Articles

Archive for Science and Medicine

The future of “integrative medicine” is too close for comfort

I was the other day. I’ve been on vacation this week (staycation, actually, as I stayed at home and didn’t go on any trips); so you would think it would take a lot to depress me. Unfortunately, today is the last day of that vacation; so the thought of diving back into the fray trying to fund my lab. It didn’t help that I read Scott Gavura’s Thursday post how another once-proud academic medical center, the University of Toronto, is letting the Trojan horse that is “integrative medicine” into the halls of its medical school and school of pharmacy. As I frequently say, much to the annoyance of advocates of “complementary and alternative medicine” (CAM) and “integrative medicine,” what “integrative medicine” does is to “integrate” quackery with real medicine, which neither validates the quackery nor improves the real medicine. Or, as my good bud and fellow SBM blogger Mark Crislip so aptly put it:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

Yes, I’ve been trying to come up with a quote that captures the essence of “integrative medicine” better than Mark’s quote. I’ve yet to succeed; so I steal his quote whenever I need to. It’s sort of the same way that I didn’t actually coin the term “quackademic medicine” to describe the infiltration of quackery into academic medicine. (Dr. R. W. Donnell did, as far as I’ve been able to ascertain.) However, I believe I’ve done more than anyone else to use and promote the term, both here and at my not-so-super-secret other blog. As I like to say say, mediocre bloggers borrow. Great bloggers steal.

Be that as it may, Scott’s post reminded me that I hadn’t looked much at quackademic medicine, at least not at the status of its infiltration into medical academia, in a while. Then I saw a review article entitled The Future of Integrative Medicine in The American Journal of Medicine by Victor S. Sierpina, MD, ABFM, ABIHM and James E. Dalen, MD, MPH. (Note that ABIHM stands for the American Board of Integrative Holistic Medicine and ABFM stands for the American Board of Family Medicine.). The article itself has no place in any self-respecting peer-reviewed medical journal, but there it is, much the same way that quackademic woo has been intermittently infiltrating the New England Journal of Medicine. The article itself is one massive apologia for integrative medicine. In fact, it’s useful to look at because it follows a script that virtually all such articles follow, with only relatively minor variations.

(more…)

Posted in: Medical Academia, Science and Medicine

Leave a Comment (26) →

California Acupuncturists Don’t Need to Know English!

English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy and should not be used by the Board to discriminate against talented and skilled individuals who seek to provide high-quality acupuncture services in California.

— State Senators Curren D. Price Jr. and Darrell Steinberg, letter to the California Acupuncture Board, March 22, 2013.

To appreciate the recklessness of this statement, and to illustrate the Senators’ disconnect with the reality of Oriental medicine, let’s take a look at a consummate example of services provided by acupuncturists. The following video features the “Master” Kim Nam-soo demonstrating his moxibustion technique. He conducted a similar workshop for future acupuncturists in 2010 at Emperor’s College of Traditional Oriental Medicine in Santa Monica, CA. Make sure you do not miss the part where the Master is skillfully adding his own spit to the treatment!

Kim Nam-Soo (also known as “Gudang”) is a 97-year-old acupuncturist from South Korea. In this video, he is teaching a form of moxibustion (burning of a mugwort cone on or near the skin). He is first preparing a wad of mugwort (Artemisia vulgaris), he is then placing it on an acupuncture point and burning it with an incense stick. Note that he is using his own saliva to make the mugwort more malleable before sticking it to the patient’s skin!

Besides acupuncture and moxibustion, the other services these “talented and skilled” individuals provide consist of massage, cupping, breathing techniques, and the use of herbal, animal and mineral products. In most states, bloodletting is not part of their scope of practice — except for Arkansas.
(more…)

Posted in: Acupuncture, Politics and Regulation, Public Health, Science and Medicine, Traditional Chinese Medicine

Leave a Comment (48) →

The Trojan Horse called Integrative Medicine arrives at another medical school

Trojan Rabbit

Medicine is a collaborative practice. Hospitals are the best example, where dozens of different health professionals work cooperatively, sharing responsibilities for patient care. Teamwork is essential, and that’s why health professionals obtain a large part of their education on the job, in teaching (academic) hospitals. The only way that all of these different professions are able to work together effectively is that their foundations are based on an important, yet simple, principle. All of us have education and training grounded in basic scientific principles of medicine. Biochemistry, pharmacology, physiology – we all work from within the same framework. As a pharmacist, my role might include working with physicians and nurses to manage and monitor medication use. A team approach is only possible when you’re working from the same playbook, and with the same aim. And in medicine, that playbook is science.

That’s why “integrative” medicine frightens me so much. Integrative medicine is a tactic embedding complementary and alternative medical practices into conventional medical care. Imagine “integrating” a practitioner into the health system that doesn’t accept germ theory. Or basic disease definitions. Or the effectiveness of vaccines. Or even basic biochemistry – perhaps they believe in treatments that restore the body’s “vital force” or manipulate some sort of “energy fields”. Instead of relying on objective signs and symptoms, they base treatments on pre-scientific beliefs, long discarded from medicine. There may be entirely different treatment goals, which are potentially antagonistic to the scientific standard. Imagine a hospital or academic setting where this occurs, and the potential impact on the quality of care that is delivered. (more…)

Posted in: Acupuncture, Medical Academia, Science and Medicine, Traditional Chinese Medicine

Leave a Comment (129) →

Survey Says…

Surveys are evidently a popular way to get a paper published. Put “complementary alternative medicine survey” into Pubmed and get 2,353 hits. I would have trouble coming up with a hundred groups about whom I would be interested in their use of SCAMs, but I tend to be a lumper rather than a splitter. But if you want to know about SCAM use in chronic pain patients in one Singapore hospital, the information is available.

I am a survey magnet and a remarkable number of people send me dead tree and electronic surveys which I generally ignore. So people like me, those who ignore surveys (but support public television), are underrepresented in surveys. But evidently there is no group whose attitudes about SCAM are not amenable to analysis including my medical brethren, Infectious Disease doctors.

So I was understandably curious when I was sent a link to “Infectious Diseases Physicians’ Attitudes and Practices Related to Complementary and Integrative Medicine: Results of a National Survey“. The abstract makes it sound like my colleagues are a bunch of ignorant rubes who just fell off the turnip truck: (more…)

Posted in: Acupuncture, Clinical Trials, Critical Thinking, Homeopathy, Science and Medicine

Leave a Comment (34) →

A Different Perspective: Placebo, SCAM, and Advertising

Summertime, time, time

Child, the living’s easy.

Fish are jumping out

And the handicap, Lord

Handicaps high, Lord so high

~ Janis Joplin

It is summer. Time for the kids and the outside, not the computer. What follows is a summertime blog entry, for which I admit to feeling guilty for the comparatively little time I have spent on it, but as I have said before, no dying patient has ever told me “Doc, I wish I had spent more time at work.”

Mt. Hood has been a constant feature to the east my entire life. The mountain, on a clear day at least, is Portland’s most impressive geologic feature. If you are in the right part of the city, you may see Mt. St. Helens or the tips of Jefferson, Adams and even Rainier, but Mt. Hood dominates. It is solitary mass of rock, (diminishing) ice and snow only 50 miles from where I live. I have spent uncountable hours hiking in the Mt. Hood wilderness. When I think of Mt. Hood, in my mind’s eye it is from the perspective of west Portland looking east.

Last week was our yearly summer vacation in Sunriver, just south of Bend Oregon on the eastern side of the cascades in the Oregon High Desert. Driving north/south on highway 97 puts Mt. Hood in a different perspective. From the high desert you can see the huge swaths of the Cascades: calderas, mountains, lava fields and cinder cones. You see Mt. Hood differently. Not a single mountain to the east, but part of a chain of recent and distant historical volcanic activity along the Rim of Fire. Photographs do not do the view of the Cascades justice from this vantage point.

The eastern view puts Mt. Hood in a broader geologic and time perspective. It is still the same Mt. Hood, but in a different context. Like running into a nurse outside of the hospital, you have to recalibrate the context in which you understand and know the person.

I have written on placebo, the placebo effect, and its relationship to SCAM. To my understanding the preponderance of literature indicates there is no placebo effect upon any objective medical problem, only a change in the patients perspective of the problem. (more…)

Posted in: Basic Science, Clinical Trials, Science and Medicine

Leave a Comment (32) →

Irlen Syndrome

Those who cannot remember the past are condemned to repeat it.
– George Santayana

Science-based medicine is more than a set of methods or certain philosophy of medicine – it is an entire approach to what should be the core questions for any interventionist profession: is it real and does it work?

These are often deceptively difficult questions to answer. Fortunately we have at least a century of experience applying systematic methods to answering these questions within the context of medicine. This is a wealth of history from which to learn, full of cautionary tales and enlightening examples.

However, as Winston Churchill lamented, we tend to forget the lessons of the past leading to, “…the most thoughtless of ages. Every day headlines and short views.”

Part of the mission of science-based medicine (and skepticism in general) is to remember the lessons of the past as they relate to science and pseudoscience, and to constantly remind the public and our colleagues of these lessons.

(more…)

Posted in: Science and Medicine

Leave a Comment (330) →

“Postnatal depression blood test breakthrough” or Churnalism?

Postnatal depression blood test breakthrough” proclaimed the headline. The UK Guardian article then declared:

British doctors reveal ‘extremely important’ research that could help tens of thousands of women at risk.

Here it comes. Readers were going to be fed a press release generated by the study’s authors and forwarded undigested by the media but disguised as writings of a journalist.  If only the journo had asked someone in the know about the likelihood of a single study yielding such breakthrough blood test for risk of depression in new mothers.

The story echoed earlier churnalism from Sky News, British satellite television news service:

There is evidence that if you can identify women at risk early you could treat early or introduce measures to prevent or stop the process of the disease.

A study of 200 pregnant women, published in the Journal of Psychiatric Research, found two molecular “signatures” in the genes that increased the risk of postnatal depression by up to five times. One in seven new mothers suffer from depression.
(more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

Leave a Comment (7) →

The Overuse of Antibiotics for Viral Infections in Children

“For every complex problem there is an answer that is clear, simple, and wrong.”

-H. L. Mencken

This approach is not endorsed by the American Academy of Pediatrics.

As I sit in an apartment full of unpacked boxes and grumpy children, only a few days removed from driving 1,600 miles to a 3rd floor walk-up and a better life just outside of Boston, I find the task of writing a post somewhat daunting. But I must admit that this new town is not without the potential for inspiring future musings. In fact, I find myself surrounded by irregular medicine of all shapes, sizes and dilutions.

Next door is a chiropractor who cures Tourette’s syndrome and, according to the pamphlet available outside the clinic entrance, only uses the in-house x-ray machine on select patients who truly need it. A few buildings down from me is an acupuncturist that treats athletic injuries with ear acupuncture and Kinesio-tape while liberally sprinkling references to his practice of “sports medicine” and “orthopedics” throughout the clinic’s promotional material. But at least I was reassured that acupuncture is completely harmless because it is a natural medicine. Finally, a block further down the road, completing my welcome committee of woo is a clinic that uses homeopathy to treat just about every real and fictional condition under the sun. I checked out their website and it’s a good thing that the walls are well insulated or my neighbors would have surely been forced to ignore the sound of my forehead pounding a wooden desk like a flagellant monk hoping for divine intervention.
(more…)

Posted in: Medical Ethics, Science and Medicine

Leave a Comment (26) →

Yoga Woo

Yoga is an increasingly popular form of exercise in the US. According to Yoga Journal more than 20 million Americans use yoga as their form of exercise. As a form of exercise yoga is fairly straightforward, involving stretching and holding poses that strengthen muscles. It also carries the generic benefits of any exercise in terms of calorie-burning and cardiovascular health.

Yoga, however, is more than exercise – it also comes with a “spiritual” angle. The term itself refers to a number of practices originating in ancient India meant to strength mind, body, and spirit. For this reason it has become a popular target for marketing the latest health pseudoscience. You will be hard pressed, in fact, to find a yoga class that does not incorporate some degree of outright woo, the only question really is not if, but how much. This is unfortunate because yoga may be an effective alternative for low-impact exercise.

There is some evidence that yoga, for example, is effective in relieving low back pain, although it may not be more effective than usual care. There is a lack of quality studies comparing yoga to other forms of exercise, and so we may just be seeing the generic benefits of exercise. Still, if the classes are fun and they keep people motivated to continue their exercise regimen, that is useful.

Yoga, therefore, fits into a more general phenomenon of marketing a specific intervention as if it has specific benefits, when in fact it only has generic benefits. For example, there are many studies showing that transcendental meditation is effective for lowering blood pressure. However, studies generally compare TM to no intervention, not to other forms of relaxation. The parsimonious interpretation is that TM confers the generic benefits of relaxation, but there is no evidence to suggest it confers any specific benefits.

(more…)

Posted in: Science and Medicine

Leave a Comment (44) →

Religion and SCAM

I do not worry much about being dead although the process of getting there gives me pause. I have witnessed a few unpleasant deaths and I hope to never see the Grim Reaper coming my way.

One of the more awful and pointless deaths occurred early in my career. I had a patient with hepatitis C and cirrhosis. He had low platelets, low clotting factors (many of which are made by the liver), a previously undiagnosed clotting disorder, and a mouth full of bad teeth that were removed all at once when he acquired dental insurance.

Then he started to ooze blood from his extractions. An ooze that did not stop, it was a constant trickle of blood that would not clot. After several visits to his dentist he almost passed out and came to the emergency room. After 4 days he had bled out about half his blood volume, his haemoglobin had gone from 12 to 6. At this point we geared up for transfusions of red cells and clotting factors and he let us know that he was a Jehovah’s Witness and, no thank you, he would not accept any blood or blood products.

For the next week he continued to ooze despite all the interventions we could come up with to stop the bleeding and he remained adamant in his refusal of transfusions of any kind, despite the risk of death. At about a hemoglobin of 2 he had a large stroke and severe muscle pain from ischemia. At 1 he had a large heart attack and died. If you could rank deaths as pointless and horrific, this would be in my top 10. And I was struck at how nonplussed the family was, accepting this completely preventable death matter-of-factly. (more…)

Posted in: Science and Medicine

Leave a Comment (121) →
Page 10 of 81 «...89101112...»