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Archive for Energy Medicine

Down the Virtual Rabbit Hole

The interwebs are more than a series of tubes, it has the power of endless distraction and tangents, a series of clickable rabbit holes that can drag you deeper and deeper into the alternative universes that are parallel with our own. One moment you can be on Science Based Medicine, grounded on the terra firma of reality, and then with a click of the mouse you can lose your way in the electronic warren.

It started as an advertisement on a skeptical website, perhaps SBM, perhaps not. The entrances to rabbit holes are Hogwartian in nature, never being in the same place twice. It is how I remember it.

Google serves up ads based on what their algorithm perceives as the content of the website. The algorithm lacks a certain, shall we say, nuance, and fails to understand that advertisements suggesting training in homeopathy or the promoting the practice of chiropractic may not have a close relationship to the content of Science Based Medicine. Still the ad did intrigue me, as it mentioned that the practitioner was Oregon’s only MD Acupuncturist. So I clicked. (more…)

Posted in: Energy Medicine, Herbs & Supplements, Humor

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Journal of Clinical Oncology editorial: “Compelling” evidence acupuncture “may be” effective for cancer related fatigue

Journal of Clinical Oncology (JCO) is a high impact journal (JIF > 16)  that advertises itself as a “must read” for oncologists. Some cutting edge RCTs evaluating chemo and hormonal therapies have appeared there. But a past blog post gave dramatic examples of pseudoscience and plain nonsense to be found in JCO concerning psychoneuroimmunology (PNI) and, increasingly, integrative medicine and even integrations of integrative medicine and PNI. The prestige of JCO has made it a major focus for efforts to secure respectability and third-party payments for CAM treatments by promoting their scientific status and effectiveness.

Once articles are published in JCO, authors can escape critical commentary by simply refusing to respond, taking advantage of an editorial policy that requires a response in order for critical commentaries to be published. An author’s refusal to respond means criticism cannot be published.

Some of the most outrageous incursions of woo science into JCO are accompanied by editorials that enjoy further relaxation of any editorial restraint  and peer review. Accompanying editorials are a form of privileged access publishing, often written by reviewers who have strongly recommended the article for publication, and having their own PNI and CAM studies to promote with citation in JCO.

Because of strict space limitations, controversial statements can simply be declared, rather than elaborated in arguments in which holes could be poked. A faux authority is created. Once claims make it into JCO, their sources are forgotten and only the appearance a “must read,” high impact journal is remembered. A shoddy form of scholarship becomes possible in which JCO can be cited for statements that would be recognized as ridiculous if accompanied by a citation of the origin in a CAM journal. And what readers track down and examine original sources for numbered citations, anyway?
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Posted in: Acupuncture, Cancer, Clinical Trials, Energy Medicine, Neuroscience/Mental Health, Traditional Chinese Medicine

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Don’t call CAM “cost-effective” unless it’s actually effective

Your health insurance plan probably covers anti-inflammatory drugs. But does it cover acupuncture treatments? Should it? Which health services deliver good value for money? Lest you think the debate is limited to the United States (which is an outlier when it comes to health spending), even countries with publicly-run healthcare systems are scrutinizing spending. Devoting dollars to one area (say, hospitals) is effectively a decision not to spend on something else, (perhaps public health programs). All systems, be they public or private, allocate funds in ways to spend money in the most efficient way possible. Thoughtful decisions require a consideration of both benefits and costs.

One of the consistent positions put forward by contributors to this blog is that all health interventions should be evaluated based on the same evidence standard. From this perspective, there is no distinct basket of products and services which are labelled “alternative”, “complementary” or more recently “integrative”. There are only treatments and interventions which have been evaluated to be effective, and those that have not. The idea that these two categories should both be considered valid approaches is a testament to promoters of complementary and alternative medicine (CAM), who, unable to meet the scientific standard, have argued (largely successfully) for different standards and special consideration — be it product regulation (e.g., supplements) or practitioner regulation.

Yet promoters of CAM seek the imprimatur of legitimacy conferred by the tools of science. And in an environment of economic restraint in health spending, they further recognize that showing economic value of CAM is important. Consequently they use the tools of economics to argue a perspective, rather than answer a question. And that’s the case with a recent paper I noticed was being touted by alternative medicine practitioners. Entitled, Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations, it attempts to summarize economic evaluations conducted on CAM treatments. Why a systematic review? One of the more effective tools for evaluating health outcomes, a systematic review seeks to analyze all published (and unpublished) information on a focused question, using a standardized, transparent approach to evidence analysis. When done well, systematic reviews can sift through thousands of clinical trials to answer focused questions in ways that are less biased than cherry-picking individual studies. The Cochrane Review’s systematic reviews form one of the more respected sources of objective information (with some caveats) on the efficacy of different health interventions. So there’s been interest in applying the techniques of systematic reviews to questions of economics, where both costs and effects must be measured. Economic evaluations at their core seek to measure the “bang for the buck” of different health interventions. The most accurate economic analyses are built into prospective clinical trials. These studies collect real-world costs and patient consequences, and then allow an accurate evaluation of value-for-money. These types of analyses are rare, however. Most economic evaluations involve modelling (a little to a lot) where health effects and related costs are estimated, to arrive at a calculation of value. Then there’s a discussion of whether that value calculation is “cost-effective”. It’s little wonder that many health professionals look suspiciously at economic analyses: the models are complicated and involve so many variables with subjective inputs that it can be difficult to sort out what the real effects are. Not surprisingly, most economic analyses suggest treatments are cost-effective. Before diving into the study, let’s consider the approach:

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Posted in: Acupuncture, Chiropractic, Energy Medicine, Herbs & Supplements, Homeopathy, Naturopathy, Science and Medicine

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Low Level Lasers: N-Rays in action.

I do not want to get all angsty and omphaloskeptic, but I have been thinking more of late about the purpose of the blog and my role in it.  Blogs,and the people who write them,  are ephemeral.  It takes a unique personality and commitment to churn out these essays and commit them to the ether.  Especially since Michelson and Morley.

I have never given much thought as to who our readers are, at least as a composite.  I read most of the comments on every entry and have certainly developed a mental picture of some of our regular commenters, although I suspect I probably do not have even the gender correct most of the time.  The commenters represent a tiny fraction of the regular readers and an even smaller fraction of occasional readers.  It occurs to me I haven’t a clue who the real audience of this blog is.

I write  first for my own education and entertainment, then for the slightly bored and overwhelmed medicine resident, since that is who I spend most of my time educating at work.  Someone educated with an understanding of basic medicine but has more important things on their mind than a need for a detailed understanding of why homeopathy is complete nonsense.  I doubt the majority of my readers are health care workers and I suspect  continuing medical education is not a major part of the blog.

I never considered SBM to be a consumer protection group, but this week my wife showed me a half page advertisement in the local paper, and I realized that not only was the advertisement a good topic for blogging, but consumer protection is a fundamental result of this blog.  There really is no site on the interweb that looks at both SCAM and real medicine with quite the same skeptical eye.  Here is the headline:

A Special Wellness Report

New Medicine Based On An 88- Year Old Theory By Albert Einstein Can Help Almost Everyone Who Is Sick Or Injured! (more…)

Posted in: Basic Science, Energy Medicine, Health Fraud, Science and Medicine, Science and the Media

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Vital Signs

As I have mentioned in the past, almost all of my practice is inpatient medicine, doing infectious disease consults in acute care hospitals. I only spend three hours a week in the outpatient clinic, so I have a skewed perception of medicine and disease. The patients I see are sick, really sick, often trying to die and are a complicated collection of abnormal labs and deranged physiology.

I remember finishing residency thinking that a potassium of 2.8, a hemoglobin of 9.8 or a bilirubin of 4.5 wasn’t all that bad, losing track of normal physiology amongst all the medical pathology. I never did lose track of normal vital signs (VS): pulse, respiration, blood pressure and temperature. Like trying to be the fifth Beatle, over the years other values have vied to become the fifth vital sign: pain level or O2 saturation, but none have the importance of the fab four. I can live without pain*, but I can’t live long if the other vital signs are abnormal for extended periods of time. Watching the vital signs return to normal is often an important variable that signifies the patient is improving. (more…)

Posted in: Energy Medicine, Faith Healing & Spirituality, Science and Medicine

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What Would It Take?

I recently wrote a SkepDoc column on fantasy physics in Skeptic magazine in which I mentioned a study that had allegedly measured 2 milligauss emanations from a healer’s hands. A reader inquired about it and went on to ask “what criteria is [sic] necessary for gaining acceptance in the scientific community in regards to purported healing processes using energy fields generated in the human hand, specifically the palm area.”

What would it take to prove this implausible claim to the satisfaction of the scientific community? That is an excellent question with a complicated answer. It’s worth looking at because there is only one science and the same standards apply to how science evaluates any claim. I’ll take a stab at it, and perhaps our commenters can add words of wisdom.

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Posted in: Energy Medicine

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There’s an app for that ?!?

There is no shortage of technology in my household: computers, smart phones and tablets of one kind or another. The nice thing about being a blogger and an app developer is I can justify it all. Well, mostly. The “It’s probably tax deductible” gambit can only be used so many times. It is remarkable how much of my life is filtered through the digital lens. I think if google glasses ever become a reality, my kids and I will be the first up to be permanently wired into the world. To my way of thinking, the Daemon haunted world looks like hog heaven.

There is an app for just about anything, many of which feed into my OCD. I keep track of my daily walk and I have walked over 1500 miles since July 1, 2011. When I developed my middle aged bloat I had the option of medications to control the metabolic results or lose some damn weight. Losing weight is simple in concept, hard in execution. Take in fewer calories than you expend and the weight will slowly, ever so maple bar free slowly, come off. It took 9 months to drop the 45 pounds needed, and I must say I feel just as old and creaky as I did before, but my labs are better. The opposite of the placebo effect: I am subjectively the same but am objectively better. I’ll take it.  One of the cool features of the app I used, and still use, for calorie management is that it will take a picture of the bar code of food and give you the nutritional information for entry in the program. Amazing.

A fellow bugdoc sent me a link to story about Chinese Tongue diagnosis. The journal article has been accepted for publication as Automated Tongue Feature Extraction for ZHENG Classification in Traditional Chinese Medicine 

It is as fine a piece of tooth fairy science and tooth fairy engineering as I have ever encountered. (more…)

Posted in: Energy Medicine, Science and Medicine, Traditional Chinese Medicine

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Bach Flower Remedies

May is the month associated with flowers, so I thought it would be timely to look at flower remedies. You may have heard of “rescue remedy” or other Bach flower remedies. (The preferred pronunciation is “Batch,” but it’s also acceptable to pronounce it like the composer.) They contain a very small amount of flower material in a 50:50 solution of brandy and water, and are said to work by transmitting a vibrational energy through the memory of water (not the same as homeopathy, but equally implausible).

Bach was trained as a homeopath and even created some bacterial homeopathic nosodes, but then he branched out. He used his intuition to access a psychic connection to plants. He would hold his hand over different plants to see which one affected his emotional state, and he would collect the dew from that plant to use as a remedy.

The Remedies

A facsimile edition of Bach’s 1936 book The Twelve Healers is available free on the Internet. It makes interesting reading. It starts off:

From time immemorial it has been known that Providential Means has placed in Nature the prevention and cure of disease, by means of divinely enriched herbs and plants and trees. The remedies of Nature given in this book have proved that they are blest above others in their work of mercy; and that they have been given the power to heal all types of illness and suffering.

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Posted in: Energy Medicine, Herbs & Supplements

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More “bait and switch” acupuncture studies

Acupuncture has been a frequent topic on this blog because, of all the “complementary and alternative medicine” (CAM) modalities out there, it’s arguably the one that most people accept as potentially having some validity. The rationale behind acupuncture is, as we have explained many times before, little different than the rationale behind any “energy healing” method (like reiki, for example) in that it claims to redirect the flow of “life energy” (the ever-invoked qi). The only difference is that acupuncturists claim to bring this therapeutic qi rearrangement about by sticking thin needles into the pathways in the body through which this qi is fantasized to flow. These pathways, called meridians, are just as much a fantasy as qi itself or the “universal source” that reiki masters claim to be able to channel through themselves and into believers. Contributing to the popularity of acupuncture is its mythology as having been routinely practiced for over two thousand years, a myth that was the creation of Chairman Mao, who elevated what was a marginal practice at the time to a modality that the state supported and promoted (1,2,3,4).

In addition, because acupuncture involves sticking actual metal objects into the skin rather than simply laying on hands or making magical gestures over the patient, it retains some credibility, even among doctors. It doesn’t matter that, reviewing the totality of the research, one finds that it doesn’t matter where you stick the needles or even if you stick the needles in the skin. The results are the same and indistinguishable from placebo. The inescapable conclusion is that acupuncture is placebo medicine with needles. Personally, I’d prefer my placebo medicine without needles, but that’s just me.

Yet, the studies keep rolling in, trying desperately to demonstrate that acupuncture works or assuming that acupuncture works . Two more popped up within the last couple of weeks, and one of them, if you read the press releases, sounds really convincing. As is frequently the case, for this latter study, there is less to it than meets the eye. I’ll start, however, with a study that is a followup to a study I blogged about a couple of years ago that I characterized as another overhyped acupuncture study misinterpreted. This one, thankfully, is not nearly as hyped as the study from two years ago—or as the second study I will discussed, but it is very instructive how the original misinterpreted story is leading to a classic CAM “bait and switch” applied to acupuncture.
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Posted in: Acupuncture, Basic Science, Energy Medicine, Science and the Media

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The regulation of nonsense

 The most meticulous regulation of nonsense must still result in nonsense.

– Edzard Ernst, M.D., PhD., professor, Complementary Medicine, Peninsula Medical School, University of Exeter, UK

One necessity of licensing so-called “complementary and alternative,” or “CAM,” practitioners is to spell out exactly what is encompassed in the CAM scope of practice. This is unfortunate for the practitioners because it forces an exposé of the nonsensical precepts underlying their claims. For example,

‘Acupuncture’ refers to a form of health care, based on a theory of energetic physiology that describes and explains the interrelationship of the body organs or functions with an associated acupuncture point or combination of points located on ‘channels’ or ‘meridians’. . . Acupuncture points are stimulated in order to restore the normal function of the aforementioned organs or sets of functions.

(Delaware acupuncture practice act.)

[Chiropractic is] the science of adjusting the cause of the disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.

(North Carolina chiropractic practice act.)

The practice of naturopathic medicine includes, but is not limited to, the following services:. . . ordering, administering, prescribing, or dispensing for preventive and therapeutic purposes: food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, botanical medicines, herbal remedies, homeopathic medicines, dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, glandulars, protomorphogens, lifestyle counseling, hypnotherapy, biofeedback, dietary therapy, electrotherapy, galvanic therapy, oxygen, therapeutic devices, barrier devices for contraception, and minor office procedures, including otaining specimens to assess and treat disease. . .

(Minnesota naturopathic practic act.)

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Posted in: Energy Medicine, Legal, Politics and Regulation, Science and Medicine

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