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Antipodean CAM

It is one of the pleasures of travel to read the local newspapers of places I visit. I wholly agree with In a Sunburned Country author Bill Bryson, who observed,

It always amazes me how seldom visitors bother with local papers. Personally I can think of nothing more exciting – certainly nothing you could do in a public place with a cup of coffee – than to read newspapers from a part of the world you know almost nothing about. What a comfort it is to find a nation preoccupied by matters of no possible consequence to oneself. I love reading about scandals involving ministers of whom I have never heard, murder hunts in communities whose name sound dusty and remote, features on revered artists and thinkers whose achievements have never reached my ears, whose talents I must take on faith.

In a Sunburned Country chronicles Bryson’s travels in Australia, which I recently visited, along with New Zealand. Lovely places both – friendly people, jaw-dropping scenery, delicious food and wine. And a welcome vacation from American political wars, American economic wars and American war wars.

Oh no! Not CAM again!

It was not to be a vacation from “complementary and alternative medicine,” as it turned out. Upon settling into Auckland, I picked up a copy of The New Zealand Herald, which was that very day beginning a series on “alternative relaxation and remedies.”

Today: Greek leech therapy

Tomorrow: Koran jimjjibang

Thursday: Indian ayurveda

Friday: Thai yoga massage

Saturday: Japanese ganbanyoku

I read this in the comfortable surrounds of the Auckland Langham Hotel which touted, in addition to the upcoming Seafood Festival, “Chuan Spa’s Traditional Chinese Medicine Wellness Retreat” via which I could start the new year “revitalized.” Included in this “holistic approach of Chinese medicine” was “a TCM consultation with our qualified TCM practitioner” who would interpret my “state of wellbeing,” followed by “a TCM treatment to restore any imbalance in the equilibrium of Yin and Yang.” As well, I would receive a “Micronised Marine Algae Wrap” [ewww!] to relieve my “muscular fatigue, boost circulation, detoxify and re-balance” my metabolism. All this for just NZ $1,186 per person for the two-day retreat, or NZ $1,746 for the three-day version. I decided to go sight-seeing instead.

But the NZ news media was not content to stop at five days worth of CAM. Even after that steady diet, I still had homeopathy, quantum physics and Vitamin C to go. So it came to be that I followed Kiwi CAM through Auckland, Rotorua, the Tongoriro River, Dunedin, Queenstown, Franz Josef and Christchurch. Although some of the featured modalities were unfamiliar, the rhetoric was not. Nor was the credulous reporting.

The Herald series started out with Greek leech therapy. (The article also reported a survey revealing a majority of New Zealanders believed in “alternative remedies.”) According to Mehdi Jaffari, an Auckland practitioner at Life Clinic Hirudotherapy, the first recorded use of leech therapy was by Greek physician Nicander in 200 B.C. Jaffari claimed the leeches can treat problems ranging from arthritis, diabetes, endometriosis, hepatitis, and “high blood pressure to bronchitis.” And leeches can reduce wrinkles to boot. They are no less than “nature’s gift to mankind to keep us in good health.”

Let’s see. Popularity? Check. Ancient therapy? Check. The one true cure? Check. Natural? Check.

On Wednesday, there was Korean jjimjilbang, which translates literally as “heated bathrooms.” I am all in favor of heated bathrooms but the literal translation doesn’t really do the place justice. We in the “west” we would think of a jjimjilbang as more of a spa. And like U.S. spas, there were outsized claims to go along. Treatment begins in a heated bath, which “circulates magnetic waves,” followed by a trip to the sauna and steam rooms “to flush out bad toxins and promote circulation.” Then there is the room with heated stones (in this case tourmalines) to aid in “skin rejuventation, enhanced circulation and [to] cut body odour.” In other words, it’s Eastern + magnetic waves + detoxification + rejuvenation + circulation promotion + B.O. eliminator. While the rest are familiar CAM claims to fame, I must admit the B.O. is a new one.

On Thursday, a reporter wrote up her visit to a practitioner of “the ancient natural healing system” ayurveda. Apparently, in New Zealand one can go straight to an ayurveda practitioner instead of a “Naturopathic Doctor,” which at least eliminates the fiction that ayurveda has been vetted by a “medical” school and is therefore somehow evidence-based. This practitioner said that ayurveda is “the most holistic health science system in the world.” Science?  I don’t think so. And the most holistic? Are the other systems just partially whole? How can that be?

According to this practitioner:

The human body is made up of five basic elements, and whenever there is any disorder, these elements become imbalanced and they affect bodily channels and tissues, creating illnesses in the system.

[Ayurveda is] about finding out the cause factors responsible for the imbalances, and getting that balance right, which is different for every individual.

Improper digestion can also create toxins in the body system, and these travel into deep tissues that leads to disorders in vital organs. Treatments include panchakarma (body cleansing), chakra (energy centre) balancing, meditations, yoga, massage with stimulations at 107 neuromuscular points and shirodhara, an oil treatment to stimulate the brain. . . . Besides relaxation, ayurvedic massage also removes toxins from deep tissues, cleanses the body and rejuvenates internal systems.

One hundred seven neuromuscular points seemed like an awful lot, but ayurveda has nothing on Friday’s topic, something called Thai yoga massage, “believed to have first been performed more than 2500 years ago.” The “theory” (their term) of Thai yoga massage is that the body is permeated with air, which, once it is inhaled into the lungs, travels along 72,000 pathways. Seventy-two thousand! They must be really, really tiny. The massage stimulates these channels and moves the air through the body with a “pumping action.”

What, no homeopathy?

As it turned out, it was only a matter of time. Several days later, the New Zealand Sunday Star-Times ran an article noting that, according to a recent survey, 51 percent of New Zealanders believe that homeopathy has been scientifically proven. Fortunately, this paper’s reporter had the good sense to ask a real doctor about homeopathy. His assessment: “It’s absolute nonsense.” This was countered by a Christchurch homeopath, who retorted, “we constantly get that it’s never been proven and it’s not working but that is not true.”

And what’s the evidence? Well, according to the NZ Council of Homeopaths, there are the accounts from the 1918 influenza epidemic and cases of success in homeopathic hospitals. Then there is the case of a NZ homeopath who gave a homeopathic remedy to a woman having trouble conceiving. And guess what? A few weeks later she was pregnant! Who can argue with that kind of success?

On the very same page, the Star-Times reported on the “Pawtect,” a pet flea and tick collar which, according to its developer, uses “proven bioenergetic technology” as well as combining “quantum physics and homeopathic principals to stimulate pets’ natural processes to return them to a harmonious state.” It was not made clear why this harmonious state would have any deleterious effect on fleas or ticks. In fact, one would assume fleas and ticks prefer pets in a harmonious state and therefore less apt to scratch away furiously when bitten.

Here’s how the collar, um, “works:”

Every living thing carries a frequency and there is a counter frequency that repels it. . . . [T]he frequencies that repel ticks and fleas were ‘imprinted’ on the Pawtect collar using a computer. Another frequency that supported a healthy immune system was also imprinted.

Of course, there was also the ubiquitous testimonial, this from an Auckland dog owner who found the “Pawtect” flea collar worked like a charm.

Fortunately, the story quoted Dr. Siouxsie Wiles of Auckland University, who said that when she saw some of what passed for “scientific” she “nearly choked.” Dr. Wiles decried people such as the flea collar developer who “used the language of science without any of its method.” She added, “it’s frankly offensive considering the time I spend writing papers so my peers can pull them apart.” Dr. Wiles summarized the “Pawtect” collar nicely as “bollocks” and “just a load of nonsense.” Well said, Dr. Wiles!

A letter to the New Zealand Journal Medical Journal criticizing alternative medicine was also mentioned. According to the news story, the letter’s authors lamented that “there were a plethora of different alternative medicine therapies and products, but that the ‘vast majority (were) either not biologically plausible and/or not supported by research evidence.’” The New England Journal of Medicine could take a lesson here from the New Zealand Medical Journal.

Disturbingly, the news story ended with the flea collar developer’s statement that “there are plans to launch a similar product for humans next year.”

The final NZ news story about CAM was a sad one. As reported in the Star-Times, NZ physicist Sir Paul Callaghan, who has terminal colon cancer, started high-dose intravenous vitamin C infusions, a highly touted alternative cancer treatment, in June, 2011. He made clear that he was never an advocate of the treatment, just curious, as scientists are. Of course, this didn’t stop alternative medicine advocates from using his experiment to promote this unconventional treatment in a misleading way, a fact that caused Callaghan some concern.

He tracked the treatment’s effectiveness via a blood test for protein carcinoembryonic antigen (CEA), which indicates cancer levels, according to the news report. Callaghan has now announced an end to his experiment, stating “I have, as a result, learned enough to say that there is absolutely no evidence of any beneficial effect of high-dose intravenous vitamin C in my case.” He said he wanted to make the results known because of the risk that his use of vitamin C would be used to falsely promote it, adding that the way people promoted products without evidence was “quite repellent.”

A protest against quackademia

Fortunately, the trip ended with some really good news. Back in Australia, according to a story in The Sydney Morning Herald (and Dr. Novella yesterday on SBM), a group of more than 400 doctors, medical researchers and scientists have formed a group, Friends of Science in Medicine, to pressure universities to stop teaching alternative medicine. The Institute for Science in Medicine, which includes a number of SBM posters among its founders and members, is supporting the new group in its efforts.

As it stands now, several Australian universities award degrees in complementary medicine, chiropractic, naturopathy, herbal medicines, acupuncture and traditional Chinese medicine. There are also individual courses in homeopathy, reflexology and aromatherapy.

The Morning Herald reported that the newly formed group wrote to the universities at the end of January, stating that by giving “undeserved credibility to what in many cases would be better described as quackery” and by “failing to champion evidence-based science and medicine” the universities are damaging their reputations. Harvard Medical School, take note. The group is also asking that government and private health insurance providers stop covering alternative medical treatments.

The news report noted that soon it would no longer be possible in Great Britain to receive a degree from a publicly-funded university in any type of alternative medicine, including homeopathy and naturopathy. As well, German and British health insurers are in the process of ending coverage of alternative therapies. In Australia, the federal government is looking at ways to get the Therapeutic Goods Administration to enforce more stringent criteria for proof of efficacy for CAM products.

What I learned on my summer/winter vacation

Although some of the practices and products are different, CAM down under is depressingly similar to CAM at home. Wildly implausible treatments and products marketed with pseudoscientific explanations of their supposed mechanisms of action. Use based not on science or evidence, but rather on (supposed) antiquity and popularity. “Eastern” versus “western” medicine. Credulous reporters. The one true cure for everything. And, of course, quantum physics.

There were encouraging signs of a push-back, more so than in the U.S. — demands to end university CAM courses and degrees as well as health insurance coverage for CAM, and possible strengthening of regulations to reign in CAM claims. And scientists there are willing to go on record in calling CAM quackery, nonsense and bollocks, at least when reporters bother to ask.

It’s all a part of the whack-a-mole experience of fighting CAM. Smack down university reflexology courses. Up pops Greek leech therapy. Smack down Vitamin C infusions. Up pops Thai yoga massage. Smack down bioenergetic technology-based pet flea collars. Up pops bioenergetic technology-based human flea collars. It’s exhausting. I simply must get revitalized.

 

Posted in: Humor, Science and the Media

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16 thoughts on “Antipodean CAM

  1. nybgrus says:

    I hope you enjoyed Rotorua. I’ve been there and it was amazing. I’d never actually been to an active hot springs park (like Yellowstone in the US). Plus we did a traditional Moari “hangi” or dinner celebration and show and that was quite an experience.

    Sadly the CAM is indeed rife, but as you pointed out the push back is even stronger. I actually just sent an email to my counterpart back there about taking our student organization up to the task as well, to at least lend our voice. After all, the CAM lecturer at our school of med apparently said this semester that thought can cure and/or cause cancer. And he told me last year that Reiki must have some legitimacy to it because of greater effect sizes in senior practitioners (which to him is analagous to better outcomes that attendings get relative to interns).

    We also had a lecture in which the PharmD told us that it is perfectly reasonable, acceptable, and evidence based to prescribe glucosamine to OA sufferers, but not feverfew for migraine sufferers. She cited Cochrane reviews and “NaturalStandard.com” as an evidence base for both. Strangely, Cochrane said neither had good evidence, and NaturalStandard gave both therapies the exact same strength of evidence in review. I flat out asked her how can you recommend one and not the other based on the exact same analysis and strength of evidence, and she had no answer.

  2. Scott says:

    I flat out asked her how can you recommend one and not the other based on the exact same analysis and strength of evidence, and she had no answer.

    She couldn’t exactly tell the truth and admit “because my recommendation has nothing to do with analysis or evidence,” I guess.

  3. “Let’s see. Popularity? Check. Ancient therapy? Check. The one true cure? Check. Natural? Check.”

    Works for a plethora of (subjective, experiential) indications? Check.

    Focus on the exotic intervention, rather than the problem? Check.

    These stories always rave about the intervention. But for what? “Oh, that doesn’t matter – just come to the spa/clinic/herbal remedy store and try it!! -This intervention is so good, you just fill in the blank with the malady.”

    Doesn’t it seem weird that so much “medical” talk goes on with the malady in second place to the remedy?

    Somehow this relates to hammer-nail.

    This makes it occur to me: if the CAM focus STARTs with the intervention, then proceeds to consider indications, then the indications really don’t matter much.

    If the indications really don’t matter much, then you ought to take/participate in the intervention anyway, regardless of any pressing indication.

    I believe this is what we see with the CAM enthusiasts: they use remedies, but have vague reasons for doing so. Possibly, simply for prevention of unknown whatevers.

    With this kind of thinking, CAM users end up with a cabinet-full of remedies they take routinely, and a bunch of lifestyle/practice habits they engage in routinely – high colonic, ear-candling, acupuncture, the hot-stone, etc.

    I know some of these ppl. Do others see this same thing? There is no “indication,” “presenting problem,” yet a panoply of intervntions are followed?

  4. Janet Camp says:

    And this today in the NY Times:

    http://well.blogs.nytimes.com/2012/02/09/tai-chi-benefits-patients-with-parkinsons/?hp

    I hope someone here (Dr Hall, Crislip, Gorski, Novella, Atwood?) will take a look because it looks very fishy to me starting with the “Oregon Research Institute”–their site reveals (quite revealingly) almost nothing about them that isn’t completely vague.

    The study doesn’t seem to have been blinded at all just for starters. It is, however, reported on without the slightest criticism because, I presume, it was published in the NEJM.

    I hope someone more influential and better versed in the technical reading of studies than I will make a comment at the Times.

  5. @Janet Camp,

    I just scanned the report in the NEJM. It looks reasonable, although you are correct that the trial wasn’t blinded. The authors mention this as a limitation:

    …participants were aware of their intervention assignments. This awareness may have introduced biases in the results, since persons interested in participating may have had positive expectations about the benefits of exercise.

    Nevertheless, the conclusion that Tai Chi worked better than “low-intensity, low-impact exercise programs” is entirely plausible, because the Tai Chi group worked specifically on improving “postural stability,” which was the question being asked:

    The primary aim of this study was to examine whether a tailored tai chi program could improve postural stability in patients with Parkinson’s disease. Because the program emphasized rhythmic weight shifting, symmetric foot stepping, and controlled movements near the limits of stability, we hypothesized that tai chi would be more effective in improving postural stability in limits-of-stability tasks than a resistance-based exercise regimen or low-impact stretching (control).

    It is entirely plausible—it would be surprising if it turned out not to be the case—that people, even Parkinson’s patients, can improve their postural stability by practicing it. This happens all the time in other contexts.

    The point of Tai Chi, as several of us have pointed out, is that it is a form of exercise. It is not really “CAM,” but is one of those methods that “CAM” apologists like to claim as their own, both because it has a mysterious, Asian pedigree, which appeals to gullible honkies, and because it actually works for some things. And why wouldn’t it? After all, it’s a form of exercise.

    I’m happy to report that the funding for this trial came not from the NCCAM, but from the National Institute of Neurological Disorders and Stroke. Exactly as it should have. MedVsTherapy’s point about sCAMsters putting the cart before the horse is also true for “CAM” researchers and institutes, such as the NCCAM, who start with methods and try to “validate” purported applications—the opposite of what biomedical research in general, including the rest of the NIH research portolio, does. That’s why the NCCAM is the only part of the NIH that is named for treatments rather than for diseases or organ systems.

  6. I forgot to add: Jann Bellamy, you are an excellent writer. It’s a pleasure to read your stuff.

  7. Janet Camp says:

    Thank you Dr. Atwood. I still wonder if Tai Chi is any better than any other exercise regimen that would be targeted specifically to the problem, as Tai Chi was to “postural stability” in this case?

    I guess I must admit that I may have overreacted to the question of validity of this study, but if it wasn’t blinded, the bias seems to be enough to call the study into serious question, or at least warrant further study. The first thing I wondered about was how much the Tai Chi group was likely to favor that intervention–especially in Eugene (I know they weren’t all from Eugene, but how many of the TC group were?), Oregon. The ORI is also located in Eugene. Talk about a hot bed of all things CAM! Anyway, your remarks are useful in the furthering of my “how to read a study” education, so thank you again.

    Regardless of Tai Chi being exercise, I think it has CAM overtones because of its being favored on grounds of “ancient practice”. I would much rather have my doctor prescribe targeted physical therapy than to take up odd poses and movements that reflect cultural practices that have (perhaps through trial-and-error), hit on working the appropriate muscle groups.

  8. Janet Camp,
    Tai Chi has strong CAM overtones because of its underlying philosophy and belief system.

    I’d rather an MD, physical therapist, etc recommend an exercise/PT routine that “used some of the movements of Tai Chi” rather than Tai Chi itself (even if the actual routine was the same), since in my opinion, recommendation/promotion of any CAM modality implies endorsement of the underlying philosophy/understanding. If the motions of Tai chi are useful and beneficial, and you don’t believe in the BS of Chi, dump the woo baggage and promote a new type of light exercise. Don’t just wink and assume we all know better.

    I consider it important to always keep in mind that when certain things types of “CAM” overlap with legitimate, validated scientific health practices and are beneficial or somewhat effective for certain applications, whenever there’s an unscientific basis to or understanding of that modality, it generally should not be embraced, endorsed, or recommended as is. Yes, a good diet, proper nutrition, light exercise, relaxation, and the use of certain herbs/ natural drugs (pharmacognosy), can be valid health practices, but when prescribed and practiced in the context of CAM, the train typically goes off the rails and often jumps the shark into unvalidated, unsupported, pseudoscientific, and potentially harmful applications of those practices. A pseudoscientifc underlying philosophy encourages the rail and shark jumping.

  9. Darcy Cowan says:

    Great article,

    Reading it I felt compelled to add that the NZ Science blog collective Sciblogs put out a series of posts countering many of the alternative remedies promoted by the Herald.

    A full post by Dr Wiles on the “Pawtect” collar can also be found there, along with many other excellent posts by the good Dr. and many other great writers and scientists.

    I am of course biased, being a blogger there myself. I posted on the Thai Yoga Massage at the time.

  10. Grant Jacobs says:

    I hope you can excuse me giving New Zealand science communicators a shout-out – and to invite readers here to help our modest efforts to draw attention to this nonsense closer to it’s source.

    We at sciblogs.co.nz (http://sciblogs.co.nz) covered these articles as they came out. While others tackled the NZ Herald series; I have written about Paul Callaghan’s experiment and have previously covered homeopathy in NZ many times.* A number of my colleagues have written letters to the editors over these and other articles (some are still coming out).

    (I’d list some of the articles for readers here, but I suspect that would cause this comment to fall into spam.)

    * We are likely to have another run of dealing with homeopathy coming up because of a breaking story.

  11. Jann Bellamy says:

    @ Kimball Atwood:

    Thanks!!!!!

    @ Grant Jacobs:

    Really enjoyed looking at the website, especially the posts on the articles I’d read. You might want to look into the Auckland Langham Hotel and it’s “TCM” spa as the subject of a post. It appears to be a rich target. Keep up the good work — we can’t let “CAM” get away with this stuff. Plus, I LOVE YOUR COUNTRY!

  12. Janet Camp says:

    @Karl Withakay

    Thank you. That’s what I was trying to say.

  13. NZ Pharmacist says:

    As a UK pharmacist recently moved over to NZ and a keen reader of this and other sites – as well as a member of the skeptics in the pub in both countries (http://auckland.skepticsinthepub.net.nz/) – it’s pretty appalling the amount of “woo” that is both available for purchase (as the writer discovered) and the amount that is publically funded through ACC. See http://www.acc.co.nz/for-providers/contracts-and-performance/osteopathy-acupuncture-and-chiropractic-services/WPC089744 for example.

    Having sat through a looped marketing video for chiropracty in the waiting room of a chiropracter my wife was visiting for funded manipulative treatment I was warned not to respond to the fancy claims around subluxations and assorted other quackery being displayed (my better half is fully aware of my predilictions!)

    Fortunately my BP remained 120/70.

    I’m saddened to see so many of my profession having, literally, a whole wall of a community pharmacy devoted to various vitamin, mineral and bacilli supplements with the usual blurb around rebalancing, well being, bowel health, boosting the immune system and sundry other vague and unproveable claims. And even a general vitamin and mineral supplement – a one a day – is expensive. Having made somewhat tongue in cheek enquiries in several aroudn addressing my vitamin needs my wallet could have been a lot lighter if I’d taken notice…….

    Like other countires there is a bill coming before parliament on Natural Health Products to start to regulate this area and it does contain some provision about evidence for claims made but one suspects this may lead to claims of being approved or recommended being added to the marketing message!

    See http://www.parliament.nz/NR/rdonlyres/11E3FB9C-3445-45BD-A523-CF131303E548/201630/1927NaturalHealthProducts1.pdf

    Graham

  14. nybgrus says:

    @scott:

    Indeed. And actually we (myself and a few like minded colleagues) sat and spoke with her for an hour after the lecture. She was very amenable, pleasant, and not dogmatic. However, it was clear that she simply just didn’t know her stuff all that well. Which is very strange for an actual PharmD teaching a course to med students. I really didn’t get the impression she herself was biased and had an agenda (though she did have a touch of bias towards the naturalistic fallacy, she was distinctly different than the MD lecturer I have spoken about) but merely not well enough informed on the history of the topics and just acting as a moutpiece for the regs being sent down her way. After our discussion she seemed genuinely impressed and commented that the likes of us should be sitting on the guideline committees.

    To add to the NaturalStandard issue… it seems that the reason why NS was touted as the best source for evaluating evidence for “natural therapies” (i.e. CAM), had nothing to do with their actual legitimacy. Nor did they factor in the fact that one of the managing editors is herself a naturopath. No, the way the determined it was to take 16 (IIRC) common “CAM” therapies and do their own independent evaluation of them. Then, they reviewed all the sites like NS and compared their analysis to the in-house analysis. The site that matched the most (not entirely, and not disclosed how much, just “the most”) was NS and was thus picked as the best resource. That’s it. No sense of critical thought invloved, merely a “we need to teach this for unkown reason, so lets pick the source that fits best with our small sample of common therapies and leave it at that.” Hardly a good way to go about things, IMO

  15. Hi Jann

    Glad you enjoyed your trip to NZ.

    As you say, we are definitely playing whack-a-mole but we are doing our best. Another Sciblogger, Michael Edmonds, has become quite a dab hand at reporting many CAM adverts to our Advertising Standards Authority and is having some success.

    Alas, my own complaint against a local ayurvedic practitioner was not upheld, but I’ll keep trying :)

    Siouxsie

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