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Acupuncture for Menopausal Symptoms

Acupuncture

A newly published meta-analysis of studies looking at acupuncture for symptoms resulting from natural menopause (not drug or surgically induced) by Chiu et. al. is entirely negative. That is not what the authors or the press release conclude, however.

This disconnect between the study results and the interpretation of those results is a persistent problem in medicine generally to some degree, but is endemic and profound within the CAM (complementary and alternative medicine) culture. Acupuncture in particular is promoted almost entirely based on this type of misinterpretations – the kind that can magically turn negative studies into positive studies.

In the abstract the authors conclude:

This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.

Let’s take a close look at the results, however. Indeed, when comparing acupuncture to no treatment controls there was a significant decrease in subjective symptoms in the pooled data. Outcomes were hot flash frequency, hot flash severity, other menopausal symptoms, and quality of life. Some of the included studies were large controlled trials, which the authors used to argue that their results are valid. They also point out that their results showed heterogeneity and lack of publication bias.

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Posted in: Acupuncture

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Beware The P-Value

Part of the mission of SBM is to continually prod discussion and examination of the relationship between science and medicine, with special attention on those beliefs and movements within medicine that we feel run counter to science and good medical practice. Chief among them is so-called complementary and alternative medicine (CAM) – although proponents are constantly tweaking the branding, for convenience I will simply refer to it as CAM.

Within academia I have found that CAM is promoted largely below the radar, with the deliberate absence of public debate and discussion. I have been told this directly, and that the reason is to avoid controversy. This stance assumes that CAM is a good thing and that any controversy would be unjustified, perhaps the result of bigotry rather than reason. It’s sad to see how successful this campaign has been, even among my fellow academics and scientists who should know better.

The reality is that CAM is fatally flawed in both philosophy and practice, and the claims of CAM proponents wither under direct light. I take some small solace in the observation that CAM is starting to be the victim of its own success – growing awareness of CAM is shedding some inevitable light on what it actually is. Further, because CAM proponents are constantly trying to bend and even break the rules of science, this forces a close examination of what those rules should actually be, how they work, and their strengths and weaknesses.

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Posted in: Clinical Trials

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Food Fears

all natural banana

A new Cornell University study examines the origins of food fears, and possible remedies. It’s a survey of 1,008 mothers asking about foods they avoid and why.

Food fears are a common topic on SBM, likely for several reasons. Humans have an inherent emotion of disgust, which is likely an adaptation to help avoid contaminated or spoiled food. In our modern society this reflex can be tricky, because we do not always have control over the chain of events that leads to food on our plates. Other people grow the food, transport it, process it, and perhaps even cook it.

Modern food technology can also involve many scary sounding substances and unusual processes. As the saying goes, you may not want to know how the sausage is made, as long as the end result is wholesome.

This leads to a second reason for modern food fears – we are living in an age of increasing transparency, partly brought about by the dramatic increase in access to information on the internet. I think ultimately this is a good thing – people are seeing how the sausage is made, which makes it more difficult to hide shady practices. This introduces a new problem, however. If you’re going to inspect the process of making sausage, then you need to know something about sausage-making. (more…)

Posted in: Nutrition

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Surgery Under Hypnosis

Recurrent laryngeal nerveThe BBC recently reported that a Guinean singer, Alama Kante, sang through her surgery in order to protect her voice. The reporting is unfortunately typical in that it emphasizes the seemingly amazing aspects of the story without really trying to put them into proper context. Specifically, the story emphasizes that hypnosis was used during the surgery, since Kante could not be placed under general anesthesia and still be able to sing, reporting:

“The pain of such an operation is intolerable if you are fully awake. Only hypnosis enables you to stand it,” he was reported as saying by to French publication Le Figaro.

“She went into a trance listening to the words of the hypnotist. She went a long way away, to Africa. And she began to sing – it was amazing,” he said.

Reports of major surgery being performed using self-hypnosis or hypnosis instead of anesthesia crop up regularly, because of the obvious sensationalism of such stories. I reported a similar case from 2008, for example. At least in this case the news report gave the critical piece of information, often missing entirely from such reports:

The Guinean singer, who is based in France, was given just a local anaesthetic and hypnotised to help with the pain during the operation in Paris.

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Posted in: Neuroscience/Mental Health, Science and the Media

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Prolotherapy

Prolotherapy is a treatment technique used for chronic myofascial pain, back pain, osteoarthritis, or sports injury. It involves repeated injections of dextrose solution or other irritating substances into the joint, tendon, or painful tissue in order to provoke a regenerative tissue response. Similar techniques have been used for about a century, but the first formal publication describing prolotherapy dates back to 1956, by Dr. George Hackett. He wrote:

Within the attachment of weakened ligaments and tendons to bone, the sensory nerves become overstimulated by abnormal tension to become not only the origin of specific local pain, but also definite areas of referred pain throughout the body to as far as the head, fingers and toes from specific relaxed ligaments and tendons.

Prolotherapy. A treatment to permanently strengthen the “weld” of disabled ligaments and tendons to bone by stimulating the production of new bone and fibrous tissue cells has been developed.

Initially the concept, referred to a sclerotherapy, was that the injections formed scar tissue to stabilize the joint, tendon, or ligament. The newer concept, called prolotherapy, is that the injections provoke the proliferation of tissue, allowing for limited regeneration. (more…)

Posted in: Science and Medicine

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Delaying Vaccines Not A Good Idea

AndEvil Mr. Vaccine and the consequences of vaccination.

There’s nothing like cold hard data to counteract opinion and propaganda. The anti-vaccine movement hit upon a clever marketing phrase with their “Too Many, Too Soon” campaign. Unfortunately, it is often difficult to capture the complexity and nuance of scientific data with a witty slogan, so such slogans tend to work better for those who don’t really care about such things as scientific data.

I’ll give it a try in any case: how about “too few, too late.” Or maybe, “A day late and an antigen short.”

OK, now you know why I’m not in the marketing business. So let’s talk about the actual scientific data.

The recommended vaccine schedule is not, it turns out, arbitrary or designed to maximize the profits of the vaccine industry. The Center for Disease Control (CDC) recommended vaccine schedule is designed to give children vaccines as soon as they need them and are old enough to handle them – maximizing benefit while minimizing risk. Booster shots are optimized to produce a sufficient antibody response for maximal protection. I don’t think anyone would argue that the schedule is perfect, but it is rational and evidence-based. (more…)

Posted in: Vaccines

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PETA Embraces Autism Pseudoscience

got-autism-billboardPETA (People for the Ethical Treatment of Animals) has a history of (as the old saying goes) using science as a drunk uses a lamppost – for support rather than illumination. In that way they are typical of ideological groups. They have an agenda, they are very open about their beliefs, and they marshal whatever arguments they can in order to promote their point of view.

Favoring information that supports our current beliefs is a cognitive bias common to Homo sapiens, but ideology tends to take this simple bias to a new level. It can lead to the systematic distortion or denial of science, and render belief systems immune to logic and evidence.

PETA provides us with a nice example of how having an ideological agenda can motivate an individual or a group to embrace dubious science. In an article currently on their website, and making the rounds in social media (this is repeating a claim from at least 2008, but the current article is undated), the group warns: Got Autism? Learn About the Link Between Dairy Products and the Disease. They claim:

The reason why dairy foods may worsen or even cause autism is being debated. Some suspect that casein harms the brain, while others suggest that the gastrointestinal problems so often caused by dairy products cause distress and thus worsen behavior in autistic children.

Saying that “how” dairy harms the brain is being debated implies “that” dairy harms the brain is accepted and not being debated. This is misleading. It is not accepted that dairy harms the brain or is in any way linked to autism, and the evidence is largely against it. (more…)

Posted in: Epidemiology, Nutrition, Science and Medicine

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Vaccines Still Not Linked to Autism

Myths tend to be persistent and require periodic maintenance debunking. The anti-vaccine movement arguably can credit its recent increase in effect to successfully spreading fears that vaccines in general, and particularly either the MMR vaccine (mumps, measles, and rubella) or the vaccine preservative thimerosal, are linked to autism. This claim was never based on legitimate science, and over the last 15 years has been overwhelmingly repudiated by multiple independent lines of scientific evidence.

It is easier to spread fears than it is to reassure anxious parents with abstract scientific data, but still we must try. It also seems that giving people information is not an effective way to change their opinions or their behavior. But at the very least I hope to better inform those who are already on board with the science-based approach, and perhaps we can reach the occasional person on the fence who is simply misinformed and open to changing their mind.

A new meta-analysis seems like a good opportunity to remind the public that vaccines are safe and effective, and that they are not linked to neurodevelopmental disorders. The study is: “Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies,” by Taylor, Swerdfeger and Eslick, is published in the journal Vaccine. They found: (more…)

Posted in: Vaccines

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Dialogue on “Alternative Therapies”

A recent opinion piece in The New York Times is an invitation to a dialogue on so-called alternative therapies, written by James Gordon. Gordon directs the Center for Mind-Body Medicine and was chairman of the White House Commission on Complementary and Alternative Medicine Policy appointed by President Bill Clinton. The piece, unfortunately, represents many of the common misconceptions about mainstream medicine and CAM (complementary and alternative medicine).

He begins:

Even more distressing, the Affordable Care Act will likely reinforce current practice, which dictates surgical and pharmacological interventions that can be expensive, inappropriate, burdened by side effects and, often, ineffective.

His piece is doomed right from the start. Current practice does not “dictate” drugs and surgery, no matter how often CAM proponents claim that it does. This is simply a straw man designed by CAM advocates to create a niche for their brand. Mainstream medicine uses treatments that are backed by sufficient plausibility and evidence, regardless of modality. At least, this is what mainstream medicine strives for. We acknowledge the implementation is imperfect, and improving the standard is part of what we strive for at SBM. (more…)

Posted in: Science and Medicine

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CureCrowd – Crowdsourcing Science

curecrowd-HAA new website came to my attention that promises to “Discover what truly works.” The idea is to essentially crowdsource anecdotal reports about what treatments work for specific conditions.

This is an interesting idea, that can harness the power of information flow over the internet to do what is essentially an observational, uncontrolled, and unscientific study about treatment effects. At its best, this type of information would consist of what we call a pragmatic study – an open-label study of the real-world application of specific treatments.

Pragmatic studies have their place – they add information about the practical applicability of various treatments. Pragmatic studies, however, are not efficacy trials – they cannot and should not be used to make efficacy claims. It has recently come into vogue for proponents of various CAM treatments to rely on pragmatic studies to make efficacy claims, when actual efficacy trials have failed to show effectiveness. (more…)

Posted in: Clinical Trials, Computers & Internet

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