Straight Dope on Quackwatch

[74westy]

@DSeid

As an example that is in the news - long before the Preventative Services Task Force made their new recommendation against the established and still clung to by many dogma that screening women 40-49 with mammography is a clearly wonderful thing that every woman should do, that it may actually cause more harm than good, Cochrane (in 2001) was sayingDid he go after that subject? I don’t think so.

I can’t find anywhere were he specifically “went after” mammography for women 40-49 but the topic came up in an article (last revised on July 16, 2004) on Bio Miracle Life Sciences Pvt. Ltd where he said

@quackwatch

The most elementary ethical principle of cancer screening is that it is justified only if clear-cut intervention to produce positive impact on survival is possible. That is the reason why compelling evidence and relatively unanimous agreement exist for only three cancer screening recommendations: Papanicolaou (Pap) smears; mammography in women older than 50 years; and fecal occult blood testing (FOBT), flexible sigmoidoscopy or colonoscopy to screen for colon cancer.

So we can argue that he didn’t rail against the pseudo science of 40-49 mammography but he certainly recommended against it.

[74westy]

@CurtC

On re-reading 74westy’s posts, I think I need to clarify my point. You were saying that either traditional acupuncture or sham acupuncture is better than a placebo, in the cases where the placebo is something like a pill.

As we both agree, if you’re comparing a pill vs. jabbing you with something sharp, then if the patient is conscious there is no blinding for the test. The whole point of giving a placebo is to blind it so that the patient doesn’t know which treatment he’s getting, so you can’t blind an acupuncture trial with a pill placebo.

The researchers who came up with the sham acupuncture did so specifically to give them a fake treatment that the patient wouldn’t be able to tell the difference. In other words, the sham acupuncture was the placebo in those tests. And the genuine article acupuncture did no better than the placebo, therefore the null hypothesis is not rejected, and we can’t say that acupuncture works (acupuncture being the sticking of needles into the skin).

Now I think what you’re saying is that jabbing someone’s skin with something sharp, such as a toothpick, but not actually penetrating the skin, works better than placebo. This seems like a conclusion that’s unjustified by the data, because it has not been tested against a placebo.

Now maybe poking people with toothpicks really does help with pain, and I admit that this hasn’t been disproved, but it also doesn’t have any data in its favor. We have no data about that. If you can figure out how to test it against a valid placebo I’m sure researchers would be interested.

Your statement earlier that I objected to was that we now know that acupuncture is more effective than a placebo against pain. I hope it’s clear now why I think this is not true. Acupuncture is the sticking of needles under the skin, and when you test this idea by testing some patients with acupuncture and just making some of them think that they’ve had acupuncture, there is no difference. What matters seems to be whether the patient thinks he’s had acupuncture, and that’s a failed hypothesis.

I don’t think we disagree about anything important.

[DSeid]

Not quite advising against it, but counts as having acknowledged the lack of evidence behind the dogma. That’s something. Still, if he believes that such is the “most elementary ethical principle of cancer screening” and that only those three meet that standard why did he not feature an article railing against the guidelines advising a host of other screens: screening mammography; screening colonoscopy,; prostate cancer blood tests; etc.? He rightly calls the makers of that particular test to task for failing to live to that guideline, but never the traditional docs who present these other screens as being of unquestionable of proven benefit greater than risk when their benefits are actually of a much more questionable nature. Would those organizations who endorse him still do so if he did?

[CurtC]

@DSeid

As an example that is in the news - long before the Preventative Services Task Force made their new recommendation against the established and still clung to by many dogma that screening women 40-49 with mammography is a clearly wonderful thing that every woman should do, that it may actually cause more harm than good, Cochrane (in 2001) was sayingDid he go after that subject? I don’t think so.

I feel like I’m sounding like a Barrett fanboy here, but really, the mammogram debate is not quackery. It’s taking more data than we had before and figuring out where the expected value of the gamble becomes positive. That’s good, valid medical debate that should happen.

You can probably find exceptions, but the stuff Barrett takes on are usually quackery, not the valid back-and-forth that goes on within legitimate medical science.

[74westy]

@DSeid

He rightly calls the makers of that particular test to task for failing to live to that guideline, but never the traditional docs who present these other screens as being of unquestionable of proven benefit greater than risk when their benefits are actually of a much more questionable nature.

It would help if I knew who these traditional docs were.

[DSeid]

These traditional docs are the vast majority of internists, and the point is exactly that, that he doesn’t go after them because they are cloaked within “legitimate medical science” even though it also clearly does not meet his standard of elementary ethics. The lack of evidence that early mammography saves lives is not new. Again, Cochrane pointed it out 8 years ago.

Let’s look at prostate cancer screening - there is no, and never has been any evidence that it saves many lives -

there may be some men who are diagnosed with prostate cancer and have the side-effects of treatment, such as impotence and incontinence, with little chance of benefit …

… The U.S. Preventive Services Task Force, whose recommendations are considered the gold standard for clinical preventive services, recently concluded that there is insufficient evidence to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 and recommended against prostate cancer screening in men age 75 and older.

And while the American Cancer Society now advises only discussing and offering prostate screening, most internists and FPs just do it. After all, big name docs say things like

I think we really need to continue to screen everybody.

and docs are (rightly) afraid that they will be sued if they even give patients the option to not get tested and that person ends up being the one who has a cancer. (It happens. Really.)

By Barret’s stated standard that quoted doc and the large number who screen all men from 50 on should be called quacks - advising doing something that has been shown to have no significant chance of benefit and some real risk of harm. And cost.

Does he do that? Does he apply the same standard to things regular docs do? No.

Hey the Alternative Med folks are easy targets - they waddle, they swim … they quack more often than not. If you are* fair* you also look at those don’t look as much like ducks too, cause sometimes something that looks like a swan may quack just as loud.

[Irishman]

**Jackmannii ** said:

See post #10.

Sigh How did I guess this would happen? Someone would miss my point. I saw post #10 - back in post #10.

To recap, my point was not to agree that the comments were appropriate or inappropriate in that column. My point was that Lamar Mundane was trying to highlight what he thought was a poorly structured and misleading article because it had what to him seemed irrelevant comments included, not that Lamar Mundane was trying to defend acupuncture – Which is what DanBlather accused.

So, does anyone have proof Lamar Mundane is supporting acupuncture anywhere?