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Acupuncture Odds and Ends

I’m cheating.  No, I’m recycling.  Tis the season to have to no time to get anything done.  Since I know none of you pay attention to the blog of at the Society for Science-Based Medicine and I have no time with work and the holidays to come up with new material, I am going to collect and expand on the entries on acupuncture I wrote from SfSBM.  Anything I write really is worth reading twice.  I really need to make my multiple personality disorder work for me, but the goth cowgirl persona is a luddite at best, so you are stuck with the over -extended ID doctor.  Here goes.

Acupuncture Beer Goggles or Expensive Wine?

Painting with a broad brush, I would say that acupuncture doesn’t work. By ‘work’ I would say that it has no effect that would change the underlying physiology or anatomy of the person receiving the acupuncture.

‘Works” is different from having an effect, even a beneficial effect. Positive interactions between a patient and a health care provider, even when offering a pseudo-medicine, will make some patients feel better about their disease. I compare these pseudo-medicines, like acupuncture, to beer goggles. They change perception but not reality.

While changing the perception of disease for the better is of benefit, it is just not ethical to base treatment on the lie that acupuncture ‘works’.


What happens with a process like acupuncture to alter patients perception? It doesn’t matter where the needles are placed or even if needles are used; twirled tooth picks are just as effective as ‘real’ acupuncture, what ever that may be. What matters most for efficacy is if the patient thinks they are getting acupuncture and if they believe acupuncture is effective. Then acupuncture will have a salubrious effect on subjective endpoints. That’s it. So what is going on?

Another hint as to the mechanism of acupuncture is found in When pain is not only pain: Inserting needles into the body evokes distinct reward-related brain responses in the context of a treatment.

In this study 24 people received three identical stimuli: tactile, acupuncture, or pain stimuli. There were two groups to receive the three stimuli, an acupuncture treatment (AT) group and an acupuncture stimulation (AS) group. What differed is what they were told before the stimuli

participants in the AS group were primed to consider the acupuncture as a painful stimulus, whereas the participants in the AT group were told that the acupuncture was part of therapeutic treatment.

They had fMRI (who doesn’t) and a questionnaire about their subjective experience.

Behavioral results generally revealed no differences between the AT and AS groups. The questionnaire results confirmed that there were no significant differences in expectancies, fear, or anticipation and subjective pain ratings related to needles being inserted into the body between patients in the AT and AS groups.

They found no analgesic effect in the acupuncture group. But there was a difference in the fMRI (for what that is worth):

We found that reward-related regions (specifically, the ventral striatum) of the brain were activated by acupuncture stimulation and that in response to painful simulation, activity in pain-processing regions(the SII and DLPFC) was decreased only when participants were told that acupuncture needles were a therapeutic tool.

and

As greater activation of the ventral striatum is generally correlated with more expectations of pleasure and rewards, our results could be interpreted to suggest that acupuncture stimulation was associated with the expectation of a reward – possibly an analgesic effect – for patients experiencing acupuncture in the context of a treatment (AT group).

So depending on the context,  people process the same stimulus differently. A needle that is thought to be for therapeutic acupuncture is different than the exact same needle thought to be used for painful stimulation.

Maybe. It is a small study and fMRI’s have issues as we know from dead salmon. But taken in the context of the literature pointing to the predominantly positive subjective effects of pseudo-medicines it is curious finding.  Maybe not beer goggles; probably more like making wine taste better by giving it a higher price.

Acupuncture Needs Belief to Work

Well not really acupuncture, at least not as the ancient Chinese did it. I do not think they had electricity to apply to the needles. But this was an interesting study, Expectancy in Real and Sham Electroacupuncture: Does Believing Make It So?

The took patients with joint pain due to aromatase inhibitors being used to treat breast cancer.

The patients had either sham electroacupuncture (no current applied),  electroacupuncture or a wait list control group, only about 20 in each group.

No surprise, those who had an intervention, be it sham or electoacupncture, had more pain relief than the wait list control. An intervention, even if worthless, usually changes the subjective complaint for the better.

But here is where it is interesting. They used the Acupuncture Expectancy Score (AES), a measure of how much the patient thought acupuncture would help their problem.

Over all, the higher the AES score, the better the pain response

Each point increase in Baseline expectancy in the SA group is significantly associated with a greater percent pain reduction at Week 8 (regression coefficient = 7.9, SE= 2.8, P = .007).

In the sham group those with a high AES also had a better pain response. What is also interesting is that in the sham group there was no increase in the AES score over time and the decrease in the pain was constant.

Some in the electroacupuncture group increased their AES score with time and with a concomitant decrease in pain.  Those who maintained a low AES scores had a pain response that was unchanged over time.

What they do not mention, which is a flaw, is whether blinding was effective. A little current across an acupuncture needle could easily be noticed by some of the patients and might have affected their perception of the intervention.

They say in the discussion

Expecting a positive outcome (expectancy) at the beginning of the trial was associated with the response to SA. In contrast, patients who responded to EA had increased expectancy over the course of their acupuncture treatment as compared with nonresponders, suggesting that positive responses during the process of EA increased the expectations of positive outcomes. Our findings imply that distinct mechanisms underlie the apparently similar clinical effect of EA and SA. These findings have important implications for acupuncture and pain research as well as for clinical practice.

It may be the responders to electroacupuncture were the ones who noticed a tingling from the current and responded accordingly. Electroacupuncture is just a TENS unit tarted up with Traditional Chinese Pseudo-Medicine and this study has no implications for acupuncture except to reinforce its mechanism as an elaborate placebo.

I will mention here that I had always been taught that TENS was a legitimate form of pain relief. A quick review suggests TENS may be nothing but a placebo as well. Since more elaborate placebos yield better responses, it may be that those with the increase AES score were also those who knew they were getting TENS, a more elaborate placebo.

I wish they had tested for effectiveness of blinding, it would have been a nice addition to understanding what happened in evaluating two different placebos.

The authors say in the introduction that

Although the response to SA has led skeptics to consider the acupuncture effect no more than placebo

and conclude with

Our findings suggest that distinct mechanisms exist between SA and EA and challenge the notion that acupuncture is “all placebo.”

Methinks you doth protest to much. I see the study has variations of placebo effect, all placebo and nothing but placebo.

There were four kinds of beer goggles evaluated in this study; sham acupuncture with low or high AES and electroacupuncture with low or high AES with the added potential confounder that some in the high AES group may have known what they were getting TENS. The increasing AES and subsequent improved pain response may be no more than the effects of a more elaborate placebo with a positive feedback loop.

To my mind this is more data to support the notion that the effects of acupuncture, like the effects of all of CAM, is simply the patient deciding they are getting better, the pseudo-medical equivalent of kissing a boo boo to make it feel all better.

Animal Torture

Psychology was, I admit, not my strong suite back in my pre-med days, the one class that ruined an otherwise exemplary report card.

The only thing I took away from my psychology class was the concept of learned helplessness, perhaps because that describes a lot of medical education. To quote the ever helpful wikipedia,

Learned helplessness is a behaviour in which an organism forced to endure aversive, painful or otherwise unpleasant stimuli, becomes unable or unwilling to avoid subsequent encounters with those stimuli, even if they are escapable. Presumably, the organism has learned that it cannot control the situation and therefore does not take action to avoid the negative stimulus.

Put a dog in a box, shock it, and it gets depressed and stops looking for an escape. I think of learned helplessness  when I see someone abusing an animal by jabbing it with useless needles aka acupuncture. I know it is projection, but every time I see pictures of animals getting acupuncture, I see a depressed animal with learned helplessness.

Do any of these poor animals look happy with their acupuncture?  Not to my eye.

The most recent animal to undergo well intentioned, and we know what the road to hell is paved with, torture are Spanish owls.

1200 injured owls are brought every year to a hospital in Spain where, for the last 6 years, then have been tortured with needles once a week for 10 weeks. Although they brag that 70% survive, I wonder if the added stress helped to kill the remaining 30%. Ten weeks of weekly torture cannot be good for wild owls. More likely they are improving in spite of the acupuncture rather than because of the acupuncture and given the lack of gloves with the punctures, I wonder how many died of inadvertent infections.

They give the usual nonsensical reason for using acupuncture and the usual denial of harm:

It stimulates self-curing mechanisms in the organism. It does not cause side-effects…

Don’t you think before you inflict pseudo-medicine on animals you would want to do a study not only to show efficacy, but to prove that you are killing the animals with the added stress?  I would.  That is the nice things about animals: they are unable to complain about the numerous complications of acupuncture and so the practitioner can delude themselves as to the safety of their torture.

Poor owls. I am not a PETA kind of guy, but I am sympathetic to all the animals needlessly abused with completely worthless ‘therapeutic’ and experimental acupuncture.

After the Fact Rebuttal

I  spent 5 days wandering the NE:  Boston, Newport, Plymouth, back to Boston, Salem and then home. I was invited to give a talk on influenza and participate in a panel discussion about low back pain.  The panel consisted predominantly of those who take care of backs for a living and I felt a bit like an Alzheimer’s patient who wandered into the room by mistake.

The panel was asked about using pseudo-medicines and as one of the militant members of the science-based medicine community,  I gave my best 3 minute summary on which SCAMs are useless. Then one of the members of the audience made a comment that, due to time constraints, I was unable to respond to.

So here is a paraphrase of the comment  and my response.

He started by saying he was a big believer of science-based medicine but…

But. Beware the but. That often means the speaker is about to endorse some bit of pseudo-medicine that he thinks deserves our consideration because, hey, I use it and it works for me.  I was not disappointed.

He continued, mentioning that he has treated plantar fasciitis for years, usually with a single needle, often with only one or two treatments and it works more often than not.

This is, I suspect, the greatest reason that pseudo-medicines continue to thrive.

First is  relying on experience as a valid criteria for deciding on a therapeutic intervention. Experience makes us better heath care workers in so many mays it is virtually impossible for HCW’s to recognize that the three most dangerous words in medicine are not “I lack insurance” but “In my experience.” They are a powerful meme for the speaker and totally useless to the listener.

Variations of the concept are found in the ideas that

the plural of anecdote is anecdotes, not data

and the Richard Feynman quote:

The first principle is that you must not fool yourself–and you are the easiest person to fool. So you have to be very careful about that. After you’ve not fooled yourself, it’s easy not to fool other scientists. You just have to be honest in a conventional way after that.

The problem is that Dunning-Kruger appears to be the default mode for most health care workers, the

cognitive bias in which unskilled people make poor decisions and reach erroneous conclusions, but their incompetence denies them the metacognitive ability to recognize their mistakes.

So to my mind the speaker personified what may be the primary issue with pseudo-medicines in health care: the reliance on experience and the inability to recognize that it is useless.

He concluded with the usual chestnut about not throwing out the baby with the bath water.  I hate that cliche.

Me? When it comes to pseudo-medicine I would throw out the baby, the bath water, the tub, the soap, the shampoo, the washcloth and the towel.

Lipstick on a Pig?

I was wandering the Oxford English Dictionary and found a new definition for worthless: “Noun. A clinical efficacy trial with no blinding, no placebo, and only subjective endpoints derived from patient self-reporting.”

The OED is a stickler for examples of usage, so they pointed to Effect of Perineal Self-Acupressure on Constipation: A Randomized Controlled Trial in the Journal of General Internal Medicine. The study is out of UCLA, Yale and the Southwestern Law School !?!

They compared usual care or perineal acupressure for constipation. Perineal acupressure. Where did perineal acupuncture come from? I don’t know. The introduction has a discussion on the potential benefits of perineal massage and pressure, which can alter perineal muscles, increase rectal tone (wouldn’t that increase constipation?) and perhaps aid in defecation.

Then they jump to testing

perineal self-acupressure, which consists of a patient repeatedly applying external pressure to the perineum.

Why acupressure? Why the acu? They make no mention of meridians or chi, which suits me fine.

There is an acupoint in the perineum in Traditional Chinese Pseudo-Medicine and it is not used for constipation, but rather it regulates yin

• For yin deficient headaches

• Cold penis – a condition usually but not always associated with a lack of sexual desire

• Amenorrhoea and irregular menses

• Heat in the chest

• Pain in skin of the body, especially of abdomen and perineum

• Impotence, infertility and sterility, possibly frigidity

• Calms the Mind: used for mania but can be used in less extreme conditions

The perineal points have nothing to do with constipation. So why the acu? Because tarting up a lousy study with pseudo-medicine gives the results more cachet and press than it deserves? That is my theory.

This is not an isolated example.  A study adds ‘acu’ and now it gets far more attention than one that doesn’t. We saw this with  Dopamine mediates vagal modulation of the immune system by electroacupuncture.

Virtually anything can get the acu designation if desired, and then more attention. I give antibiotics through acupuncture IV’s. Much cooler than regualar IV’s. I can publish a study on my outcomes for cellulitis using acupuncture IV’s. I’ll tell half the patients they are getting acupuncture IV’s and half will get standard IV’s. I predict better satisfaction in the acupuncture IV cohort.

Maybe we jump on the bandwagon as well to get more press: Acu-Science-Acu-Based Acu-Medicine?

Bad Studies Lead to Wasting Money

It is amazing how quickly a single study can lead to an analysis as to whether an intervention should be used because it is cost effective.

There is no reason that acupuncture, a complicated magical ritual, should have any specific effect on any pathologic process. However, when I watch videos of acupuncture the process looks quite nice, except, of course, for the whole needles being stuck in the skin with zero attention to infection control. Relaxing in a caring and supportive environment cannot help but make people feel better, as long as they do not get hepatitis B or MRSA.

Like all interventions that do nothing, acupuncture is indicated for virtually everything (except as a form of contraception), at least by their proponents. Depression is on the list of processes that are not effectively treated by acupuncture.

After reviewing thirty, count ‘em thirty, studies, with 2812 patients, the last Cochrane review

found insufficient evidence to recommend the use of acupuncture for people with depression.

One would think when that after 30 studies demonstrate that an intervention with no basis in reality is useless that no self respecting IRB could ethically approve the 31st study.  Nope.  In 2013 there was yet another study, Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial that demonstrated that counseling and acupuncture were associated with the same degree of reduction of depression at three months.

With no wait list and no sham acupuncture control there can be zero conclusions made about the whether or not acupuncture per se (as opposed to the magical ritual) was of benefit or whether it was the natural history of the depression in that population.

The authors call it

A pragmatic trial asks whether the intervention works under real-life conditions.

While I would call the trial a waste of time and money, whose methodological flaws proves nothing. Again, isn’t part of the ethical and practical considerations of IRB’s to avoid studies that are methodologically garbage? Guess not.

The article states no conflicts of interest, which I am sure is true technically i.e. financially, but when the lead author of a study suggesting magic helps depression is

previously trained as a practitioner of acupuncture and Chinese herbal medicine and subsequently founded the Northern College of Acupuncture

I remember the ever so wise words

Conflicts of interest are very common in biomedical research, and typically they are inadequately and sparsely reported. Prejudice may not necessarily have financial roots. Scientists in a given field may be prejudiced purely because of their belief in a scientific theory or commitment to their own findings.

I will mention as an aside that PLOS does not publish author titles (Lac, ND, MD) in their papers. If a pseudo-medicine is being evaluated it would be nice to know which kind of pseudo-medical provider is doing the evaluation. As the old saying goes “Go to Midas, get a muffler.”

So we have a preponderance of literature that demonstrates acupuncture is useless for depression and a fatally flawed study that proposes an efficacy that doesn’t exist. What to do next? Not go to Disneyland.

You are a proponent of acupuncture. You have just finished a methodologically horrible study that you can spin into demonstrating acupuncture is helpful for depression despite a vast contradictory literature. You note that

Acupuncture is rarely provided within the UK’s mental health service or primary care, but private provision of acupuncture for depression is not uncommon.

although what constitutes “not uncommon” from the reference is vague. In a table 7% of providers use acupuncture for “psychological” disorders and the only mention of depression in the text is

Anxiety, stress and depression were the three most prevalent psychological complaints and more commonly treated by independent acupuncturists.

In what looks like a manipulation of PLOS as part of a marketing program to increase the use of acupuncture in England, most of the same authors of the original paper hired an economist who found that, hey, acupuncture is cost effective.

If I had a conspiratorial bent, I would point to this as proof that the medical literature is being manipulated to further the financial gain of Big Pseudo-Medicine.

But it is not.

Just another sad example of the failure of peer review when applied to pseudo-medicine.

Bad Infection Control

In a prior entry I have mentioned my visual Googlewhack: I could find only one picture of gloves being used during acupuncture, and it was not being performed by an acupuncturist but a physical therapist doing dry needling.

I have also discussed the recalcitrance to basic infection control that informs the practice of acupuncture. It gives me the willies to watch acupuncture videos.  It often looks as if they are trying to spread contagion with their technique.

Up north in British Columbia an acupuncture clinic was closed because of poor

infection prevention and control standards (that) poses a health hazard to clients.

That defines all the acupuncture I have witnessed.

Based on the investigation of the centre, we are alerting clients of Ms. Hu that they may be at increased risk of exposure to blood-borne infections that can be transmitted by improper and unsanitary acupuncture techniques.

The article alludes to acupuncture as the source of infections as well as

other treatments involving blood or bodily fluids.

What was going on in the clinic?

How many people were exposed is not certain as

Murti said Hu did not keep proper records, and it’s difficult to know how many people might have been affected.

but it is more than 1000 people.  Take that, Typhoid Mary. The health department is recommending testing by clients for blood borne pathogens. Normally I would worry about HIV and Hepatitis B and C, but evidently Hu had even worse technique than I would have thought possible.

On her door is a list of diseases for which she wants her clients to contact her if they have been exposed to or currently have so she can make a special appointment.

acupuncture_clnic

The diseases include smallpox. Smallpox.

Yes, if you have or have been exposed to smallpox, most certainly see Hu for acupuncture, or perhaps other treatments involving blood or bodily fluids.

This list is a further suggestion that infection control is not well understood in the acupuncture world.

Cupping

We only have one big time professional sports team in Portland, the Trailblazers. No football or baseball. We do have professional soccer, but that doesn’t really count. In Portland the Blazers rule.

I had long thought cupping in athletics was a protective device to prevent groin injuries, although it is evidently voluntary in the NBA, as some have learned to their discomfort.

I think protective cupping would be a good idea. Therapeutic? Not so much. Evidently promoted by their Director of Player Health and Performance, cupping is a form of pseudo-scientific nonsense that is being used by the Blazers. I have discussed one form, moxibustion, before. Like most pseudo-medicine, it is an elaborate placebo with no real effects on real disease.

Its alleged mechanism of action is

the idea is the suction draws fluid out of the area, Kaman explained, allowing tissues to heal more quickly.

and is not based on known processes. It is more akin to the wet sock treatment  for stuffy nose, divorced from anatomy and physiology,

I am not surprised the Blazers are using it, since athletes often use pseudo-science.  I suspect golfers lead the list. I still had to laugh at one quote

“It’s scientific stuff,” Kaman said. “I could sit here and talk to you about it, but you wouldn’t know what I was talking about. I’m not calling you dumb it’s just a mixture of Western and Eastern medicines and some people think it works, some people don’t.

It is not scientific stuff, it is pseudo-scientific stuff. That is why no one understands what you are talking about. The theory and practice behind cupping is gibberish. Those who think cupping  does not work are probably those who understand reality.  As one meta-analysis said

Although RCTs provide a higher quality of evidence, we included non-RCTs in this study because the limited number of RCTs did not provide convincing evidence.

Demonstrating the usual results of alternative medical studies: it only has effects when the studies are poorly done. The most unreliable form of evidence is the anecdote:

“I find it works pretty good,” Kaman said and “It works,” Batum said.

Well, it doesn’t in any well done study. Any positive results are due to placebo effects, the medical beer goggles.

I wonder if the Blazers will suggest giant magnets (3:52 mark) next for player injuries?

Posted in: Acupuncture, Traditional Chinese Medicine

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TV Doctors Give Unreliable Recommendations

DrOzMiracleIt’s always preferable to have objective empirical evidence to inform an opinion, rather than just subjective impressions. Confirmation bias will make it seem as if the facts support your opinion, even when they don’t. Of course, when objective evidence (such as published studies) does seem to support your position, you still have to keep your critical shields up. Confirmation bias can still kick in, resulting in cherry-picking favorable evidence, finding fault with studies whose conclusions you don’t like, and too-easily accepting those that confirm your position.

I therefore had to be careful in evaluating the following study from the BMJ, because it nicely confirms what I and many others here at SBM have been saying for years – recommendations made by TV doctors, particularly Dr. Oz, are unreliable and insufficiently based on evidence.

This was a prospective study that:

…randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program.

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Posted in: Science and the Media

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The Marvelous Dr. Mütter

The Mütter Museum in Philadelphia has a marvelous collection of human bones, surgical specimens, monsters in jars, and medical memorabilia. It holds attractions for everyone, from the jaded medical professionals who thought they’d seen it all to the coveys of youngsters who compete to point out the grossest items to their friends, from the student of history to the connoisseur of the macabre. There is an enormous megacolon said to look like a sandworm from Dune, a plaster cast of the famous Siamese twins Chang and Eng along with their actual preserved conjoined livers, a collection of bizarre swallowed objects, an iron lung, a tumor removed from president Grover Cleveland’s jaw while he was in office, a shocking assortment of deformed fetuses…the list goes on.

I knew about the museum and greatly enjoyed visiting it, but I didn’t know anything about Dr. Mütter himself until I read a delightful new book by Cristin O’Keefe Aptowicz , Dr. Mutter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. I learned that the good doctor was every bit as marvelous as his museum, and the book took me on a fascinating trip back to the medicine of the early 1800s that made me better appreciate all that modern medicine has accomplished.

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Posted in: Book & movie reviews, History, Surgical Procedures

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Stem cells versus Gordie Howe’s stroke

GordieHowe1

Seven years ago I returned to Michigan, where I was born and spent the first quarter century of my life, after an absence of more than 20 years. In the interim, I had done my surgical residency and earned my PhD in Cleveland, a surgical oncology fellowship in Chicago, and worked in New Jersey at my first academic job for eight and a half years. Then I was lured back with a job in Detroit. One of the odd things about this return after such a long absence was the culture shock, how much I had forgotten about the Detroit area. One of those things that I had forgotten is just how crazy about hockey Michigan, in particular Detroit (meaning the Detroit metropolitan area), is. Detroiters love their Red Wings—love them. Hockey is ingrained in the suburban culture from a very young age, so much so that many Canadians would feel right at home here. Memories of trying and failing to be halfway decent at street hockey and of not being anywhere good enough a skater even to try real hockey as a teen came flooding back to me. (It didn’t help that back then I was approaching six feet tall and weighed only 135 lbs.; “beanpole” didn’t even begin to describe me back then.) In fact, the “cultural center” of the town where I live consists of—I kid you not—a hockey rink and some classrooms that are used for various community functions. No, really, it’s named the city’s Cultural Center.

So it should be no surprise, given how much Detroiters love hockey in general and their Red Wings in particular that it was big news here in late October when Red Wing legend Gordie Howe at age 86 suffered a debilitating stroke that paralyzed the right side of his body, a condition known as hemiplegia. Understandably, there was an outpouring of good wishes for recovery, coupled with retrospectives of Howe’s stellar hockey career. Indeed, I remember that Howe’s condition sounded bad enough from the tenor of the news reports at the time that it seemed likely that he would not survive. But survive he did, and is apparently recovering slowly, with occasional setbacks, such as a recent hospitalization in early December for a suspected “mini-stroke” that turned out to be dehydration and several much smaller strokes before that. The most recent press report I saw before the announcements I’m going to discuss described Howe as on the upswing again.

Then, on Friday, I saw headlines all over the place that were basically similar to this Detroit Free Press headline, “Gordie Howe underwent stem cell clinical trial in Mexico.” The story consisted largely of a press release from Howe’s family that read:
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Posted in: Clinical Trials, Medical Ethics, Pharmaceuticals, Science and the Media

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Reflexology for Babies?

babyreflexology
In the fascinating, if not rational, world of so-called complementary and alternative medicine, the age of the patient rarely seems to matter. This stands in stark contrast to the practice of science-based medicine. Sure, there is some physiological overlap across the spectrum of age, but caring for children often requires a vastly-different approach and there are numerous conditions not seen or only seen in kids.

Alternative medicine is more about the underlying belief system rather than the actual physiology, however. Chiropractic is chiropractic whether the subluxation belongs to a neonate or a nonagenarian. In traditional Chinese medicine, the flow of chi is obstructed in youngsters and old fogeys alike. No matter the length of our telomeres in fact, every major form of alternative medicine appears to contain a subset of practitioners that claim unique expertise in maximizing health and wellbeing at any age. But for kids, they simply do the same thing they would do for an older patient.

Newborns appear to be an increasingly-popular target of irregular medical practitioners. Even the unborn baby still in their mother’s womb isn’t safe. A generous interpretation would be that these true believers simply wish to aid in establishing health early in a child’s life, while the cynic in me worries that establishing a lifetime of billing opportunities might be the primary motivating factor. (more…)

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No, the HPV vaccine does not cause promiscuity

Vaccine Smile

Today’s post isn’t about the flu vaccine, but that vaccine played a part in bringing you today’s topic. It seems that this year’s vaccine is a mediocre match for the circulating strains of influenza, and I was one of the unlucky ones in whom it didn’t appear to provide much protection. After spending several days effectively bedridden, I still feel like I’m emerging from a cognitive fog. So today’s post will be short. In the midst of my own infection, the results of a new study were announced that examined the effects of HPV vaccination on indicators of sexual behaviour in adolescent girls. I admit to being a bit dumbfounded by the topic when I heard it, and I initially thought I had heard the research question incorrectly. After all, the answer seemed (to me) so clearly self-evident, I questioned if this was an ineffective use of research dollars. This question seemed as pertinent as continuing to study the relationship between vaccines and autism: there is little reason to think there would be any causal relationship. But surveys of parents show this is a real concern for some. And now we have an answer grounded in real-world evidence. (more…)

Posted in: Vaccines

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Communicating Health Science News

From the Wikimedia Commons.

Pictured: Test subjects probably not worth a press release.

A recent study addresses the problem of sensationalism in the communication of science news, an issue we deal with on a regular basis. The study was titled “The association between exaggeration in health related science news and academic press releases: retrospective observational study“. The results show two interesting things – that university press releases frequently overhype the results of studies, and that this has a dramatic effect on overall reporting about the research.

The authors reviewed “Press releases (n=462) on biomedical and health related science issued by 20 leading UK universities in 2011, alongside their associated peer reviewed research papers and news stories (n=668).” They found that 40% of the press releases contained exaggerated health advice, 33% overemphasized the causal connection, and 36% exaggerated the ability to extrapolate animal and cell data to humans.”

Further:

When press releases contained such exaggeration, 58%, 81%, and 86% of news stories, respectively, contained similar exaggeration, compared with exaggeration rates of 17%, 18%, and 10% in news when the press releases were not exaggerated.

This study points a finger directly at academic press offices as a significant source of bad science news reporting. This does not let other links in the news chain off the hook, however. (more…)

Posted in: Medical Academia, Science and the Media

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Study of “Acupressure” for Constipation

constipationA recent study in the Journal of General Internal Medicine evaluated a treatment for constipation. It tested whether training patients to massage the perineum (the area between the vagina or scrotum and the anus) would improve their reported bowel function and quality of life at 4 weeks after training. They found that it did. It’s a simple, innocuous treatment that may be worth trying, but why, oh why, did they have to call it “acupressure”? That irritated me. Should it have? Why should it matter? Isn’t a rose by any other name still a rose? Is this a meaningless semantic quibble and hypersensitivity on my part, or am I right to see it as yet another example of quackademia’s attempts to infiltrate science-based medicine? I’ll explain my thinking and let you decide for yourself. (more…)

Posted in: Acupuncture, Clinical Trials, Traditional Chinese Medicine

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Hostility towards scientific consensus: A red flag identifying a crank or quack

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I have yet another grant deadline to deal with, this time for the Department of Defense Congressionally Directed Medical Research Programs, this time around its Breast Cancer Research Program. Unfortunately, that put a high degree of time pressure on me. Fortunately, there’s still stuff in the archives of my not-so-secret other blog that I deem quite appropriate for this blog and that can be updated with minimal effort. If you don’t know what I’m talking about when I refer to my not-so-secret other blog, then it’ll definitely be new to you. If you haven’t been reading that blog for at least four and a half years, it’ll be new to you as well. And even if you have seen it before, I think it’s worth revisiting.

Why? It came up because of an encounter I had on Twitter with Jane Orient, MD, who, as you might recall, is the executive director of the American Association of Physicians and Surgeons (AAPS). I’ve written about the AAPS before. You can get the details in the link, but if you don’t have time suffice to say that it is an entire organization of libertarian-leaning “brave maverick doctors” who think Medicare is unconstitutional, don’t believe that the government should have much, if anything, to do with regulating the practice of medicine, and reject evidence-based guidelines as an unholy affront to the independence of the physician. Along the way, the AAPS, through its journal, The Journal of American Association of Physicians and Surgeons (often abbreviated JPANDS), promoted antivaccine views, including the discredited concept that vaccines cause sudden infant death syndrome, HIV/AIDS denialism, and the scientifically unsupported idea that abortion causes breast cancer (a topic I might have to revisit, given the activity promoting it recently).

In any case, two or three weeks ago, I was having a bit of an exchange with Dr. Orient over anthropogenic global climate change (often abbreviated as AGW, for anthropogenic global warming, for short), the well-accepted science that concludes that CO2 generated by human activity is having a serious warming effect on the earth’s climate. As you might expect, she’s not big on this particular scientific consensus. I forgot about it, but then the other day saw this Tweet exchange between Dr. Orient and Ed Wiebe:
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Posted in: Critical Thinking, Science and Medicine

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