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Clinical trials of integrative medicine: testing whether magic works?

 

I just thought that I’d take the editor’s (and, speaking for Steve, the founder’s) prerogative to promote our own efforts. Regular readers of SBM are familiar with our message with respect to randomized clinical trials of highly implausible “complementary and alternative medicine” treatments, such as homeopathy or reiki. Well, believe it or not, Steve and I managed to get a commentary published in a very good journal in which we present the SBM viewpoint with respect to these trials. Even better, at least for now, you can read it too, because it doesn’t appear to be behind a paywall. (I’m at home as I write this, and I can read the whole thing on my wifi, no VPN needed.)

The article is entitled “Clinical trials of integrative medicine: testing whether magic works?” There’s also been a fair amount of news coverage on the article, and I’ve been frantically doing interviews over the last couple of days, including:

There are likely to be at least a couple more, given the interviews I’ve done; that is, unless editors reject the ideas.

In any case, Steve and I are interested in your comments. Trends in Molecular Medicine is good in that it published our article and it’s a pretty high impact review journal, but it doesn’t have a section for comments. So consider this your section for comments on our article.

Posted in: Basic Science, Clinical Trials, Homeopathy

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“Atavistic oncology” revisited: Dr. Frank Arguello responds

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EDITOR’s NOTE: There are three Addendums after this post, containing the complete text of e-mails.

EDITOR’s NOTE #2 (8/19/14 4:51 PM): There is one more Addendum, as Dr. Arguello has sent me another e-mail.

EDITOR’s NOTE #3 (8/20/14 7:18 PM): There is yet another Addendum, as Dr. Arguello is now complaining to my place of work.

The following post will be of a type that I like to refer to as “taking care of business.” That’s not to say that it won’t be, as my posts usually are, informative and entertaining, but it does say that I’m doing it instead of what I had originally had in mind because something came up. That something is a rather unhappy e-mail from the doctor about whom I wrote three weeks ago. It’s just an indication that, although it’s a great thing that this blog is becoming more and more prominent, it’s also a two-edged sword. People actually notice it when I (or other SBM bloggers) criticize them for dubious medicine. We see this in how Dr. Edward Tobinick has launched what I (and many others) consider to be a frivolous lawsuit against SBM founder Steve Novella over a post from 2013 clearly designed to silence criticism. It’s legal thuggery, pure and simple. That’s the bad end of the spectrum. I’ve been at the receiving end of similar retaliation that could have just as bad an impact on me personally as far as my career goes when antivaccine activists tried to get me fired from my job four years ago.

The more common (and far less agita-inducing) end of the spectrum consists of e-mails or letters of complaint. Sometimes they come from eminent radiologists who don’t like my criticism of their attacks on mammography studies. (Actually, truth be told, it is rarely eminent radiologists—or eminent physicians and scholars—who complain.) More commonly, it’s practitioners who object to how their treatments have been described. This time around, it’s a man named Dr. Frank Arguello, whose “atavistic chemotherapy” I criticized in one of my typical long posts that also explained why. Last week, I received this e-mail from Dr. Arguello:
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Posted in: Cancer, Clinical Trials, Evolution

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The false dichotomies of CAM and “integrative medicine”

Falsedichotomy

A lot of medical specialties have throwaway newspapers/magazines that are supported by advertising and somehow mysteriously managed to show up for free in the mailboxes of practitioners. In my case, I’ve found myself on the subscription list for such papers about oncology, but also general surgery (I’m Board-certified as a general surgeon). When I have to recertify in about three years, it will be as a general surgeon, which was really fun to try to do last time after having specialized as a breast cancer surgeon, and will likely be even more fun next time, when I will be 10 years further out from my general surgery and surgical oncology training. In any case, that must be why, no matter where I end up working, sooner or later I end up receiving General Surgery News (GSN).

As throwaway professional newspapers go, GSN is not bad. However, occasionally it publishes op-ed articles that make me scratch my head or even tick me off with their obtuseness. Lately, apparently, it’s started some blogs. The one in particular that is the center of attention for this post is by Victoria Stern, is called “The Scope” and is billed as “exploring the lesser known sides of surgery.” Of course, it’s a bit odd that some of the first posts on this blog are about work hour restrictions and whether they leave new surgeons unprepared to practice surgery, the debate over breast screening, and what it takes to train expert surgeons, none of which are exactly “lesser known sides of surgery.” Work hour restrictions, in particular, have been discussed in surgery journals, at conferences, and among surgeons ad nauseam, particularly whether we are training a generation of surgeons unable to deal with the rigors of practicing surgery in the real world.
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Posted in: Critical Thinking, Medical Ethics

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Medical marijuana as the new herbalism, part 2: Cannabis does not cure cancer

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About a month ago, I finally wrote the post I had been promising to write for months before about medical marijuana. At the time, I also promised that there would be follow-up posts. Like Dug the Dog seeing a squirrel, I kept running into other topics that kept me from revisiting the topic. However, over the past couple of weeks, the New York Times gave me just the little nudge I needed to come back and revisit the topic, first by openly advocating the legalization of marijuana, then by vastly overstating the potential medical benefits of pot (compare the NYT coverage with my post from a month ago), and finally this weekend by running a story lamenting the federal law that makes research into medical marijuana difficult in this country.

I stated my position on marijuana last time, which is that marijuana should be at least decriminalized or, preferably, legalized, taxed, and regulated, just like tobacco and alcohol. I also likened the cult of medical marijuana to the “new herbalism,” because it (1) vastly inflates the potential of medicinal uses of marijuana and (2) ascribes near-mystical powers to smoking or making extracts out of marijuana, rather than identifying and isolating constituents of the plant that might have medicinal value. All of this is very much like herbalism in alternative medicine. Indeed, promoting laws legalizing medicinal marijuana is such an obvious ploy to open the door to full legalization that some advocates don’t even bother to disingenuously deny it any more. Given that I tend to support legalization, as a physician this sort of deception irritates me. It also has consequences, particularly when overblown claims are made for what cannabis can do. Perhaps the best example of this is the claim that cannabis cures cancer, which pops up all over the Internet in memes such as the one in the image above.
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Posted in: Cancer, Herbs & Supplements, Politics and Regulation

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Ebola outbreaks: Science versus fear mongering and quackery

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Ebola virus particles” by Thomas W. Geisbert, Boston University School of Medicine – PLoS Pathogens, November 2008 doi:10.1371/journal.ppat.1000225. Licensed under CC BY 2.5 via Wikimedia Commons.

Without a doubt the big medical story of the last week or so has been the ongoing outbreak of Ebola virus disease in West Africa, the most deadly in history thus far. Indeed, as of this writing, according to a table of known Ebola outbreaks since 1976 at Wikipedia, in Guinea, Sierra Leone, and Liberia, the three nations affected thus far, there have been 1,440 cases and 826 deaths. Worse, the World Health Organization (WHO) is reporting that it is spreading faster in Africa than efforts to control it. In particular, late last week it was announced that two Americans who had been infected with Ebola were going to be flown back to the US, specifically to Emory University, for treatment, a development that ramped up the fear and misinformation about Ebola virus to even greater heights than it had already attained, which, unfortunately, were already pretty high. Indeed, the ever-reliably-histrionic Mike Adams of NaturalNews.com wrote a typically hysterical article “Infected Ebola patient being flown to Atlanta: Are health authorities risking a U.S. outbreak?” On Saturday, we learned that Dr. Kent Brantly, an aide worker for Samaritan’s Purse, a Christian charity run by Franklin Graham, son of the well-known preacher, Billy Graham, who had been evacuated from Liberia aboard a private air ambulance, had arrived in Georgia.

This latest development inspired medical “experts,” such as Donald Trump, to stoke fear based on the arrival of two infected Americans in the US. For instance, last Friday, after it was first announced that the Ebola-infected Americans would be flown back to the US, Trump tweeted:

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Posted in: Epidemiology, Health Fraud, Homeopathy, Public Health, Vaccines

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Cold reality versus the wishful thinking of cryonics

We all seek immortality in some way. Death has been one of the prime terrors haunting us since humans first started realizing that every living thing dies and death is permanent. After all, no one wants to face the end of everything that one has been, is, and will be. Indeed, a key feature of many religions is a belief that death is not the end, that there is an afterlife where we will all live forever. In some religions, in the afterlife evil is punished and good rewarded. Even if, as seems most likely, death is simply the end, and the time after death is just like the time before we were born (or, more properly, before our first memories), something that seems relatively benign just thinking about it, emotionally we still don’t want it. Being human, I get it, particularly now that I’m on the wrong side of 50 and, unless I’m far more long-lived than my genes are likely to permit, have considerably less life to look forward to than the lifetime I’ve already lived. I also realize that the number of people who are remembered long after they are gone by anyone outside of their family and friends is exceedingly small—and even that memory fades rapidly among family members. As the succeeding generation dies off, direct memory of the generation that spawned it disappears. I get it. Fifty years from now, it’s likely that all that will remain of my existence will be some scientific papers and a faint memory held by my nieces and nephews and maybe, if I’m lucky, a few of my youngest readers.

I don’t, however, get cryonics.

Detroit, like many large cities, has a free weekly “alternative” newspaper, The Metro Times. This week’s issue features this cover:

MetroCryonic

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Posted in: Basic Science, Science and the Media

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Dr. Frank Arguello’s “atavistic oncology”: Another dubious cancer therapy to be avoided

EDITOR’S NOTE: Dr. Arguello has responded. See his response and my reply here.

Not infrequently, I’m asked why it is that I do what I do. Why do I spend so many hours of my free time, both here and at my not-so-super-secret other blog (NSSSOB), to write my detailed analyses of various forms of quackery, analyses of scientific studies, and expressions of my dismay at the infiltration of pseudoscience into medicine, particularly medical academia in a phenomenon I like to call “quackademic medicine”? One reason, of course, is because I passionately believe in what I am doing. Another reason is that I want information countering various forms of dubious medicine to be out there, and I have two well-trafficked blogs as a platform, although SBM long ago surpassed my NSSSOB in traffic and reach.

Over the last six years, there are some topics that I’ve written about many times, such as the antivaccine movement, Stanislaw Burzynski, cancer quackery, and common myths about cancer treatment. Surprisingly, there are some topics left that I should have written about a long time ago but haven’t, even though I had heard of them before. One such topic, atavistic oncology and chemotherapy, was brought to my attention a couple of weeks ago by a reader, who basically pointed me to a particular dubious bit of cancer treatment whose chief proponent, Dr. Frank Arguello, is apparently currently touring Canada to do conferences and meet with potential patients, placing ads in local newspapers in the cities in which he will be appearing. His meeting with patients in Canada seems particularly problematic, because his cancer practice is located in San Jose del Cabo, Baja California Sur, Mexico, a location that, given the nature of his practice and claims, struck me as remarkable only because it’s not Tijuana. In any case, Dr. Arguello just appeared in Saskatoon on Friday and is scheduled to appear in Regina on July 30, with appearances in Winnipeg, Vancouver, Calgary, Edmonton, and Toronto promised in the future, as well as U.S. appearances in San Francisco and Los Angeles. Specifically, after his appearance in Regina, advertised here:

ArguelloRegina

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Posted in: Cancer, Health Fraud

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How “they” view “us” revisited: Mike Adams goes off the deep end

Monsanto-Collaborators-Homepage

This post might look familiar to some of you who know me from what I like to call my not-so-secret other blog (NSSSOB). However, what happened last week was important enough that I wanted to make sure that it was covered on SBM, just as Steve Novella covered it on his own blog on Friday. (Fear not, there will be fresh material tomorrow, as always.) Another reason that I wanted to recycle and update this for SBM is because I believe the incident involving über-quack Mike Adams provides to me a “teachable moment” related to my talk at TAM two weeks ago, which was entitled “How ‘They’ View ‘Us’” and based on a post of mine here on SBM entitled, appropriately enough, How “they” view “us”.
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Posted in: Critical Thinking, Genetically modified organisms (GMOs), Science and the Media

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The false hope of “right-to-try” metastasizes to Michigan

Nurse administers chemotherapy

Ed. note: Please read disclaimer in Dr. Gorski’s profile!

There are times when supporting science-based health policy and opposing health policies that sound compassionate but are not are easily portrayed as though I’m opposing mom, apple pie, and the American flag. One such type of misguided policy that I’ve opposed is a category of bills that have been finding their way into state legislatures lately known as “right to try” bills. Jann Bellamy and I have both written about them before, and with the passage of the first such bill into law in Colorado in May, I had been meaning to revisit the topic. Although “right-to-try” laws are a bad policy idea that’s not new, versions of such bills having been championed by, for example, the Abigail Alliance for at least a decade, the recent popularity of the movie Dallas Buyers Club appears to have given them a new boost, such that Colorado state Senator Irene Aguilar even frequently referred to her state’s right-to-try bill as the “Dallas Buyers Club” bill. It’s a topic I’ve been meaning to revisit since the news out of Colorado, but apparently I needed a nudge, given that it’s two months later now.

Unfortunately, that nudge came in the form of a right-to-try bill (Senate Bill 991) being introduced into the legislature in Michigan by Senator John Pappageorge and unanimously passing, almost without comment by the committee and certainly with minimal news coverage, through the first hurdle, the Michigan Senate Health Policy Committee. In parallel, the same legislation (House Bill 5651) has been introduced into the Michigan House of Representatives.
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Posted in: Cancer, Pharmaceuticals, Politics and Regulation

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The Texas Medical Board vs. Stanislaw Burzynski, 2014 edition

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As I begin this post, I’m on a miserably crowded, hot, stinky flight winging my way home from TAM. This puts me in the perfect mood to write about my bête noire to conquer all bêtes noires, namely Stanislaw Burzynski, the Polish expat doctor who claims to have much better results treating deadly brain cancers than conventional oncology, even though he is not an oncologist and has never even completed the prerequisite training for an oncology fellowship, namely an internal medicine residency. Actually, I don’t mean that in the way that you probably think I mean it. This time around, unlike the last time around, writing about Burzynski will put me in a better mood to endure being slapped into a sardine can in coach, barely able to move, barely able to type, but needing to get a blog post out on Monday.

If you remember, the last time I wrote about Burzynski, the Food and Drug Administration (FDA) had caved, and by “caved” I mean that it had lifted the partial clinical hold on Burzynski’s clinical trials. As is usual with the long and winding saga that is Burzynski, I feel compelled to give a brief review for any newbie who might encounter this post. Old hands at this story can skip ahead or just skim.

Two years ago, a child named Josia Cotto died of hypernatremia (elevated sodium level in the blood) due to receiving treatment for a brain tumor from the Burzynski Clinic using Burzynski’s “miracle drug” antineoplastons. Hypernatremia is a known complication of ANP treatment, and, as a result of this child’s death, the FDA put a partial clinical hold on Burzynski’s clinical trials for pediatric patients, which meant that he could continue to treat children already enrolled in his clinical trials but could not enroll any new patients. Six months later, this partial hold was extended to all of Burzynski’s clinical trials, and in early 2013 the FDA inspected the Burzynski Clinic and Burzynski Research Institute (BRI). (more…)

Posted in: Cancer, Clinical Trials, Politics and Regulation

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