Diet fads seem to test the limits of science since forever. I’m an ancient feathered dinosaur, and I’ve seen it all from the popcorn diet to the South Beach diet to the paleo diet to the ketogenic diet.
I’m sure that the ancient Romans had some diet fad diet that the aristocracy followed to keep themselves healthy – oh wait, the Roman upper class followed the Mediterranean diet, which may be one diet fad that stood the test of time and science.
Outside of the aforementioned Mediterranean diet, which includes whole grains, olive oil, seafood, legumes, and nuts, most of these diets lack robust scientific evidence supporting their usefulness in weight loss or maintaining some unbiased standard of health. But they certainly make a lot of money for those promoting them. It was a US$66 billion market in the USA alone in 2017. Wait, maybe I should invent the Raptor Diet?
One of the current fads is the ketogenic diet, which is all the rage among those looking to lose weight, improve their health, and, I’m sure, prevent cancer. Before someone thinks it really prevents cancer, it does not. In fact, it may increase the risk of cancer. But that’s another story for another day.
Listen to the radio for a few minutes. Or watch late night television for a bit. Through the commercials hawking insurance with talking geckos, promoting treatments for erectile dysfunction, and, exhibiting the coolest, fastest, most fuel-efficient car, you will run across the reason for all that ails you–your failure to use colon detoxification to fix your problems.
Today is Valentine’s Day, 2016. For many of you, it’s all about roses and chocolates. But for a bunch of us, it’s all about The Walking Dead and zombies. And in honor of the return of The Walking Dead, let’s talk about zombie anti-vaccine tropes that never die – the infamous CDC whistleblower oh my.
The antivaccination cult, lacking any real evidence for their unscientific beliefs, tend to grab on tightly to the flimsiest of stories. They love to scream “GOTCHA” to anything that shows up on the internet that puts vaccines in a bad light. A few years ago, they were jumping for joy regarding some comments from Dr. Diane Harper, who was promoted by the antivaccination crowd as the “lead researcher” for Gardasil. Except, the story was a lot different than they claimed.
The claims for acupuncture have any clinical usefulness are vastly overblown with evidence ranging from weak to nonexistent to dangerous. As Steven Novella at Science-Based Medicine once wrote, acupuncture is nothing more than “theatrical placebo.” On the long list of ridiculous claims for this pseudoscience is using acupuncture for hypertension treatment – and once again, real biomedical science shows it is worthless.
The supplement industry is huge and unregulated. Americans spend more than $30 billion annually on them, yet contaminated supplements are part of the industry’s method to make their mostly useless products appear to have some clinical effect.
There is growing evidence that these contaminated supplements contain unlabeled ingredients that are found in regulated pharmaceuticals – all without telling the consumer about them. Or testing them. Or listing warnings for their use.
As I’ve written many times, supplements are basically worthless, unless you have specific chronic medical conditions or suffer from chronic malnutrition that prevents you from receiving enough micronutrients, like vitamins and minerals. In addition, those on highly restrictive diets, like vegans or those who have had weight-loss surgery, may require supplementation, although both could be considered “chronic medical conditions.”
Because a lot of people favor confirmation bias as their go-to argument, I constantly hear, “hey Skeptical Raptor, vitamin C prevents scurvy, ergo all supplements are the greatest thing we can consume.” Scurvy is fairly rare these days in developed countries, but it can happen especially to smokers since cigarette smoke inhibits uptake of vitamin C (and another reason not to smoke).
So unless your diet only includes steak, ice cream, and junk food, an average American or European will get more than adequate amounts of vitamin C from their diet. Anyone deficient in vitamin C could be considered to be malnourished, and, of course, they will benefit from a vitamin C supplement. But vitamin C does not prevent colds, flu, or cancer. It is not a miracle vitamin, despite the oft-debunked claims of the pseudoscience-based supplement proponents.
Despite the utter lack of or weak evidence of the usefulness of supplements, unsurprisingly, over half of all Americans take dietary supplements. I guess chronic malnutrition and medical conditions afflict over half of Americans. The facts are that human needs for nutrients, like vitamins, are more than adequately met by a broad, healthy diet that includes a lot of fruits and vegetables.
Of course, many of the answers provide answers that are supported by scientific evidence – CAM cancer cures do not work. Of course, there are a few scam artists answering the questions who make outlandish claims about cancer cures. And the number of times someone claims that cannabis is one of the best cancer cures is ridiculous – the evidence is extremely weak (see Note 1).
A paper was recently published that examined the survivability of individuals with curable cancers that refused conventional cancer treatments and chose complementary and alternative medicine. We will get to that article, but spoiler alert – CAM doesn’t work and may be dangerous.
What is complementary and alternative medicine?
CAM is any “medical” treatment that is not supported by robust scientific evidence or incorporated into evidence-based medicine. Most complementary and alternative medicine have no clinical effects beyond placebo (see Note 2), and it cannot treat any serious medical condition. CAM is pure pseudoscience.
CAM is known by its other names – quackery, quackademic medicine, snake oil, woo, or junk medicine. CAM quacks invent absurd pejorative names for evidence-based medicine just to create a silly false balance – terms like allopathy, conventional medicine, or Western medicine. You science-based readers will see through this nonsense, and understand what they really mean is “evidence-based medicine, but we prefer our pseudoscientific medicine.”
CAM is popular because it provides false hope to those interested. These quacks can make outrageous claims about cancer cures because they can play to fears of cancer patients about surgery, chemotherapy, or radiation therapy. These scammers promise cures that are easy, but these “therapies,” in fact, don’t work.
You know what they call alternative medicine that’s been proved to work?
Cancer is a group of diseases characterized by abnormal cell growth which can invade or metastasize to other tissues and organs. Although people use tumor and cancer interchangeably, not all tumors are cancer. There are benign tumors that do not metastasize and are not cancers.
The variance in number results from the lack of precise definitions for some cancers. So researchers may group several different cancers into one heading. But clearly, there are up to 200 or more different cancers.
Furthermore, each of these cancers has a different etiology (cause), pathophysiology (development), treatment and prognosis. When someone is called a “cancer researcher,” they are rarely studying all cancers, but they’re studying one small part of the story of one of the 200 or so cancers.
Geneticist Bert Vogelstein and mathematician Cristian Tomasetti, at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, conducted the study, a follow-up to an earlier one, which arrived at the same conclusion. The researchers wanted to know whether replications errors were behind most cancers, versus other factors, such as tobacco.
The researchers found, after examining 32 different kinds of cancer, that 66% of these cancers were a result of chance mutations in cells, 29% resulted from the environment, and 5% from inheriting a mutation.
These mutations aren’t “naturally” a part of the cell’s physiology. Moreover, these mutations can have a lot of different causes – environmental (like smoking or UV radiation), viral (hepatitis B and human papillomavirus are the most famous), heredity, and maybe other things. These mutations are more or less random, and they can’t be prevented by anything special–if only it were that easy.
There are a few things you can do to prevent cancer, such as quitting smoking, staying out of the sun, getting your hepatitis B and HPV vaccinations, not drinking alcohol, keeping a low body weight, and eating a balanced diet. But even if you are a paragon of healthy living, a random mutation in some cell in your body can lead to cancer.
The study, by Skyler B Johnson, MD, of the Yale School of Medicine, was published in JAMA Oncology in July 2018. The researchers examined a huge database of cancer patients over a 20-year period of time – it included an impressive 2 million individuals. They sorted to through the records to compare patients who used alternative medicine to treat their cancer to a matched sample of individuals who relied upon evidence-based cancer treatments.
I also want to emphasize that the researchers specifically selected for individuals who had easily treatable cancers.
Let’s cut to the chase – after controlling for confounding variables, that is, variables that can influence both the cause and the effect, individuals who utilized CAM for cancer treatment were statistically much worse off.
CAM users had a much lower chance of surviving 5 years after cancer diagnosis.
They were 2X more likely to die of cancer.
Less than 70% of CAM users were alive seven years after diagnosis. This compared to more than 82% of those who relied upon evidence-based medicine who survived seven years.
The mortality risk for those individuals who used CAM increased every year that they avoided standard cancer therapy.
Now, this doesn’t mean that the study found that CAM had a negative effect on cancer patients. CAM is worthless, it has no effect on health. However, what the researchers did state is that those individuals who preferred CAM were refusing or delaying conventional cancer treatments that actually work.
Because CAM is worthless, it probably doesn’t matter if the patient uses it along with conventional cancer therapy. It is amusing that many patients will give credit to the CAM therapy rather than the conventional one when their cancer goes into remission. Of course, most of us know the scientific facts about it.
If you have a cancer diagnosis, use real evidence-based medicine to treat it, not CAM quackery. Despite patient fears of surgery, chemotherapy, and radiotherapy, the evidence has shown us that they work and that the mortality rate for many cancers continues to drop every year. The trope that Big Pharma, Big Hospital, and Big Oncology are hiding the one cure to cure them would be amusing if it weren’t so dangerous.
Let’s be clear – complementary and alternative medicine is worthless. The evidence that it provides cancer cures just doesn’t exist – the best, most robust, highest-quality evidence shows the way we treat cancer is best done by real physicians with real backgrounds in oncology.
If any compound of the marijuana plant can actually treat cancer, it will be isolated by real medical researchers, they will create a method to deliver that component directly to the site of the cancer, they will test it for efficacy and toxicity, and then seek FDA approval. Anecdotes and weak pre-clinical studies for any of the claimed cancer cures are nearly valueless to real science-based medical treatments for cancer.
Many people overstate the value of placebos – officially, a placebo means that the effect is nothing more that can be found by giving the patient a sugar pill. The effect is almost always psychosomatic, so placebos effects are more prevalent with neurological conditions like pain, although the evidence that CAM can treat pain is laughably inconsistent. However, placebos have never been shown to treat cancer, mend a broken bone, cure an infectious disease, save a trauma victim, or do anything for other serious medical conditions. In science, anything with a “placebo effect” is considered a failure, and it would never receive FDA approval. The placebo effect is simply a myth.
Maybe some of you haven’t been following the reports about the European measles epidemic, but it’s scary news. The BBC Newsreported that more than 41,000 people have contracted measles in the first six months of 2018. Worse yet, 37 of those people have died of that virus.
Let me be blunt – nearly every one of those 41,000 cases and 37 deaths could have been prevented by the MMR vaccine (for measles, mumps, and rubella). Period. Full stop. End of story.
In case I wasn’t clear, let me repeat myself – indulge me, we’re talking about children dying of an entirely preventable disease. Every single case of measles could have been prevented. Every single death could have been prevented. This isn’t a complicated story.
Maybe you think that Europe is a big area with over a half billion people, so this might be expected. That would be incorrect. Measles was almost extinct in much of the developed world. In 2016, there were just 5,273 measles cases for the whole year. In 2008, there were only 3,575 cases and one death. Measles was almost eliminated.
Figuring out the quality of sources, that would separate good from bad science, took me a long time. I was sleep-deprived, had postpartum anxiety, and was scared of something I had not previously thought that much about before having kids.
The woman who had been a mentor to me in my career, with whom I had entrusted my life and that of my child through my pregnancy and birth, whispered in my ear a few minutes after my son was born to not let the hospital give him the hepatitis B vaccine. This was the first and last communication we had about vaccination, but filtered through my trust for her it planted a seed of doubt and convinced me at the time there was a good reason to avoid it. Her suggestion that I followed could have cost my son his life, but it took me almost two years to figure out why.
I set out on a path of sleepless nights to figure out what those reasons might be, and the internet can certainly deliver on that front. The problem was, most of what I was reading was misinformation designed to exploit my fears. I wasn’t yet familiar with the idea of confirmation bias or that search engines had a lot of first page hits for poor sources because of the way the search algorithms work.
It took me some time to figure out that Google is the confessional of our anxieties, the most commonly typed in fears get boosted, and higher quality links with more technical language tend to lag behind as we often don’t know what keywords will give us the answers we are looking for. If we think of the internet as a library, it would be like if register adjacent tabloids and flyers handed to you on the street by conspiracy theorists were filed in the most prominent shelf spaces amongst the reference books.
Quality information is available, but it can take some digging to get to it. As a result, I got a lot more scared before I learned how to better interpret the quality of what I was finding. I eventually learned to type whatever scared me alongside “+criticism” or “+debunked” if I wanted to find a different perspective on a topic. Doing that is how I stumbled upon Skeptical Raptor’s well-cited breakdowns of things I had been reading that had me all twisted up in knots. Learning to use Google Scholar for searches also helped to cut through the noise when I was looking for actual research.
There are so many myths, tropes, and memes pushed by the anti-vaccine religion that it’s almost a full-time job to keep up with it all. One of the most ridiculous is that vaccines aren’t tested, especially in clinical trials. This is ridiculous on so many levels, the most important of which is that testing vaccines are critical to receiving regulatory approval across the world.
The anti-vaccine religion believes that vaccines aren’t tested thoroughly before being used on unsuspecting infants. I do not know where this started, or why it started, but like much in the anti-vaccination world, it really doesn’t matter. It just passes from one person to another across social media, and individuals with no research background hold this particular belief as if it were the Truth™.
I have been skeptical of supplements for a long time – not because I have some predisposition against them. My skepticism results from the relative lack of any robust evidence that supplements have any positive effect on human health other than in unique situations of chronic diseases or malnutrition. In fact, most of the high-quality evidence about supplements show that it does not work. And a recently published review shows that using supplements for cardiovascular diseases are expensive and useless.
Since many readers fail to read what I wrote above, let me repeat myself for clarity. Supplements are not completely useless – of course, they are important for those who have chronic diseases or conditions may require supplements of some or many micronutrients. Someone who has had bariatric surgery or other types of serious gastrointestinal surgery may not be able to consume enough vitamins and minerals from food, and they will require multivitamins.
Also, some individuals may be malnourished, which doesn’t mean just not eating enough, but not eating some foods that have specific nutrients. For example, avoiding certain foods that contain vitamin C could put you at risk for a disease called scurvy, which can be deadly. There are several other diseases that result from missing key nutrients. However, in the modern developed world, these diseases are extremely rare because of the varied diet we have – and the availability of supplements to treat those diseases.
The whole supplement industry has an overreliance on logical fallacies (like appeal to popular belief or appeal antiquity) or anecdotes (which aren’t data) to convince customers to buy their nonsense. They do this because they are not required to undergo gold-standard clinical trials to convince the FDA to approve their claims. Real pharmaceuticals, on the other hand, take 10-20 years of research and clinical trials before they are approved for use.
Big Supplement (yeah, it’s a huge industry, over US$100 billion annually, worldwide) also pushes the trope that if a little helps, a lot is better. This is not good science. The millions of years of human evolution (following up a billion years of immune system evolution) has led to a rather powerful immune system that is exceedingly complex and has always been able to do its job without the addition of supplements (unless early Homo sapiens had access to a GNC someplace).