also causes them. This incident is but one more example from history in which an insight from a homeopathic perspective has provided an important breakthrough in medical treatment.”
I suppose since smoking causes cancer you should treat lung cancer with cigarettes and since alcohol causes cirrhosis you should treat cirrhosis is with vodka and guns cause acute lead poisoning so maybe we should shoot gunshot victims. That I suppose, would be reasonable conclusions from homeopathic theory derived from metaphor and faulty metaphor that.
What nostrums are recommend for radiation therapy? Cadmium iodatum, Ceanothus, and Cadmium sulphuratum, for which there are no Pubmed references to support treating radiation toxicity, even though the author says they are a well-known remedies for that condition. Not well known to medical science I suppose. Ah the wisdom of homeopathy, where saying it makes it so.
Then the author suggests
“Calendula (marigold) is a well-known herbal and homeopathic medicine. Highly respected research has found excellent results in using Calendula ointment on people who experienced radiotherapy-induced dermatitis.”
Now why is Calendula a homeopathic medicine? I went to the original reference and it appears from the literature to be a worthwhile agent for the prevention of radiation term burns. But I am not so sure I would classify Calendula as a homeopathic preparation. According to the producers site it is “Calendula Fresh Plant 4%” and in the original article it is “is fabricated from a plant of the marigold family, Calendula officinalis. The digest is obtained by incubation at 75°C in petroleum jelly to extract the liposoluble components of the plant.” The authors do not use the word homeopathic anywhere in the reference.
Real product came containing real parts of the plant at a measurable concentrations, hardly homeopathic in nature. Calendula ointment has not been subjected to proving, nor has it been potentiated, as if either are helpful. It is not a homeopathic preparation just because a preparation made by a producer of homeopathic nostrums, although that appears to be the reason. It is a new definition of a homeopathic preparation: if it is made by a homoepathic producer it is therefore a homeopathic preparation. By this standard, the effluent of the Boiron toilets would also be considered homeopathic preparations.
When it comes to homeopathy, not only has the world moved on, rational thought and consistency has moved on.
And there is acupuncture. There is a link to an article entitled As Medical Costs Rise More Americans Turn to Acupuncture. This is an article from AOL linked from the Huffington Post (now owned by AOL). If you want to get the heebie-jeebies take a look at the opening picture on that page. The text says “Practitioners must use needles produced and manufactured according to U.S. Food and Drug Administration standards, which require needles to “be sterile, nontoxic, and labeled for single use by qualified practitioners only.” The needles may be sterile, but what good is a sterile needle used by a bare hand?
Look at the accompanying photograph. That middle finger does not inspire confidence. It is no wonder that acupuncture is associated with outbreaks of hepatitis C, hepatitis B, and MRSA infections. Most the pictures of acupuncture on this website demonstrate that acupuncturists lack understanding of basic technique. It is hard to infect people with an injection. Heroin users inject themselves with a rich melange of bacteria every day without getting infections. It is hard to infect patients in the hospital with blood draws and IV’s. But if an infection can happen, it will happen. And those fingers, just recently in a nose, or picking a tooth, or scratching a butt, will spread an infection with an acupuncturist’s needle to one unlucky patient. Not only has the world moved on for acupuncture, it took with it an appreciation of germ theory.
The Huffington Post seems to be immune from advances in understanding of all of so-called intergrative medicines, or even basic anatomy and physiology. They link to a video entitled The Meridian System in Oriental Medicine. They might have linked to the anatomy of Orcs or the physiology of Dementors, for all the application to reality it represents. The video is gibberish when compared to nature as we understand it. The world has moved on.
When Huffington Post published absolute nonsense, I have to wonder how good their analysis is on issues like politics, war, the environment and other important areas. I was always taught to judge a man by the company he keeps. I have the same problem with my local newspaper, the Oregonian, which publishes the occasional nonsense piece in the Living section. They often get things wrong in Infectious Diseases, the one area I have expertise. If they are wrong in areas I know, can I trust their writings on other topics?
When I finish the series, I’ll let you know, metaphorically, what the alt med Dark Tower is.
Can Vitamin C Induce Abortion?
Editors Note: This is a guest contribution from two medical students, one from Chicago and one from Queensland. If you like their work, we’ll consider having them write more for us.
Authors:
Andrey Pavlov Jr.
UQ-Ochsner
University of Queensland School of Medicine
Igor Irvin Bussel
Chicago Medical School
Rosalind Franklin University of Medicine and Science
In hopes of joining the SBM movement as medical students, we wanted to take aim at a topic that has yet been finely dissected a la Novella or logorrheicly dismembered a la Gorski. Having realized that a fellow medical student, Tim Kreider, is already addressing integrative medicine on campus, we decided that we would attempt to find a controversial topic that has yet to be addressed on SBM. A serendipitous question from a friend sent us on a mission to explore the pseudo-scientific underbelly of the web and science-based rationale of the claim that vitamin C can induce abortion.
The World Wide Web is a stranger place than we can ever imagine. Most users are aware that they can’t believe everything they read on the Internet, yet they often feel like Sherlock Holmes when they find an esoteric and isolated clue to their own unique health puzzle. Recently, we were asked if there was a connection between vitamin C, menstruation and abortion. We were caught off guard by the question, finding it such a strange connection to make. The story, it seems, is that our friend had come down with a cold and taken mega doses of vitamin C to stave it off (another false belief, but not the subject here). A couple of days later her menses began and she was surprised since it was 4 days earlier than normal. She of course turned to Dr. Google and was quickly provided with numerous sources indicating that indeed, vitamin C would induce the start of a menstrual cycle and can even act as a “natural” abortefacient and a substitute for the ‘morning after’ pill. Being a bit more keen than your average Dr. Google user, she was surprised and continued searching, trying to find evidence to contradict these claims. Alas, she found nothingexcept more sites parroting and corroborating the claim. Then she realized she knew a couple of medical students and asked us what we thought. Our literature review turned up a slew of websites using the standard repertoire of trite pseudo-scientific tactics. Any attempt to find a credible source, validated claim, or independent consensus proved futile.
At the time of this writing, Google yielded over 400,000 results when searching for “vitamin C abortion” and around 45,000 results when searching “ascorbic acid abortion.” While both search queries resulted in about 38 entries on PubMed, nothing was found using Up-To-Date or Cochrane Collaboration. However, regardless of query terms, we could find no sites that refuted the claim of vitamin C as an abortefacient.
The top returned website references a Russian article written in 1966 by Samborskaia and Ferdman. This site will be the focus of our piece since it appears the most legitimate having a complete “references cited” section. This gives the illusion of credible research and bears thorough debunking. Sadly, the Russian article is the most relevant and “scholarly” article. The author of the site offers this analysis to support her claim:
The article is in Russian, and finding a copy was a problem… as was the language barrier. I had been corresponding with a lady from Slovak Republic (Slovakia) and mentioned the article. She went out looking for it, and was able to find a copy. She was able to translate it for me, and noted that the author did not specify the doses of ascorbic acid administered to the women, and the author also did not say specify how the women received the ascorbic acid; ie, liquid, injection, tablet.
The scientists who conducted the research, Samborskaia and Ferdman, came to the conclusion that high doses of Ascorbic Acid appeared to increase estrogen levels which contributed to the interruption of an otherwise normal pregnancy. 20 women who approached doctors requesting an abortion participated in the study. Research was conducted by ob/gyn L.I. Ivanyuta. The women ranged from 20 to 40 years of age. The article does not say if a positive pregnancy test was obtained from the participating women. We also don’t know how much ascorbic acid the women were given. They did however measure estrogen levels before and after treatment with ascorbic acid, finding that estrogen levels were higher after taking the ascorbic acid. Of the 20 women, 16 began menstrual type bleeding within 1 to 3 days from administration of ascorbic acid.
So the evidence cited here is from an article the author could not find, in a language she could not understand, translated by some unknown woman in Slovakia, with a sample size of 20, no known dosages or methods of administration, and even an admission that there was no documentation that all 20 women were even pregnant. Already riddled with biases, flaws, and fallacies, the author continues:
Also, in my own personal research, I’ve come into contact with numerous women who did confirm their pregnancies with a test, then used ascorbic acid (sometimes in conjunction with other herbs) to terminate those pregnancies successfully… While it can’t be considered scientific data, it is none-the-less proof that these home remedies do work for some women.
That which can’t be considered scientific data can’t be asserted as proof. This is a common failing in pseudo-scientific writings – an appeal to some other form of proof or “other ways of knowing.” The author continues with the empiric discussion:
It is said that on average 1 in every 4 pregnancies end in miscarriage. This would be 25% of all pregnancies. Statistics vary somewhat, and age is a factor, some say as few as 16% up to as much as 30% of all pregnancies end in miscarriage. A government website says 50% of all fertilized eggs die or are lost spontaneously – usually prior to the woman knowing she is pregnant, many of which do not implant in the uterine wall. In known pregnancies, they say that about 10% miscarry naturally and this normally happens between the 7th and 12th week of pregnancy. With this in mind, observations from my own research and data collection, about 45% of women with confirmed pregnancies are successful when using vitamin c (ascorbic acid) with the intention to end a pregnancy at home. This is well above the estimated rate of natural miscarriages (non-induced), so even if some of these women would of miscarried on their own without the steps they took to induce miscarriage at home (10% of known pregnancies miscarrying naturally or 1 in 4 pregnancies (known or unknown) ending naturally) these figures do not account for the increased rate of spontaneous abortion that I’m seeing through the data these women voluntarily provide.
The author cites a wide range of data on spontaneous abortion rates and concludes that “up to 30%” of all pregnancies end in miscarriage, though “a government website says 50% of all fertilized eggs die or are lost spontaneously”. From her own personal anecdotal “data” she finds that “45% of women with confirmed pregnancies are successful when using vitamin C… with the intention to end pregnancy at home.” For her, this is “well above” the estimated rate of “natural miscarriages” and therefore evidence that vitamin C works for this purpose. She further states that if the attempted vitamin C abortion does not work, it is important to go ahead and obtain a clinical abortion since even though the USDA does not list vitamin C as teratogenic, such a mega dose in an embryo has “too many unknowns” and one should not risk “having a messed up kid.” How can we ignore such sage medical advice and dutiful statistical analyses?
At least she can admit that “[n]atural or do-it-yourself does NOT mean it is SAFE [her emphasis].” That is about the only redeeming part to this travesty of medical advice. However, even the author’s own “statistics” indicate that, at best, there is only a very slight increase in the rate of abortion with vitamin C over spontaneous miscarriage. Considering the very small sample size, poor data quality, and complete lack of rigor it is safe to say this is either just completely false or normal noise with no statistical significance at all – not that we could even run a statistical analysis with the “data” we are given. Once again, the common pseudo-science tactic of asserting a statistical conclusion with no actual analysis rears its head.
Although we focus here on only one site devoted to this “naturalistic” nostrum, the remaining sites we found either reference this one, the original Russian article, or simply parrot the same piffle with no references at all. For example, NaturalMiscarriage.org has similar preposterous claims to the efficacy of many herbal abortefacients, including vitamin C, and even claims that in their respondent survey that 171 of 235 women (73%) who tried vitamin C had successful miscarriages. A few lines down we find that 93 of 118 women (79%) who tried “visualization and prayer” had a successful miscarriage. And apparently 38 of 46 women (83%) who tried avocados had a successful miscarriage – so we should clearly suggest avoiding guacamole at your church social if you are pregnant.
This pseudo-scientific claim has already failed from an evidence-based medicine perspective, but how about throwing a little science in the mix and conjecturing a prior probability? From the only article cited as reference to a human population, the mechanism is described as both “elevating estrogen levels to interrupt a normal pregnancy” and the “acid” of ascorbic acid (vitamin C) acting to disrupt the endometrium directly leading to the sloughing of menses. A quick PubMed search reveals four articles relating in at least some way to “vitamin C and abortion” in humans. One is a 2005 Cochrane review that examines multi-vitamin prenatal treatment as a prevention of miscarriage and stillbirth (not specifically vitamin C) and finds no relation between miscarriage and prenatal vitamin consumption. A 2011 update to the review holds the same conclusions. Two have no article or abstract available (one is in Polish from 1987 and the other in the Lancet from 1974). The last one is also a very small study (n=50) and found no causal relationship between vitamin C and spontaneous abortion. Furthermore, any biology undergraduate who passed physiology would know it is the drop in hormonal levels (including estrogen) that triggers the start of menses. Additionally, from a simple physiological point of view, the notion that ingesting a large amount of “acid” can alter the pH balance of the endometrium significantly enough for a physiological response is ludicrous. There is no mechanism by which vitamin C would be preferentially localized to the uterine wall and if the blood pH was changed enough to cause an endometrial sloughing, late menses would be the last of your worries.
In today’s political climate in America, especially in light of the recent vote to remove the federal funding for Planned Parenthood, having access to accurate medical advice based in science is important, regardless of your personal stance on the issue. Notably, based on a 2011 study in the American Journal of Obstetrics and Gynecology, 1.4% of 9,493 women surveyed, reported using vitamin C or herbal products to attempt to end a pregnancy. Though this is not an urgent danger to public health, others on the web have snagged onto this idea and have begun posting this same advice on forums such as eHow and women are actually seeking advice since these authors give the impression of authority on the matter. The startling thing is that there are simply no sources out there that say anything else about vitamin C and abortion – every searched source claimed efficacy of the method. The echo chamber of the Internet repeats the original assertion without any information to the contrary. For a person like our friend, there is little recourse except to assume that there must be some truth to this farcical claim. She had us to ask and it is our hope that this piece will give others a credible source to refute the claim that vitamin C induced abortion is legitimate.
