Making sense of biomarker research

Everything you know may be wrong. Well, not really, but reading the research of John Ioannidis does make you wonder. His work, concentrated on research about research, is popular among those that want to improve the way we deliver medicine. And that’s because he’s focused on improving the way evidence is brought to bear on decision-making. His most famous papers get to the core of questioning how we know what we know (or what we assume) to be evidence. Continue reading

Skeptics in the Pub – The References

Crowd shot at SiTP, courtesy Dave Bailey/ASR

Thank you to everyone that attended my talk yesterday at Skeptics In the Pub on the topic of Over-The-Counter drugs. I enjoyed the opportunity to speak, and all the discussion it generated.  As promised, here’s a list of references and further readings. Some are written by myself, some by my colleagues at Science-Based Medicine or other blogs. Some are direct link to the source material. Continue reading

Placebos as Medicine: The Ethics of Homeopathy

sugar + lactoseIs it ever ethical to provide a placebo treatment? What about when that placebo is homeopathy? Last month at Science-Based Medicine I blogged about the frequency of placebo prescribing by physicians. I admitted my personal discomfort, stating I’d refuse to dispense any prescription that would require me to deceive the patient. The discussion continued in the comments, where opinions seemed to range from (I’m paraphrasing) “autonomy, shmatonomy, placebos works” to the more critical who likened placebo use to “treating adults like children.” My SBM co-blogger Harriet Hall noted, “We should have rules but we should be willing to break them when it would be kinder to the patient, and would do no harm.” And on reflection, Harriet’s perspective was one that I could see myself accepting should I be in a situation like the one she described. It’s far easier to be dogmatic when you don’t have a patient standing in front of you. But the comments led me to consider possible situations where a placebo might actually be the most desirable treatment option. If I find some, should I be as dogmatic about homeopathy as I am about other placebos?

Nicely, Kevin Smith, writing in the journal Bioethics, examines the ethics of placebos, based on an analysis of homeopathy. Homeopathy is the ultimate placebo in routine use — most remedies contain only sugar and water, lacking a single molecule of any potentially medicinal ingredient. Smith’s paper, Against Homeopathy — A Utilitarian Perspective, is sadly behind a paywall. So I’ll try to summarize his analysis, and add my perspective as a health care worker who regularly encounters homeopathy.
Continue reading

Supplements: Who needs them?

NHS Choices, a unit of the UK’s National Health Service, has prepared an excellent review for the general public on the evidence supporting various supplements:

Covered are:

  • Vitamins
  • Weight Loss Products
  • Treatments for Colds and the Flu
  • Gingko, Ginseng, and Glucosamine
  • Fish Oils
  • Body Building Supplements

Many of these subjects have been already discussed on this blog. This publication is consumer friendly and ideal for those that may not want to read a lot of blog posts. Recommended.