SfSBM @ NECSS or "SBM is fun!"

SfSBM @ NECSS or "SBM is fun!"

The Society for Science-Based Medicine made its second appearance at the Northeast Conference on Science and Skepticism (NECSS) in New York City this past weekend. On Friday, May 13, or "SfSBM day," a full slate of talks on science-based medicine teed off the conference

This year, SfSBM called on our fellow bloggers at SBM to fill the day's schedule. Grant Ritchey DDS, Scott Gavura, D. Pharm., Clay Jones, MD, John Snyder MD and Saul Hymes MD, joined SfSBM Board members Harriet Hall MD, Steve Novella MD, and me to cover CAM in its many guises.

Harriet Hall started the day with "Functional Medicine is Dysfunctional." She helped us navigate the word salad of the Institute for Functional Medicine's "explanation" of functional medicine, chock full of the meaningless medico-babble that characterizes "integrative medicine." Bottom line: As with IM, FM is just an excuse to incorporate diagnostics and treatments that have insufficient evidence for inclusion in "conventional" medicine, plus sell some expensive dietary supplements to patients. 

Grant Ritchey's "Where the Tooth Meets the Truth," introduced the audience to the decidedly fringe advocates behind removal of amalgam fillings and anti-fluoridation, as well as assorted CAM treatments that have invaded the practice of dentistry. Among them was a hilarious video of a continuing education course on "cranial dentistry," a variation of cranial-sacral "therapy." Cranial dentistry purports to move the facial bones around so as to "align" them. He and his staff recreated the demonstration in his dental office, clearly showing that this purported movement of the facial bones was actually accomplished by shifting the soft tissues of the face. Who would have guessed?

Our SBM resident pharmacist, Scott Gavura, and I teamed up for a presentation on dietary supplements. He took the audience through a layperson-friendly mini-course on pharmacokinetics, one I found quite helpful in understanding all the internal bodily hoops a supplement has to jump through before there is any possibility that it will hit its supposed target. Of course, drugs are engineered to do this. Dietary supplements are not, leaving the distinct possibility they'll be excreted from the body without doing a thing.

Actually, this might be the best result for the consumer, considering the dangers of contamination, missing ingredients or inherent characteristics of some supplements that can cause harm, a subject that both Scott and I covered. Given the fact that DSHEA was engineered to protect dietary supplement manufacturers, not the consumer (the subject of my talk), there is no pre-market testing of supplements for efficacy or safety. I ended my presentation with a screen shot of Peter Lipson's 2009 SBM post "DSHEA: A travesty of a mockery of a sham." Dr. Lipson was right.

During "Your Baby's Spine will be Just Fine without a Chiropractic Adjustment," pediatrician Clay Jones had the audience alternately laughing at chiropractic's nonsensical explanation of why your baby spine must be adjusted right after birth (due to "birth trauma") and gasping in horror as a chiropractor audibly cracked an infant's back, followed by a cry of pain from the baby. He also detailed the many ways chiropractors use scare tactics to bring patients in the door, such as the absolutely unethical claim that failing to have your child adjusted may result in your child dying of SIDS.

Pediatrician John Snyder's presentation, "Kids & CAM: Playing Make-Believe with Children's Health," also engendered that same mix of fascination and outrage. Some of his patients also go to a local "integrative medicine" practice. Test results that are either within normal ranges or meaningless are spun by the "integrative" doctors as indicating a need for a regimen of supplements and other useless treatments.One slide said it all: a typical medical building, representing his pediatric practice, was shown beside a colorful landscape, standing in for the IM practice, featuring rainbows and a unicorn (think My Little Pony-style graphics) – science-based medicine versus la-la land.

Pediatric infectious disease specialist Saul Hymes discussed another science vs. pseudoscience battleground in his presentation on "Chronic Lyme" disease. (Our own ID doctor, Mark Crislip, would be proud.) After going through the basics of diagnosing real Lyme disease, he explained how the "chronic" version is (purportedly) diagnosed by "Lyme literate" doctors. More audience horror: the unnecessary treatment of "Chronic Lyme" with long-term antibiotics. He included a photo of a patient who had an infusaport so that antibiotics could be regularly injected directly into her subclavian vein.

Drs. Jones, Snyder and Hymes then joined forces for a panel moderated by Dr. Ritchey: "Should Pediatricians 'Fire' Anti-Vaccination Patients?" On the one hand, there is an issue of safety for their own patients, who might contract a vaccine-preventable disease in the waiting room. On the other, the physician has an ethical duty not to abandon patients. As it turns out, none of them would actually fire patients because they, or, actually, their parents, were anti-vaccination. All believed they could continue to discuss the issue in a non-judgmental way and perhaps change some of the parents' minds. There is also the risk that parents will turn to unreliable providers for care if turned out of their offices, such as chiropractor or naturopath. And, there is the risk that their patients could not readily access care at all.

In the last presentation, Steve Novella presented a course on Bayesian statistics for the masses, which even the statistically-illiterate (myself included) could follow.  He showed us how CAM proponents worship the p-value as the definitive word in studies of their treatments, when, in fact, it is nothing of the sort. By taking into account prior probability, Bayesian statistics prevents researchers from passing off studies with negative or marginal results as positive. He also discussed how the p-value is misinterpreted.

We asked the audience to Tweet or write questions about our presentations during the day. They came up with topics ranging from punishing parents for failing to provide medical care for their children (our answer: it happens, but is not always possible or even desirable), to the placebo effect (it's complicated), to our ideas for an effective dietary supplement regulatory system (requiring evidence of at least safety and – even better – effectiveness prior to marketing).

Although SfSBM can't take credit, the day was capped with a fabulous Skeptic's Guide to the Universe Extravaganza featuring special guest Bill Nye "the Science Guy" and an appearance by the NECSS keynote speaker, Richard Wiseman.

Part of our purpose in creating SfSBM was to "go on the road" and spread the word about the dangers of pseudoscience.  But, as one NECSS audience member said, in essence, "you're preaching to the choir." They wanted to know: How can we get the message out to the rest? Steve Novella pointed out that it is important to do both, and I agree.  As for reaching that part of the populace already taken in by the gospel of integrative/complementary/alternative medicine, there are no easy solutions. For example, what does one say, as one person in the audience wondered, to the claim that "it worked for me"?  That's the hardest part of our job as supporters of science-based medicine.  Science doesn't offer easy solutions, only an attempt to discover what is supported by sufficient evidence of safety and efficacy and what is not.  This is the one big advantage CAM/IM has over SBM: when you don't need evidence for your claims, the "easy button" is always at the ready. 

Points of Interest 05/16/2016
Points of Interest 05/13/2016

Related Posts