10 Questions to Distinguish Real From Fake Science

14 11 2012

[Note: This is a version of a post that first appeared here and here. Its message is worth repeating.]

Pseudoscience  is the shaky foundation of practices–often medically related–that lack a basis in evidence. It’s “fake” science dressed up, sometimes quite carefully, to look like the real thing. If you’re alive, you’ve encountered it, whether it was the guy at the mall trying to sell you Power Balance bracelets, the shampoo commercial promising you that “amino acids” will make your hair shiny, or the peddlers of “ natural remedies” or fad diet plans, who in a classic expansion of a basic tenet of advertising, make you think you have a problem so they can sell you something to solve it.

Pseudosciences are usually pretty easily identified by their emphasis on confirmation over refutation, on physically impossible claims, and on terms charged with emotion or false “sciencey-ness,” which is kind of like “truthiness” minus Stephen Colbert. Sometimes, what peddlers of pseudoscience say may have a kernel of real truth that makes it seem plausible. But even that kernel is typically at most a half truth, and often, it’s that other half they’re leaving out that makes what they’re selling pointless and ineffectual. But some are just nonsense out of the gate. I’d love to have some magic cream that would melt away fat or make wrinkles disappear, but how likely is it that such a thing would be available only via late-night commercials?

What science consumers need is a cheat sheet for people of sound mind to use when considering a product, book, therapy, or remedy. Below are the top-10 questions you should always ask yourself–and answer–before shelling out the benjamins for anything, whether it’s anti-aging cream, a diet fad program, books purporting to tell you secrets your doctor won’t, or jewelry items containing magnets:

  1. What is the source? Is the person or entity making the claims someone with genuine expertise in what they’re claiming? Are they hawking on behalf of someone else? Are they part of a distributed marketing scam? Do they use, for example, a Website or magazine or newspaper ad that’s made to look sciencey or newsy when it’s really one giant advertisement meant to make you think it’s journalism?
  2. What is the agenda? You must know this to consider any information in context. In a scientific paper, look at the funding sources. If you’re reading a non-scientific anything, remain extremely skeptical. What does the person or entity making the claim get out of it? Does it look like they’re telling you you have something wrong with you that you didn’t even realize existed…and then offering to sell you something to fix it? I’m reminded of the douche solution commercials of my youth in which a young woman confides in her mother that sometimes, she “just doesn’t feel fresh.” Suddenly, millions of women watching that commercial were mentally analyzing their level of freshness “down there” and pondering whether or not to purchase Summer’s Eve.
  3. What kind of language does it use? Does it use emotion words or a lot of exclamation points or language that sounds highly technical (amino acids! enzymes! nucleic acids!) or jargon-y but that is really meaningless in the therapeutic or scientific sense? If you’re not sure, take a term and google it, or ask a scientist if you can find one. Sometimes, an amino acid is just an amino acid. Be on the lookout for sciencey-ness. As Albert Einstein once pointed out, if you can’t explain something simply, you don’t understand it well. If peddlers feel that they have to toss in a bunch of jargony science terms to make you think they’re the real thing, they probably don’t know what they’re talking about, either.
  4. Does it involve testimonials? If all the person or entity making the claims has to offer is testimonials without any real evidence of effectiveness or need, be very, very suspicious. Anyone–anyone–can write a testimonial and put it on a Website. Example: ”I felt that I knew nothing about science until The Science Consumer blog came along! Now, my brain is packed with science facts, and I’m earning my PhD in aerospace engineering this year! If it could do it for me, The Science Consumer blog can do it for you, too! THANKS, SCIENCE CONSUMER BLOG! –xoxo, Julie C., North Carolina.”
  5. Are there claims of exclusivity? People have been practicing science and medicine for thousands of years. Millions of people are currently doing it. Typically, new findings arise out of existing knowledge and involve the contributions of many, many people. It’s quite rare–in fact, I can’t think of an example–that a new therapy or intervention is something completely novel without a solid existing scientific background to explain how it works, or that only one person figures it out. It certainly wouldn’t just suddenly appear one night on an infomercial. Also, watch for words like “proprietary” and “secret.” These terms signal that the intervention on offer has likely not been exposed to the light of scientific critique.
  6. Is there mention of a conspiracy of any kind? Claims such as, “Doctors don’t want you to know” or “the government has been hiding this information for years,” are extremely dubious. Why wouldn’t the millions of doctors in the world want you to know about something that might improve your health? Doctors aren’t a monolithic entity in an enormous white coat making collective decisions about you any more than the government is some detached nonliving institution making robotic collective decisions. They’re all individuals, and in general, they do want you to know.
  7. Does the claim involve multiple unassociated disorders? Does it involve assertions of widespread damage to many body systems (in the case of things like vaccines) or assertions of widespread therapeutic benefit to many body systems or a spectrum of unrelated disorders? Claims, for example, that a specific intervention will cure cancer, allergies, ADHD, and autism (and I am not making that up) are frankly irrational.
  8. Is there a money trail or a passionate belief involved? The least likely candidates to benefit fiscally from conclusions about any health issue or intervention are the researchers in the trenches working on the underpinnings of disease (genes, environmental triggers, etc.), doing the basic science. The likeliest candidates to benefit are those who (1) have something patentable on their hands; (2) market “cures” or “therapies”; (3) write books or give paid talks or “consult”; or (4) work as “consultants” who “cure.” That’s not to say that people who benefit fiscally from research or drug development aren’t trustworthy. Should they do it for free? No. But it’s always, always important to follow the money. Another issue that’s arisen around pseudoscience is whether or not a bias of passionate belief is as powerful as fiscal motivation. If you have a bias detector, turn it on to full power when evaluating any scientific claim. If yours is faulty–which you might not realize because of bias–perhaps you can find someone in real life or online with a hypersensitive bias detector. Journalists, by nature of training and their work, often seem to operate theirs on full power.
  9. Were real scientific processes involved? Evidence-based interventions generally go through many steps of a scientific process before they come into common use. Going through these steps includes performing basic research using tests in cells and in animals, clinical research with patients/volunteers in several heavily regulated phases, peer-review at each step of the way, and a trail of published research papers. Is there evidence that the product or intervention on offer has been tested scientifically, with results published in scientific journals? Or is it just sciencey-ness espoused by people without benefit of expert review of any kind?
  10. Is there expertise? Finally, no matter how much you dislike “experts” or disbelieve the “establishment,” the fact remains that people who have an MD or a science PhD or both after their names have gone to school for 24 years or longer, receiving an in-depth, daily, hourly education in the issues they’re discussing. If they’re specialists in their fields, tack on about five more years. If they’re researchers in their fields, tack on more. They’re not universally blind or stupid or venal or uncaring or in it for the money; in fact, many of them are exactly the opposite. If they’re doing research, usually they’re not Rockefellers. Note that having “PhD” or even “MD” after a name or “Dr” before it doesn’t automatically mean that the degree or the honorific relates to expertise in the subject at hand. I have a PhD in biology. If I wrote a book about chemical engineering and slapped the term PhD on there, that still doesn’t make me an expert in chemical engineering. And I’m just one person with one expert voice in the things I do know well. I recommend listening to more than one expert voice.

There is nothing wrong with healthy skepticism, but there is also nothing wrong in acknowledging that a little knowledge can be a very dangerous thing, that there are really people out there whose in-depth educations and experience better qualify them to address certain issues. However, caveat emptor, as always. Given that even MDs and PhDs can be disposed to acquisitiveness just like those snake-oil salesmen, never forget to look for the money. Always, always follow the money.

By Emily Willingham





Ask Emily

24 05 2012

Will you explain the differences (and similarities) between endemic and epidemic diseases?

Yes, and I’ll throw in “outbreak” and “pandemic” for good measure.

First, anything that is endemic, whether a disease or an organism, occurs only in a specific group or area. “Endemic” implies “occurs only in.” So, the marine iguana, which occurs only on the Galapagos Islands, is an endemic species to those islands—it doesn’t live anywhere else. Substitute a disease for “marine iguana,” and you get the start of an idea of what an endemic disease is.

But there are a few extensions of that idea. First, an endemic disease can be one that occurs only in a certain area—and in this global society, that’s becoming increasingly rare. An example is Venezuelan equine encephalitis, which lurks in neotropical areas, usually in horses, but occasionally crops up among humans in these regions.

Endemic can also mean, however, that the disease has a constant presence in the population or area, perhaps at low levels, but always there—it never quite reaches zero in the defined population. Tuberculosis is an example of a disease that is endemic in many areas of the world, often carried around by people who don’t even know they’re infected.

Endemicity also comes in subtypes, depending on when infection occurs. If it occurs mostly in children in the population, the disease is holoendemic. Malaria is an example. A hyperendemic disease like influenza, on the other hand, is usually an equal-opportunity infector.

Is it possible for an endemic to become epidemic? Yes. If a disease that’s been lying low in a population suddenly shows sharp uptick in the population, that’s an outbreak. An epidemic is a burst of disease activity that spreads beyond the local population. So something that is endemic because it never quite hits zero cases—like measles—or something that’s endemic because it’s so localized, like Venezuelan equine encephalitis—could break out of its usual population bounds and spread across other populations.

Back to our endemic marine iguanas: If they suddenly kicked up their population levels on Galapagos alone but nowhere else, that would be an outbreak of iguanas. If they broke away from the Galapagos and established a claw-hold on the mainland, they’d be an epidemic of iguanas.

If the iguanas—or a disease—were to break the bounds of its immediate continental confines and spread to other continents or globally, that’s called a pandemic. A pandemic of iguanas is probably not a realistic concern, but the human population has already faced down a few pandemics in recent memory, including the Spanish flu, and still grapples with the pandemic of HIV/AIDS. While influenza remains the watchword for pandemic anxieties, no one can genuinely predict what the nature of the next pandemic will be.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of Wikimedia





Ask Emily

29 03 2012

Why does our hair thin out as we age? My aunt lost hair in unexpected places as she closed in on her 80th year.

The reasons for hair thinning as we age range from benign but perhaps unwanted processes to serious disease. One reason your hair may seem thinner as you get older is that each individual hair is itself literally thinner because the hair follicle narrows with age. The result is hair with less volume than you may have had before, which seems like thinning. Because thinner also means “breaks more easily,” you may see more hair in your hairbrush or after a shower, but that doesn’t mean your hair is actually falling out.

If your hair is really falling out, the usual cause is an inherited susceptibility to androgens. The official name is androgenetic alopecia (“androgenetic” refers to an inherited susceptibility to androgenic hormones and “alopecia” means hair loss). Most people are aware that men develop this form of hair loss, which we know of more colloquially as “male pattern baldness.” Men and women exhibit different patterns of baldness when these androgens kick in with age, and women tend to lose their hair over the front part of the scalp and have thinning all over. This loss in women also may be related to changes at menopause, and some research suggests that estrogen decline in addition to androgen activity could be involved. A recent study also found that malfunctions in the source cells for hair follicles may also be part of the pathway that leads to androgenetic alopecia.

While the loss itself is not harmful, the appearance that results can be particularly difficult for women, as most people don’t expect it to happen in women, in spite of how common it is. Treatments for androgenetic alopecia in women include use of compounds that block androgens or a compound called minoxidil that circumvents androgen activity and promotes hair growth.

While these common causes of hair thinning are relatively benign in health terms, thinning can also signal something more dire. One common health-related cause of hair loss is thyroid dysfunction. Emotional or physical stress, such as childbirth, major surgery, or severe infection can also elicit a widespread loss of hair weeks or even months after the episode occurs. The loss eventually slows.

Some infectious diseases can cause hair loss, including syphilis, while autoimmune diseases like lupus can also be to blame, although some forms of lupus and associated hair loss may actually improve with age and after menopause. In elderly women, causes of hair loss include pulling out the hair themselves in some cases, known as trichotillomania. Another potential cause of hair loss is giant cell arteritis, which is inflammation of the arteries in the upper body, head, and neck. If a person whose hair is thinning also has been diagnosed with cancer, any hair loss should be closely investigated for the possibility that the cancer has metastasized or migrated to the scalp.

The bottom line with hair loss is that any hair loss that is sudden, occurs in an odd pattern, or that you simply find worrisome justifies a call to a medical professional. As one scientific abstract noted, hair loss particularly in postmenopausal women “warrants close inspection.”

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of  Wikimedia Commons





Ask Emily

23 02 2012

Why does our skin break out in a rash with some viral infections like measles or Fifth disease?

These sorts of rashes are technically known as viral exanthems (the word derives from the Greek word “exanthema,” meaning “breaking out”).

The skin responds to infection with a rash for one of three reasons: the infectious agent releases a toxin that causes the rash, the infectious agent damages the skin and causes a rash, or the immune response results in the skin outbreak.

The skin responds in only a few ways to these challenges, although the pattern of the response can vary from virus to virus (bacteria and some other infectious organisms can also trigger a rash).

The response is the body’s attempt to deal with the presence of viral particles that find their way to the epidermis, or skin. In general, the upshot of the immune response is an area of inflammation. Because viruses cause a systemic or body-wide infection, viral rashes often cover much of the body.

Although the basic pathway to the rash is similar among viruses, the specific pattern of the rash can help distinguish the virus involved. For example, Fifth disease, so-named because it was the fifth virus in a series to be identified as causing a rash, produces a “slapped-cheek” ruddy appearance on the face and may cause a lacy, rather flat rash elsewhere on the body.

A measles rash, on the other hand, starts as an eruption of raised or flat spots behind the ears and around the hairline before spreading body-wide.

One thing to recognize is that not every rash is a viral rash or a benign viral rash, although most viral rashes will resolve on their own. Usually, a fever accompanies a viral rash. If a rash develops, you should be aware of the following warning signs that signal a call to your doctor:

  • If you suspect you have shingles. This highly uncomfortable rash tends to trace along the nerve routes under the skin but can spread out from those, as well. Starting antivirals within the first 24 hours may ward off a more intense recurrence or a permanent pain syndrome called postherpetic neuralgia.
  • If you suspect measles. Infection with this highly contagious virus should be reported immediately.
  • What you think is a rash from a severe allergic reaction or a rash that arises coincident with taking a new medication.
  • The rash accompanies a high fever, spreads rapidly, and starts to look like purple bruising. This pattern is indicative of meningitis.
  • Any rash involving a very high fever, pain, dizziness or fainting, difficulty breathing, or a very young child or that is painful.
  • Any rash that you find worrisome, including for reasons of persistence or timing with something such as exposure to infection, a new medication, or new food.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of HowStuffWorks





Ask Emily

26 01 2012

I’ve just read that there’s a kind of tuberculosis making a comeback that doesn’t respond to any known TB drugs. How does that happen and can anything be done to treat it or stop its spread?

Tuberculosis (TB) is a bacterial infection, usually of the lungs, although it can invade other tissues.

A healthy person may be infected but not show symptoms, but someone with an active infection may have a cough with blood in the sputum, night sweats, weight loss, and fever. The bacteria spread through coughs or sneezes.

As with seemingly all infections we treat with antibiotics, the TB bacterium has evolved to evade the arsenal of medications we throw at it.

While many cases still resolve after the long-term antibiotic treatment required (6 months or more), often people with the infection begin to feel better or get tired of the unpleasant side effects and will cease the therapy.

As with other similar situations with antibiotics, this premature cessation of therapy can give resistant bacteria the upper hand. The outcome is different grades of TB infection, based on the level of resistance. TB that resists most but not all drugs is multidrug-resistant. TB that resists all but drugs of last resort is extensively drug-resistant, and TB that responds to no antibiotics at all is totally drug-resistant (TDR).

That last form of TB strikes fear into the hearts of epidemiologists and public health officials because it is an infectious disease nightmare.

For a series of reasons ranging from an inability of low-resource countries to test for and detect TB to a lapse in treatment adherence because of poor healthcare management and patient follow-up, the most resistant forms of TB often emerge in areas poorly equipped to control it. Thus, when a report surfaced in January 2012 that a research team had identified 12 cases of TDR TB in India, on the heels of 15 identified cases in Iran in 2006, the worldwide response was, essentially, anxiety and fear.

The fear is that if this TDR form of TB gains a stronger foothold in overcrowded conditions where people walk ill and undiagnosed, it would be a plane flight away from toeholds anywhere else in the world. While humanity dealt with incurable and fatal TB for millennia before antibiotics started to fight back in the 1940s, this resurgence at a time when technology can take a disease around the world in a matter of hours adds a whole new dimension to the threat.

There is, of course, already the threat on the ground in India, where one of the cases is a 13-year-old girl and another of the people in the cohort has died from the disease. But lest anyone think that in their comfortable home in the West they are sheltered from threat, the news the day I wrote this contained reports of a student with TB in Fort Wayne, Indiana, which precipitated notification to 100 students who may have come in contact with their classmate. Another student in Westlake, Ohio, also had been diagnosed with TB, precipitating community action to make people aware of symptoms and prevention of spread.

The communities in these cases benefited from a public health surveillance program that moved into action once each diagnosis was made. But in India, the result has led to public health chaos, with officials arguing over whether or not some of the cases truly were TDR TB. That does not change the fact that TDR TB has already been identified in Iran, or the economic and healthcare gaps that will only continue to contribute to the likelihood of its spread.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Video courtesy of IBNLive





Ask Emily

29 12 2011

Do cold viruses mutate, or are we simply encountering new viruses with each new infection?

If you’re in situations that expose you to frequent cold viruses, I’ve got some bad news for you. First, what we collectively call the “common cold” is a non-medical way of saying “general upper respiratory infection.” Those sniffles and coughs don’t trace to a single virus or even to a single group of viruses. In fact, more than 200 different viruses can cause what we think of as a cold, and they fall into various classes. The most common is the rhinovirus (rhino refers to the nose). These cause up to 40% of colds. The other two types are coronaviruses and respiratory syncytial virus, which is fairly harmless in healthy people but can be dangerous, particularly for premature infants. Coronaviruses made the news when one turned up as the culprit in the SARS outbreak earlier this decade.

Every time we encounter and do battle with one of these viruses, we develop immunity to that specific microbe. But there are another couple of hundred of them out there, waiting to get into our nasal passages with someone else’s cough or sneeze. In addition, it doesn’t take a lot of viral particles to cause an infection, so trace exposures can still lead to illness.

That’s not even the bad news, though. While people probably muse aloud every time they get the sniffles, wondering why scientists have yet to come up with a cure or a vaccine for the common cold, the fact is, a single vaccine is unlikely. Rhinoviruses, for example, are quite complex and mutate fairly rapidly, evading any immunity we’ve built up to previously encountered strains. In that way, it’s like influenza viruses, which reassort around the globe each year and usually turn up as different strains in each new season.

One thing is certain: You won’t get a cold virus just from being cold. You might be more susceptible to infection if you’re stressed or tired or have allergies.

Some people may think they have the flu, but the difference between an influenza virus infection and a cold virus infection is usually quite stark: a flu infection hits hard and fast, often within hours, with a high fever, extreme fatigue, chills, and possibly gastrointestinal involvement. A cold builds up more slowly, peaking after a few days, and fever is relatively uncommon.

Is there anything you can do to at least ease the symptoms of this incurable but usually benign blight on humanity?  Washing hands is one way to avoid picking up a nasty cold virus, but once symptoms develop, your options are limited. Antibiotics are useless against any viral infection. Vaporizers, fluids, some TLC, and time are your best weapons against riding out infection with any of the viruses that cause the common cold.

And go ahead and resign yourself to the idea that even when you’re over this one, new versions linger out there, waiting to find their way up your nose.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham 





Ask Emily

27 10 2011

I got a flu vaccine one year and ended up getting the flu anyway. Doesn’t that mean the vaccine doesn’t work?

Influenza viruses are notorious for constantly changing. Making vaccines against them is also notoriously difficult because it requires several months of advance preparation before the viral doses can be ready.

If you’ve heard of “bird flu,” you may realize that flu viruses flourish pretty well in the bird-related environment, and vaccine developers grow their viruses within fertilized chicken eggs (that’s why you’ll be asked if you’re allergic to egg proteins). Every vaccine requires about three eggs to yield sufficient (killed) virus, which translates into millions of chicken eggs (i.e., making 300 million vaccine doses would require 900 million eggs).

It also translates into six months of lead time for producing the viruses required to make the vaccine. To find out more about the current year’s strain selection, visit the Centers for Disease Control and Prevention site, which offer comprehensive information about influenza vaccines.

That advanced lead time means a delay between growing the viral strains authorities have determined may be most prevalent in the upcoming flu season and the actual arrival of the current season’s viruses. Experts can keep an eye on how flu goes in the southern hemisphere’s winter and use that as a gauge for which strains may be most prominent during winter in the northern hemisphere, but there’s no real guarantee that the viral strains pinpointed as most likely for a given season will turn out to be an accurate prediction.

The global surveillance network consists of 130 centers in 101 countries monitoring which strains are most prevalent. These are the people who try to predict months ahead of time which patterns of infection will prevail in a given geographic area.

So, it’s possible to be vaccinated against the flu and still get the flu. Why? Because if you’re exposed to a circulating strain that’s not included in this year’s vaccination mix, then you’re not vaccinated against catching that particular form of the virus. The good news is, the predictions generally turn out to be pretty on target, preventing most people who receive a vaccine from developing influenza.

Keep in mind that even if the vaccine misses a circulating strain, if you choose not to be vaccinated, you can contract influenza more than once in a season if you’re exposed to two different circulating strains.

Final answer? Yes, you can receive a flu vaccine and still come down with the flu. But that doesn’t mean the vaccine didn’t work. It did work against the strain it targeted, and if it hadn’t, you might’ve had to go through that misery more than once. So, get the influenza vaccine as indicated. It will certainly prevent infection from the strains it targets, and at the least can save you half the misery of flu season.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham