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Archive for the 'Health' Category

Friday, July 25th, 2014

“The mind–body dualism has long overstayed its visit” — Concluding Thoughts from Shadow Medicine

“The mind–body dualism has long overstayed its visit. Western science needs to advance beyond the cur­rent reductionist model to some blending of the subjective and social aspects of healing.”—John S. Haller Jr.

Shadow Medicine, John S. Haller Jr.We conclude our week-long feature on Shadow Medicine: The Placebo in Conventional and Alternative Therapies with an excerpt, fittingly enough, from the concluding chapter. In “Reassessment,” Haller examines some of the challenges confronting alternative medicine as it tries to gain greater legitimacy as well as the need to integrate our understanding of what both alternative and conventional medicine offer:

With approximately 80 percent of the world’s population, including half the US population, using some form of [contemporary and alternative medicine] (CAM), the scientific community can no longer view these thera­pies as simply a fringe interest among consumers. However, because CAM therapies diverge sharply from reductionist science, the nature of their evidence and the subjective manner of their production create substantive problems for evidence-based medical knowledge. This suggests a remark­able similarity between CAM therapies and numerous nonspecific theo­ries and practices such as psychotherapy that, although difficult to explain in terms of their modus operandi, have proven beneficial to patients. The current tension between conventional therapies and unconventional ther­apies represents a collision of epistemologies. For the former, disease cau­sation constitutes the ideal form of evidence; for the latter, outcomes are of equal or greater importance. In our postmodern world, multifactorial causation has become more accepted as doctors and medical researchers adopt a more integrative role for unconventional therapies—a road that neither is straight nor accompanied by clear markers.

As the usage of homeopathy, acupuncture, herbals, chiropractic, and other CAM modalities amply demonstrate, their poor performance in clinical trials have caused little or no diminution in their popularity. They remain robust in their claims and ever anxious to expand their therapeu­tic applications. Even with increased consumer interest, however, only a small number of CAM therapies are expected to achieve legitimacy along­side conventional medicine. Unlike biomedicine, which is constantly jus­tifying its existence through replication and evidence-based research, most CAM modalities have yet to prove their efficacy or replicability, standing firmly on a static set of principles and practices that appear to “work,” albeit only marginally better than the placebo. To date, only a few have been able to build a scientific explanation for their efficacy. And for those that have achieved this status, the outcome has not always been to their benefit. The fact that the management of chronic disease constitutes 78 percent of medical expenditures in the United States explains why con­ventional medicine has been so aggressive in fighting CAM and, where possible, co-opting its more effective therapies.

(more…)

Thursday, July 24th, 2014

Conventional vs Alternative Medicine — An Excerpt from Shadow Medicine by John Haller

“In addressing the standoff between the dueling protagonists of conventional and unconventional medicine, the placebo has served as both mediator and judge….” —John S. Haller Jr.

We continue our week-long feature on Shadow Medicine: The Placebo in Conventional and Alternative Therapies by John S. Haller Jr. by presenting an excerpt from the book . In the introduction, Haller examines the debate between proponents of conventional and alternative medicine and the role in which the placebo plays in challenging both positions.

Wednesday, July 23rd, 2014

An Interview with John Haller, author of Shadow Medicine

“The question at hand is not only whether conventional and unconventional therapies can stand on their own self-authenticating authority, but whether it is possible to modify the context of these two opposing camps into something both can benefit from sharing. To date, there is no hard-wired connection, but the bridge between them is nowhere as long, nor is the chasm beneath them as deep as it once appeared.”—John S. Haller Jr.

John Haller, Shadow MedicineThe following is an interview with John S. Haller Jr, author of Shadow Medicine: The Placebo in Conventional and Alternative Therapies. For more on the book, read John Haller’s essay The Medical Challenge:

Q: In Shadow Medicine, you use the term conventional medicine. What do you mean by that?

John Haller Jr.: Conventional (or reductionist) medicine identifies statistical baselines against which to measure its therapies, looking to physiological, pathological, biochemical, and molecular processes derived from physical matter and to treatment based on the calculus of probabilities. That is to say, conventional medicine draws its authority from the clinical trials and laws embedded in the natural sciences. At its best, conventional medicine encourages a healthy skepticism and urges various forms of sampling, followed by repeated experimentation to reaffirm a hypothesis. Its identity is thus based on the unambiguous application of normative science whose laws interpret the body as a materialistic system that can be reduced and analyzed according to its component parts.

Q: You seem to suggest, however, that conventional medicine has limits? How so?

JH: While conventional medicine continues to provide the most credible information for justifying a clinical judgment, its ultimate value remains uncertain because much of what happens in a clinical trial fails to capture the myriad of variables that affect the physician/patient encounter. For this and other reasons, the clinical trial remains an imperfect tool.

Calibrating the outcome of a medical procedure or the efficacy of a pharmacologic treatment defies certitude insofar as the organic side of medicine tends to be infused with psychotherapeutic interventions—some intended and, others, hidden. This suggests that conventional medicine has overestimated the value of the clinical trial in resolving the challenges presented in medicine and that more creative efforts are needed that compare “whole treatments.”

Q: How does conventional medicine contrast from complementary and alternative medicine?

JH: Today’s complementary and alternative healers focus their attention on forces or energies that, although undetectable by the tools of science, are thought to be real. Such phrases as “paradigm change,” “probability waves,” “string theory,” “chaos theory,” “new physics,” “ectoplasm,” “chakras,” and “spirit-release therapy” are used to anoint beliefs wholly distinct from empirically-based laboratory science. Challenging the discrete boundaries between objectivity and subjectivity by including consciousness in the reframing of reality, today’s unconventional healers insist that “life forces” can be transmitted or channeled into the patient to mediate physical, mental, or emotional needs. This secularized notion of body, mind, and spirit forms the basis of homeopathy, psychic healing, crystal healing, reiki, light therapy, acupuncture, qigong, aromatherapy, distant healing, transcendental meditation, therapeutic touch, and other paranormal healing systems.

(more…)

Tuesday, July 22nd, 2014

The Medical Challenge — A Post by John S. Haller Jr.

Shadow Medicine, John S. Haller Jr.The following post is by John S. Haller Jr., author of Shadow Medicine: The Placebo in Conventional and Alternative Therapies:

“The placebo has undermined the positivist model of biomedicine by interjecting subjectivity, uncertainty, and ambiguity into the clinical encounter. It suggests that a specific disease or illness does not exist apart from the manner in which the society conceptualizes it and addresses it.”—John S. Haller Jr.

Conventional medicine is founded on the belief that the body is the outcome of material forces. Given this assumption, it looks to physiological, pathological, biochemical, and molecular processes derived from physical matter to diagnose and treat disease. Its basic tool is the randomized clinical trial, guided by the fact that its active pharmaceutical substances “work” (even when the patient is unaware of their administration) and that their effects can be demonstrated, measured, and replicated. As authority figures, conventional physicians not only project a certain level of scientific legitimacy but purport to have legal authority, political privilege, and cultural acceptance—entitlements that also come with obligations that include standardized training, accreditation, licensing, and regulation.

While the randomized clinical trial provides the most credible information for justifying a specific treatment, its ultimate value remains uncertain because much of what happens in a trial fails to capture the myriad of independent and/or related variables that affect the physician/patient encounter. For all its hype, the randomized clinical trial remains an imperfect tool. Although it informs individual clinical expertise, it does not (and should not) replace it. Conventional medicine has overestimated the value of its clinical trial and more creative methods are needed that compare “whole treatments” rather than just the normative components which biomedicine is most acquainted.

In contrast to conventional medicine, complementary and alternative medicine (CAM) defines health in psychological and spiritual terms and emphasizes patient individualization and self-healing. It is founded on a philosophy of organism known as “vitalism” which explains life not by the laws of physics and chemistry but by a principle, force, or spirit-like power that comes from beyond the material world to animate organic matter. Consisting of a mixture of religion, mysticism, cosmic energy, disbelief in Western reductionism, and an increased fascination with Eastern philosophies, CAM encourages a more metaphysical encounter with the world, one that questions the basic assumptions about the nature of reality. In this new setting the patient’s experience becomes intensely personal and compares strikingly to certain types of spiritual awakening. In its intuitive approach to healing, the goal of the healer is to assist the individual in finding harmony with nature.

(more…)

Monday, July 21st, 2014

Book Giveaway! Win a Free Copy of Shadow Medicine, by John Haller

The Collapse of Western Civilization

This week our featured book is Shadow Medicine: The Placebo in Conventional and Alternative Therapies, by John S. Haller Jr.

In addition to features on our blog, we will also be posting about the book on twitter, and facebook.

We are also offering a FREE copy of Shadow Medicine to a lucky winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, July 25 at 1:00 pm.

“This provocative book is aimed at challenging the research community, and the questions it raises are important for patients and doctors alike.” — Publishers Weekly

Read the introduction to Shadow Medicine:

Friday, June 27th, 2014

Interview with Alfredo Morabia, author of Enigmas of Health and Disease

Enigmas of Health and DiseaseThe following is an interview with Alfredo Morabia, author of Enigmas of Health and Disease: How Epidemiology Helps Unravel Scientific Mysteries. You can also read Morabia’s blog post Michelle Obama and Epidemiology: An Inspiring Example

Question Your book offers a fascinating and frequently surprising history of epidemiology. How does our understanding of this history help us confront contemporary issues relating to medicine and public health?

Alfredo Morabia: If I have to isolate one key lesson of this historical voyage, it is that society’s success in confronting health issues depends on its ability to use epidemiology to identify medical and public health interventions that work. This was the great discovery of the 17th century, and it finally stopped and reversed the inexorable and millenary progression of the great epidemic diseases.

Q: As you looked back at the history, were there particular events or moments that you found particularly surprising and perhaps changed the way you think about epidemiology?

AM: I had always associated the history of epidemiology mostly with the history of public health but this is not true. The history of epidemiology belongs just as much to the history of clinical medicine. Group comparisons were used to assess the efficacy of treatments by clinical doctors throughout the 350 years of existence of epidemiology.

Q: Your book stresses the importance of group comparisons. Why is this so central to epidemiology?

AM: Comparison is the basic tool of science. In epidemiology, by comparing groups of people we can learn whether a specific drug works, whether an exposure is beneficial or deleterious, or whether a screening test can prolong life. Groups are predictable and comparable; individuals are not.

(more…)

Thursday, June 26th, 2014

Michelle Obama and Epidemiology: An Inspiring Example

“American children can learn from someone like Michelle Obama, who decides on the basis of scientific evidence, not on mere speculation.”—Alfredo Morabia

Enigmas of Health and DiseaseThe following post is by Alfredo Morabia, author of Enigmas of Health and Disease: How Epidemiology Helps Unravel Scientific Mysteries

In her May 28th New York Times op-ed, The Campaign for Junk Food, Michelle Obama offers a lesson to Congress and an inspiring example to American children. She explains that before she began advising on policy to reduce child obesity, she first looked to “what works”.

“What works!” because, as Michelle Obama writes, “when we rely on sound science, we can actually begin to turn the tide on childhood obesity.”

Today, Michelle Obama can stand in front of children who may ask her about the importance of fruits and vegetables, less salt, etc. for a healthy diet. She can explain that kids from schools in which lunch menus have slashed sugar, salt, and fat are healthier compared to kids from schools which keep offering junk food; that kids from neighborhoods without nearby grocery stores have poorer eating habits compared to kids from areas with fresh-food retailers; that kids who go to child care centers offering healthier food and more physical activity acquire healthier habits compared to kids who don’t. She can also state that after reducing access to junk food, there is less obesity compared to the situation before the launching of the Let’s Move initiative. It worked!

Now contrast the example of Michelle Obama’s to that of Congressmen fighting the changes she is promoting in the school lunch program. These Congressmen want to see more white potatoes, less fruits and vegetables, more sodium, fewer grains on the menu, and consider pizza sauce a vegetable. How would these Congressmen respond to children asking them: “How do you know that your initiatives will not hurt our health?” The reality is that they cannot answer the question because there is no evidence supporting these decisions. They can only say that they believe otherwise, and claim their right to do so.

(more…)

Wednesday, May 21st, 2014

Why Umami is Good For You and 12 Ways to Add it to Your Diet

Umami: Unlocking the Secrets of the Fifth Taste

In Umami: Unlocking the Secrets of the Fifth Taste, Ole Mouritsen and Klavs Styrbaek explain the health benefits of umami:

Food with umami can often be prepared with significantly less salt, sugar, and fat without sacrificing the delicious taste of the resulting dish. Salt, in particular, is frequently applied too liberally in order to compensate for ingredients that are insipid or unpalatable. In many cases, its use can be reduced by as much as a half by incorporating foodstuffs with umami into the recipe. The fifth taste spurs the appetite, an attribute that can be exploited to advantage in caring for the sick and the elderly, who may have lost interest in eating. At the same time, however, umami promotes satiety, which helps to curb overeating by those who are inclined to overindulge. Either way, adopting a diet that has an abundance of umami may be a way for modem humans to eat in a healthier manner and to adjust their caloric intake to suit the needs of their bodies.

So where can you find umami? Well, the authors also provide a list of 12 easy way to add umami:

Mushroom salt
Cut shiitake or other dark mushrooms into slices and dry them in an oven on low heat. Crush them into a powder and mix it with Maldon sea salt flakes.
Use to season fish, soups, vegetables, and pasta dishes.

Marinated mushrooms
Marinate mushrooms in a little soy sauces or garum
Can be fried or used raw in salads.

Essence of Worcestershire sauce
Concentrated reduction of the sauce kept at the ready in a small bottle with an eyedropper.
Just add a couple of drops to meat that is being fried or to a sauce or a dressing. Rounds out the taste of a pâté or an egg dish.

Highly concentrated chicken bouillon
1 L (4¼ c) chicken stock reduced to 1 dL (½ c) or less.
Use as an essence in gravies that are a little flat or to add depth to a dressing, or drizzle on pasta or salads.

Miso paste
Light or dark paste made from fermented soybeans; available where Asian foods are sold.
Adds a nutty, savory taste to dressings, sauces, marinades, and soups (especially those with shellfish); or use it like butter to coat warm vegetables just before serving.

Anchovy paste
Available in a squeezable tube to keep in the refrigerator.
For all types of vinaigrettes, dressings, marinades, pesto, and pâtés.

(more…)

Friday, January 18th, 2013

Read an Excerpt from our Book of the Week: Jonathan Kahn’s Race in a Bottle

This week, we’ve brought you an interview and author post from Jonathan Kahn, Hamline Law Professor and expert on BiDil, the first race-specified drug approved by the FDA (click here for the story of BiDil). To wrap up our feature of this Book of the Week, we’re letting Kahn’s work speak for itself with an excerpt from his new book, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age.

Read the introduction, “Race and Medicine: Framing [Is] the Problem” (to view in full screen, click on icon in bottom right-hand corner)

Tuesday, June 19th, 2012

Henry J. Aaron on Health Care Reform

The Economists' Voice 2.0In the following excerpt from Henry J. Aaron’s “Systemic Reform of Health Care Delivery and Payment,” which appears in The Economists’ Voice 2.0: The Financial Crisis, Health Care Reform, and More, Aaron examines some of the challenges confronting the implementation of The Affordable Care Act. He concludes by arguing “As things now stand, the future of the ACA is highly uncertain. Yet its success is of critical national importance.”

THE AFFORDABLE CARE ACT (ACA) became law on March 23, 2010, but little of it is yet actively in effect. Not until January 1, 2014, will the Medicaid extensions, the individual mandate to buy insurance, the state-managed health exchanges, and the subsidies to make in­surance affordable take effect. The tax on high- premium plans will not be imposed until 2018. Tight restrictions on the operations of the Independent Medicare Advisory Board will remain until 2018.

Before those dates, the law will have to clear four hurdles. The odds that it will emerge unscathed are small. It is important to under­stand those obstacles and to consider how they may change the reform or even prevent it from taking effect. The first hurdle is judicial. Several states are challenging the consti­tutionality of the individual mandate—the requirement that everyone (with a few exceptions) who is not insured at work or covered by a public program must personally buy health insurance. Scholars are divided on whether the Constitution empowers the federal govern­ment to impose such a requirement. The courts will decide….

Should the mandate requiring individuals to carry health insur­ance be declared unconstitutional, much of the rest of the bill would become unsustainable, unless some alternative mechanism to create a sustainable risk pool were to be found. Various alternatives could work. Paul Starr has suggested that people who refuse each year to buy insurance should be barred for an extended period—say, four years—from buying insurance in the regulated market and from qualifying for income-related subsidies. The German health system uses such an arrangement and achieves near-universality. The an­swer to the question whether such a penalty could be adopted in the United States is not obvious. Nor is it clear how well such a penalty would work in the United States. Uninsured Americans would be able, as now, to show up at emergency room doors if they are seri­ously ill, because federal law requires that hospitals provide them ser­vices. The subsidies in the ACA might well tip the balance for most in favor of buying insurance. Such a provision would not have to work perfectly, just well enough to prevent the collapse of the health insurance pool.

Were the individual mandate to be declared unconstitutional, enacting some replacement would doubtless open up the whole bill to amendment. Approval of a time-limited exclusion from subsidized coverage or any other mechanism to maintain a risk pool would re­quire sixty votes in a badly fractured Senate and approval by a major­ity in a House of Representatives now controlled by a party that has pledged to repeal the law. Opponents of the law would be disinclined to agree to provisions that sustain it; at a minimum, their price for accepting such amendments would be high.

(more…)

Thursday, April 5th, 2012

Geoffrey Kabat Breaks the Bad News About the Good News About Chocolate

Geoffrey Kabat, Hyping Health RisksA recent report that got widely disseminated claimed that “that subjects who ate chocolate more frequently had lower body mass index compared to those who consumed it less often, and this was not affected by taking calorie intake or level of physical activity into account.” The notion of chocolate as a new weight-loss strategy obviously has it appeal but what about the science behind this study and the methods applied?

Geoffrey Kabat, author of Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology, questions the basis of the study in a recent op-ed in Forbes, The Bad News About the Good News About Chocolate .

In the piece, Kabat questions and faults the way in which the study was conducted:

This is a cross-sectional study, meaning that the information analyzed was collected at one point in time. Thus, it tells us nothing about weight gain or weight loss or factors contributing to these changes.

Furthermore, the researchers obtained information about the usual consumption of over a hundred foods by means of a “food-frequency questionnaire.” The authors do not tell us how many other food items and other behaviors were correlated, either positively or inversely, with body mass. What about nuts, broccoli, jello, coffee, beer, veal? What about the frequency of other behaviors – going to the movies, sexual intercourse, ice-skating?

(more…)

Wednesday, March 21st, 2012

Interview with Nicoli Nattrass, author of “The AIDS Conspiracy: Science Fights Back”

Nicoli Nattrass, The AIDS Conspiracy: Science Fights BackThe following is an interview with Nicoli Nattrass, author of The AIDS Conspiracy: Science Fights Back

Question: What is AIDS conspiracy theory?

Nicoli Nattrass: The central AIDS conspiracy theory is that HIV was created in a laboratory (perhaps with the help of the CIA) to inflict harm. Ironically, the idea that U.S. scientists invented HIV was initially promoted by the Russian KGB and the East German Stasi in a genuine conspiracy to spread misinformation. There are now many local variants of AIDS conspiracy beliefs–for example, in South Africa a common story is that HIV was created by the apartheid government’s chemical warfare program, with assistance from the United States.

Q: Why does AIDS conspiracy theory matter?

NN: AIDS conspiracy beliefs matter because they reflect and reinforce broader suspicions toward medical science. AIDS conspiracy believers in the United States and South Africa are less likely to use condoms, less likely to test for HIV, and less likely to take antiretroviral treatment. Why did you write the book? I was concerned about the way that AIDS conspiracy theories had been promoted at the highest levels in South Africa, and continue to resonate today. The book is the product of my exploration of how these ideas travel and take root, why they resonate socially, and what can be done to fight them. (more…)

Thursday, March 15th, 2012

Nicoli Nattrass on the AIDS Conspiracy

Nicoli Nattrass, The AIDS Conspiracy: Science Fights Back

In the opening to her book The AIDS Conspiracy: Science Fights Back, Nicoli Nattrass discusses how she became interested in AIDS conspiracy theories.

The Conspiratorial Move Against HIV Science and Its Consequences

Most people do not believe conspiracy theories about the acquired immune deficiency syndrome (AIDS). But suspicions that the human immunodeficiency virus (HIV) may have been created in a laboratory, and that the pharmaceutical industry invented AIDS as a means of selling toxic drugs, persist on both sides of the Atlantic. During the 2008 US presidential campaign, Barack Obama had to deal with politically embarrassing revelations that his pastor, Jeremiah Wright, believed the government had created HIV to harm blacks. Four years earlier, the Nobel Prize–winning Kenyan ecologist Wangari Maathai stunned the world with her casual observation that HIV had been “created by a scientist for biological warfare.” Most tragically, conspiracy theories about HIV were promoted in the early 2000s by then South African president Thabo Mbeki and his health minister Manto Tshabalala-Msimang—with devastating consequences for AIDS policy.

(more…)

Wednesday, March 14th, 2012

Nicoli Nattrass on The Specter of Denialism

Nattrass, The AIDS Conspiracy

In a recent op-ed for The Scientist, Nicoli Nattrass, author of The AIDS Conspiracy: Science Fights Back , describes the harm that has been done by AIDS denialists in South Africa and elsewhere.

Nattrass argues that a small group of AIDS denialists have kept alive the myth that antiretroviral treatment (ART) is harmful and that HIV science has been corrupted by commercial interests. Even though these claims have been disproved by science, they have hindered the battle to stop and treat AIDS. South African President Thabo Mbeki, debated the issue of the effectiveness of ART, holding up treatment and leading to the unnecessary death of 330,000 South Africans.

Nattrass also discusses the contested work of University of California virologist Peter Duesberg, another Denialists as well as activist Christine Maggiore, seen as a key icon for the Denialist movement: “Maggiore campaigned against the use of ART to prevent mothers passing HIV to their babies, Despite her 3-year-old daughter’s succumbing to AIDS, Maggiore remained staunchly opposed to HIV science and ART. She opted for alternative therapies and died at the age of 52, from AIDS-related infections.”

(more…)

Tuesday, March 13th, 2012

Nicoli Nattrass discusses AIDS Denialism and AIDS in South Africa

In the following interview, Nicoli Nattrass, author of The AIDS Conspiracy: Science Fights Back, discusses the issue of AIDS denialism as well as her work on AIDS in South Africa:

Monday, March 12th, 2012

Book Giveaway!: The AIDS Conspiracy: Science Fights Back, by Nicoli Nattrass

This week our featured book is The AIDS Conspiracy: Science Fights Back, by Nicoli Nattrass. (To browse the book.)

Throughout the week we will highlight aspects of the book and we are also offering a FREE copy of the book to one winner.

To enter our book giveaway, simply e-mail pl2164@columbia.edu with your name and address (U.S. and Canadian mailing addresses only, unfortunately). We will randomly select one winner on Friday at 1:00 pm. Good luck and spread the word!

Praise for The AIDS Conspiracy: Science Fights Back:

“Nicoli Nattrass does a wonderful job uncovering the dangerous consequences of following fringe ideas in health and medicine. Her new book puts medical myths and misinformation square in front of us, and she tells the story with such passion, we dare not look away.” — Seth C. Kalichman, Ph.D., University of Connecticut, author of Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy

Tuesday, September 27th, 2011

Geoffrey Kabat on Cell Phones and Climate Change

Geoffrey Kabat“We … need to rely on scientists and health agencies to use logic, analytic rigor, and clear language to assess what things are worth worrying about.”—Geoffrey Kabat

Geoffrey Kabat, author of Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology, recently published Behind The World Health Organization’s “Cancerous” Pronouncement On Cell Phones in Forbes.

In the article Kabat critiques a recent report on cell phone use and radiofrequency radiation (RF) from the International Agency for Research on Cancer (IARC), which is part of the World Health Organization. Kabat challenges their finding that RF from cell phones is “possibly carcinogenic, which does not square with his reading of the scientific data.

Kabat also discusses the controversial composition of the working group, and the process behind the report. Kabat writes:

By any set of criteria for evaluating evidence, the conclusion should have been that – although we have not monitored the effects of cell phone use for long enough – the substantial evidence currently available provides no suggestion that cell phone use contributes to the risk of brain tumors. The ambiguous label “possible carcinogen” is unfortunate because it means one thing to scientists working for IARC and something quite different to the general public when trumpeted in the headlines.

In classifying RF as a “possible carcinogen,” IARC has aligned itself with the “precautionary principle,” which sounds perfectly reasonable, except that it is often used to conjure up the existence of a possible hazard in the face of extensive and solid evidence suggesting the non-existence of a hazard. Of course, we need to spell out the limits of current knowledge, but we also need to rely on scientists and health agencies to use logic, analytic rigor, and clear language to assess what things are worth worrying about.

(more…)

Wednesday, July 27th, 2011

Brent Stockwell on the Future of Medicine

“Over the last 15 years, the annual number of approved new drugs has been declining dramatically. Meanwhile, the pharmaceutical industry, as well as academic and government researchers, have dramatically increased the amount of money spent on drug discovery and development. Why is the large increase in funding not translating into new medicines?”—Brent Stockwell

In an essay for Rorotoko, Brent Stockwell, author of The Quest for the Cure: The Science and Stories Behind the Next Generation of Medicines, examines the challenges confronting scientists and pharmaceutical companies. Stockwell explains, “Drugs function by interacting with, i.e. attaching to, specific proteins within the body, which are called ‘drug targets.’ However, only 2% of the proteins found in humans have been targeted with drugs.” He continues, “The majority of proteins are considered undruggable. These proteins control nearly every disease process, from many types of cancer to neurodegenerative diseases such as Alzheimer’s, Parkinson’s and Lou Gehrig’s, to many other diseases.”

In an effort to spur the development of new medicines the Obama administration has created a new center within the National Institutes of Health. While this is encouraging and will help bridge the gap between expensive research and commercial use, Stockwell warns that there are challenges:

But there is a more significant challenge to discovering new medicines than simply bringing basic discoveries to market. So if the new NIH center were to focus on a simple catalyst role, it would represent a lost opportunity.

The more fundamental challenge to discovering new drugs involves the basic science issue of protein druggability. It is this that could have a far more significant impact on the number and type of future medicines.

It is possible that new technologies and approaches could solve the challenging problem of protein druggability. However, if we abandon the undruggable proteins, we abandon the hope for truly transformative medicines. We must be able to translate the vastly detailed molecular networks emerging from basic science studies into therapeutics.

Currently, many of the root causes of diseases are considered undruggable and cannot be addressed directly with medicines. If we could solve the mystery of protein druggability, we could open up a vast number of possibilities for new medicines, and ultimately end the drug discovery crisis.

Thursday, June 9th, 2011

Geoffrey Kabat on Cancer and Cellphones

Geoffrey KabatThe following post by Geoffrey Kabat, author of Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology discusses the recent World Health Organization’s report on cellphone use and its possible link to cancer. Kabat questions some of the conclusions made in the report and the problem of labeling something a “possible carcinogen.”

Thirty years ago, a professor at the Harvard School of Public Health published a study in a prestigious medical journal purporting to show that drinking coffee increased a person’s risk of pancreatic cancer. When asked how his results had influenced his own habits, he responded that he had stopped drinking coffee. The following day a professor of biostatistics set up a Mr. Coffee in the departmental offices, indicating what he thought of his colleague’s study.

I mention this because last week a committee of the International Agency for Research on Cancer, a branch of the World Health Organization, announced that it would classify cellphone use as a “possible carcinogen,” putting it in a category with 240 other exposures, including coffee and the pesticide DDT. Despite decades of research, neither of these exposures has turned out to be a carcinogen in humans.

Although the report from the committee has not yet been published, we know that the WHO based its conclusion largely on the 13-country Interphone study, which provoked a large degree of confusion when published a year ago.

Read the rest of the op-ed on The Daily.

Wednesday, June 8th, 2011

Brent Stockwell: The National Institutes of Health and the Drug Discovery Crisis

Brent Stockwell, Quest for the CureBrent R. Stockwell is the author of The Quest for the Cure: The Science and Stories Behind the Next Generation of Medicines, and Associate Professor of Chemistry and Biological Sciences at Columbia University, and an Early Career Scientist of the Howard Hughes Medical Institute.

It is becoming increasingly difficult to discover new drugs. Over the last 15 years, the number of new drug approvals has declined substantially, even in the face of a huge increase in funding for drug discovery research. Put simply, it is becoming increasingly expensive and challenging to create new medicines. It is not overstating the point to say that we are facing a drug discovery crisis, which has stimulated recent mega-mergers and acquisitions within the pharmaceutical industry. Drug pipelines are drying up, and many are asking, what can be done?

The Obama administration has proposed a new initiative to help address this drug shortage. Concerned with the paucity of new medicines, the administration has proposed to create a controversial new center within the National Institutes of Health (NIH) that is focused on aiding the discovery and development of new medicines. This new center, called the National Center for Advancing Translational Sciences, is meant to catalyze the transfer of discoveries from basic science laboratories to clinical studies that involve patients, and eventually into commercial products. The NIH website indicates that the new center will be synthesized from existing programs within NIH, so that the center is an administrative reorganization rather than a dramatic shift in policy. The stated hope of NIH officials is that this new center will make it easier to bring discoveries from basic science into the clinical arena.

What can this new NIH center do that will help address the drug discovery crisis? On a practical level, the center can help to move discoveries down the drug discovery path to the point that they become attractive for commercial entities to adopt and invest in. Pharmaceutical and biotechnology companies and venture capitalists have become increasingly conservative in their investment strategies, especially since the economic disruptions in 2008. This conservatism has resulted in a lack of investment in early-stage technologies and drug candidates, making it difficult to translate these discoveries into a commercial and clinical setting. In short, the well-known “valley of death” that separates basic sciences from commercial and clinical translation has grown larger and more ominous. Therefore, by assisting the development of selected technologies and compounds through the early stages of drug discovery and development, the new NIH center could help to bridge this valley and bring the most promising technologies to market.

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