Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish


Dr. Edward Tobinick might not be a quack, but his behavior suggest otherwise.
 

Having a medical degree does not mean not a quack.

Using FDA (Food and Drug Administration) approved drugs does not mean not a quack.

Having a medical web site that does not have the word “quantum” all over the place does not mean not a quack.

Threatening to sue people for writing about the lack of evidence for his treatments does not mean not a quack.
 

Dr. Edward Tobinick is suing Science-Based Medicine for writing about Dr. Edward Tobinick’s dubious medical practices.

That strongly suggests that Dr. Edward Tobinick is a quack.
 

The claims and practice of Dr. Tobinick have many of the red flags of a dubious medical practice, of the sort that we discuss regularly on SBM. It seems that Dr. Tobinick does not appreciate public criticism of his claims and practice,[1]

 

Essentially, what Dr. Edward Tobinick is saying is, Your valid criticism of the way I apparently take advantage of patients might discourage patients from shelling out money for my untested treatment.

or –

Your valid criticism of the way I apparently take advantage of patients might encourage patients to ask reasonable questions about my untested treatment – questions that I cannot honestly answer.
 

Etanercept might work, but so might steroids, or ribavarin, or eye of newt, or a kick in the groin.

All of these treatments are equally valid. Oddly, the patients receiving a kick in the groin will probably report the fewest symptoms after treatment. 90% of the kick in the groin patients claimed to be cured and not in need of any further treatment.

Without evidence, and with his opposition to evidence, Dr. Edward Tobinick is just a quack with a brainstorm. Nothing original there.
 

Dr. Edward Tobinick injects etanercept (Enbrel) around the spine. This is not something he covered in his dermatology residency, so has he injected etanercept into the spine yet?

Why etanercept? Etanercept is an immune suppression/anti-inflammation drug. Inflammation is a problem with everything, so preventing/reversing inflammation is the simplistic cure. If this worked in real people, and not just in the hypotheses of pathophysiologists, steroids would have cured everything decades ago.

Perhaps Dr. Edward Tobinick is imitating Dr. Michael Bracken, who is able to produce improved outcomes with steroids (anti-inflammation drugs) for spinal injury, but only when he is in charge of the data.[2]

At least Dr. Michael Bracken published some research to support his claims. Dr. Edward Tobinick just wants us to believe that his interpretation of pathophysiology is miraculously prescient.
 

Evidence? We ain’t got no evidence. We don’t need no evidence! I don’t have to show you any stinkin’ evidence!
 

Maybe Dr. Edward Tobinick does have some valid evidence.

Maybe Dr. Edward Tobinick is just hiding the valid evidence because it is proprietary. 😉

Here are a couple of comments by Dr. Novella on science and the importance of evidence. They probably were not directed specifically at Dr. Edward Tobinick, but they do apply to him.
 

What do you think science is? There’s nothing magical about science. It is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. Which part of that exactly do you disagree with? Do you disagree with being thorough? Using careful observation? Being systematic? Or using consistent logic?

 

Science is the way we learn what works.

Dr. Edward Tobinick’s criticism is evidence that he does not understand science.

Is any treatment, that is not based on evidence, likely to provide a benefit to patients?
 

History is strewn with ideas that were intuitive and made sense at the time, but were also hopelessly wrong.

 
Alternative medicine, opposition to EBM (Evidence Based Medicine), and opposition to SBM (Science-Based Medicine) are all the same mistake – evidence denialism.

Evidence denialism is devotion to being hopelessly wrong and remaining ignorant of being wrong.
 

Barbara Streisand?[3]

Footnotes:

[1] Another Lawsuit To Suppress Legitimate Criticism – This Time SBM
Posted by Steven Novella
July 23, 2014
Science-Based Medicine
Article

[2] Cochrane and a Significantly Biased Review of Steroids for acute spinal cord injury
Fri, 25 May 2012
Rogue Medic
Article

[3] Streisand effect
Wikipedia
Article

Maybe there is no such thing as bad publicity for a quack, but the publicity associated with this law suit means that people will associate the name quack with Dr. Edward Tobinick, or vice versa.

Dr. Edward Tobinick is stating I am not a quack.

Reasonable people are hearing –

I, Dr. Edward Tobinick, am a quack.

.

Comment on ‘No More Comments on Popular Science’

 

In the comments to No More Comments on Popular Science is this from Duke Powell
 

Rogue Medic says Epinephrine is no good.

 

I have been critical of epinephrine because we are routinely giving epinephrine in cardiac arrest, but we do not have any evidence that epinephrine improves any outcome that matters. ROSC (Return Of Spontaneous Circulation) is not an outcome that matters. Epinephrine does improve ROSC, but there is no increase in people leaving the hospital with good brain function (the outcome that matters and surviving for more time is better). There is evidence of harm.[1] The evidence of harm is not great, but the evidence of benefit does not exist.
 


 

More ROSC, but fewer survivors. That is not a benefit.

I do not claim that epinephrine is good, bad, or neutral. I point out that there is probably a subset of cardiac arrest patients who do benefit from epinephrine, but we have no way of knowing who those patients are.

I describe the lack of evidence of benefit and explain that standards of care should be supported by valid evidence of improved outcomes.
 

He says backboards are no good.

 

There is also no valid evidence of improved outcomes with backboards for unstable spinal fractures.

Where is the evidence that using backboards on patients with unstable spinal fractures results in fewer disabled patients (the outcome that matters)? There is evidence of harm.[2] The evidence of harm is not great, but the evidence of benefit does not exist.
 


 

Rogue Medic disagrees about a lot of things that scientists have said are “best practices” for EMS.

 

Scientists?

What scientists?

I disagree with using treatments that are not based on valid science.

I disagree even more strongly with standards of care that are not based on valid science.

I am also very critical of bad science, even if the results agree with what I think is true.[3],[4]
 

In most instances this medic with over 40 years experience agrees with Mr Rogue Medic. Not because of the science, but because of my experience.

 

That is not a very good reason for disagreeing with standards of care. It is a good reason for asking questions of the people who would know about the evidence, but even a 40 year career is just a series of anecdotal experiences. What kind of control has been used to minimize the effects of bias?

What has been done to make sure that confirmation bias does not limit recollection to those anecdotes that support individual bias?
 

But disagree with him on global warming? He calls you a science denier and says you can’t think for yourself.

 

I described some of the reasons you appear to be a science denialist above. That is science denialism on the topic of EMS.

You would get the same responses to EMS science denialism if you understood climate change. There are people who are willing to agree with science when it agrees with their prejudices, but are science denialists when science does not confirm their prejudices.

The problem is with the people, not with science.

Science does not care about prejudices.

Science just tells us what is real.

Science is not perfect.

Because science is not perfect, it depends on confirmation by different methods and by replication (preferably more than once). And most of all, science depends on rigorous attempts at objectivity, because everyone has biases.

Science does not exist to confirm biases.
 

Fact of the matter is, I am thinking for myself in terms of climate change. I’m not the guy following the crowd. Just as you are not the guy following the crowd with EMS best practice.

 

I am the guy basing decisions on science.

You appear to be the guy claiming that science does not matter. You appear to be the guy basing decisions on politics.

It isn’t the decision that matters, but the way we get there. Political decisions should be made based on valid science, rather than denying science or trying to make science fit political goals.
 

BTW, make sure your furnace is working, things are about to get colder, starting tomorrow.

Ha!!

Now you are discussing weather.

You do not appear to know the difference between weather and climate, but you seem to think that you know enough to tell scientists that they are wrong.

Thank you for reinforcing my point.

Footnotes:

[1] Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.
Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S.
JAMA. 2012 Mar 21;307(11):1161-8. doi: 10.1001/jama.2012.294.
PMID: 22436956 [PubMed – indexed for MEDLINE]

Free Full Text from JAMA.

[2] Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed – indexed for MEDLINE]

Free Full Text from Academic Emergency Medicine.

[3] Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients – Part I, Part II, and Part III
Rogue Medic

02/20/2011
Part I

02/22/2011
Part II

03/01/2011
Part III

[4] Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis.
Haut ER, Kalish BT, Cotton BA, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC.
Ann Surg. 2010 Dec 20. [Epub ahead of print]
PMID: 21178760 [PubMed – as supplied by publisher]

Full Text in PDF format from www.medicalscg

.

No More Comments on Popular Science


 

Why use Rush Limbaugh and his liberal twin, Michael Moore, as examples?

Because these two are irresponsible in their presentation of information and they have a lot of gullible followers.

Rush Limbaugh is actually known for followers who are too ignorant to have thoughts of their own. They call themselves ditto heads.

Popular Science is eliminating comments from their stories, because there is so much nonsense in the comment section that it detracts from the science reporting.[1]

Limbaugh is whining that the scientifically illiterate will be deprived of their ability to throw anti-science tantrums on this science site.

People with more spare time than sense are being told that their ignorance is not as good as a scientist’s education. The horror. The horror.

Am I exaggerating?
 

Let me tell you: This is Popular Science cutting off comments because of a “politically motivated, decades-long war on expertise.”[2]

 

Don’t have your vehicle fixed by an expert (mechanic), since expertise is bad.

Don’t have your illness treated by an expert (physician), since expertise is bad.

Should Jenny McCarthy and her University of Google followers be treated as if they know what they are doing?
 

[youtube]uDYba0m6ztE[/youtube]
 

When it comes to science, is Jenny McCarthy any different from Rush Limbaugh?

Climate change denialists (people who pretend that reality is not real) have been insisting that the planet is not warming because the yearly temperature does not move in a straight line and they seem to think in the most simple terms.
 


 

The data (green) are the average of the NASA GISS, NOAA NCDC, and HadCRUT4 monthly global surface temperature anomaly datasets from January 1970 through November 2012, with linear trends for the short time periods Jan 1970 to Oct 1977, Apr 1977 to Dec 1986, Sep 1987 to Nov 1996, Jun 1997 to Dec 2002, and Nov 2002 to Nov 2012 (blue), and also showing the far more reliable linear trend for the full time period (red).[3]

 

If we were treating a septic patient, should we rejoice that his peripheral temperature (skin, arms, legs) is coming down?

Should we assume that the patient is getting better by cherry picking data that appears to support what we want to happen?

An expert (physician) should ignore the predictable anomaly and realize that the core temperature is what matters.

Should the septic patient be treated according to science, or should we make treatment about politics?
 

cranks tend not to mind the crankery of others, since they see themselves as opposed to a scientific orthodoxy. Consistency be damned, they just want to see science with egg on its face so they can prove that they are being persecuted.[4]

 

Rush Limbaugh, Michael Moore, Jenny McCarthy, . . . are cranks. They do not understand science and cannot tell the difference between nonsense and science.

Climate change is not politics. Ways of dealing with climate change will involve politics.

Persuading people that climate change is politics is one way of avoiding science and claiming that any ignorant criticism is as valid as understanding science.

Climate change is science.

Science is not politics.

Science denialism is politics.

Footnotes:

[1] Why We’re Shutting Off Our Comments – Starting today, PopularScience.com will no longer accept comments on new articles. Here’s why.
Popular Science
By Suzanne LaBarre
Posted 09.24.2013 at 8:15 am
Article

[2] Popular Science Ends Reader Comments Because Too Many People Disagree with Them
The Rush Limbaugh Show
Quick Hits Page
Link to Quick Hits Page – there does not appear to be any link to the actual article by Limbaugh.

[3] The Escalator
Skeptical Science
Article

[4] Crank Magnetism
Denialism Blog
Posted by Mark Hoofnagle
June 28, 2007
Article

.

Informed Consent and Vaccines

 

Oregon is changing its policy for vaccine exemptions, but only by requiring parents to be informed about the risks they are dealing with.

Vaccines are not 100% effective and doctors do not pretend that vaccines are 100% effective, but anti-vaccine propagandists claim that nobody is endangered when they do not vaccinate their children.

That claim is a lie.

There will always be some people for whom the vaccine is not effective. These children are endangered by unvaccinated children transmitting vaccine-preventable diseases.

There will always be people who cannot get vaccinated for medical reasons. Cancer patients are just one example of a large group of people endangered by unvaccinated children transmitting vaccine-preventable diseases.
 

Proponents point to the current 6.4 percent of Oregon kindergartners whose parents exempted them on religious grounds from at least one vaccination this year — the highest rate in the nation and one that has increased steadily over the past decade.[1]

 
 

Image credit. Click on images to make them larger.
 


 

This is measles, but the same is true of other vaccine-preventable diseases. They have been increasing since Andrew Wakefield tried to discredit the MMR vaccine in order to sell his own competing vaccine.

Vaccine-preventable diseases are not good for children.

Opponents of the bill claim that this is discrimination against religious people because the exemption waiver states that the child is not vaccinating for religious reasons.

This is also a lie.

While the waiver does state that it is for religious reasons, the anti-vaccine propagandists have encouraged their followers to claim that they have religious objections. This does nothing to prevent parents with religious reasons for refusing vaccination for their children from continuing to refuse vaccination for their children.

There is no current requirement that parents know anything about vaccines before preventing their children from being vaccinated. this bill would require that they receive accurate information from an online video or receive information from a doctor before preventing their children from being vaccinated.

Parents will still have the option of receiving inaccurate information about vaccines from the few anti-vaccine doctors out there, like Dr. Jay Gordon,[2] an anti-vaccine propagandist. They will still be able to have their biases reinforced by an anti-vaccine doctor. Yes, the terms anti-vaccine and doctor do indicate a lack of understanding of medicine.
 

Sen. Doug Whitsett of Klamath Falls said he personally believes vaccination is “the right thing to do.”

But “who are we to tell the parents of children that they must vaccinate … their children? Where do we get that right?” he asked.[1]

 

That is suggesting that the bill would force vaccination, which is not true, but why should we expect truth from politicians?

Informed consent is the standard of care and this bill is attempting to present parents with accurate information, rather than the misinformation that anti-vaccine groups use to try to scare parents.

Parents are only trying to do what is best for their children.

We should be helping them to make good decisions based on information that is true.
 

A similar law implemented in Washington state in 2011 reduced by 25 percent the rate of kindergartners with at least one religious exemption from immunization, officials said.[1]

 

We are faced with a return of diseases that killed children at the beginning of the last century, but were almost completely eliminated near the end of the century. These diseases are coming back and killing children again, due to the actions of anti-vaccine propagandists.

This is a simple action to help parents protect their children from vaccine-preventable diseases.

Footnotes:

[1] Vaccine opt-out change advances – Senators vote to require parents who don’t want a child vaccinated to get a science lesson first
By Saul Hubbard
The Register-Guard
Published: 12:00 A.M., June 7
Article

[2] Dr. Jay Gordon’s profound misunderstanding of science
Respectful Insolence
Posted by Orac on February 18, 2011
Respectful Insolence
Article

.

We cater to the most stupid people out of fear of . . . whatever

 

What do I mean by stupid?

This is an excellent example of stupid.
 

Florida country radio morning-show hosts Val St. John and Scott Fish are currently serving indefinite suspensions and possibly worse over a successful April Fools’ Day prank. They told their listeners that “dihydrogen monoxide” was coming out of the taps throughout the Fort Myers area.[1]

 

dihydrogen monoxide?
 

Terrifying.

di = Two
hydrogen = H
mono = One
oxide = O

Two Hs and One O.

We can rearrange these into the familiar chemical expression of H2O.

Danger! There is H2 in the drinking water!

I hope so. Water is not water, if there is no H2O.

So, some people were worried and called the water company. The water company should have stated –

Dihydrogen monoxide is just water.

Today is April Fools’ Day.

You have been fooled.

Have a laugh at yourself and get on with your day.

But no.

That would have been too reasonable.

This was the response – and threats of felony charges.
 


Click on images to make them larger.
 

Don’t tell people that there is dihydrogen monoxide in the water! Tell them that the reported problem is just a prank, but do not use the opportunity to educate people about what you sell them.

Feed their ignorance.
 

the two hosts could face felony charges for, again, reporting that the scientific name of water was coming out of the pipes. “My understanding is it is a felony to call in a false water quality issue,” Diane Holm, a public information officer for Lee County, told WTSP, while Renda stood firm about his deejays: “They will have to deal with the circumstances.”[1]

 

There is water in the water. – That is not a false water quality issue unless you are an idiot.

There are idiots making threatening to bring felony charges to try to deflect attention from the stupidity of the idiots. – That is a real water quality issue.
 

 
This is dihydrogen monoxide –
 


 

 

 

 
This is water –
 


 

 

 
Do you understand the difference?

What we call it has nothing to do with what it is.

Water is dihydrogen monoxide is H2O.

Water has also probably had every deadly disease in it for as long as there has been water. People, and other animals defecate in that water. The water company cleans the water that they provide to us.

The result is that tap water is almost always much cleaner than the bottled water you buy in a store.

We also fluoridate water in many places. fluoride protects teeth. The result is that the water is healthier with fluoride than without fluoride.

Some people make the mistake of thinking that a complicated name means that something is dangerous.

Or they think that a chemical is more dangerous than something that is natural.

Or they think that something man made is more dangerous than something that is natural.

That is not just wrong, it is Jenny McCarthy wrong, it is Creationist wrong, it is climate change denialist wrong, it is homeopathy wrong, it is just plain stupid, but too many of us are afraid to tell stupid people to stop spreading their stupidity, because we think that is not nice.

By that niceness, we lower ourselves to their level of stupidity.
 

How many scientists support Jenny McCarthy’s anti-vaccine conspiracy theories? Only a handful – and they seem to make money off of it.

How many scientists support Creationism’s anti-evolution conspiracy theories? Only a handful – and they seem to make money off of it.

How many scientists support climate change denialists’ conspiracy theories? Only a handful – and they seem to make money off of it.

How many scientists support homeopathy’s anti-medicine conspiracy theories? Only a handful – and they seem to make money off of it.
 

We give these con men equal time out of some distorted sense of balance between reality and their even more distorted misunderstanding of reality. Maybe these nuts should go hug a unicorn and leave sensible people alone.

Stupidity is not a virtue.

The cure is education, not denialism.

 


 

I do not know the origin of the Deadly Facts About Water poster. If you know, please send me the link and I will give credit. This poster is great.

Footnotes:

[1] Florida DJs May Face Felony for April Fools’ Water Joke Worse Than Rubio’s
By Alexander Abad-Santos
April 2, 2013
The Atlantic Wire
Article
 

Update, Wednesday: St. John and Fish were back on the air Wednesday, and officials with the local health department tell The Atlantic Wire that felony charges are not expected.

 

Maybe somebody did point out that criminal charges would be stupid and open them up to ridicule, but I had already written this when that update was posted.

.

Can Anyone Show That Christine Maggiore Did Not Die Of AIDS?

At Respectful Insolence, the story HIV/AIDS denialist Christine Maggiore is dead, raises one big question.

If her family believes that she was right about HIV/AIDS – Prove it.

If her family believes that she did not die from complications of HIV/AIDS – Prove it.

If her supporters believe that she was right about HIV/AIDS – Prove it. Get the family to consent to an autopsy.

If there is no autopsy, why not? What are you afraid of?

If there is no autopsy, why not? What are you hiding?

The answer is obvious.

Christine Maggiore Did Die Of AIDS.

How many people will be convinced to avoid treatment, because of her delusion?

How many more people will she be responsible for killing?

She already killed her daughter.

Isn’t that enough?

.