@CommonHealth: Wikipedia and “energy” therapist clash over definition of “respectable scientific journals”

ss We link to a CommonHealth guest post by a Spaulding Rehab doc Eric Leskowitz. He promotes new age approach to pain known as “energy medicine “ and says he’s  been dismissed by Wikipedia as a “quack” despite his peer-reviewed work and Harvard cred

Hard to disagree with the first part of Wikipedia’s response to a petition supporting Leskowitz…

 If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately..

.…except to say: What’s defines a “respectable”  journal.  True, not all peer review is equal, but who makes that call?

Wikipedia errs on the safe side and sets a high evidence bar. Still, Wikipedia’s ‘s citation of  Quackwatch – a virulently  anti-alt medicine web site — seems shaky. That site casts its net widely, ragging on everything from faith healers to acupuncture and massage therapy.

And the rest of Wikipedia’s response seemed kind of harsh…

What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t.

At the same time, Leskowitz doesn’t do himself any favors by citing Dr. Mehmet Oz’s endorsement.  Dr. Oz has been known to promote less than substantiated therapies.

Energy Psychology has even gotten some fairly mainstream attention, from television’s Dr. Oz to The Huffington Post.

 

 

Could lunch lady fare be healthier than school lunch from home?

Seems the fluffernutter  has moved from the cafeteria to the lunch sack. The Globe offers a story about the joys of getting a kid to eat a healthy lunch.   Tufts found that the contents of those brown bags sometime fall short on the nutrition scale.

fruit-photo

The nutritional shortcomings of school lunches have been a matter of national debate for decades — but the focus has been on what schools serve, not on what moms and dads pack in the lunch bags.

Now Tufts University researchers have looked inside all those bags — and discovered that none of the lunches met all five National School Lunch Program standards, which emphasize fruits, vegetables, whole grains, and low- or nonfat dairy, and only 27 percent of the lunches met at least three of the goals.

So, now that the lunch lady has moved beyond tater tots, lets give him or her some credit.

 

 

NYTimes Magazine: Recalling the debate over repressed memories

ssThis weekend’s profile of Boston Dr. Bessel van der Kolk brought up some bad memories of the debate over what is clinically known as “dissociative amnesia.” The story profiles van der Kolk’s approach to treating Post Traumatic Stress Disorder, known as psychomotor therapy.  

“Trauma has nothing whatsoever to do with cognition,” he says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures, regions that, he says, no cognitive therapy can access. “It’s not something you can talk yourself out of.” That view places him on the fringes of the psychiatric mainstream.

Not the first time, the story notes, as it recalls the doctor’s past support of repressed memories – a much debated concept that came into play when charges of sexual assault were levied against day care workers and priests in the ‘80s and ‘90s. Dr. van der Kolk’s Harvard colleague, psychologist Richard McNally, called the concept “the worst catastrophe to befall the mental-health field since the lobotomy era.”

From the Times:

For a time, judges and juries were persuaded by the testimony of van der Kolk and others. It made intuitive sense to them that the mind would find a way to shield itself from such deeply traumatic experiences. But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned. Most research psychologists argued that it was much more likely for so-called repressed memories to have been implanted by suggestive questioning from overzealous doctors and therapists than to have been spontaneously recalled. In time, it became clear that innocent people had been wrongfully persecuted. Families, careers and, in some cases, entire lives were destroyed.

After the dust settled in what was dubbed “the memory wars,” van der Kolk found himself among the casualties. By the end of the decade, his lab at Massachusetts General Hospital was shuttered, and he lost his affiliation with Harvard Medical School. The official reason was a lack of funding, but van der Kolk and his allies believed that the true motives were political.

Not clear what the story means by “political,” but the implication is that he was banished for promoting an unpopular concept.

It didn’t help critics of repressed memory that the concept was being used in cases against alleged pedophiles. Most notoriously, lawyers defending defrocked priest Paul Shanley,  who was convicted of raping a young boy, used doubts about the concept to discredit the grown-up victim who testified that he had repressed memories of abuse. Shanley — who was the subject of numerous complaints to the church —  was found guilty in 2005. His lawyers filed an appeal, again based on the shakiness of the repressed memory concept.

From a Times story on the appeal

You have prominent scientists, psychologists and psychiatrists saying this is not generally accepted. So why allow it in a court of law in a criminal proceeding?” Mr. Stanley’s lawyer, Robert F. Shaw Jr., asked the state’s highest court Thursday.

The debate over repressed memory — the idea that some memories, particularly traumatic ones, can be inaccessible for years — has simmered since the 1980s, when some patients in therapy described long-past scenes of sexual abuse. Some of those experiences turned into high-profile legal cases. The scientific controversy boiled over in the 1990s — as experts raised questions about many claims — and then died down.

Recently, scientists have begun to spar again over the theory. New studies suggest, and many scientists argue, that what people call repression may just be ordinary forgetting; memory is not “blocked.” Others say the process is more complex and may involve a desire to forget.

“My impression is there continues to be a few scientists who honestly believe that it is actually possible for someone to be involved in a traumatic event and not be able to remember it at all,” said Dr. Harrison G. Pope Jr., a professor of psychiatry at Harvard. “But you cannot possibly argue that it’s generally accepted, which is the criteria for it to be admissible from a legal standpoint.”

In 2010, The Globe reported that the request for a new trial was thrown out

Jan 16, 2010: “In sum, the judge’s finding that the lack of scientific testing did not make unreliable the theory that an individual may experience dissociative amnesia was supported in the record, not only by expert testimony but by a wide collection of clinical observations and a survey of academic literature,” Justice Robert Cordy wrote for the SJC.

Shanley, now in his late 70s, was originally prosecuted by Martha Coakley, who is now attorney general and a Democratic candidate for US Senate. Her successor, Middlesex District Attorney Gerard T. Leone Jr., whose prosecutors defended the conviction before the SJC, applauded the ruling.

“As the SJC recognized, repressed memories of abuse is a legitimate phenomenon and provided a valid basis for the jury to find that the victim, a child at the time of the assaults, repressed memories of the years of abuse he suffered at the hands of Paul Shanley, someone who was in a significant position of authority and trust,” Leone said.

But Shanley’s appellate attorney, Robert F. Shaw Jr. of Cambridge, said the SJC had made a grievous mistake. Shaw, who argued in court papers that recovered memory was “junk science,” said Shanley deserved a new trial.

The SJC noted – literally in a footnote – that repressed memories alone may not be enough to convict a defendant. From the Globe:

The court also said that it may decide in the future to throw out a conviction where the only evidence is based on recovered memories.

“We do not consider whether there could be circumstances where testimony based on the repressed or recovered memory of a victim, standing alone, would not be sufficient as a matter of law to support a conviction,” Cordy wrote in a footnote.

But, the debate goes on. A review in the current issue of the American Psychological Association’s journal Psychiatric Bulletin, tries the put the issue to rest. Harvard’s McNally is one of the authors.  The article is in response to a 2012 paper in the same journal supporting the concept of repressed memories.

 (Although) a key assumption of the TM (Trauma model) is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma–dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorder. 

 

Storify: The Boston skinny on fat

Over-treatment? There’s an app for that

ss accCritics have knocked the recently updated guidelines  on statins for patients at risk of heart disease. While some heart specialist spent years putting together advice for the high risk, others said the guidelines will result in massive overtreament.

Still, health monitoring apps are hot,. The American College of Cardiology is now offering an iPhone/ iPad risk calculator,  the Globe’s Daily Dose reports. This paragraph from the Boston.com post was cut off the print version of the story.

The app does instruct doctors to have a discussion about the risks and benefits of statins and to consider patient preferences; whether busy primary care providers will make the time to have that discussion, rather than simply prescribing the drugs, remains to be seen. 

The headlines were different as well. 

Print: App Calculates Heart Disease

Boston.com: Heart disease risk app may increase statin prescriptions

Don’t like the ACC app? There are already a handful of others.

Another study questions benefit of mammograms, via Globe, Times

The Globe isn’t sharing much with Boston.com these days. But, you can still access most of the blogs.

Mom, post breast cancer

Mom, post breast cancer

Today’s Daily Dose is on the mammography debate. We all thought early detection was key. For breast cancer, maybe not. 

In a research finding that will add to doubts about the value of breast cancer screening, Canadian researchers determined that women ages 40 to 59 who had yearly mammograms enjoyed no added survival benefit up to 25 years later compared with those who skipped the screening X-rays….

The latest finding, published Tuesday in the British Medical Journal, confirms earlier results from the Canadian trial, which first came out two decades ago and is unlikely to discourage many doctors from recommending screening…

But the researchers also determined that 22 percent of breast cancers initially detected on mammograms in the early 1980s were “over-diagnosed”—meaning they never would have been found otherwise and would not have become life-threatening. Most of these women had surgery to remove these tumors which, in hindsight, was unnecessary…

Such findings haven’t, though, swayed the opinions of most women and doctors, who remain more concerned about a life-threatening cancer going undetected than a harmless one being over-treated

Two local docs defend the procedure:

“Mammography is an imperfect test at best, but at this point, it’s the best test we have,” said Dr. Ann Partridge, a breast oncologist at Dana-Farber Cancer Institute. She and others highlighted some potential methodological flaws of the Canadian study.

For example, Partridge said, technology has improved significantly over the past 30 years with X-ray machines and digitized film that yield clearer images….

Some radiologists have sharply attacked the study investigators, accusing them of having a bias against mammography by designing a study in which the control group of women in their 50s received breast exams performed by skilled nurses every year instead of mammograms.

“The principal investigator set out to prove that all you needed to do was a physical examination,” said Dr. Daniel Kopans, director of breast imaging at Massachusetts General Hospital, in an e-mail responding to the new study finding. “The nurse examiners were highly trained while the radiologists and technologists [who performed the mammograms] had no training.”

Not everyone is sticking with mammography. The advocates at Breast Cancer Action have long questioned its usefulness.

And, the New York Times story offered this telling quote:

“It will make women uncomfortable, and they should be uncomfortable,” said Dr. Russell P. Harris, a screening expert and professor of medicine at the University of North Carolina, Chapel Hill, who was not involved in the study. “The decision to have a mammogram should not be a slam dunk.”

Press (blue) button; get health records — Hacking health this weekend in Boston

ssThe Blue Button “is a simple concept: give patients’ access to their own data. The U.S. Department of Veterans Affairs (VA) first used the Blue Button logo on its patient portal in 2010 ,By clicking on the button, individuals could download their medical records in digital form.

Since then, millions of Veterans have logged onto the tool to download their personal health information, and many of the country’s largest data holders, including federal agencies such as the Centers for Medicare & Medicaid Services (CMS) and the Department of Defense (DoD) and private health plans such as United HealthCare and Aetna, have embraced Blue Button as a way to make health care data readily available to their beneficiaries.”

This weekend:

Tufts MedStart and MIT Hacking Medicine in collaboration with the ONC Present:

The Blue Button Boston Innovation Challenge

Tufts MedStart and MIT Hacking Medicine are excited to announce their collaboration with the Office of the National Coordinator for Health IT (ONC) on the January Blue Button Code-a-thon taking place from Friday, January 17th to Sunday, January 19th.  Blue Button is an international movement to engage patients in their health through access to their health data in both human and machine-readable formats. This fall, all providers using MU2 certified technology will be able to support patients viewing, downloading, and transmitting their clinical data to a consumer endpoint, like a personal health record, or provider through Blue Button + Direct.

This codeathon is an opportunity for providers, patients, and the developers of consumer facing technology to come together to learn about Blue Button, identify high priority use cases, and build exciting new products that are ready to receive Blue Button data. We hope this event will foster collaborations that exist long after the codeathon ends. The ONC recently sponsored a successful codeathon on device data and health financial data in San Francisco, and we are excited to work with a new community in Boston!

The event will focus on use cases that take advantage of patient clinical data liberated through Blue Button + Direct, a technology available in all Meaningful Use certified technology starting winter 2014. The event will open with patients and providers sharing their highest priority Blue Button use cases which will guide development over the weekend and judging criteria. Example ideas may include but are not limited to:

  • Co-designed applications that can improve communication between the health care provider and the patient. (ie. care plans and notes that both the patient and physician can contribute to)
  • Simplifying medical jargon, content, and diagnoses for patients. (ie. consumer friendly definitions of clinical terms)
  • Clinical health information visualizations. (ie. interactive lab results)
  • Population trend analysis. (ie. seasonal, location specific tracking of symptoms at an aggregate level)
  • Patient record matching to clinical trials.

 

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