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Amber Waves of Woo

As a pediatrician I have an opportunity to observe a wide variety of unusual and sometimes alarming parental efforts meant to help children through illness or keep them well. I have recently noticed one particular intervention that seems to be becoming more prevalent, at least in my practice. I’ve begun to see more and more infants sporting Baltic amber teething necklaces. These consist of multiple small beads of amber on a string that is worn around a baby’s neck, and are supposed to relieve the discomfort of teething. Before I had any idea what these necklaces were for or how they were supposed to work, my first reaction was to inform these parents of the dangers of necklaces or anything placed around an infant’s or young child’s neck. Strangulation is a known cause of accidental injury and death in children, and pediatricians are trained to discuss this as part of the routine anticipatory guidance we give to parents. In addition, we strongly advise against giving infants or young children any small items that could be accidentally aspirated, such as the beads found in a necklace of this sort. But I was equally surprised to learn that these necklaces are not intended for babies to chew or gum. Instead, they are supposed to ease a baby’s teething discomfort simply by lying against the skin.

I will not discuss teething here, or the many myths that surround it; that was well covered in a previous post. I will reiterate that there is little-to-no evidence that the majority of concerns parents have about teething are actually due to teething, including fever and diarrhea. The irritability associated with teething also tends to wax and wane for only several days before and after the emergence of a tooth. But let’s assume for the moment that these necklaces actually work to ease the discomfort of teething, and whatever other problems parents tend to associate with the long period of time during which infants and young children develop their teeth. Assuming these necklaces work as recounted in the glowing testimonials on countless websites and parent blogs, how do they produce their dramatic results?
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Posted in: Critical Thinking, Energy Medicine, Health Fraud, Herbs & Supplements, Pharmaceuticals

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Naturopathy vs. Science: Allergy Edition

snakeoil

I glanced at my pharmacy license recently, and noticed I became a licensed pharmacist almost exactly twenty years ago. Two decades seems like a long time to do pretty much anything, yet I can still vividly recall some of the patients I encountered early in my career, working evenings in a retail pharmacy that drew heavily on the alternative medicine crowd. It was the first pharmacy I’d ever seen that sold products like homeopathy, detox kits, salt lamps, ear candles, and magnetic foot pads. And the customers were just as unorthodox. There were some that told me they manipulated their own pH, and others that insisted any prescription drug was designed to kill. And there was a huge clientele that relied on the pharmacy for their “bioidentical” hormones. It was an instructive learning experience, as it was as far from the science of pharmacy school as you could expect to find in a place that still called itself a pharmacy. One of the really interesting aspects of that pharmacy was the enormous supply of vitamins and supplements for sale. It stretched over multiple aisles and even back into where the drugs were kept, as there were some brands kept behind the counter. This wasn’t for any regulatory reason – it was because these were the “naturopathic” supply, the brands often recommended by naturopaths. In order for this pharmacy to sell them they had to keep the products behind the counter, presumably to grant these supplements a veneer of medical legitimacy. After all, they were “special”, and had the prices to prove it. (more…)

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

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Oil Pulling Your Leg

Oil pulling is a traditional Ayurveda method of oral care. It involves swishing sesame oil or a similar oil, perhaps mixed with other substances, in the mouth for 10-20 minutes as a means of preventing caries (cavities), reducing bacteria, and promoting healthy gums. In our internet-fueled age of misinformation, oil pulling has seen a surge in popularity as it makes the rounds on Facebook and other popular social media sites.

The proliferation of unscientific medical advice also essentially assured that oil pulling would be updated to incorporate the latest marketing memes in the alternative marketplace. It is therefore not surprising that this technique is being presented as a cure-all, treating all sorts of systemic diseases by allegedly pulling toxins from the mouth. The Wellness Mama (the first hit on Google) proclaims:

Oil pulling is an age-old remedy that uses natural substances to clean and detoxify teeth and gums. It has the added effect of whitening teeth naturally and evidence even shows that it is beneficial in improving gums and removing harmful bacteria!

Food Matters also gushes:

It is believed that these oils help the lymphatic system of the body as harmful bacteria are removed and beneficial microflora are given with [sic] a healthy environment to flourish. Because of this holistic perspective, oil pulling has been used as a preventative health measure for many other conditions.

This is followed by a long list of conditions from migraines to bronchitis. (more…)

Posted in: Dentistry, Herbs & Supplements

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Accused of Lying about ASEA: Not Guilty

I wrote about ASEA in August, 2012. To quote the company’s website, “ASEA is trillions of stable, perfectly balanced Redox Signaling Molecules suspended in a pristine saline solution—the same molecules that exist in the cells of the human body.” Molecules that supposedly have all kinds of antioxidant benefits for health and for athletic performance through “redox signalling.” They claim it is “a mixture of 16 chemically recombined products of salt and water with completely new chemical properties.” But they never specify exactly which molecules those are, what they mean by balanced, or how they can determine that they remain stable. The product label only lists salt and water. If those 16 recombined molecules are really in the product, the FDA can and should act against them for false labeling.

An ASEA distributor (part of the company’s multi-level marketing cadre) recently wrote an e-mail, not to me, and not to the editors of SBM, but to an assistant editor, to demand that my article be taken down, or that at least the comments for that article be re-opened. Since the e-mail was not sent to me, and I don’t have the writer’s permission, I won’t name him or quote him directly but will paraphrase what he said. He said my article had prevented thousands of people from benefitting from the health effects of ASEA. Thousands? I don’t think I’m that influential; I only wish I were! Anyway, it has not been established that ASEA offers any health benefits. He complains that I don’t have any evidence that ASEA doesn’t work, and of course I don’t. The burden of proof is not on me to prove it doesn’t work, but on those making the claims to prove it does.

He says there is real scientific evidence showing that it does work. My article said there was nothing about ASEA listed in PubMed, and he countered that there are 102 mentions. I was skeptical, so I checked for myself. What I found left me rolling on the floor in paroxysms of laughter. (more…)

Posted in: Herbs & Supplements

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Twenty days in primary care practice, or “naturopathic residency”

The metastasis of alternative medicine throughout the health care system comes, in no small part, at the hands of the federal and state governments, mostly the latter and most particularly the state legislatures. Under their jurisdiction rests the decision of who can, and cannot, become a licensed health care practitioner, and what they can, and cannot, do. This is the gateway through which much of pseudo-medicine flows.

I’ve read many CAM practitioner licensing statutes (all of the chiropractic practice acts, in fact) and many legislative proposals to license or to expand the scope of practice. Typical of the boilerplate recited in support of this legislation is the education and training of these practitioners, which is touted as a means of protecting the public from charlatans and quacks out there selling snake oil to the credulous. Naturopathic licensing bills routinely require graduation from a naturopathic “medical” school accredited by the Council on Naturopathic Medical Education. (See, for example, Michigan House Bill 4152, which both David Gorski and I have discussed on SBM.) Unfortunately, what CAM provider legislation often does is simply provide legal cover for selling that very same snake oil.

Naturopaths are licensed in 17 states so far, although what they can and can’t do varies considerably. In some states, they have a scope of practice similar to that of an M.D. or D.O. primary care physician. At the most liberal end of this spectrum, N.D.s can prescribe drugs (as Michigan’s bill would allow), although this, too, varies depending on what’s listed on the state’s naturopathic formulary.

All of this has led me to conclude that the state legislatures do not have internet connections. Because, if they did, it would be pretty easy to Google around and figure out just what this naturopathic “medical” education entails and how practicing naturopaths apply their education and training in actual practice. In fact, I’ve done this myself and reported the results here on SBM. In the last day or so, I found out even more by looking around the websites of the Council on Naturopathic Medical Education, the American Association of Accredited Naturopathic Medical Schools, and its member institutions. We’ll get to the fruits of that research in a minute. (more…)

Posted in: Herbs & Supplements, Homeopathy, Legal, Naturopathy, Pharmaceuticals, Politics and Regulation

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Ngrams and CAM

Ngram is a Google analytic tool/way to waste lots of time on the internet, a byproduct of Google’s scanning millions of books into its database. In a matter of seconds, Ngram scans words from about 7.5 million books, an estimated 6 percent of all books ever published. Type a word or phrase in the Ngram Viewer search box and in seconds a chart of its yearly frequency will appear. You can also search for a series of words or phrases and the Viewer will provide a color-coded chart comparing frequency of use. More sophisticated searches (e.g., making the search case sensitive, or not) are also possible.

As explained in the New York Times, researchers “have used this system to analyze centuries of word use, examining the spread of scientific concepts, technological innovations, political repression, and even celebrity fame.” Erez Aiden, a computer scientist who helped create the word frequency tool, says he and his co-researcher, Jean-Baptiste Michel, wanted “to create a scientific measuring instrument, something like a telescope, but instead of pointing it at a star, you point it at human culture.” In fact, the title of their new book is Uncharted: Big Data as a Lens on Human Culture. Still, they caution that, like other scientific tools, Ngram’s results can be misinterpreted. An example: the fax machine. If you query that term, it looks as if the fax appears almost instantaneously in the 1980s. In reality, the machine was invented in the 1840s but was then called the “telefax.”

If Ngram can search for scientific concepts, how about unscientific concepts? What might a search of unscientific concepts tell us about our human culture? Let’s find out. (more…)

Posted in: Acupuncture, Chiropractic, Computers & Internet, Herbs & Supplements, History, Homeopathy, Naturopathy, Traditional Chinese Medicine

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The New Cough and Cold Products for Children: Evidence is Optional and Science is Marketing

Zarbee's Helixia, Oscillococcinum

It’s the time of year where if you’re not sick, someone you know probably is. The influenza season in the Northern hemisphere started out slowly, but seems to be accelerating and hasn’t peaked yet. Add that to cold viruses circulating, and you get the peak purchasing period for cough and cold remedies. John Snyder gave a nice summary of the evidence base for the common treatments a few weeks ago. In short, despite all the advertising, there is little evidence to suggest that most of the “tried and true” products we’ve used for decades have any effect on our symptoms. One of the most sensible developments that’s occurred over the past few years has been the discontinuation or relabeling (depending on your country) of cough and cold products for children. The rationale to pull these products is compelling: Cough and cold remedies have a long history of use, and were sold without prescriptions before current regulatory standards were in place. They were effectively grandfathered onto the marketplace. When it comes to their use in children, the data are even more limited. There are few published trials and the results are complicated by different age groups, irregular dosing, lack of placebo control, and very small patient numbers. What’s even harder to believe was that doses were based mainly on expert opinion, not data, and generally didn’t consider that children don’t handle drugs the way adults do. So why withdraw them from pediatric use, but not adult use? Like most regulation, it comes down to risk and benefit. Both are troubling for pediatric use. (more…)

Posted in: Herbs & Supplements, Science and Medicine

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Vitamin E for Alzheimer’s

Recently you may have seen headlines like “Vitamin E slows decline in patients with mild Alzheimer’s” or “There’s still no cure for Alzheimer’s disease, but the latest hope for slowing its progression is already on drugstore shelves.” They were referring to an article in the January 1, 2014 issue of the Journal of the American Medical Association (JAMA) announcing the results of the TEAM-AD VA Cooperative Randomized Trial of vitamin E and memantine (Namenda) for Alzheimer’s disease (AD).

The study attracted a lot of media attention. Most of the news reports I have seen were accurate and cautious, explaining the nuances of the study rather than suggesting that everyone should run out and buy vitamin E; but I wouldn’t be surprised to learn that a lot of readers ignored the fine print and did just that. It would be interesting to track sales of vitamin E and see if there was a bump following the publicity.

We know of no treatment that will delay, prevent or cure Alzheimer’s disease, or that affects the underlying disease process. It’s a tragic, frustrating disease that takes away the very things that make us who we are: memory and personality. It is affecting more and more people as the numbers of elderly increase. Available prescription medications are only modestly effective in slowing functional decline and delaying the need for institutionalization. They are expensive, they don’t help everyone, and when they do help, they only help for a limited time. It is very exciting to think an inexpensive vitamin could help patients with mild to moderate AD, but we must resist the temptation to read too much into this study. (more…)

Posted in: Clinical Trials, Herbs & Supplements, Neuroscience/Mental Health

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The Detox Scam: How to spot it, and how to avoid it

The Detox and Cleanse Scam

Note to SBM’s regular readers: Today’s post revisits some older material you may have seen before. Happy New Year!

New Year, New You, right? 2014 is the year you’re finally going to get serious about your health. You’re winding down from a week (or more) of celebrations and parties. You’re pretty much recovered from New Year’s Eve by now. It’s time to make some resolutions. Conveniently, there is no shortage of solutions being advertised to absolve you of your sins while overhauling your body and soul for 2014: What you need to do is “detox”. You’ll see the detox kits at your local Whole Foods (or even your local pharmacy). Books, boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths all promise detoxification. The advertising suggests you’ll gain a renewed body and better health – it’s only seven days and $49.95 away. Or try to cleanse yourself with food alone: Dr. Oz is hyping his Holiday Detox plan. Bon Appetit is featuring their 2014 Food Lover’s Cleanse. Or what about that old standby, the “Master Cleanse”? It’s the New Year – wouldn’t a purification from your sins of 2013 be a good idea to start the year? After all, the local naturopath offers complete detoxification protocols, including vitamin drips and chelation. There must be something to it, right? (more…)

Posted in: Health Fraud, Herbs & Supplements, Homeopathy, Naturopathy

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Garcinia Probably Works But Is Far From a Weight Loss Miracle

Women make up a majority of Dr. Oz’s audience. The majority of women would like to lose weight. That is a match made in heaven, a marketer’s dream. And Oz has never hesitated to exploit that fact to increase audience share, playing fast and loose with sensationalized evidence instead of giving his viewers science-based advice.Garcinia

Dr. Oz has promoted a series of weight loss supplements on his show. Raspberry ketones were presented as a fat-busting miracle, then green coffee bean extract was touted as “magic,” “staggering,” and “unprecedented.” And now both of those miracles have apparently been superseded by an even greater miracle: Garcinia cambogia extract.

Dr. Oz calls it “The newest, fastest fat buster.” A way to lose weight without “spending every waking moment exercising and dieting.” “Triples your weight loss.” “The most exciting breakthrough in natural weight loss to date.” “The Holy Grail.” Oz claims that “Revolutionary new research says it could be the magic ingredient that lets you lose weight without diet or exercise.” That sounds too good to be true, and it is. Garcinia probably does work to some extent to improve weight loss, but the evidence doesn’t begin to justify such grandiose claims. (more…)

Posted in: Herbs & Supplements, Science and the Media

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