May 8 – Medicine
Out topic this week is medicine. A lot of this post is also covering pseudoscience which was our topic last week, but there is a lot of overlap.
There are a lot of supplements and there are a lot of claims made about them. However it is always important to treat such claims with skepticism. If you aren’t aware, you do NOT need to prove a supplement is effective in order to sell it. You just have to show it is “Generally Regarded As Safe.” This chart is probably the most comprehensive I’ve ever found that looks at various supplements and how much research there is to support their claims.
Note that each bubble represents only one claim, but a supplement can be listed multiple times. For example, according to this chart, there is strong evidence that garlic helps with heart disease so it is near the top of the page, but there is less compelling evidence that garlic is helpful for cancer prevention, so that bubble is below the “Worth It” line.
Science-based Medicine has a pretty thorough overview of the claims and lack of evidence for acupuncture.
In 1998, Andrew Wakefield published a study linking autism to vaccinations. The results of that study were never reproduced. This underlies the difference between “a study” and “the literature.” Technically the process of peer-review was successful, since the study was reviewed and found to be lacking (and there was strong evidence that he falsified data and made other fraudulent claims). The journal officially retracted the study and he has been barred from practicing medicine in the UK.
Despite the continued refutation, the anti-vaccine movement has been picking up steam in recent years due to endorsements by “celebrities” (like Jenny McCarthy) and “activists” (like Robert F. Kennedy Jr.).
As a result of this media attention, vaccination rates have fallen in Europe and the US and this may have led to increase in preventable diseases.
If you are interested in how long pseudoscience can be sustained without ever having to prove itself, there is Stanislaw Burzynski. He has been treating cancer patients since the 1970s despite having no specialty training in oncology or internal medicine.
Right to Try Laws
This also leads to “right to try” laws that are being proposed in several states (and now federally). Basically, certain organizations want to be able to sell their treatments to terminally ill patients without going through the proper testing.
However, several states want to short circuit this system and allow terminally ill patents to try “investigatory” methods that have not completed the full cycle of trials. The thinking is that there are effective drugs stuck in the testing phase and the process may take too long for people sick today. However, this ignores the fact that most drugs aren’t shown to be effective by the time they end the full trial process. Also, the “right to try” laws focus on drugs that have only passed the Phase I testing, which is problematic because those trials don’t necessarily find all the complications or side effects.
In short, Phase I trials only test for toxicity in small groups (as few as 20 people) and they can’t really make any conclusion about the efficacy of the drug. Most drugs that pass this phase still don’t pan out as effective.
“Think of phase I trials as a screening test looking for the most obvious toxicities, with phase II and III studies confirming them. Indeed, even phase III trials can’t always adequately demonstrate that a drug is safe; it’s not uncommon for less common adverse effects not to show up until post-marketing surveillance, when much larger numbers of patients receive the drug. Moreover, only 5% of all cancer drugs that enter clinical testing are ultimately approved for patient use.”
It ultimately comes down to an ethical question. Is it right to sell people medicine that hasn’t been shown to be effective?