Feed aggregator
Chelation for Autism - Putting the Cart before the Unicorn
Autism spectrum disorder (ASD) is a challenging neurological condition characterized by difficulty with social interaction and communication. As the name implies, it occurs across a wide spectrum from barely detectable to debilitating. ASD is usually diagnosed by 3 years old, but studies have found that signs are often present as early as six months old.
It is understandable that parents of children with ASD are eager for effective treatments and feel obligated to do their best for their children by leaving no stone unturned. This is not, however, always the best approach in medicine. Some stones can cause harm and are best left unturned.
There is a cottage industry of so-called "biomedical" treatments for ASD - they treat ASD as a biological disease that can be cured or at least significantly ameliorated. This conflicts with the current scientific consensus regarding ASD, that it is a neurodevelopmental disorder (a result of brain wiring), and not an active disease. Legitimate interventions focus on improving function. Critics of biomedical treatments (myself included) argue that such treatments are unscientific, exploit parental desperation, and even victimize children with ASD.
A recent systematic review looks at one popular biomedical treatment for ASD, chelation therapy. The idea here is that autism is caused by, or significantly worsened by, the presence of toxic heavy metals, such as mercury, in the body. This is often tied to the claim that vaccines are the source of the heavy metal poisoning and therefore are linked to autism (a claim that has been soundly refuted by the evidence).
Chelation therapy is a legitimate treatment for real heavy metal poisoning. Chelating agents can be given orally or intravenously, they bind to heavy metals and help the body excrete them. In this regard they work well - after receiving chelating agents the body will excrete heavy metals.
Chelation therapy, however, has been a popular target for the fringe. For decades a persistent but tiny minority of physicians have believed that chelation therapy is an effective treatment for vascular disease, despite the fact that the evidence has refuted this claim on both basic science and clinical grounds.
One has to wonder if the fact that chelation therapy is an expensive procedure and has to be given multiple times is a factor in its popularity on the fringe.
In any case - at best chelation therapy can be considered experimental for autism. This raises issues regarding the ethics of giving experimental treatments, ethics which have been thoroughly explored.
First, experimental treatments should not be offered instead of proven therapies. In other words, they are not a justification for withholding standard of care treatment. In cases where such treatments are not available or insufficient, however, resorting to experimental treatments is reasonable.
Experimental treatments, however, should be reasonably justified by existing evidence. There should be good reason to believe that such treatments are likely to be safe and effective, often stated as - they are more likely to produce benefit than harm.
When researchers are applying for grants and permission to perform human medical experimentation, they have to provide data to support this conclusion. If they cannot do so, then the experiment is considered unethical and likely will not get approved. The threshold does vary depending on the situation. For terminal illnesses without effective treatment we are willing to dip deeper into speculative treatments (so-called "compassionate" use).
It is also generally accepted that experimental treatments should be given, whenever possible, in the context of a clinical study, so that we can learn whether or not the treatment is effective. This also assures that proper informed consent will be given, and further means that patients will be given proper follow up and will not be charged for experimental treatments.
In every regard chelation therapy for ASD fails. The treatment is based on the hypothesis that heavy metal poisoning causes or contributes significantly to ASD. The evidence does not support this conclusion; however, and in fact it is reasonable to say that this hypothesis has already been rejected by existing evidence. Further it is often given outside of the context of a proper clinical trial.
The new systematic review looks at five clinical studies of the effectiveness of chelation therapy for ASD. They found that four of the five studies had mixed results, while the fifth had positive results. All the studies, however, suffered from fatal methodological flaws (they were weak, poorly designed studies), and therefore collectively they do not provide evidence to support the use of chelation therapy for ASD.
Despite this, about 7% of parents of children with ASD have tried chelation therapy. The review also warns that chelation therapy is not without direct risk. The lead author is quoted as saying:
"The chemical substances used in chelation treatment have a myriad of potentially serious side effects such as fever, vomiting, hypertension, hypotension, cardiac arrhythmias and hypocalcaemia, which can cause cardiac arrest," said Tonya N. Davis, Ph.D., assistant professor of educational psychology in Baylor's School of Education and co-author of the study.
Conclusion
Offering chelation therapy for ASD is a basic violation of medical ethics. If the treatment is considered experimental (which is generous) then it should only be given as part of a well-designed clinical trial. Existing trials, however, are anything but well designed.
But calling chelation therapy for ASD experimental gives it more credit than it deserves. It is not even speculative. There is evidence to suggest that the basic premise of chelation for ASD is wrong. Giving chelation for ASD is therefore not really an example of putting the cart before the horse, but putting the cart before the unicorn.
It is therefore not only unacceptable to give chelation for ASD, it is also unethical to even perform a clinical trial of chelation for ASD - the basic science justification is simply not there.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.
James Randi Educational Foundation: Chelation for Autism - Putting the Cart before the Unicorn
Autism spectrum disorder (ASD) is a challenging neurological condition characterized by difficulty with social interaction and communication. As the name implies, it occurs across a wide spectrum from barely detectable to debilitating. ASD is usually diagnosed by 3 years old, but studies have found that signs are often present as early as six months old.
It is understandable that parents of children with ASD are eager for effective treatments and feel obligated to do their best for their children by leaving no stone unturned. This is not, however, always the best approach in medicine. Some stones can cause harm and are best left unturned.
There is a cottage industry of so-called "biomedical" treatments for ASD - they treat ASD as a biological disease that can be cured or at least significantly ameliorated. This conflicts with the current scientific consensus regarding ASD, that it is a neurodevelopmental disorder (a result of brain wiring), and not an active disease. Legitimate interventions focus on improving function. Critics of biomedical treatments (myself included) argue that such treatments are unscientific, exploit parental desperation, and even victimize children with ASD.
A recent systematic review looks at one popular biomedical treatment for ASD, chelation therapy. The idea here is that autism is caused by, or significantly worsened by, the presence of toxic heavy metals, such as mercury, in the body. This is often tied to the claim that vaccines are the source of the heavy metal poisoning and therefore are linked to autism (a claim that has been soundly refuted by the evidence).
Chelation therapy is a legitimate treatment for real heavy metal poisoning. Chelating agents can be given orally or intravenously, they bind to heavy metals and help the body excrete them. In this regard they work well - after receiving chelating agents the body will excrete heavy metals.
Chelation therapy, however, has been a popular target for the fringe. For decades a persistent but tiny minority of physicians have believed that chelation therapy is an effective treatment for vascular disease, despite the fact that the evidence has refuted this claim on both basic science and clinical grounds.
One has to wonder if the fact that chelation therapy is an expensive procedure and has to be given multiple times is a factor in its popularity on the fringe.
In any case - at best chelation therapy can be considered experimental for autism. This raises issues regarding the ethics of giving experimental treatments, ethics which have been thoroughly explored.
First, experimental treatments should not be offered instead of proven therapies. In other words, they are not a justification for withholding standard of care treatment. In cases where such treatments are not available or insufficient, however, resorting to experimental treatments is reasonable.
Experimental treatments, however, should be reasonably justified by existing evidence. There should be good reason to believe that such treatments are likely to be safe and effective, often stated as - they are more likely to produce benefit than harm.
When researchers are applying for grants and permission to perform human medical experimentation, they have to provide data to support this conclusion. If they cannot do so, then the experiment is considered unethical and likely will not get approved. The threshold does vary depending on the situation. For terminal illnesses without effective treatment we are willing to dip deeper into speculative treatments (so-called "compassionate" use).
It is also generally accepted that experimental treatments should be given, whenever possible, in the context of a clinical study, so that we can learn whether or not the treatment is effective. This also assures that proper informed consent will be given, and further means that patients will be given proper follow up and will not be charged for experimental treatments.
In every regard chelation therapy for ASD fails. The treatment is based on the hypothesis that heavy metal poisoning causes or contributes significantly to ASD. The evidence does not support this conclusion; however, and in fact it is reasonable to say that this hypothesis has already been rejected by existing evidence. Further it is often given outside of the context of a proper clinical trial.
The new systematic review looks at five clinical studies of the effectiveness of chelation therapy for ASD. They found that four of the five studies had mixed results, while the fifth had positive results. All the studies, however, suffered from fatal methodological flaws (they were weak, poorly designed studies), and therefore collectively they do not provide evidence to support the use of chelation therapy for ASD.
Despite this, about 7% of parents of children with ASD have tried chelation therapy. The review also warns that chelation therapy is not without direct risk. The lead author is quoted as saying:
"The chemical substances used in chelation treatment have a myriad of potentially serious side effects such as fever, vomiting, hypertension, hypotension, cardiac arrhythmias and hypocalcaemia, which can cause cardiac arrest," said Tonya N. Davis, Ph.D., assistant professor of educational psychology in Baylor's School of Education and co-author of the study.
Conclusion
Offering chelation therapy for ASD is a basic violation of medical ethics. If the treatment is considered experimental (which is generous) then it should only be given as part of a well-designed clinical trial. Existing trials, however, are anything but well designed.
But calling chelation therapy for ASD experimental gives it more credit than it deserves. It is not even speculative. There is evidence to suggest that the basic premise of chelation for ASD is wrong. Giving chelation for ASD is therefore not really an example of putting the cart before the horse, but putting the cart before the unicorn.
It is therefore not only unacceptable to give chelation for ASD, it is also unethical to even perform a clinical trial of chelation for ASD - the basic science justification is simply not there.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.
Leeds Skeptics in the Pub Events: The Sex Myth
Leeds Skeptics in the Pub Events: Stereotype threat
National Capital Area Skeptics: Jan 19 - Jim Lippard - The Decline (and Probable Fall) of the Scientology Empire
The Secular Outpost: Another Fellow Christian Offers Blunt Response to AFA's Bryan Fischer
Why Evolution Is True: “MOOC”s on critical thinking at Michigan State and on genetics and evolution at Duke
The Gay Epi-Genes?
This is cross-posted from Queereka. I initially did not cross-post it to Skepchick because I didn’t see it making the rounds in the skeptical/atheist blogosphere. But now that I see it popping up (in quite unskeptical ways, I might add), I figured I’d cross-post this to give a different take than I’ve seen elsewhere.
I came across this awesomely bad article late last night. It is either an example of really bad science reporting, really bad science, or both.
Actual Headline: Scientists May Have Finally Unlocked Puzzle of Why People Are Gay.
I’m sure many of you are familiar with the ever-elusive “gay gene” and the plethora of studies that have attempted to find it (and failed). Well, apparently we’ve moved on from that folks: now it’s all about the EPI-MARKS!
So what the hell is up with this story? Well, for starters it’s not actually science.
The team of researchers used mathematical modeling to suggest that teh gay is passed through epigenetic markers, not through genetics. How does this work?
Evolutionarily speaking, if homosexuality was solely a genetic trait, scientists would expect the trait to eventually disappear because homosexuals wouldn’t be expected to reproduce. But because these epi-marks provide an evolutionary advantage for the parents of homosexuals: They protect fathers of homosexuals from underexposure to testosterone and mothers of homosexuals from overexposure to testosterone while they are in gestation.
So what’s the conclusion these scientists draw? Welllll……
“These epi-marks protect fathers and mothers from excess or underexposure to testosterone — when they carry over to opposite-sex offspring, it can cause the masculinization of females or the feminization of males,” Rice says, which can lead to a child becoming gay. Rice notes that these markers are “highly variable” and that only strong epi-marks will result in a homosexual offspring.
So there you have it folks. These epi-marks create us sissy boys and butch girls, which clearly causes teh gay. Nevermind all the masculine gay men, feminine lesbians, trans* gays and lesbians, androgynous queers, bisexuals, asexuals, pansexuals, and so on. They’re clearly just abberations that don’t fit into the neat homo/hetero binary based on heteronormative stereotypes and are therefore unimportant. Case closed!
Except, it’s not. Why?
Rice’s model still needs to be tested on real-life parent-offspring pairs, but he says this epigenetic link makes more sense than any other explanation, and that his team has mapped out a way for other scientists to test their work.
“We’ve found a story that looks really good,” he says. “There’s more verification needed, but we point out how we can easily do epigenetic profiles genome-wide. We predict where the epi-marks occur, we just need other studies to look at it empirically. This can be tested and proven within six months. It’s easy to test. If it’s a bad idea, we can throw it away in short order.”
So the whole “may have unlocked the puzzle of why people are gay” headline really should read “Hypothesis about epigenetic causes of homosexuality needs to be tested” or “Scientists seeking empirical evidence for basis of heterosexist understandings of homosexuality.” Or just “more biological reductionist crap from the media” would suffice as well. I mean, really, this whole thing about nellies and tomboys is right out of the sexology playbook circa late 1800s. Havelock Ellis and Richard von Krafft-Ebing would be so proud!
The thing is, I don’t doubt there are some biological components to sexual orientation. But to completely ignore the wide varieties of how same-sex behavior is expressed and experienced cross-culturally is asinine. Simplistic explanations like this never pan out because sexuality is complicated and fluid and not so easily defined.
You can find a copy of the study here.
The Introspective Ramblings of a Middle-Aged Doubter: 12.15.2012 – Back?
The Skeptics Guide #387 - Dec 15 2012
Skeptic's Subreddit: Something to sink your teeth into: "An Anatomy of the Motivated Rejection of Science"
Skeptic's Play: The "Santa is real" narrative
In particular, I remember lots of Santa-related movies, where the kids believe in Santa but the adults do not, and it's the kids who are right. This is mostly a general impression, but to name a specific example, I watched The Santa Clause (starring Tim Allen) several times when I was young. These movies did not strike me as strange at the time, but they strike me as strange now.
The moral of those movies was essentially, "Santa is real, and you kiddies should believe in him." It just seems like a rather wacky moral to me. It doesn't seem like the kind of thing which is appropriate to kids.
On kids shows when I was growing up, the morals were usually much more straightforward and incontrovertible. "Don't give in to peer pressure." "Don't be greedy. Share." "Be self-confident." "Eating too much candy is bad for you." "Looting and polluting is not the way." "One day you'll like girls. Like like." That kind of stuff. The only things with questionable morals were the breakfast cereal commercials.
And then Santa. Geez. The moral is, "You should believe, because it's adorable when kids do that. You should also believe because Santa happens to be real even though the parents believe otherwise. Your parents are wrong."
I... I just don't understand the appeal of this narrative. Why do parents promote this to kids? I assume there's some religious appeal, but it doesn't make sense even within my mental model of a religious person.
(I believe the relevant TVTropes article would be Values Dissonance. I also referred to Cereal Vice Reward.)
Sandwalk: Ann Gauger Describes the Intelligent Design Creationist Version of Population Genetics
Sandwalk: Texas Wants to Protect the IDiots in Universities
The elected members of the Texas legislature are well aware of this discrimination against stupidity so they've taken steps to stop it. Bill HB285 "Relating to prohibiting discrimination by public institutions of higher education against faculty members and students based on their conduct of research relating to intelligent design" should do the trick, if it becomes law.
Here's the key provision,
An institution of higher education may not discriminate against or penalize in any manner, especially with regard to employment or academic support, a faculty member or student based on the faculty member’s or student’s conduct of research relating to the theory of intelligent design or other alternate theories of the origination and development of organisms.I suppose it was inevitable that politicians in Texas would finally recognize that their children might flunk out of university.
Skeptic's Subreddit: What is your opinion on grass-fed beef vs. corn-fed beef?
I haven't been able to find much reliable information on the topic. Wikipedia has a small section suggesting grass-fed cattle have better nutritional content but require more land-use than corn-fed cattle (although more land is needed to grow the corn).
Is grass-fed actually "better" than corn-fed in your opinion? Do the benefits really matter much in the context of price and availability of land use?
submitted by IRSgimli[link] [49 comments]
Why Evolution Is True: Let the apologetics begin
Atheism and Me: Religious people vs. donkeys
Meditation - Specific or Non-Specific Effects
One of the challenges of scientific investigation, perhaps especially in the complex arena of medicine, is teasing apart specific from non-specific effects. A specific effect is one that derives from the details of a particular intervention, with a distinct mechanism of action. Non-specific effects are everything else.
Non-specific effects are part of placebo effects, but not the same as placebo effects also include statistical effects, bias, and other sources of illusory effects. Non-specific effects are real; they just do not derive from the specific intervention itself.
For example, with therapy techniques for anxiety or depression, non-specific effects would include the caring attention of the therapist, taking time out from one's regular schedule to think and talk about their feelings and problems and the hope generated from taking positive action to address one's symptoms. Any specific technique, therefore, would seem to be effective due to these non-specific effects of the therapeutic interaction.
Before one claims that moving the eyes back and forth, or guided imagery, or being regressed to a prior life has specific effects, and is therefore evidence of a specific mechanism, the non-specific effects outlined above need to be carefully controlled for. This is especially true when the alleged mechanism is outside the bounds of currently known biological phenomena.
This confusion of specific with non-specific effects is at the core of much of what is labeled "alternative" medicine. Acupuncture is another great example. The best evidence strongly supports the conclusion that there are only non-specific effects from acupuncture, deriving from the kind attention of the acupuncturists. It doesn't seem to matter where or even if you stick needles through the skin, arguing against any specific underlying mechanism.
Another treatment increasingly popular in the world of alternative medicine is meditation, or specifically transcendental meditation. Interestingly, one study on TM (http://www.ncbi.nlm.nih.gov/pubmed/23204989) contained the following statement: "Transcendental Meditation and TM are trademarks registered in the US. Patent and Trademark Office, licensed to Maharishi Vedic Education Development Corporation and are used with permission." I noticed that few other studies of TM contained this statement, and realized it was probably because the studies were all conducted at the Maharishi University of Management (more on that below).
TM is a specific meditation technique and proponents claim that it is effective at reducing blood pressure, reducing cardiovascular risk factors and generally promoting health. This sounds like another perfect example of confusing specific and non-specific effects. Relaxation therapy and stress reduction have been demonstrated to lower blood pressure and cardiovascular risk. There is a known mechanism for this - emotional stress increases sympathetic tone, which raises blood pressure and stresses the heart.
Unless there is very good evidence controlling for the non-specific effects of stress reduction, there is not reason to believe that TM has any additional specific effects that relate to the details of the TM procedure. Occam's razor would favor the known over the unknown as an explanation.
In looking over the literature on this question, however, I ran into a significant problem. All of the primary research into TM is conducted at one or another Maharishi institution. Every one. Perhaps this has something to do with their patent. I could not find any truly independent replication. I did find one review (the one above with the patent disclaimer), but this was just a review of Maharishi studies.
A conflict of interest alone does not prove that the results are unreliable, but given how difficult it often is to tease apart specific from non-specific effects and the obvious motivation to promote TM, it certainly places a question mark at the end of all such research. Further, it is impossible to fully blind such interventions - subjects know if they are performing TM or not.
Subjects could be trained in one of several relaxation techniques, without being told which one, and then assessed by blinded evaluators. That would be one way to reasonably separate specific from non-specific effects of TM. Until then, it's difficult to take pro-TM research at face value.
Further, the result of TM on blood pressure and cardiovascular risk tend to be modest, barely statistically significant and variable from study to study (where various outcomes are measured - systolic vs. diastolic BP and stress response vs. ambulatory blood pressure, for example). (http://www.ncbi.nlm.nih.gov/pubmed/9134445 and http://www.ncbi.nlm.nih.gov/pubmed/15691622). The data, in other words, are a bit noisy if generally positive.
I remained unconvinced that there is any specific effect from TM that is not present with any reasonable method of stress reduction. The kind of studies that would tease apart specific from non-specific effects, independently replicated by researchers not affiliated with TM, would be more convincing.
Meanwhile, any method of stress reduction appears to be a reasonable intervention for high stress people with increased blood pressure or cardiovascular risk.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.
