Placebo: Now available in maximum strength

By Maggie Koerth-Baker at 11:47 am Wednesday, May 16 • Comments • Share

For only 6 British Pounds, you can cure what ails you with Placebo maximum strength sugar pills.

I'm a little sad that Etsy user spellingmistakes got to this idea before I could start marketing Placebex, as I've been threatening to do since approximately 2001. Maybe there's an intellectual property lawsuit in there someplace. ;)

And, before you ask, yes ... there really is some evidence that placebos work even if the people taking them already know that the drug is a placebo. Back in 2010, a study of ethical placebos used with irritable bowel patients got a lot of press. It was a follow up to a 2008 study that found roughly the same results.

If you want to read more on ethical placebos, I'd recommend checking out the following stories:

• Evidence that placebos work even if you tell people they're taking placebos by Ed Yong
• Meet the ethical placebo by Steve Silberman

Or, perhaps, you might like to purchase some Placebo maximum strength.

Via Darren Cullen

Chimpanzee testing: the beginning of the end? (video)

By Xeni Jardin at 6:46 am Friday, May 11 • Comments • Share

For PBS NewsHour, Miles O'Brien reports on whether there are ever instances in which the scientific value of research should offset the moral cost of working with chimpanzees. The US government has moved to limit some of the research it funds with chimps in recent months. Medical experiments on chimps can be invasive: one animal may endure dozens of injections, blood samples and liver biopsies in her lifetime. But some scientists argue that this is the only way to advance medicine. MP3 and transcript here, along with video.

PHOTO: Miles O'Brien. "If they could talk, what would these residents of Chimp Haven tell us?"

What cancer statistics actually mean

By Maggie Koerth-Baker at 12:00 pm Thursday, May 10 • Comments • Share

Genius science writer Ed Yong used to work for a cancer charity, so he's seen how the cancer research sausages get made. In a new post at Not Exactly Rocket Science, Ed takes you on a brief tour of the factory, explaining why even good data doesn't necessarily mean what you think it means.

The post is based around a new study that says 16.1% of all cancers worldwide are caused by infections. This statistic is talking about stuff like HPV—viruses and other infections that can prompt mutations in the cells they infect. Sometimes, those mutations propagate and become a tumor.

That statistic tells us that infections play a role in more cancers than most laypeople probably think, Ed says. It gives us an idea of the scale of the problem. But you have to be careful not to read too much into that 16.1%.

The latest paper tells us that 16.1% of cancers are attributable to infections. In 2006, a similar analysis concluded that 17.8% of cancers are attributable to infections. And in 1997, yet another study put the figure at 15.6%. If you didn’t know how the numbers were derived, you might think: Aha! A trend! The number of infection-related cancers was on the rise but then it went down again.

That’s wrong. All these studies relied on slightly different methods and different sets of data. The fact that the numbers vary tells us nothing about whether the problem of infection-related cancers has got ‘better’ or ‘worse’. (In this case, the estimates are actually pretty close, which is reassuring. I have seen ones that vary more wildly. Try looking for the number of cancers caused by alcohol or poor diets, if you want some examples).

And that's only one of the complications involved in understanding cancer statistics. You really should read Ed's entire post. After you do, a lot of apparent inconsistencies in cancer data will make a lot more sense to you. For instance: What about the cancers caused by radiation exposure?

Read the rest

TOM THE DANCING BUG: Medical Marijuana - Gateway Drug!

By Ruben Bolling at 9:30 am Wednesday, May 2 • Comments • Share

View the comic

How to: Read science news

By Maggie Koerth-Baker at 8:22 am Monday, Apr 30 • Comments • Share

How you read matters as much as what you read. That's because nothing is written in a vacuum. Every news story or blog post has a perspective behind it, a perspective that shapes what you are told and how that information is conveyed. This is not, necessarily, a bad thing. Having a perspective doesn't mean being sensationalistic, or deceitful, or spreading propaganda. It can mean those things, but it doesn't have to. In fact, I'm fairly certain that it's impossible to tell any story without some kind of perspective. When you relate facts, even in your personal life, you make choices about what details you will emphasize, what emotions you'll convey, who you will speak to—and all of those decisions are based on your personal perspective. How we tell a story depends on what we think is important.

Unfortunately, sometimes, perspective can be misleading. That's why it's important to be aware that perspective exists. If you look at what you're reading, you can see the decisions the author made, you can get an idea of what perspective they were trying to convey, and you will know whether that perspective is likely to distort the facts.

Emily Willingham is a scientist who blogs about science for the general public. Over at Double X Science, she's come up with a handy, six-step guide for reading science news stories. These rules are a great tool for peeking behind the curtain, and learning to think about the perspective behind what you read. In the post, she explains why each of these rules is important, and then applies them to a recent news story about chemical exposure and autism.

3. Look at the words in the articles. Suspected. Suggesting a link. In other words, what you're reading below those headlines does not involve studies linking anything to autism. Instead, it's based on an editorial listing 10 compounds [PDF] that the editorial authors suspect might have something to do with autism (NB: Both linked stories completely gloss over the fact that most experts attribute the rise in autism diagnoses to changing and expanded diagnostic criteria, a shift in diagnosis from other categories to autism, and greater recognition and awareness--i.e., not to genetic changes or environmental factors. The editorial does the same). The authors do not provide citations for studies that link each chemical cited to autism itself, and the editorial itself is not focused on autism, per se, but on "neurodevelopmental" derailments in general.

4. Look at the original source of information. The source of the articles is an editorial, as noted. But one of these articles also provides a link to an actual research paper. The paper doesn't even address any of the "top 10" chemicals listed but instead is about cigarette smoking. News stories about this study describe it as linking smoking during pregnancy and autism. Yet the study abstract states that they did not identify a link, saying "We found a null association between maternal smoking and pregnancy in ASDs and the possibility of an association with a higher-functioning ASD subgroup was suggested." In other words: No link between smoking and autism. But the headlines and how the articles are written would lead you to believe otherwise.

The one rule of Willingham's that I would question is "Ask a Scientist", not because it's bad advice, but because it's not something most people can easily do. Twitter helps, but only if you're already tied into social networks of scientists and science writers. Again, most people aren't. If you want to connect to these networks, I'd recommend starting out by picking up a copy of The Open Laboratory, an annual anthology of the best science writing on the web. Use that to find scientists who write for the public and whose voice you enjoy. Add them in your social networks, and then add the people that those scientists are spending a lot of time talking to. That's the easiest way to connect with some trustworthy sources. And remember: An expert in one subject is not the same thing as an expert. It doesn't make sense to ask a mechanical engineer for their opinion on cancer treatments. It doesn't make sense to as an oncologist about building better engines.

Read the rest of Emily Willingham's post on reading science news.

Buy The Open Laboratory 2010 (the 2011 edition hasn't been published yet).

“My breast has fallen off. Can you reattach it?”

By Xeni Jardin at 12:08 pm Tuesday, Apr 24 • Comments • Share

Atlanta Magazine has an interview with Otis Webb Brawley, M.D., and an excerpt from his new book "How We Do Harm: A Doctor Breaks Ranks About Being Sick in America."

The excerpt tells the story of 53-year-old Edna Riggs, of Atlanta, Georgia. Fear of cancer, medical debt, and losing her job caused her to not seek treatment for her breast cancer until it reached a very advanced state.

(Graphic content, may be upsetting; via @rogersmatthew)

Why we still don't totally understand how diseases spread

By Maggie Koerth-Baker at 4:34 pm Monday, Apr 16 • Comments • Share

 

When I was little, I read a Reader's Digest book of great disasters, which included a segment on the Black Death. One of the things the book tried to do was explain, on a child's level, why it wasn't easy to figure out that rats and fleas were the source of the plague. You couldn't just look for patterns, because there seemed to be no pattern. Half a household might drop dead while the other half only got a little sick, or remained entirely healthy. Plague doctors who handled the sick every day lived another 20 years. The real spread of disease wasn't like the movies, where one person coughing means everyone in close proximity is doomed.

One reason for the emergence of strange non-patterns like this is something called "super spreaders"—basically, some people spread disease more effectively than others. The infamous Typhoid Mary is the poster child for super spreaders, but the effect has been well-documented in a range of infectious diseases and it goes beyond the simple story of one woman who infected thousands. In fact, what makes the super spreader phenomenon so fascinating is that it isn't an anomaly at all. Super spreaders are the primary way some diseases spread. The Contagions blog—which is all about the history of infectious disease—has a great post up about this.

Eventually new models arose like the “20/80″ rule that says that 20% of cases are responsible for 80% of the transmission and formed a core ‘high risk’ group. This model works well for some diseases but not all.

For pathogens that do rely on super-spreaders, the majority of cases will not transmit the infection to anyone. This can lead to a sense of false security because it seems poorly communicated. As Galvani and May assert, “heterogeneously infectious emerging disease will be less likely to generate an epidemic, but if sustained, the resulting epidemic is more likely to be explosive”. Super-spreaders tend to beget more super-spreaders, although most of the cases they generate will still not transmit the infection to anyone. For example, a super-spreader begets 30 cases, 3 (10%) of which become new super spreaders. The rest may transmit to 0-1 people.

Super-spreading has been documented for HIV, SARS (Sudden Acute Respiratory Syndrome), measles, malaria, smallpox and monkeypox, pneumonic plague, tuberculosis, Staphylococcus aureus, typhoid fever, and a variety bacterial sexually transmitted diseases.

And that brings us back to medical mysteries because, the Contagion blog explains, we don't know exactly why some people are super spreaders and others aren't—or why some people are more vulnerable to infection than others. So far, what we have to go on is a list of well-established correlations.

Read about what makes a super-spreader at the Contagions blog.

Image: Thomas Bartholini's illustration of beak doctor from 1661. Via Wikipedia.

A doctor reviews the science of "House"

By Maggie Koerth-Baker at 1:22 pm Friday, Apr 13 • Comments • Share

Earlier this week at The Conference on World Affairs, I watched a panel about science in the movies. During the panel, physicist and science writer Sidney Perkowitz said that, out of all the people writing about science and medicine in Hollywood, the writers of House are some of the people who care the most about accuracy.

After I tweeted that, reader Jay Rishel pointed me toward Polite Dissent, a blog written by a doctor that periodically reviews the medical science presented on episodes of House.

It's a nice reminder that even the writers who care the most about getting science right, don't always succeed. That said, I am pretty impressed that, for the most part, the complaints the doctor-blogger has are usually closer to the nit-pick end of the spectrum. For a show that is so densely packed with medical information, that's pretty good. Some of the complaints about Season 2, Episode 1:

I’m surprised the inmate didn’t have a severely elevated blood pressure with the pheochromocytoma, and I’m equally surprised that his abdominal surgery went so well since pressure on the abdomen is enough to cause the tumor to release a large amount of adrenalin. This sends the blood pressure rocketing dangerously high.

The patient got over his respiratory depression remarkably quickly — one minute he’s sick enough to require intubation, and the rest of the time he’s fine. (And why wasn’t the endotracheal tube taped in place?)

It takes a great deal more alcohol than a few shots to clear that much methanol from the body, and that’s why IV ethanol is generally used.

Check out all of Polite Dissent's House-related posts.

Via Jay Rishel

LAPD probing Lap-Band weight loss surgery provider after patient deaths

By Xeni Jardin at 12:17 pm Tuesday, Apr 10 • Comments • Share

Billboards for weight loss surgery provider "1-800-GET THIN" were ubiquitous around LA freeways until recently; the company has since come under scrutiny by the FDA, consumer affairs watchdogs and Consumer Reports for sketchy business practices. Now, the Los Angeles Police Department is investigating the firm over the recent death of a patient. Snip from LA Times report:

In a civil lawsuit, two former surgery center workers alleged that a series of medical gaffes contributed to [55 year old patient Paula] Rojeski's death. That lawsuit, filed in January, said an intravenous line was not properly inserted into Rojeski's arm during surgery, causing solution to pool on the floor of the operating room. Former surgical technicians Dyanne Deuel and Karla Osorio also said in the lawsuit that the anesthesiologist forgot to turn on the oxygen tank before surgery.

The LA Times report goes on to list four additional patient deaths. (photo: LA Times)

Herbal remedy used to treat kidney ailments causes kidney ailments

By Xeni Jardin at 11:48 am Monday, Apr 9 • Comments • Share

A plant known as "birthwort," popular in Asian and European herbal medicine for hundreds of years, causes kidney failure and cancer. Dan Vergano at USA Today digs into the fascinating medical detective work that solved this mystery: scientists compared genetic mutations in the tissue of humans and lab mice who'd been poisoned by the plant's toxic component:

"The big clue was the plant itself," says pharmacologist Arthur Grollman of Stony Brook (N.Y.) University. "Once it was appreciated that it contained a potent kidney toxin and human carcinogen, we could get to the bottom of things."

Grollman and colleagues have unraveled a genetic signature left behind by birthwort in cases of cancers and kidney failure, as reported in the March journal of Kidney International. And in upcoming work, they report signs that use of the drug in Chinese medicines may be responsible for Taiwan's sky-high rate of kidney disease.

Read more: Herbal 'remedy' may trigger widespread kidney failure – USATODAY.com.

How long does food poisoning last?

By Maggie Koerth-Baker at 9:10 am Thursday, Apr 5 • Comments • Share

I recently had what I am pretty sure was foodborne illness. It arrived in the middle of a friend's birthday party, a sudden onslaught of misery that lasted for the next 8 hours, reminding me, horribly, of a similar scene in The Mask of the Red Death. It was followed by two days of pretty much constant sleep. I don't recommend it.

But if a growing body of research is right, that 48-hours of grossness might not be the end of your body's interaction with a foodborne bug. In fact, some people seem to have otherwise unexplained symptoms persisting for years after they thought they'd recovered from food poisoning. This is best documented in people whose food poisoning experience was much worse than mine—folks who ended up in the hospital or the doctor's office and were, thus, accurately diagnosed, so we know they had a foodborne illness and not, say, a stomach flu. But it's an interesting hypothesis.

Maryn McKenna, my favorite Scary Disease Girl, has a story about this at Scientific American, plus some extra information at her Wired blog, where she explains why this phenomenon is so difficult to study.

I start the story with the tale of a Florida teen named Dana Dziadul, who 11 years ago was hospitalized with Salmonella and now at 14 has what is called “reactive” arthritis. Her mother Colette struggled for years to figure out why this was happening to her daughter, but didn’t put the pieces together until she was asked to complete a survey of foodborne illness survivors, and spotted a list of possible after-effects — sequelae, technically — that the surveyors were curious about. That caused her to go back into Dana’s medical chart, where she realized that her daughter’s joint problems actually began while she was hospitalized as a 3-year-old.

The challenge of proving this connection is that our system for investigating foodborne illness is not set up for tracking victims long afterward. That’s first because state health departments, which bear the burden of identifying outbreaks, are most concerned with finding people at the time, not keeping track of them; and second, because many outbreaks are spread across multiple states, with only a few victims in each state — so that maintaining contact with former victims would require a shared effort that no one is set up, or funded, to do. (That’s not even to mention the complication of people moving from one jurisdiction to another. Myself, for instance, I’ve moved five times in the past 10 years.)

Read the full story at Scientific American.

Read Maryn's summary of the research, and extra info, at her Wired blog.

Image: X.L.D. Agar 1 - detail, a Creative Commons Attribution (2.0) image from nathanreading's photostream

Diverse nursing uniforms modeled by not-particularly-diverse cast of nurses

By Maggie Koerth-Baker at 11:48 am Wednesday, Apr 4 • Comments • Share

These nursing uniforms come from the Philippines, Denmark, British Honduras; Hong Kong, Madeira, Kenya; Nepal, Dominican Republic, and Colombia. The nurses, one suspects, do not.

The photo, though, is really interesting. I'd love to know more about why nursing uniforms differed so dramatically. Some of it is surely cultural. But then you look at things like the sleeves on the Hong Kong nurse and you think there's got to be a practical reason behind some of this stuff.

This comes from Hidden Treasure—a book that catalogs amazing images from the archives at the National Library of Medicine. You can see a slideshow of images from the book—including Hitler's head x-ray!—at Wired.

Via David Dobbs

How to: Survive rabies without really trying

By Maggie Koerth-Baker at 11:36 am Wednesday, Apr 4 • Comments • Share

This is an awkward sort of "How To" post because nobody really knows the answer. Here's the rather bleak reality: Rabies is not, typically, something you live through. If you think you've been exposed, you can get a life-saving vaccine. But, if you miss that window, and symptoms start to appear, your chances of survival are pretty much nil.

There are exceptions. We've talked before here about the Milwaukee Protocol, a medical intervention that some doctors think has allowed a handful of people to escape death. But the Milwaukee Protocol is not a simple thing. It involves hospitalization, as doctors put the affected person into a coma. Basically, they reboot the system. And it might not be as effective as we think it is. Five people have gotten the Milwaukee Protocol and survived. Thirty-two others received the treatment and still died. There's a lot of effort that goes into the Milwaukee Protocol, and it might be wasted effort.

Then there's this: In 2009, a teenage runaway walked into a Texas hospital, exhibiting symptoms of rabies—a diagnosis that was later confirmed. She didn't get vaccinated before symptoms started. She never got the Milwaukee Protocol. Instead, she recovered on her own and left the hospital hale and healthy three weeks later.

That's not supposed to happen in humans.

The Austin American-Statesman has a fascinating story about this case. At the heart is a big mystery. The young woman cut off contact with hospital researchers shortly after she was discharged from the hospital. She was homeless—in fact, she'd probably contracted rabies from a bat while camping in a cave. There's a very good chance that we may never know why she survived when so many others don't.

Veterinarians know that not all animals die after exposure — usually from a bite — to the rabies virus, which is carried in saliva and other bodily fluids. Much depends on how much of the virus is transmitted, the severity and location of the bite, and the immune system of the bitten animal.

"Abortive rabies is not unusual in research animals — it happens spontaneously all the time," Rupprecht said.

Rupprecht said the blood of certain human populations — maybe 1 percent of raccoon hunters, for example — also tests positive for rabies antibodies, indicating they have been exposed to the virus without becoming acutely ill. In the Amazon, where indigenous tribes are at daily risk of rabies from vampire bats, "it could be in the 10 percent or more range," he said.

The rabies vaccine, injected in a series of five doses, prevents onset of the disease if given soon enough after exposure. About 35,000 people receive the expensive shots — the series costs about $1,600 — in the U.S. each year. Seldom do more than a handful of people die from rabies in a year. But once rabies symptoms appear, the vaccine is no help.

"We don't have poster children. In our field, 99.9 percent of our cases are in the ground," Rupprecht said.

Read the rest of the article at the Austin American-Statesman

Image: White-Shouldered Bat, a Creative Commons Attribution Share-Alike (2.0) image from wilsonb's photostream

Via GrrlScientist

How to: Replace unnecessary antibiotics with a good dose of empathy

By Maggie Koerth-Baker at 8:20 am Thursday, Mar 29 • Comments • Share

A key component of antibiotic resistance is the over-use of antibiotics. We talk about this a lot in the context of over-the-counter antibacterial cleansers, but there's a doctor's office side to this story, as well.

When sick people come into a doctor's office, part of what they are looking for is psychological wellness. They want to feel like somebody has listened to them and is doing something to treat their illness. Sometimes, that means they ask their doctor for antibiotics, even if antibiotics aren't the right thing to treat what they have.

In the past, and sometimes still today, doctors go ahead and prescribe antibiotics almost like a placebo. It's hard to say no to something a patient really wants, especially when it's likely to make them feel better—just because taking anything, and treating the problem, will make them feel better. But that is definitely not a good thing in the long term.

At KevinMD, family physician Dike Drummond offers some really nice advice for doctors who are struggling with how to make a patient feel better, but also want to avoid contributing to the growing antibiotic resistance problem. What I like best about Drummond's advice: It starts with empathy.

If you have a major challenge working up some empathy one of two things is happening.

You are experiencing some level of burnout. Empathy is the first thing to go when You are not getting Your needs met. This is a whole different topic and “compassion fatigue” is a well known early sign of significant burnout.

You are not fully present with the patient and their experience. In many cases this can be addressed by taking a big relaxing, releasing breath between each patient and consciously coming back into the present before opening the door.

Read the rest at KevinMD

Via Nick Bennett