There are two topics about which I know a fair amount. The first is Infectious Disease. I am expert in ID, Board Certified and certified bored, by the ABIM. The other, although to a lesser extent, is SCAMs.
When I read the literature on these topics, I do so with extensive knowledge and, in the case of ID, 30 years of clinical experience. The extensive knowledge, and, one hopes, understanding, has led me to read meta-analyses with a grain of salt substitute. They average meta-analysis and systematic review is good for gaining a general understanding of the topic within, as well as, and here is the key phrase, the limitations of the included studies.
And like all the published literature, when writing a meta-analysis, those with an axe to grind will grind it. Even, or perhaps especially, the Cochrane reviews.
Just because something is labelled as a systematic review does not mean it is any good. We have to be just as vigilant now as ever. Even a review with a Cochrane label does not make its true. Four out of 12 Cochrane reviews on acupuncture were wrong. Caveat lector rules, OK? (more…)
There are many forms of Traditional Chinese Medicine (TCM), and many have the same underlying theory: they stimulate non-existent acupuncture points to alter the flow of non-existent qi. For each form of TCM there are many variations on a theme. There are, for example, a half-dozen styles of acupuncture and multiple forms of cupping all trying to move the qi. That qi is an untameable beast, hard to corral into a proper gate even by the best acupoint wrangler.
There is, fortunately, yet another way, moxibustion, to alter that most intractable mysterious life energy.
Moxibustion is the burning of mugwort over acupoints.
What is mugwort? I resist the urge to make a Harry Potter pun about where Muggles go to school. No wait, I just did. Sorry. You know the old saying: yield to temptation, it may not pass you way again. Mugwort is a member of the daisy family, related to ragweed and, like ragweed, a common cause of hay fever. It is also used in food and was used in beer before hops was discovered.
Always start with an excuse. I have been ill for the last 10 days. I suspect I picked up an infection from the woman I slept with in Vegas.* I normally go through the day at warp 5 (I do not want to destroy space-time), but this illness has reduced my mental functioning in the evening to one-half impulse at best, with thoughts moving at the speed of a cold Oregon slug. So bear with me.
There can be an odd popularity to medicine. I see this in antibiotics usage. When a patient is admitted to the ICU with sepsis, while awaiting cultures you try and kill all the likely bacteria that may be trying to kill the patient. At any given time most doctors can only remember two antibiotics and the current popular duo is vancomycin and pipericillin/tazobactam. It is a reasonable choice, one of many combinations that would treat most patients with sepsis. I am not certain how this combination became so popular, although I have been told that the pipericillin/tazobactam reps have been very active at the Universities with medical students and residents. As the adage goes, “Give me a student until he is seven and I will give you the doctor.”
There are also popular trends in alternative medicine as well. Every now and then there is a flurry of mentions on the interwebs suggesting that a pseudo-medicine has become all the rage. Or maybe it is just the echo chamber that is the interwebs.
This week it is Oil Pulling Might Be The Next Big Thing — Or Not and What is cupping? Lena Dunham the latest celeb to try the ancient Chinese remedy for pain relief. (more…)
A comment from the blog:
Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is. One story I love telling comes from my friend in the year behind me. His parents are professional chemists and he came home one day and saw his mother had a bottle of homeopathic medicine. He asked why and she gave the typical non-committal response of “well, I thought it may help and I saw it on the shelf at the pharmacy.” He explained what homeopathy actually is and they were absolutely dumbfounded. They are well aware of Avogadro’s number, after all. People generally don’t study what the CAM in question actually is – merely the fluff PR garbage that gets touted around and without direct and clear demonstration of harm, give it a pass as a result. After all, the business of real medicine is time consuming and difficult enough.
Participating in activities that have a permanent record gives one the fortunate, or unfortunate, opportunity to revisit the past and see just how you worked early in a career. (more…)
I seem to be writing a lot about acupuncture of late. As perhaps the most popular pseudo-medicine, there seems to be more published on the topic. I have a lot of internet searches set up to automatically feed me new information on various SCAMs. Interestingly, all the chiropractic updates seem to be published on chiropractic economics sites, not from scientific sources. Go figure.
Here is a hodgepodge of articles, mostly from the scientific literature, I have read concerning acupuncture and TCM. (more…)
Which headline is real?
- I Visited a Alchemist. As American alternative chemistry grows in popularity, I decided to experience an even older style of nontraditional transmutation of metals.
- I Visited an Astrologer. As American alternative astronomy grows in popularity, I decided to experience an even older style of nontraditional stargazing.
- I Visited a Bloodletter. As American alternative medicine grows in popularity, I decided to experience an even older style of nontraditional treatment.
- I Visited a Chickasaw Healer. As American alternative medicine grows in popularity, I decided to experience an even older style of nontraditional treatment.
Difficult? They are similar in that alchemy, astrology, bloodletting and (as we will see) Chickasaw healing are not based on reality. Bloodletting, as best I can determine, is not offered in the US, at least based on the notion of an imbalance of the 4 humors. I have no doubts that a reader will find a practitioner, likely with Hepatitis B and C, somewhere in the US. Probably in Sunnydale.
It was the final option, from The Atlantic. Given their medical reporting in the past, I would not be surprised if any of the above headlines originated in that magazine. This gets to an issue I have with all media. There are two things about which I have expertise: infectious diseases and SCAM. So often the media get both wrong, although I probably notice more when they get it wrong in the areas of my expertise. If they get it so wrong in areas about which I know something, how can I trust the veracity of reporting in all the areas where I have no knowledge? (more…)
As some may know I am infectious disease doctor. Urinary tract infections (UTI) butter my bread. Figuratively speaking. There is an enormous amount known about the pathophysiology of UTI’s. It is both a common and complex problem. But for all our knowledge, chronic and recurrent UTI’s remain a vexing issue for the patient and the doctor.
One reason people develop recurrent UTI’s is not because of altered chi along meridians altered by needles stuck in the skin distant from the bladder. That would be ridiculous. I like reasoning from basic principles. Given what we know about anatomy, physiology and microbiology, how might acupuncture interfere with the development of a urinary tract infection? Would it prevent colonization with pathogenic E. coli? Prevent retrograde travel of bacteria up the urethra into the bladder? Stop E. coli from binding to uroepithelial cells? Have a bactericidal or bacteriostatic effect?
None of the above seem likely. To my mind, postulating any of the above as a potential mechanism for acupuncture as a preventative for UTI’s would be ludicrous. And spare me your Boosting the Immune System, a concept that exists as a marketing tool, not a useful therapeutic intervention. My boss used to say that many an academic career floundered on attempting to prevent and treat UTI’s using an immune system approach. With some exceptions, and there are always exceptions, recurrent UTI’s in normal humans are usually due to anatomic or microbiological anomalies.
Despite its popularity, it is clear that acupuncture is not based on reality and, like all pseudo-medicine, only has demonstrable efficacy in poorly-designed studies. Acupuncture displays the usual progression of all pseudo-medicines. Increasingly-well-done studies show decreasing effect until a study that removes all bias shows it to be no better than placebo. Which one would expect for an intervention based on fantasy. Prior plausibility (the toy boat of SBM, try saying it three times very fast) would predict that acupuncture is worthless. And that should be acupunctures, all 6 styles are an elaborate ritual with no more likelihood of efficacy than the superstitions in a Budweiser commercial. (more…)
Those who cannot remember the past are condemned to repeat it.
- George Santayana
Most people don’t have that willingness to break bad habits. They have a lot of excuses and they continue to produce bad clinical studies.
- Carlos Santana (Well, not the last 4 words.)
One is a guitar player, one is a philosopher. I get them confused.
I think George was in charge of SCAM research at the NIH. It was Dr. Gorski who first used the term Whac-a-Mole to describe what we do. The same badly-done studies are done over and over and misrepresented over and over, with only very minor variations on a theme. This is especially true of acupuncture, the most extensively studied pseudo-medicine in search of something, anything, for which it might be effective. They are still searching.
I loved going mano-a-mano with my kids when they were younger on the Whac-a-Mole machine in the Seaside arcade followed by root beer and elephant ears. It was the last time I beat either of them at any athletic endeavor. So I enjoy Whac-a-Mole, with mechanical rodents or bad research. (more…)
We are proud to announce a new organization: The Society for Science-Based Medicine.
A Society for a community of like-minded individuals, both in and out of health care, who support the goals of Science-Based Medicine.
People should not suffer, die, go bankrupt, and lose time and hope because of complementary and alternative pseudo-medicine.
We received the following letter:
Your blog, the SBM page, has come up for me several times in my research. I’m an RN trying to research cancer treatment, for myself, I am the patient. I’m also a licensed massage practitioner with a 30 year history using “alternative” or “complementary” medicine successfully to treat myself for various things. When your blog has come up I’ve read into it, picking up some useful information.
My question is, why the sarcasm? Why do you and the responders on your site have such disdain and anger? Why do you feel threatened? Your physician status gives you the top of the totem pole, the extensive training, the authority and the privilege. Very doubtful you are going to be knocked off the top of that totem pole in this or any several more lifetimes to come. (more…)