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Integrative Medicine’s Collateral Damage

Integrative medicine combines the practice of medicine with alternative medicine. Proponents tend to take a paragraph or two to say this, but that is what remains when boiled down to its essence. By putting this more concise definition together with Tim Minchin’s often-quoted observation about alternative medicine, you get: integrative medicine is the practice of medicine combined with medicine that either has not been proved to work or proved not to work. If it is proved to work, it is medicine.

I couldn’t find an official start date for integrative medicine, but it seems to have been around for about 15-20 years. (Osher Center for Integrative Medicine at the University of California, San Francisco, an early adapter, opened in 1997.) Yet despite some lofty pronouncements about transforming patient care, there is still no good evidence that integrative medicine improves patient outcomes. It seems unlikely that such evidence is forthcoming. It is illogical to assume that adding therapies that do not work, or are proven not to work, would benefit a patient except by inducing the ethically problematic placebo response.

Whatever its goals initially, integrative medicine now appears to serve two purposes. First, it attracts funding from wealthy patrons (Samueli, Bravewell) and the government (the military, NCCAM). Second, it is a marketing device used by hospitals, academic medical centers and individual practitioners. As an added bonus, alternative medicine is usually fee-for-service because very little of it is covered by insurance. And whatever its charms as a money-making device, given the lack of proven health benefit it is fair to ask: is integrative medicine worth it? To answer that question, let us look at what might be called the supply side of integrative medicine practitioners’ delivery of alternative medicine. Here we run into some unpleasant facts proponents seem unwilling to acknowledge: integrative medicine’s collateral damage. (more…)

Posted in: Acupuncture, Chiropractic, Energy Medicine, Herbs & Supplements, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Traditional Chinese Medicine, Vaccines

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Licensing Naturopaths: the triumph of politics over science

Naturopaths shouldn’t get too excited about having a special week in their honor. The U.S. House of Representatives gave watermelons a whole month. As between naturopathy and watermelons for my good health, I’ll go with the watermelons any day. You’ll soon understand why.

Today is not my usual blogging day. But when David Gorksi announced SBM’s celebration of Naturopathic Medicine Week, I volunteered an extra post to answer the question I am sure is on everyone’s mind: How in the heck do they get away with this stuff?

The answer lies in the creation of Naturopathic Medicine Week itself: politics. Just as Sen. Barbara Mikulski turned her credulous acceptance of naturopathy into a Senate Resolution and slipped it by her Senate colleagues, clueless legislators around the country are sponsoring bills to license naturopaths, in some cases as primary care physicians. And it’s not as if these legislators don’t know they are incorporating quackery into primary care. Practices such as naturopathic “organ repositioning” (an anatomical impossibility) and Mark Crislip noted, what little data there is suggests that naturopathic primary care is associated with worse outcomes. But evidence is not necessary in the political realm. And now the political process has given naturopaths an additional incentive for licensure. They argue that the Affordable Care Act mandates reimbursement for their services. (more…)

Posted in: Cancer, Energy Medicine, Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

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Biotin: Haircuts Plus Health Advice?

A friend asked me, “What do you know about biotin?”

I said, “Not much. Why do you ask?”

She explained that the woman who cuts her hair at the hair salon recommended she take biotin to strengthen her nails and improve hair growth. She tried it, and within a couple of months, her nails looked better than they ever had in her whole life: the ridging was gone and they were no longer splitting or bending. And her hair, which had begun to thin, was noticeably thicker again.

I know what you’re going to say: this is nothing but a testimonial, and she could have been mistaken: post hoc ergo propter hoc and all that. Hair salons are not reliable sources of health advice, and perhaps not even a very reliable source of hair advice. I am leery of their recommendations for expensive shampoos and gimmicky conditioners. They offer things I don’t want, like hair coloring (I consider my gray hairs hard-earned badges of honor), waxing, eyebrow arch threading, scalp massage, and facials. Some of them have tanning beds in a back room. Incredibly, several of them in my area even offer ear candling! (more…)

Posted in: Herbs & Supplements

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Dietary supplement industry says “no” to more information for consumers (again)

Once again, the dietary supplement industry is fighting efforts to give consumers more information about the safety and effectiveness of dietary supplements.

Big Supp is very clever. It sells consumers on the phony idea that they need dietary supplements for good health. Even as the evidence continues to mount that consumers don’t need supplements and shouldn’t take them, the industry continues to convince the public otherwise. And in 2011 they raked in $30 billion.

The state and federal governments have served as handmaidens to the industry in this clever marketing strategy. Congress’s gift to the supplement industry, the Orwellian-named Dietary Supplement Health and Education Act (DSHEA) “effectively excludes manufacturers of these products from virtually all regulations that are in place for prescription and over-the-counter drugs, and puts the requirement to demonstrate harm on the FDA, rather than the onus on the manufacturer to show a product is safe and effective,” as SBM’s Scott Gavura pointed out. DSHEA allows supplements to make “structure and function” claims, although no one seems to know what that means, including the FDA.

States have done their part in granting chiropractors and naturopaths the authority to give “nutritional” advice and recommend dietary supplements, sometimes on the basis of dubious diagnostic testing purporting to reveal imagined nutritional deficiencies. This gives them carte blanche to sell supplements to their patients, a clear conflict of interest.

And when proposed regulation threatens their profits, the dietary supplement industry and its surrogates enlist the very public it duped to join the battle. The industry convinces the public that someone is trying to take away their access to supplements they never needed in the first place. This threat is dressed up in terms designed to push all the buttons of a public already primed to be leery of “the government” – their “health freedom” may be taken away. Actually, freedom to choose among health care practices is most threatened by withholding readily-available information which would adequately inform health care decisions. (more…)

Posted in: Herbs & Supplements, Legal, Politics and Regulation, Public Health

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CAM Docket: Functional Endocrinology Update

Sometimes the media gets it right.

From time to time, SBM has reported on the disheartening credulity of reporters when they cover so-called “alternative” medicine. Denver’s Channel 7, an ABC affiliate, is a happy exception to the rule. Reporter Theresa Marchetta first broke the story of Brandon and Heather Credeur, chiropractors practicing “Functional Endocrinology.” And for three years Marchetta, with the assistance of reporter Phil Tenser, followed up, interviewing hundreds of patients who lost thousands of dollars paid to the Functional Endocrinology Center of Colorado for treatment of their diabetes and other endocrine disorders. They’ve reported regularly as the Credeurs legal travails progressed through various judicial and administrative forums. Channel 7 and its reporters deserve substantial credit for pursing this story. The Credeurs might have escaped further censure without their persistence.

Another recurring frustration at SBM is medicine’s embrace of alternative medicine, expressed repeatedly at SBM in posts on quackademic medicine and the branding device known as integrative medicine. We’ve also lamented the seeming complicity of the state medical societies in allowing quackery to be legalized in the form of complementary and alternative medicine provider practice acts.

But sometimes medicine gets it right.

The Colorado Medical Board has somewhat redeemed itself in ordering Brandon and Health Credeur to cease and desist the unlicensed practice of medicine. That’s right. A medical board has finally put its collective foot down and pushed back against chiropractic’s increasingly aggressive push to practice medicine.

And sometimes SBM appears to be making inroads into the hostile incursion of alternative medicine.

I recently discovered that if you google “functional endocrinology”, first up on the list is CAM Docket: Functional Endocrinology, the very post updated today. Admittedly, it appears at the head of a depressingly long list of chiropractic websites advertising the practice, but at least we get a first crack at anyone who might be considering paying thousands of dollars and wasting time, and perhaps their health, on this useless nonsense.

A trifecta in the war on quackery! Revel in this victory, supporters of science-based medicine, for it is small and the victory may be fleeting. Let’s see how the battle is going. (more…)

Posted in: Chiropractic, Health Fraud, Herbs & Supplements

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I’ve been prescribed an antibiotic. Should I take a probiotic?

We are not one organism, we are many organisms. And when we disturb the relationship with our symbiotic partners, we can suffer unpleasant and sometimes life-threatening consequences. One of the most fascinating areas of medical research is the study of how our bodies interact with the the various organisms that we carry around, on us and in us. A focus is the gastrointestinal tract, particularly how the composition and function of those organisms contribute to what we think of as “normal” function, and how they can affect our risk for obesity and disease. My favorite analogy is from SBM’s own Mark Crislip who likened it to a “metaphorical rainforest” giving a vivid mental image of the of the number of species (thousands) in our guts, and the complexity of that ecology. If the gastrointestinal tract is a rainforest, then antibiotics are the metaphorical clear cutters, wiping out some of the normal bacteria, and creating the conditions where unwanted bacteria can grow.

Antibiotics are among the most useful (if not the most useful) classes of drugs in widespread use today. They’re also among the most widely prescribed, and both antibiotic overuse and their addition to animal feed present real dangers to their ongoing effectiveness. Their popularity stems in part from their effectiveness, but also from the perception that they are safe. And, in general, a course of most antibiotics is usually well tolerated. Among the side effects, diarrhea is common (with an incidence of 5% to 39%). It’s due in part to the antibiotic killing off  our normal “good” bacteria, which can significantly change the most prevalent species. In some cases, “bad” bacteria can surge as a result. Clostridium difficile infection is pretty much the worst gastrointestinal consequence of antibiotic therapy. It isn’t just a cause of antibiotic-induced diarrhea, “C. diff” infections are virulent and vicious, spreading easily, especially among hospitalized patients, causing widespread misery and even killing. (more…)

Posted in: Herbs & Supplements

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Melatonin for sleep disorders – Safe and effective?

It’s summertime, and the living is easy. Forget the solstice. For most of North America, this week is the real start of summer – July 1 in Canada, and July 4 in the USA. Vacation time means breaking out of that those usual routines of work and school. I’m amazed after a few weeks of vacation how much sleep my body will accept if given the opportunity, where it will climb from six to nine hours a night within a week. I try not to change my kids’ habits too much, and one area I’m fairly disciplined with is maintaining a predictable sleep/wake cycle, even when they’re on vacation. I’ve learned, mainly through trial and error, that I suffer the consequences when my own kids don’t get enough sleep, or when their sleep cycle is thrown off. It wasn’t always like this. I remember a period of what felt like years when I had to crawl out of my child’s bedroom on my hands and knees so as to not disturb a child who simply would not fall asleep. And when it finally, mercifully, occurred, it would be a brief respite before the cycle began again. The sleepless nights left us all cranky and exhausted. Admittedly I was fortunate, either due to my successful parenting (but more likely mean reversion) and my kids are pretty good sleepers now. I’m reminded of my good fortune when I speak with exhausted and frustrated parents who have children that cannot sleep and are worried about the causes and consequences of persistent insomnia. As a pharmacist I’m regularly asked about insomnia for both kids and adults as there are a number of over-the-counter products available, and many consumers are understandably apprehensive about seeking out prescription products. Tell someone there’s “natural supplement” for sleep and there’s usually a lot of interest. That’s what I’ve seen with melatonin, a hormone that is sold without a prescription in Canada, the United States, and other countries. It is widely perceived as safe and alternative health purveyors like naturopaths, and even some health professionals, may recommend it for treating sleeping problems in both adults and children. Beyond sleeping, some believe melatonin is a wonder drug with efficacy for diseases ranging from chronic fatigue to cancer to irritable bowel. (more…)

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

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Coenzyme Q10 for heart failure: The hype and the science

Could a product sold as a dietary supplement really be delivering the benefits that advocates have claimed for decades? That’s what you might be wondering about coenzyme Q10, following recent stories like:

What’s caused all the excitement about CoQ10 is the Q-SYMBIO trial, more properly called “The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure”, presented at the European Society of Cardiology conference last month. I’d normally wait for the full article to come out, and will review it if possible at that time, but the results are too interesting to ignore so I’ll dive into the study and the reaction – which is equally as interesting for advocates of science-based medicine. (more…)

Posted in: Clinical Trials, Herbs & Supplements

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“Sense and nonsense” about alternative medicine in USA Today

Sometimes, between blogging, a demanding day (and night) job doing surgery and science, and everything else, I embarrass myself. Sure, sometimes I embarrass myself by saying something that, in retrospect, I wish I hadn’t. More often, I embarrass myself by letting things slide that I shouldn’t. For instance, when friends send me a prepublication copy of their books, I should damned well read them, don’t you think? So it was that Paul Offit sent me a copy of his latest book, which just hit the bookstores and online outlets this week, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, and I haven’t finished it. Oh, I’ve read a good chunk of it, but it’s not a huge book (around 335 pages); so I should have finished it by now, particularly since it’s quite good. My failure to properly read and plug the book aside, I’m glad to see that the book’s getting attention in a large media outlet, namely USA Today, in an article by Liz Szabo Book raises alarms about alternative medicine. There’s also a companion piece How to guard against a quack. I figure that the least I can do is to plug Dr. Offit’s book and the USA Today story in which he is featured, just as Harriet plugged his recent speaking appearance.

It’s also nice that Steve Novella and I were both interviewed. Now, excuse me while I get back to doing what I really should have had finished a month or two ago: Reading Dr. Offit’s excellent book.

Posted in: Book & movie reviews, Cancer, Health Fraud, Herbs & Supplements

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Tag Away

Skin tags

Skin tags

Skin tags (acrochordon) are benign growths, often raised on a pedicle with a tiny stem. 46% of the population has one or more of them.  They are usually ignored, but some people think they are ugly and want to get rid of them, and sometimes the lesions rub on clothing and become irritated. Never fear! Tag Away is here!

I saw it advertised on TV.  They said it is “not available in stores.” But they only meant their special TV offer is not available in stores. You can buy Tag Away on Amazon.com, at Walgreens, at Walmart, and elsewhere. Tag Away is an all-natural product that promises to remove unsightly skin tags painlessly. It comes in a 15 cc bottle and is applied with a cotton swab 3 times daily for 3-8 weeks. One website claims:

One of the secrets of this product’s amazing success rate is Thuka [sic] Occidentalis, which is world-renowned for its ability to eradicate even the largest, most unsightly skin tags.

That’s not true. It doesn’t have an amazing success rate, it’s not world-renowned, and there’s no evidence that it can actually remove skin tags of any size. (more…)

Posted in: Herbs & Supplements, Homeopathy

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