Paul A. Offit is an American pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and virology. He is the co-inventor of a rotavirus vaccine that has been credited with saving hundreds of lives every day. Offit is the Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the University of Pennsylvania, Chief of the Division of Infectious Diseases, and the Director of the Vaccine Education Center at The Children's Hospital of Philadelphia. He has been a member of the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices. Offit is also a Founding Board Member of the Autism Science Foundation.
Paul's pick: "The Emperor of All Maladies: A Biography of Cancer."
Wakefield said that nothing can convince him that vaccines don't cause autism? *gasp* And what would convince Offit that vaccines do cause autism?
ReplyDeleteOffit should debate Steven Novella about the ethics of prescribing placebos, and what it does to informed consent. He sure seemed upset when he was prescribed a placebo.
Dietary supplements by definition can't guarantee that their ingredients are as labeled? What about the USP Verified ones?
Dietary supplements are not regulated? Yet a Vitamin D supplement can't be advertised as preventing Vitamin D deficiency, because disease claims are prohibited.
Medical guidelines are reliable because they change often, even if it means they often do more harm than good?
It should be easy to test whether the efficacy of acupuncture comes from the rituals and interactions rather than the needles: compare acupuncture without rituals to acupuncture with the rituals.
The one ethical placebo medicine I can think of is hypnosis, which doesn't pretend to be anything more than suggestion.
Max,
Delete> And what would convince Offit that vaccines do cause autism? <
Ahem, evidence? Of which there's none.
> Offit should debate Steven Novella about the ethics of prescribing placebos, and what it does to informed consent. <
Or maybe they should both talk to, you know, an ethicist?
> Dietary supplements are not regulated? Yet a Vitamin D supplement can't be advertised as preventing Vitamin D deficiency, because disease claims are prohibited. <
Yes, but non-disease related claims are not regulated. I.e., dietary supplements don't have to meet the same standards as drugs.
> Medical guidelines are reliable because they change often, even if it means they often do more harm than good? <
I'm pretty sure that wasn't his point. Listen more carefully.
> It should be easy to test whether the efficacy of acupuncture comes from the rituals and interactions rather than the needles <
Not that easy, because it isn't very practical to devise a placebo control.
"Ahem, evidence? Of which there's none."
DeleteYeah? What kind of evidence? It would need to explain why all the studies finding no link were wrong. Michael Mann was asked what would convince him that there's no Global Warming. He said that at this point the jigsaw puzzle was complete enough that he can't think of a way the pieces could be rearranged into a completely different picture. So although I think Wakefield is wrong, it's not shockingly anti-scientific to admit that you can't think of evidence that would prove you wrong.
"Yes, but non-disease related claims are not regulated."
Right, DSHEA is criticized both for allowing unproven non-disease claims and for prohibiting proven disease claims. But you only covered one side of it.
"I'm pretty sure that wasn't his point."
I know his point, that science is self-correcting. So is Wikipedia, but that doesn't necessarily make it reliable. The fact that it constantly needs correcting is an admission that it keeps getting things wrong. But what's the alternative, right? Sometimes, common sense. Like, there's no MRI magnetic field strength that's known to be harmful, but common sense says that an unnaturally high dose of anything is risky. Offit pointed that out with respect to megadoses of vitamins.
"Not that easy, because it isn't very practical to devise a placebo control."
The control would be just a "clinical" acupuncture without the ritual and music. By the way, how did "clinical" come to mean "coldly detached"?
Max,
Delete> So although I think Wakefield is wrong, it's not shockingly anti-scientific to admit that you can't think of evidence that would prove you wrong. <
I'm not sure what you are arguing here. I would agree with this and the text that precedes it, which was also the meaning of my earlier comment. So?
> DSHEA is criticized both for allowing unproven non-disease claims and for prohibiting proven disease claims. <
Uh? I'm certainly not faulting regulation of the latter, only lack of regulation of the former. Again, who are you arguing against, exactly?
> I know his point, that science is self-correcting. So is Wikipedia, but that doesn't necessarily make it reliable. The fact that it constantly needs correcting is an admission that it keeps getting things wrong <
You seem to have avery black and white view of right and wrong. They actually come in degrees, and both Wikipedia and science are usually reliable. They come closer than the alternatives (certainly in the case of science).
> The control would be just a "clinical" acupuncture without the ritual and music <
No, you need a way to make the patient think you are using the needles while you aren't. Otherwise you can't account for the placebo. It can be done, but it is extremely tricky.
Entertaining show as always! Still, I'd like to remark that to be historically accurate, we should be a little more charitable towards traditional Chinese medicine, than Dr Offit suggest (his opinion presumably being based on de Morant's translation, i.e., the western caricature of acupuncture): the chinese did do dissections (on criminals), and for instance mapped out arteries reasonably well. See here for a scientifically reasonable, though a bit pro-biased, overview of the history and physiology of acupuncture: http://chriskresser.com/acupuncture
ReplyDeleteAlso, it appears (to the outsider) that the traditional oncogene theory of carcinogenesis is in trouble. I found the following viewpoint interesting as an account of the discussion within the scientific cancer community: http://robbwolf.com/2013/09/19/origin-cancer/
None of this distracts from the main message, though: that science, while flip-floppy and sometimes balking up the wrong tree for some time, will eventually give us the answers, and that there is no “alternative” medicine, just medicine, and the medical research will in time tell us whether “neurovascular nodes” are a sound explanation of acupuncture, and whether the metabolic theory of cancer will lead to better treatments, and so on.
Magical thinking is relative. That is why Dr. Offit can say that ethylmercury (thimerosal) is the magically non-toxic version of mercury that is as safe as "lemon juice" as he has previously claimed. The same magical thinking allows Offit to say a baby can be injected with 10,000 vaccines with no problem.
ReplyDeleteLet us also not forget how monied interests will taint science, such as indicted-Poul Thorsen's studies showing mercury is good for you.
If this website is really interested in rationality, how about interviewing those who would question such morally and scientifically practices as injecting pregnant women and children with mercury?
Information diminishes magic, be it card tricks or biology. The effects of drinking ethyl alcohol and methyl alcohol are dramatically different, same with mercury compounds. The only effect of removing thimerosal in 2001 from nearly all vaccines has to been to increase cost.
ReplyDeleteSimilarly, an infant is exposed to thousands of bacteria, viruses and foreign antigens from the moment of birth. Some even go through a woman's vagina before they are even born. Their nasal passages, gut and skin have to cope with millions of germs within hours and days.
Each of these topics could be expanded, with points and counterpoints made. That would be a rational discussion of biochemistry, immunology and physiology. Magic need not apply.
Science, medicine, and religion need faith in their uncertain ever changing theories, medication, (snake oils), diagnosis, and if all else fails, prayers to the gods. Whereas truth just is. =
ReplyDelete