The bloviating Peter Doshi, who loves all things anti-vaccine, filed a lawsuit against Health Canada, essentially, the Ministry of Health for the country and the ministry that regulates medications and vaccines for Canada, to retrieve all of the clinical trial data for HPV vaccines that was used to get approval for the vaccines in the country (see Note 1). He recently won that lawsuit, and, unless Health Canada appeals the ruling, so we can assume he will receive mountains of data to “analyze.”
According to an article in the CBC, the ruling gives Doshi access to clinical trial data submitted to Health Canada by the manufacturers of HPV vaccines, Gardasil, Gardasil9, and Cervarix, and of anti-viral flu medications. Doshi wants to do a “systematic review” of the findings, although I don’t think that’s what a systematic review is, we’ll discuss that below. Health Canada argued that the data was confidential, and they would only hand over the data if he signed a non-disclosure agreement. Doshi refused, and he prevailed in the lawsuit.
You may have read all of this and wondered who is this Peter Doshi and why do I dislike him so. Well, most of you know of Doshi. And then you wonder why I care at all that he gets this data. I actually don’t care, but I should talk about it anyway.
So, let’s talk about the false authority, Peter Doshi, and why it matters or not that he gets this data. Spoiler alert – it doesn’t matter, but we should be prepared. Continue reading “Peter Doshi, anti-vaccine false authority, back again to push fake science”
I am a scientific skeptic. It means that I pursue published scientific evidence to support or refute a scientific or medical principle. I am not a cynic, often conflated with skepticism. I don’t have an opinion about these ideas. Scientific skepticism depends on the quality and quantity of evidence that supports a scientific idea. And examining the hierarchy of scientific evidence can be helpful in deciding what is good data and what is bad. What can be used to form a conclusion, and what is useless.
That’s how science is done. And I use the hierarchy of scientific evidence to weigh the quality along with the quantity of evidence in reaching a conclusion. I am generally offended by those who push pseudoscience – they generally try to find evidence that supports their predetermined beliefs. That’s not science, that’s the opposite of good science.
Unfortunately, today’s world of instant news, with memes and 140 character analyses flying across social media, can be overwhelming. Sometimes we create an internal false balance, assuming that headlines (often written to be clickbait) on one side are somehow equivalent to another side. So, we think there’s a scientific debate when there isn’t one.
I attempt to write detailed, thoughtful and nuanced articles about scientific ideas. I know they can be complex and long-winded, but I also know science is hard. It’s difficult. Sorry about that, but if it were so easy, everyone on the internet would be doing science. Unfortunately, there are too many people writing on the internet who think they are talking science, but they fail to differentiate between good and bad evidence.
But there is a way to make this easier. Not easy, just easier. This is my guide to amateur (and if I do a good job, professional) method to evaluating scientific research quality across the internet.
Continue reading “Hierarchy of scientific evidence – keys to scientific skepticism”
Now for something completely different, let’s not talk about vaccines – we’re going to discuss statins! There have been more and more robust studies that statins prevent cardiovascular events, including death. Nevertheless, statins have been controversial, and are used by the alternative medicine (not medicine) lovers as an example of all kinds of medical malfeasance.
As I’ve mentioned before, I hang out on Quora answering questions about a lot of topics, mostly vaccines and cancer. But I also occasionally answer questions about statins, and I regularly state that statins prevent cardiovascular events. And just as regularly, I’ll get nasty comments (see Note 1) claiming everything from my being a Big Pharma shill to I don’t know anything about anything.
So let’s take a look at this new systematic review, and try to put to rest the nonsensical dismissal of the claim that statins prevent cardiovascular events, including death. Continue reading “Statins prevent cardiovascular deaths – a new systematic review”
In the hierarchy of scientific principles, the scientific consensus – that is, the collective opinion and judgement of scientific experts in a particular field – is an important method to separate real scientific ideas and conclusions from pseudoscience, cargo cult science, and other beliefs.
I often discuss scientific theories which “are large bodies of work that are a culmination or a composite of the products of many contributors over time and are substantiated by vast bodies of converging evidence. They unify and synchronize the scientific community’s view and approach to a particular scientific field.”
A scientific theory is not a wild and arbitrary guess, but it is built upon a foundation of scientific knowledge that itself is based on evidence accumulated from data that resulted from scientific experimentation. A scientific theory is considered to be the highest scientific principle, something that is missed by many science deniers. In addition, a scientific consensus is formed by a similar method – the accumulation of evidence.
I have written frequently about the scientific consensus, because it is one of the most powerful pieces of evidence in a discussion about critical scientific issues of our day – evolution, climate change, vaccines, GMOs, and many areas of biomedical knowledge.
This tome has one goal – to clarify our understanding of the scientific consensus, and how we arrive at it. Through this information, maybe we all can see the power of it in determine what is real science and what are policy and cultural debates.
Continue reading “Scientific consensus – collective opinion of scientists”
Here we go again, another attempt to link aluminum adjuvants in vaccines to something, despite the lack of real evidence for anything. Recently, an attempt by the disreputable pair of anti-vaccine researchers to show a link between aluminum adjuvants and autism was retracted by the journal.
Several researchers have proposed a systematic review (which are considered to be the pinnacle of the hierarchy of biomedical research) to determine if there are any links between aluminum adjuvants in vaccines to some medical condition. Read that carefully – this paper does not provide any new evidence, it is merely a description of their reasons for looking at aluminum along with the meta review protocol.
Mostly, I’d ignore these type of papers, because they aren’t providing us with any new information about vaccines. But in this case, I wanted to point out a bunch of flaws in their reasoning, which seems to indicate a high degree of bias. Therein is the problem – systematic reviews are powerful tools in science based medicine, but many of these systematic reviews are filled with a large amount of bias. And this study is starting from a very biased point of view. Continue reading “Aluminum adjuvants in vaccines – another attempt for something, anything”
Subjectively, one the wilder claims one can find on social media is that marijuana cures cancer. Or cannabis prevents cancer. It doesn’t matter what form – smoked, eaten, hemp oil (which is manufactured from the seeds of cannabis plants that don’t contain much THC, or tetrahydrocannabinol, the active hallucinogenic agent of cannabis) – some advocates for cannabis will try to make the argument that it is some miracle drug for cancer.
But is it? Yes, there are systematic reviews that indicate that cannabis may be effective in reducing nausea and vomiting in chemotherapy. But research has generated negative results in some well done clinical trials and some positive results in others. But that has nothing to do with actually curing or preventing the cancer itself, just dealing with the effects of the treatment.
So what has real research said about “marijuana cures cancer?” Well, not to give away the conclusion, but not very much. Let’s take a look.
Continue reading “Marijuana cures cancer? Scientific research says probably not”
The influenza A subtype H1N1 was responsible for the 2009 flu pandemic, the last flu pandemic to strike the planet. It was estimated to have killed 477 children in the USA alone. In response to the 2009 pandemic, the H1N1 flu vaccine was first released to be used in an attempt to contain the pandemic.
The vaccine was introduced in 2009, and it has been part of many flu vaccines since that time. There has been some discussion about the effectiveness of the vaccine, but most studies showed it to be very efficacious.
A systematic review, considered the pinnacle of the hierarchy of scientific evidence, was recently published in the journal Vaccine, included well designed studies to examine the effectiveness of the H1N1 flu vaccine in both children and adults. The investigators identified 38 studies published between June 2011 and April 2016 that met the inclusion criteria for this meta-analysis – that is, any paper that focused on the H1N1 vaccine effectiveness during the 2009 pandemic. The data included data from over 7.6 million patient records derived from several different study designs.
This review also examined the differences between adjuvanted, that is, those vaccines that contain an adjuvant to boost the immune response to the flu antigens, and unadjuvanted (no adjuvants) versions of the H1N1 flu vaccine. The children’s version of the vaccine only included adjuvanted version.
The results of the study were clear. The pooled adjuvanted H1N1 flu vaccine efficacy in 1126 children was around 86% – this is an impressive number. In the pooled data for the adjuvanted and unadjuvanted versions of the vaccine, results showed that there was moderate protection of around 49% efficacy in people older than 18 years. Similarly, in individuals older than 50 years, the data showed the vaccine efficacy for the adjuvanted vaccines was approximately 46%.
This lower efficacy in older adults has been observed in other flu vaccine studies. Although there’s no conclusive reason why there is a lower efficacy, there have been several hypotheses offered including a less fit immune system for individuals, or that the population of older adults may have already have some immunity to H1N1 through previous pandemics or circulating H1N1 subtypes.
The authors concluded the following:
We further explained the overall inverse gradient between effectiveness and age by comparing adjuvanted versus unadjuvanted vaccines in each age band. Our results show that adjuvanted vaccines were significantly more effective in children than unadjuvanted vaccines in preventing laboratory confirmed influenza illness by almost a twofold difference in effectiveness. A similar pattern was also seen for hospitalization.
However, in adults there were fewer apparent differences between the performance of adjuvanted and unadjuvanted vaccines for both outcomes. The higher effectiveness in children of adjuvanted vaccines compared to unadjuvanted vaccines noted here has also been seen in efficacy studies of seasonal trivalent influenza vaccines (TIV) in young children up to 72 months of age, in whom efficacy against PCR-confirmed influenza was 92% for adjuvanted vaccines versus 45% for unadjuvanted vaccines.
The authors also asserted that this data is important for public health policy with respect to the H1N1 flu:
Evidence from modeling studies suggests that children are a credible target group for pandemic vaccination, along with patients who have high-risk conditions.
Once again, this is robust and exciting evidence of the effectiveness of the H1N1 flu vaccine against that flu subtype. The flu vaccine is often the ignored vaccine for children, probably because of enduring myths that the flu isn’t that dangerous or that the flu vaccine isn’t very effective. The H1N1 flu is dangerous, and it can be effectively prevented by the vaccine. So please, protect your children (and yourselves) with this vaccine.
- Lansbury LE, Smith S, Beyer W, Karamehic E, Pasic-Juhas E, Sikira H, Mateus A, Oshitani H, Zhao H, Beck CR, Nguyen-Van-Tam JS. Effectiveness of 2009 pandemic influenza A(H1N1) vaccines: A systematic review and meta-analysis. Vaccine. 2017 Apr 11;35(16):1996-2006. doi: 10.1016/j.vaccine.2017.02.059. Epub 2017 Mar 14. Review. PubMed PMID: 28302409.
Recently, I read an article in the Medical Journal of Australia that lists “156 health care practices identified and flagged through the search platform as potentially unsafe, ineffective or inappropriate in certain circumstances (pdf).” They cover procedures from prostatectomies to arterial stenting that lack evidence to support their continued use in many circumstances. Unsurprisingly, the list examined acupuncture research and found it lacking – it’s not medicine.
I know, people will get all upset. They’ll throw out anecdotes, like people do with chiropractic, or cherry pick poorly designed studies to “prove” that acupuncture works. They’ll try to convince everyone who will listen that it’s some sort of racism of Western based “mainstream” medicine that dismisses acupuncture. Because if it worked for your cousin’s daughter’s hairdresser’s uncle, it must be real medicine.
However, the overwhelming opinion of evidence based medicine is that acupuncture does not work. In the article, “An industry of worthless acupuncture studies,” Steven Novella concludes,
There are now thousands of acupuncture studies looking at every indication you can imagine (which stretches credulity that there is any common underlying mechanism). We are well past the time for preliminary studies. Despite thousands of studies, there isn’t a single indication for which real acupuncture has been shown to work to a high degree of confidence. At this point I would say that acupuncture should be abandoned as a scientific concept. It is a failed hypothesis that has added no real knowledge to our understanding of health and disease.
If, however, you are going to spend the resources to do an acupuncture study, make sure it is rigorous enough to add new information, and isn’t just another preliminary study to throw on the pile and get another round of misleading headlines about how “acupuncture” works. Of course a cynical person might suspect that this is the real goal of these studies.
I’m not going to review all 150 plus medical procedures that fail to meet the standards of evidence based medicine. That would be a book! But let’s focus on what they say about acupuncture research. Spoiler alert – it doesn’t work. Continue reading “Acupuncture research – evidence is overwhelming that it is not medicine”
In my writing, I often refer to the scientific consensus, which is the collective opinion and judgement of scientists in a particular field of study. This consensus implies general agreement, though disagreement is limited and generally insignificant.
The major difference between a scientific theory and a scientific consensus is that the theory is essentially fact. It is so predictive, it is supported by so much evidence, and it is so well accepted, it takes an almost ridiculous amount of data to refute it, though it is possible.
In the hierarchy of scientific principles, we often mention scientific theories which “are large bodies of work that are a culmination or a composite of the products of many contributors over time and are substantiated by vast bodies of converging evidence. They unify and synchronize the scientific community’s view and approach to a particular scientific field.” A scientific theory is not a wild and arbitrary guess, but it is built upon a foundation of scientific knowledge that itself is based on evidence accumulated from data that resulted from scientific experimentation.
We want to focus on the scientific consensus, describing what it is. Take a deep breath, because this is a complicated one.
Continue reading “Developing and supporting a scientific consensus”
This is Part 6 of a series of six articles discussing various medical uses for cannabis or marijuana. In this part, I summarize all of the five previous articles into some bullet points so that you have quick and fast access to some scientific information about medical uses for cannabis or marijuana.
In case you missed them, here are the first five articles in this series:
Part 1. Marijuana and medicine assessing the science.
Part 2. Marijuana and cancer – assessing the science
Part 3. Marijuana and neurological disorders – assessing the science
Part 4. Marijuana and health risks – assessing the science
Part 5. Marijuana and pregnancy – assessing the science
Maybe you don’t agree with the science about marijuana’s role in medicine. But that’s not how science works. The evidence should lead you to a conclusion (actually, the acceptance or rejection of a hypothesis). One shouldn’t form an a prior conclusion, then go hunt for data. That’s not how it works.
As new systematic or meta reviews bring more clinical evidence of the benefits of the medical uses for cannabis – this takes time – maybe evidence based medicine can incorporate marijuana into the armamentarium of medical practice. But only real clinical evidence matters.
So let’s review where the evidence leads us. Continue reading “Part 6. Medical uses for cannabis – the TL;DR version”