Space Advertising – Then and Now

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Keith's note: With the popularity of retro TV shows such as "Mad Men" comes a second look at how we used to advertise things in the 1960s - products, ideas, etc. The early space age was an exciting time when we were doing things no one had done before - and we were pretty proud of doing it. Some of the artwork is rather classy and, with a few tweaks, might even work today. If you go to this page at io9 you will some examples of ads from the dawn of space exploration.

Reaching for the Stars When Space Was a Thrill, NY Times

"... Or the American Bosch Arma Corporation showing off, in Fortune, its "Cosmic Butterfly," a solar-powered electrically propelled vehicle to ferry passengers and cargo across the solar system. Most Americans never saw these concoctions, but now they have been collected and dissected by Megan Prelinger, an independent historian and space buff, in a new book, "Another Science Fiction: Advertising the Space Race 1957-1962." It is being published on May 25 by Blast Books."

Practice Fusion: Do the math: $44,000 is a LIE

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Practice Fusion:

You get $44,000 for using an EHR,

Practice Fusion is entirely free.

Do the math.

Ok.

Lie: You get $44,000 for using an EHR

Fact:  [ARRA § 4101] If an “eligible professional” is a yet-undefined “meaningful EHR user,” they could quality for Medicare and Medicaid “incentives” of “an amount equal to 75 percent of the allowed charges under this part for all such covered professional services furnished by the eligible professional during such year” from the to-be-established “Federal Supplementary Medical Insurance Trust Fund” not exceeding:

  • 2011: $15,000
  • 2012: $12,000
  • 2013:  $8,000
  • 2014: $4,000
  • 2015: $2,000
  • 2016: $0

Then, Medicare and Medicaid will penalize you up to 5% by the end of the decade from their rates which are already the lowest in the industry —unless you can prove to them why they shouldn’t. You probably won’t.

Commentary:

There is no $44,000.

Maybe you can apply for a few extra thousand dollars in medicare disbursements over several years if you are particularly sophisticated and already participate in Medicare or Medicaid.

Most practices will lose significant gross revenue from HITECH penalties by default.

Anybody who says otherwise is trying to sell you something dubious —probably more consulting to buy more consulting about how to save money through hiring consultants.

If $15,000 in 2011 is enough to matter to your practice, you are either a clueless medical student or about to go out of business.

Tea Party, Coffee Party, and now a Soda Party for New York Taxpayers

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Libertarian Republican interviewed Governor candidate Warren Redlich last night about his plans to launch a statewide "Soda Party" around Tax Day to protest Gov. Paterson, and NYC Mayor Bloomberg's proposed Sugary Sodat Tax. The duo is pushing the tax to "help save education and health services" from budget cuts.

From Politics Daily, March 8:

"An extra 12 cents on a can of soda would raise nearly $1 billion, allowing us to keep community health services open and teachers in the classroom," Bloomberg said in Sunday's speech. "And, at the same time, it would help us fight a major problem plaguing our children: obesity."

Redlich sharply disagrees with the Paterson-Bloomberg soda tax, pointing out that store-brand colas cost about 88 cents for a 2 liter bottle: "Paterson and Bloomberg want to slap a 68-cent tax on them. Do you know who buys store-brand sodas? People who can't afford Coke!"

The broad spread of the tax is also bothersome. "It's on 'sugared drinks.' That includes Gatorade, which is not only healthier than sodas, but also has fewer calories than fruit juice," Redlich noted.

Seeking support from the various Tea Party groups in New York, Redlich believes the soda tax is an issue that can bring them all together. "That's not how you operate when you have budget problems. You don't stick it to the regular people who are trying to get by," said Redlich.

If the soda tax makes it into the state budget, Redlich says there will be a Soda Party: "The original patriots dumped tea in the harbor. Pouring soda on the Capitol will be a wake-up call to Paterson, Silver and everyone else inside that bubble."

"NYS and NYC needs to look into cutting spending before thinking about driving more hard working taxpayers out of New York with more nanny taxes, which will reduce tax revenue, not increase them. Warren has the right idea with a Soda Protest Party," said Steven Vasquez, a NY State Tea Party organizer and NY State Coordinator for Campaign for Liberty.

Redlich told LR that other groups are already signing up like 9/12, 1776, and the Campaign for Liberty. It looks like the rally will be scheduled for Saturday, April 17 (right after Tax Day), at the Capitol in Albany. They are considering the use of a replica of the State Capitol to dump the soda on, right on the steps of the real Capitol. Obviously, environmental restrictions and good manners keep them from dumping the soda on the premises itself.

And what brand of soda will be used? Redlich says:

"Sam's Choice or some other price chopper brand, cause budget-minded New Yorkers will be hurt the most."

Warren Redlich is an attorney and local town councilman. He is a candidate for Governor seeking the nominations of both the Libertarian Party and Republican Party (against the favored Rick Lazio).

wredlich.com/ny

HUGE NEWS!! Libertarian Geert Wilders’ Party for Freedom takes the lead in latest Poll

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It is increasingly looking like Geert Wilders could become Europe's very first libertarian President in history.

From Reuters, March 7:

Wilders three seats ahead of rivals in Dutch Poll

The Maurice de Hond poll put the PVV on 27 seats in the June 9 national elections, while the CDA and the Labour Party (PvdA) were both on 24 seats. The poll also showed that none of the three most likely coalitions would be able to form a majority government without reaching across lines to a fourth or fifth party.

In local council polls on March 3, Wilders made substantial gains, positioning him to do well in the national election. Balkenende's Christian Democrats were seen as the biggest loser in the council voting.

A PVV triumph could also mark the first time in history that a European Nation would have a libertarian party as the governing party. Just two weeks ago, the PVV won a majority of council seats in the city of Alsmere (pop. 188,000), and placed second in The Hague, the second largest city in the Netherlands.

Split on the Right: Mark Steyn takes NeoCon Charles Krauthammer to task over Geert Wilders

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What's at issue is fighting to protect Western liberties at its core

Libertarian-Conservative Mark Steyn is critical of Fox News contributor Charles Krauthammer over some recent comments on the Fox All-Stars. Krauthammer, a NeoConservative stalwart, made disparaging statements on Dutch libertarian Geert Wilders for his anti-Islamist views.

Said Krauthammer:

What he says is extreme, radical, and wrong. He basically is arguing that Islam is the same as Islamism. Islamism is an ideology of a small minority which holds that the essence of Islam is jihad, conquest, forcing people into accepting a certain very narrow interpretation [of Islam].

The untruth of that is obvious. If you look at the United States, the overwhelming majority of Muslims in the U.S. are not Islamists. So, it's simply incorrect. Now, in Europe, there is probably a slightly larger minority but, nonetheless, the overwhelming majority are not.

Mark Steyn responded at NR 03/09:

Wilders does not need to be lectured condescendingly about distinctions within Islam, because he lives with them every day. And he has concluded, notwithstanding Dr. Krauthammer's views on the precise "minority" that identifies as "Islamist," that Islam itself is the issue — and that, therefore, regardless of the "moderation" of the "overwhelming majority" of Muslims, the more Islam the less Netherlands in any recognizable sense. Are the gangs of gay bashers on the streets of Amsterdam "Islamist" by Krauthammer's definition? Maybe, maybe not. But, either way, they make the running, and the rest of the community is either indifferent or quiescent.

As for whether Wilders is "extremist," his views on the cultural compatibility of immigrants were routine and unexceptional until the 1960s, not only in Europe, but also in the U.S. And, even in North America today, they are the stated policy of the Government of Quebec. One can certainly disagree with that, but does that make Quebec also "fascist" (Beck) or even "extreme" (Krauthammer)?

Dr. Krauthammer is also incorrect to suggest there are two issues here. When the state attempts to constrain further Europe's already too shriveled bounds of public discourse, the only issue is state power. The Continental political class does not want to debate the question of its ever more assertive Muslim populations, and so has decided to criminalize that debate. Geert Wilders lives under 24/7 security because Muslims (including the killer of Theo van Gogh) have pledged to murder him. Yet he's the one on trial for incitement? The issue is not Wilders or his views, but the Dutch state and their ever more "extreme, radical, and wrong" views on core Western liberties.

Photo of Mark Steyn with Atlas Shrugs Pamela Geller.

Liam Sarsfield Pleads Guilty

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Ex-NASA Official Pleads Guilty in Contracts Case, WS Journal

"A former high-ranking National Aeronautics and Space Administration official pleaded guilty in Mississippi to designing contracts that netted him more than $270,000 in illegal profits. Liam P. Sarsfield is a former chief deputy engineer in Washington, D.C. ... Mr. Sarsfield will be sentenced June 24. He pleaded guilty to one charge of acts affecting a personal financial interest."

Ex-NASA official pleads guilty, AP

"The U.S. Attorney's office would not comment on whether Sarsfield is cooperating with authorities in the case against Stadd. However, Sarsfield was charged in a criminal information, which is filed by prosecutors when the defendant has agreed to waive grand jury indictment and plead guilty. They are often used when a defendant is cooperating."

NASA Presolicitation Notice: Engineering Services: Liam P. Sarsfield, earlier post from July 21, 2005

"NASA/HQ intends to award a purchase order to Mr. Liam P. Sarsfield. The authority is 10 U.S.C.2304(c)(1) "only one responsible source."

More Comparative Studies Needed to Guide Physicians Study finds less than a … – ModernMedicine

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USC News
More Comparative Studies Needed to Guide Physicians Study finds less than a ...
ModernMedicine
Michael Hochman, MD, and a colleague from Harvard Medical School in Boston reviewed the six leading general and internal medicine journals during 2008 to ...
Medical studies often don't compare existing treatmentsLos Angeles Times (blog)
Few US studies compare one drug to another: reportReuters
Research Finds Shortcomings in Comparative Effectiveness Drug ResearchScientific Frontline
ModernHealthcare.com -BusinessWeek -Boston Globe (blog)
all 23 news articles »

Stupak signals it’s not just about abortion

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It may come down to the Louisiana Purchase after all

From Eric Dondero:

There's been a rather interesting development on the Health Care nationalization front. Michigan Congressman Bart Stupak is now sounding less optimistic about the Democrats coming to an agreement over abortion language.

Just breaking from The Weekly Standard...

Michigan Democrat Bart Stupak said yesterday at a townhall in his home state, "I'm more optimistic than I was a week ago" that a deal could be reached to pass a health care bill that bans public funding of abortion. Some speculated that this meant Stupak was ready to cave. "Obviously they don’t know me," Stupak said in an interview this afternoon with THE WEEKLY STANDARD. "If I didn’t" cave in November, "why would I do it now after all the crap I’ve been through?"

"Everyone’s going around saying there’s a compromise—there’s no such thing," Stupak said.

But perhaps even more telling is this other comment from the interview, where Stupak cites a budgetary matter as one of his top concerns.

Continuing:

Stupak highlighted other problems with the bill: The president's proposal has not been translated into legislative language and it still leaves some special deals in place. "If you look at the President’s proposal," Stupak said, "it says that the Cornhusker agreement is out, but the Louisiana Purchase is in."

By my estimate, having researched a multitude of sources in the last couple days, the Democrats seem to be at the very least 15 votes shy of the needed 216, but quite possibly as high as 20 to 22 votes shy. Taken the more conservative estimate of 15, 12 of those are "Stupakians"; Dems who are not voting specifically for the abortion language.

Stupak inserting the Louisiana Purchase into the mix, throws this all up in the air. Who knows how many of the 12 abortion foes, also share his anti-pork views, as well. If just 2 or 3 in the House opt out over Sen. Mary Landrieu's special treatment, it's a gonner.

(Via Memeo)

NCBI ROFL: And the March “No s**t, Sherlock” award goes to… | Discoblog

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dylanphotoEmotional fluctuations in Bob Dylan’s lyrics measured by the dictionary of affect accompany events and phases in his life.

“Lyrics for Bob Dylan’s songs between 1962 and 2001 (close to 100,000 words) were scored with the help of the Dictionary of Affect in Language (Whissell, 2006). Means for Pleasantness, Activation, and Imagery are reported for 22 Blocks characterizing this time span. Significant but weak differences across Blocks were found for all three measures at the level of individual words. Emotional fluctuations in words included in Bob Dylan’s lyrics accompanied events and phases in his life, although they were not entirely dictated by these events. Dylan used more highly Imaged and more Active words at times when his work was critically acclaimed. More Passive word choices characterized times of prolonged stress, and more Pleasant choices times of experimentation. Dylan’s three popularity peaks were used to divide the singer’s career into three stages (rhetor, poet, sage) which differed in terms of pronouns used.”

dylan

Thanks to Heather for today’s ROFL!

Related content:
Discoblog: NCBI ROFL: And September’s “No s**t, Sherlock” award goes to…
Discoblog: NCBI ROFL: Flatufonia–or the musical anus


The 2nd Yale Research Symposium on Complementary and Integrative Medicine. Part II

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The Main Event: Novella vs. Katz

The remainder of the Symposium comprised two panels. The first was what I had come to see: a Moderated Discussion on Evidence and Plausibility in the Context of CAM Research and Clinical Practice, featuring our Founder, Steve Novella, who is also Assistant Professor of Neurology at Yale; and David Katz, the other speaker who had borne the brunt of the criticism after the 2008 conference (as I wrote in Part I). According to the Symposium syllabus, he is:

David L. Katz, MD, MPH, FACPM, FACP, an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. Katz is the Director and founder (1998) of Yale University’s Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. He currently serves as Chair of the Connecticut Chapter of the Partnership to Fight Chronic Disease and represents Yale University on the Steering Committee of the Consortium of Academic Health Centers for Integrative Medicine.

The syllabus had excerpted that statement from a much larger, remarkable document, which I urge you to review.

I will attempt to report the Moderated Discussion as neutrally as possible, as though I were a disinterested journalist (don’t worry: later I’ll rail).

The session began with 10-minute remarks by each of the two panelists. Each was then asked to respond to a few scripted questions posed by the moderator, Dr. Barry Boyd (whose earlier talk I discussed in Part I). The panelists were aware of the questions beforehand.

Dr. Novella went first. He began by suggesting that everyone in the room shares a common ground: wanting to do what’s best for patients, and in particular wanting to offer them things that work. He proceeded to summarize what he means by “science-based medicine.” My notes are scant and illegible, but I’ll try to re-create the points. Steve can fill in any glaring omissions later.

Science-based medicine, said Dr. Novella, is not a list of treatments, procedures, specialties, drugs, diseases, or whatever; rather, it is a methodology. It seeks the best diagnostic and therapeutic options wherever it may find them; it is, like science in general, always open to new directions and willing to scrap existing ones, if the evidence so leads. It is based in the natural sciences, especially biology, but it also applies scientific methods to practical aspects of clinical medicine, such as testing diagnostic and therapeutic hypotheses. It assumes “consilience”: like science itself, it is not “Eastern” or “Western,” but universal.

Science-based medicine doesn’t “cherry-pick”: it starts with a problem and follows the evidence toward or away from potential solutions; it does not first pick a solution and then assemble whatever evidence there may be to support it. It acknowledges numerous sources of bias and error, from our flawed brains to small studies and studies sponsored by advocates (Steve cited drug companies). It recognizes the necessity to consider the “meta-evidence” (I think that was Steve’s term), meaning evidence gleaned from the entire range of potential sources: basic science to clinical trials to clinical realities.

Dr. Katz followed. He began by observing that it isn’t very often that he begins a debate by agreeing with the other debater. This yielded a smattering of appreciative chuckles.  He continued with a series of “bullets,” and once again I’m afraid I don’t have them all in my notes, but here’s my attempt, followed by most of the points that Dr. Katz made in his opening remarks:

  • “Plausibility and Pandora”
  • “Tail wags Dog”
  • (illegible), Serendipity
  • Absolute Relationship
  • Scylla and Charybdis

Dr. Katz mentioned that according to astrophysicists (or perhaps one in particular that he had read or heard speak), there is more empty space between the elementary particles in each of our bodies than exists in the entire universe. He doesn’t understand it himself, but assuming it is true he wonders, for example, how others can so easily dismiss Therapeutic Touch merely because it isn’t really touch, since what we think of as touch isn’t really touch, either.

He listed a few innovations in the recent history of medicine that were “heresy” when first proposed, suggesting that if plausibility had ruled the day they would never have emerged:

  1. H. pylori shown to be the cause of peptic ulcers;
  2. Beta-blockers beneficial even for patients prone to congestive heart failure;
  3. Rocky Mountain spotted fever established as caused by a bacterium.
  4. (Later he mentioned the right heart catheter as an example of something that everyone thought was safe and effective, until a study showed that it wasn’t; but even then it took a long time for MDs to finally stop using it)

He mentioned that the monoamine oxidase inhibitor (MAOI) class of antidepressants had been discovered serendipitously when TB patients taking isoniazid (INH), a related drug, didn’t seem so depressed.

He said, “relative absence of evidence is not absolute evidence of absence.”

Evoking Scylla and Charybdis, he invited the audience to consider this choice: that something “works whether or not it’s plausible”; or that something is “implausible whether or not it works.”

He offered the metaphor of a solid floor and a moving ceiling to represent proven and unproven treatments, and noted that if we insist on using only proven treatments, we will soon get squeezed (he didn’t say it exactly that way, but I think you get the point).

The two participants then sat down and the moderator asked the questions. I can remember only one, but I remember most of the discussion. A large part of it involved how to deal with patients who are suffering, but for whom scientific medicine has no clear solution. Dr. Novella argued that he would never abandon such a patient, and that there are ways to be compassionate and caring without offering implausible treatments. He has also discussed similar points here on SBM. When asked what he would do if a patient asked his opinion about a particular method, he replied that he would be honest. He said that according to surveys, only a small fraction of those who seek “CAM” do so because of having exhausted all “conventional” options. Most do it for other reasons, having more to do with their beliefs.

I must admit that I can’t remember exactly how Dr. Katz responded to that point and to Dr. Novella’s opinions, but it presumably had to do with his floor/ceiling metaphor; his views on the same general topic are available elsewhere.

The scripted question that I distinctly remember went something like this: “what would you do if your hospital decided, in response to a perceived demand in its community, to establish a Therapeutic Touch program?”

Dr. Novella replied that he would oppose it on the grounds that hospitals have made an implicit commitment to offer science-based treatments, and Therapeutic Touch does not meet that standard.

Dr. Katz disagreed, suggesting that we don’t really know that TT doesn’t work; there have been intriguing studies, he said, showing effects on cells in tissue culture that couldn’t possibly be explained by a placebo effect. He suggested that extreme skeptics believe that TT doesn’t work and can’t work, while extreme advocates are certain that it does, and thus the reasonable, moderate position—represented by himself, presumably—would seem to be somewhere in the middle. He made similar comments about homeopathy.

Dr. Katz said that if he were advising the hospital in question and certain physicians were adamantly opposed, he would suggest that the hospital offer Therapeutic Touch to patients but provide them with a disclaimer stating that those (named) physicians were opposed to it.

Dr. Novella, referring to Dr. Katz’s earlier point about the space between elementary particles justifying a tentative plausibility for TT, asserted that counter-intuitive concepts in quantum mechanics and cosmology do not apply to the macroscopic, everyday world of clinical medicine.

There was a brief exchange about plausibility and mechanism. After Dr. Katz asserted that we needn’t know the mechanism to conclude that something works, Dr. Novella replied that “knowing the mechanism” and plausibility are not equivalent.

Dr. Novella asked if “CAM” advocates would ever be willing to say that something doesn’t work; he noted that even among Cochrane Reviews one doesn’t find such conclusions for “CAM” methods. Dr. Katz said that he had concluded that one particular substance (I don’t remember what it was) doesn’t work, but he was not willing to say the same for many others, including homeopathy, TT, and Meyers’ Cocktail, although his own studies of homeopathy and Meyers’ cocktail had not shown benefit. He argued that his studies had been hampered by stipulations from the IRB that made them not applicable to typical use.

………

I’ve witnessed these sorts of debates before. The usual scenario is that the audience is heavily biased in favor of the pro-“CAM” stance, and the skeptic finds himself backpeddling from the outset. The pro-“CAM” participant need merely raise his eyebrows or utter a word such as “reductionistic” to get supportive laughter or applause, whereas the skeptic can barely open his mouth without being hissed and booed. That this did not happen at the Yale Symposium is a tribute to Steve Novella, who is better at being sympathetic to others’ heartfelt beliefs while maintaining his intellectual integrity than anyone I’ve seen in such a spot. It also reflects the civil tone of the meeting as a whole and of the tone presented by the moderator, Barry Boyd. I congratulate them all, even Dr. Katz—although I must admit to a secret suspicion that he was frustrated by not succeeding in making Steve Novella look like a curmudgeon. I could be wrong.

………

The final panel of the day consisted of Drs. Novella, Katz, and a few other Symposium faculty fielding questions from the audience. Most of the questions were directed to the two debaters, who reiterated several of the previous points. Other panelists spoke to an extent; Auguste Fortin, Associate Professor of Medicine and Director of Communication Skills Training for the Yale Primary Care Internal Medicine Residency Program, repeatedly referred to himself and his colleagues as “allopaths.”

Comment

A quick aside to Dr. Fortin: please, for the sake of your residents and of accurate communication skills in medicine, learn the basis for the term “allopath” and cease using it to refer to physicians. (Hint: look here). Modern medicine is “modern medicine.” We are “medical doctors.”

Regarding Dr. Katz’s assertions, particularly amusing to me was the one about H. pylori and plausibility. I usually find wanton self-promotion distasteful, but He Who Debunked the Marshall-and-Warren-as-Galileo Myth was sitting right there in the audience! The short story, for the benefit of John Millet and medical students in general, is that even if clinicians scoffed at the hypothesis when they first heard it, there was no discernible effect on its progress from bench to practice.

Practicing physicians and even academics tend to be conservative (with a small ‘c’) and risk-averse; this is a different issue from that of how scientific medicine as a whole deals with novel hypotheses. (Josephine Briggs also failed to appreciate the distinction when she offered her list of “quirky ideas from outside the mainstream,” reported in Part I). The notion that bacteria might cause an inflammatory lesion was entirely plausible, of course, and even if some physicians were surprised to learn that bacteria can adapt to an acidic environment, bacteriologists were not.

The H. pylori hypothesis became intriguing at the moment that Marshall and Warren reported having successfully cultured the organism. It was rapidly investigated all over the world, and within a few years the old etiologic “paradigm”—ironically, a rather implausible mind-body hypothesis involving stress—was no more. The story of H. pylori is a great triumph of science-based medicine, not a reason to dismiss plausibility arguments.

After the conference I approached Dr. Katz and suggested that the time it took for H. pylori to be accepted as the cause of peptic ulcer disease was entirely reasonable. He replied, “reasonable for whom? What about patients?” I’d meant, of course, “reasonable according to how long it takes to do the work,” which I told him, adding, “so what do you mean about patients? That we should have started treating them with antibiotics before…?” I didn’t finish the obvious question, but what would we have been treating? Marshall and Warren had no idea what the organism was when they first saw it.

In talking with Katz I quickly realized that he is surprisingly naïve for someone who holds himself out as an expert in “integrative medicine.” It hadn’t occurred to him that Therapeutic Touch (like all versions of “energy medicine”) is a form of psychokinesis (PK), nor did he know that PK has been studied for well over 100 years without having yielded any reproducible evidence for its existence. (The notion that it is a recent hypothesis deserving the attention of medical academia is a ruse). In an attempt to offer another example of strange powers that are beyond our understanding, he stumbled when he reported that during his recent vacation, a “mentalist” in a restaurant had come right up to him and effortlessly bent the tines of his fork with merely two fingers of one hand, a task that Katz himself could barely accomplish with both hands. He exclaimed, “I don’t know how he did it, but I know he did it!” I replied, “but you know that it was a trick, don’t you?”

There is no shame in being fooled by a good conjurer—most people are—unless the very field in which you claim expertise requires that you know about such things. Spoon bending (or, in this case, fork bending), is claimed by some of its more illustrious practitioners to be a form of PK. There is a pattern here: Dr. Katz’s counterpart at Harvard, Dr. David Eisenberg, is also innocent of such matters. He is also the co-author of language quoted in Part I of this report, praising chiropractors for “never failing to find a problem.”

Dr. Katz betrayed a naïveté about clinical trials, in spite of his professed expertise in that realm. When Dr. Novella and I asked what he thought the aggregate results of several trials of an ineffective but passionately advocated method are likely to be, he replied that they would certainly hover around the null. We would all like this to be true, but it isn’t. Clinical trials are not physics experiments. Even RCTs are fraught with opportunities for error and bias.

Experience shows that the typical history of clinical research for a “CAM” method is this: early trials, usually small, poorly designed, and performed by advocates, tend to be “positive”; later ones that are larger and better trend toward the null, but it can take years and many trials before it becomes clear that this is their fate—if it happens at all. There will inevitably be sporadic “positive” studies that are trumpeted by advocates, even if they can’t be replicated. The study that Dr. Katz mentioned at the Symposium, purporting to demonstrate Therapeutic Touch exerting an effect on cells in culture, is a perfect example.

It may be formally true that one can’t “prove a negative,” but this is no reason to take seriously every crackpot notion that comes along. To position oneself as “middle of the road” or “balanced” regarding a claim such as homeopathy or Therapeutic Touch is misleading and unscientific. It is the equivalent of asserting the same for long-settled questions such as whether the earth is planar or spheroid, whether or not perpetual motion machines can work, and so on. It is akin to a call to “teach the controversy” of evolution vs. “creation science.”

In the meantime, implausible “CAM” methods continue to be held out as “promising” or at the least not disproven, and more trials are invariably called for—no matter that in many cases existing knowledge is sufficient to refute the hypothesis. This has been the trajectory of research in homeopathy, acupuncture, ‘distant healing,’ the ‘supplements’ discussed by Dr. Briggs at the Symposium, and other “CAM” proposals. (Natural products are not highly implausible, of course, but for a number of reasons are usually moderately implausible). In acupuncture and homeopathy research, such futility has continued for decades. The same is true for the entire field of parapsychology (the investigation of paranormal claims such as PK, ESP, etc.), in spite of highly sophisticated experimental designs over the past 30-40 years—more sophisticated than would be possible for most “CAM” trials.

As several have argued, parapsychology research is an example of pathological science. I suspect that this is the inevitable result of performing trials of any highly implausible claim that has passionate adherents, and that much of “CAM” research is doomed to repeat this history. Just as paranormal claims are an important subset of “CAM,” parapsychology research is an important historical precursor of “CAM” research—even if most medical academics, including those who identify with “integrative medicine,” are unaware of it.

I’ve sparred with Dr. Katz in the past, in print, addressing some of the other points that he made at this Symposium:

  • Dr. Katz here; my reply (to his and a ton of other indignant letters) here (included are responses to his right heart catheter argument, a discussion of “mechanism” as it applies to plausibility, a rebuttal to post-modern language devices, and more).
  • Dr. Katz’s response to his critics following the 1st Yale Symposium here; my take on his response: here and here (including comments on the false dichotomy of proven methods vs. “CAM”; his hyping of homeopathy, TT, craniosacral therapy, Myers’ Cocktail, and other bogus treatments; his and others’ casual flouting of well-established medical ethics)

Conclusion

Most of the content of the 2nd Yale Research Symposium on Complementary and Integrative Medicine, Dr. Katz’s comments being a notable exception, was not “complementary” or “integrative,” but simply medicine. What proponents mean by the term “integrative medicine” seems to vary according to political expediency. To onlookers it is not substantially different from the “holistic medicine” of 30 years ago, described by philosophers Clark Glymour and Douglas Stalker:

Is there another, holistic, conception of medicine distinct from [modern medicine]? Certainly, many people seem to think so…Popular bookstores are filled with works on “holistic medicine,” many edited by medical doctors…[or]…authored by professors at distinguished medal schools… The therapies described and recommended in a typical book of the genre include biofeedback, hypnosis, psychic healing, chiropractic, tai chi, iridology, homeopathy, acupuncture, clairvoyant diagnosis, human auras, and Rolfing…

What ties together [these] diverse practices…? In part, a banal rhetoric about the physician as consoler… In part, familiar and rather useless admonitions about not overlooking the abundance of circumstances that may contribute to one condition or another. Such banalities are often true and no doubt sometimes ignored, with disastrous consequences, but they scarcely amount to a distinctive conception of medicine. Holist therapies can be divided into those that are adaptations of traditional medical practices in other societies—Chinese, Navajo, and so forth—and those that were invented, so to speak, the week before last by some relatively successful crank…

The recent success of the “Integrative Medicine” (IM) movement at medical schools is a curious turn of history. Enthusiasts portray it as “patient-centered,” “healing-oriented,” “preventive health” and more, but the only part of it that can honestly be held out as distinct from modern medicine is a collection of practices that don’t withstand either scientific or ethical scrutiny. To claim otherwise distorts the history of medicine and of what the practice of modern medicine involves. It misrepresents the relation between science and medicine and the extent to which the tools of Evidence-Based Medicine can be brought to bear on highly questionable claims. It distracts from the usefulness of physicians learning a wide range of critical thinking skills. Such skills might be applicable, for example, to evaluating strange powers such as PK and fork-bending, or to the ethics of studying “Lyme-Literate” practitioners. Perhaps most importantly, it constitutes a radical departure from firmly established medical ethics.

Fundamental to the movement is euphemism: accurate terms are replaced by those that seek to reassure and soothe. This obscures, rather than elucidates the phenomenon. It facilitates bait-and-switch ruses both for individual practices and for “CAM” or IM as a whole. One of our fellow bloggers, a Stanford oncologist who has been a student of such matters since the peak years of the Laetrile fraud, wrote a depressingly accurate satire explaining how medical schools have been duped by what amounts to a clever PR campaign. Language distortions have literally changed the standards of care in medicine, and not for the better. The term “integrative medicine” is now central to that change.

Medical students have not been told these things by “integrative medicine” mentors, who themselves are largely innocent of them—just as they tend to be naïve about many of the practices that they find so intriguing, as documented in the two parts of this report.

I hope that this report provides some small impetus for John Millet and other IM enthusiasts at Yale and elsewhere to re-evaluate their thoughts. They are, almost without exception I’m sure, smart, committed, enthusiastic, caring young people who are trying to become the best that they can be in medicine. I certainly developed that opinion of John in the short time that I spoke with him and observed him. He reminded me, in fact, of our very own Tim Kreider. I hope that this report will suggest to John and others that there is more to an honest, comprehensive, and ethical evaluation of IM than its proponents acknowledge.

In addition to this report and the links from it, here is a short template for how medical schools might begin to teach “CAM” in an honest, rigorous way (scroll down to “ ‘CAM’ for Medical Students”). I’m slightly embarrassed to say that we at SBM have been talking for a couple of years about creating a more comprehensive set of materials just for that purpose, perhaps to occupy its own website, but we’ve not yet done it.

For John and other Yalies, of course, there is a much better resource: Dr. Steve Novella himself, who is without a doubt the most knowledgeable skeptic under the age of 80 that I’ve ever met. I’m not kidding, Yale medical students: this guy is the real deal, and you don’t want to miss your brief opportunity to learn from him.

Finally, I’m imagining that some who read this report will wonder whether it really matters: if medical students are learning real medicine anyway, so what? Who cares if a little woo sneaks through the doors of the White Coat Academy? Isn’t it better that IM is calling attention to some things (walnuts, nutrition, exercise, relaxation methods) that tend to be short-changed by medicine even if they shouldn’t be?

Uh, nupe. Those who are interested in walnuts and exercise and relaxation are to be encouraged, but should also be encouraged to repudiate “CAM” or IM precisely because of its pseudoscientific, unethical content. There are all sorts of hazards awaiting those who fail to understand this—we saw a small example in Part I, regarding “Lyme-Literate” practitioners prescribing colloidal silver. (If the Yale IRB is still watching, please scroll down Part I to the comment from ‘rosemary’). There are, of course, larger, almost unbelievable hazards emanating from the very pinnacles of “CAM” research: for starters, look here and here.

Afterword

The philosophers Glymour and Stalker were uncanny in their predictions, made more than 25 years ago:

If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason. Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign. At times, physicians may find themselves in sympathy with the holistic movement, because some fragment of the rhetoric rings true, because of certain practices and attitudes they encounter in their daily work with colleagues and patients, or because of dissatisfaction with the economic and social organization of medicine. One hopes they will speak bluntly, but it does no good to join forces with cranks and quacks, magicians and madmen.

A not-benign result that even Glymour and Stalker may not have predicted is the epidemic of commercialism and self-promotion that would have been unthinkable only a few years ago. It is abundantly evident on Dr. Katz’s website and on “integrative medicine” websites elsewhere. If the mood of society has changed so much that this does not strike today’s medical students as profoundly unprofessional (as it would have struck us in the 1970s), I hope that at least they will consider the conflicting interests of practitioners whose patients presume will offer untainted advice. It is self-evident that we should strive to immunize ourselves, our patients, and our institutions against sales pressures from Big Pharm, no? Why should this, which by virtue of its infatuation with magical thinking is even more likely to lead us astray, be any different?


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Live kidney donors do not die sooner: study – Reuters

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ModernMedicine
Live kidney donors do not die sooner: study
Reuters
... Dr. Dorry Segev of the Johns Hopkins University School of Medicine, Baltimore, and colleagues wrote in the Journal of the American Medical Association. ...
Researchers confirm safety of kidney donationsLos Angeles Times
Kidney transplants and long-term health7Online.com
Medical News: Salt Intake, Kidney Need & MoreWCVB-TV
msnbc.com -TIME (blog) -Washington Post (blog)
all 42 news articles »

A prescription for improving science education – Scope (blog)

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Scope (blog)
A prescription for improving science education
Scope (blog)
Among the Stanford Medical Youth Science Program's college graduates, 47 percent are attending or have completed medical or graduate school and 43 percent ...
Promoting Science EducationJournal of American Medical Association (subscription)
Vanderbilt Researchers to Study Impact of 'Scientist-in-the-Classroom' PartnershipVanderbilt University News
'Eyeballs in the fridge' may be needed to encourage new scientistsIndiana University

all 4 news articles »

Generosity Is Contagious, Study Shows–But Selfishness Is Too | 80beats

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WorkingTogetherContagiousness: It’s contagious! Happiness was contagious in 2008, then loneliness last year, and don’t forget being fat. Now it’s generosity that spreads like the flu across social networks, according to James Fowler and Nicholas Christakis (who were both behind the happiness study). Their new study appears in the Proceedings of the National Academy of Sciences.

To test out whether generosity spreads, the scientists devised a game. In groups of four, each person had 20 “credits,” some of which they could decide to toss into a common fund for all the players. The scoring was set up so that giving to the fund was costly unless the other players did it too: If everyone kept their money, they’d have the 20 credits, but if everyone put all they could into the fund, each player would end up with 32. However, the players had no way to know how generous the others were being. The best payoff would come if everyone gave all their money — but without knowing what others were doing, it always made sense to keep one’s money and skim from the generosity of others [Wired.com].

The researchers found that if a person was particularly generous, the people he or she played with were more likely to be generous during the next round, when they were shuffled into groups with different people. Ultimately, the initial person’s contribution was multiplied up to three times—a result in keeping with earlier findings on social contagion suggesting that this sort of ripple effect continues for three degrees of separation [TIME]. However, while kindness and generosity spread through the network of players, selfishness did too.

Certainly, these studies have their doubters. Commenters on one of our last “contagious” posts pointed to a 2008 BMJ study noting that if social networking studies weren’t careful in looking at correlations, one could plausibly find that traits like height, acne, and headaches are similarly contagious. Though Fowler and Christakis designed their experiment to try to see cause-and-effect links, not just correlation, they say the study is a general model for group behavior, and how well it fits the more convoluted real world remains to be seen.

But we talking apes are impressionable social creatures, after all, so perhaps we really do spread behaviors—and not just disgusting infectious diseases—amongst ourselves. Says Fowler, “When people benefit from kindness they ‘pay it forward’ by helping others who were not originally involved, and this creates a cascade of co-operation that influences dozens more in a social network” [The Telegraph].

Related Content:
80beats: Sad and Ironic Study Says Loneliness Can Be Contagious
80beats: Happiness Spreads Like the Plague
DISCOVER: Why Loneliness is Bad for You
DISCOVER: How to Make Your Friends Fat (slide show)

Image: flickr / Woodleywonderworks


How Ritalin Works in the Brain: With a One-Two Dopamine Punch | 80beats

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ritalinCollege students holed up in the library or cramming for an exam have always relied on stimulants like coffee, but recently they’ve been increasingly turning to the off-label use of drugs like Ritalin and Modafinil to help them stay focused. Now scientists have found how Ritalin, a drug normally prescribed for children with attention deficit hyperactivity disorder (ADHD), helps boost learning.

In a new study of rats published online in Nature Neuroscience, scientists found that Ritalin appears to boost both attention and enhance the speed of learning by increasing the activity of the chemical messenger dopamine [Technology Review]. The study also found that one type of dopamine receptor aids the ability to focus, and another type improves the learning itself [DNA].

In their study, scientists observed that rats on Ritalin learned faster than those not given the drug; the Ritalin-drugged rats understood more quickly that a flash of light and sound meant sugary treats for them. However, when the researchers used drugs to block the dopamine D1 receptors in the rats’ brains, they found Ritalin did not aid learning speed. When another dopamine receptor, D2, was blocked, the drug failed to improve focus. The scientists concluded that both receptors play a distinct role in helping Ritalin improve cognitive performance. Said lead researcher Antonello Bonci: “Since we now know that Ritalin improves behavior through two specific types of neurotransmitter receptors, the finding could help in the development of better targeted drugs, with fewer side effects, to increase focus and learning” [Technology Review].

The researchers also observed that the drug strengthened the connections between nerve cells in the brain region called the amygdala, which plays an important role in learning and emotional memory. Strengthened connections increase the efficiency of neural transmissions, which allows for faster learning.

The findings come at a time when doctors are paying more attention to the trend of using pharmaceuticals as “smart pills.” Some doctors have warned that drugs like Ritalin and Modafinil shouldn’t be abused to get a “brain boost” ahead of exams or in stressful situations, while other scientists have provocatively suggested that such medications should be available to anyone who wants a cognitive pick-me-up.

Related Content:
80beats: Why ADHD Kids Have Trouble Doing Homework: No Payoff
80beats: Stay-Awake Drug Popular With College Kids Has Addictive Potential
80beats: Prescribe Ritalin to Everyone, Provocative Essay Suggests
80beats: Herbal Remedy Doesn’t Help Kids With Attention Deficit Disorder

Image: iStockphoto


The Universe, Season 4

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Coming up on the 15th, we have the bonus riddle.  Tom and I are working on that now, but we have the prize ready to ship out to the winner.

The Universe, Season 4 DVD collector’s set will be sure to keep you glued to your seat.  The episodes are interesting, with appeal to a wide range of educational backgrounds and age groups.  The graphics are well done; I didn’t once roll my eyes and mutter, “Yeah, right.”  The 12 episodes are divided 3 per disc, with extra’s on the 4th disc.

The episodes deal with a good mix of subjects, some close to home (“10 Ways To Destroy The Earth”), and some not (“Death Stars”).  They are easy to follow, even when dealing with some complex topics (Pulsars & Quasars”).

I can see these DVDs working equally well in the home or classroom.  The 4 DVDs are in individual cases, so it’s easy to find a specific episode and go right to it.  I think you’ll find it hard not to sit and watch all 12 episodes at once.  I did.

So, get ready to rumble on March 15th, and solve the bonus riddle.  We have one more “regular” riddle to go (on the 13th); one last chance to be eligible for the bonus riddle and a shot at winning The Universe Season 4 DVD set.

By the way, the set I reviewed is NOT the set we’ll be mailing out as a prize!

The fifth GLOBE at night is on! | Bad Astronomy

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How often do you go outside and look up? I mean really, just look up at the sky and stars?

With more and more people living in cities, and light pollution still a major problem, it seems that a smaller percentage of people actually get to see the stars. That’s why the National Optical Astronomy Observatory (NOAO) started the GLOBE at night program, an effort to get folks outside and get them to appreciate the night sky.

The program is actually pretty simple: all you have to do is go outside and look at Orion, and compare the stars in the constellation you can see with maps showing progressively fainter stars. This tells you your "magnitude limit" which in turn s tells you how bad light pollution is in your area. You can then submit your findings on the GLOBE at Night website, where they are compiled and mapped.

It doesn’t matter if you live in the middle of the Sahara or in downtown NYC. In fact, the more people who submit their results the better, so that the GaN folks can get really good coverage of the planet. Not only does this help you get a feel for the sky and for light pollution, but it helps astronomers keep track of wasted light as well.

Light pollution destroys our view of the sky, but it also represents a lot of energy totally wasted. Cities, towns, everyone can save a lot of money by installing more efficient lighting — you can find out more at the Dark Sky Rangers site. Projects like GLOBE at Night will help a lot of people realize that, too.

The project goes from now until March 16, and the website has everything you need to get started, including resources for teachers, parents, and students. Give it a shot!