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National Health Interview Survey 2007 – CAM Use by Adults

The Center for Disease Control (CDC) conducts an ongoing telephone survey of medical problems and health care utilization – called the National Health Interview Survey (NHIS). They recently released their data from 2007. This is the first year for which they specifically broke out questions assessing the use of so-called complementary and alternative medicine (CAM).

CAM is a political/ideological entity, not a scientific one. It is an artificial category created for the purpose of promoting a diverse set of dubious, untested, or fraudulent health practices. It is an excellent example of the (successful) use of language as a propaganda tool.

The fundamental intellectual flaw of “CAM” as a concept is that it is made to include modalities that are extremely diverse, even mutually contradictory, under one umbrella. Very deliberately modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities.

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Posted in: Public Health, Science and Medicine

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Is Kava Safe?

Kava is a plant that grows in the western Pacific. It was traditionally prepared as a drink and used for its psychoactive properties, including sedation, relaxation, and relief of anxiety. It is intoxicating but not addictive.

It has become a popular supplement in the US, used to treat anxiety, depression, insomnia, stress, and menopausal symptoms. It has also been suspected of killing quite a few people.

The AAFP Recommends Kava

In August 2007 American Family Physician, the journal of the American Academy of Family Physicians, published an article on “Herbal and Dietary Supplements for Treatment of Anxiety Disorders.”

They concluded that

St. John’s wort, valerian, and omega-3 fatty acids have little therapeutic value for anxiety disorders, and their use should be discouraged.

But they recommended kava. Not only that, they gave it the highest quality-of-evidence rating: A. They said,

Short-term use of kava is recommended for patients with mild to moderate anxiety disorders who are not using alcohol or taking other medicines metabolized by the liver, but who wish to use “natural” remedies.

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Posted in: Herbs & Supplements

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The worst of times for antivaccine believers: Yet another study fails to show any link between the MMR vaccine and autism

ResearchBlogging.orgTHE BEST OF TIMES

It was the best of times (for antivaccinationists). It was the worst of times (for antivaccinationists). It was the age of wisdom (definitely not for antivaccinationists). It was the age of foolishness (definitely for antivaccinationists). It was the epoch of belief (for antivaccinationists).

Such is the time we live in, my apologies to Charles Dickens, even though he is long dead.

Let’s face it. If we ignore the science, it is, alas, indeed the best of times for antivaccinationists. I’ve lamented the rise of non-science-based fearmongering among the antivaccine brigade before many times. Indeed, I’ve lamented how the influence of ignorant, unscientific dolts like Jenny McCarthy spouting nonsense about vaccines has already resulted in the resurgence of vaccine-preventable diseases such as measles in areas of the U.S. to the point where I’m not along in fearing that the bad old days will soon return, just as Andrew Wakefield’s litigation- and money-driven “studies” suggesting that the MMR was somehow responsible for autism and GI problems linked with autism resulted in the measles going from being conquered in the U.K. 14 years ago to being declared endemic again there, all because of the fear stoked in parents by bad science, paranoia, and anti-vaccine fearmongering.

Truly, it is the best of times for antivaccinationists, or so it seems from a superficial view.
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Posted in: Clinical Trials, Public Health, Science and the Media, Vaccines

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Prepare for Surgery, Heal Faster?

Quacks and their apologists often cite surgery and emergency treatments of traumatic injury and a few other catastrophic or potentially catastrophic events as the only ”conventional” or “allopathic” methods that they consistently recommend. Explicitly or implicitly, for most problems they tout “holistic” or “CAM” treatments. In modern medicine, however, there are plenty of non-surgical and non-emergency treatments whose outcomes are so manifest that even the most exuberant advocates of implausible medical claims (IMC) seem careful to steer clear, lest they blow their cover. Where are the promoters or consumers of homeopathic contraceptives? Why haven’t we heard of a chiropractic adjustment for high blood sugar? How many pitches for Ayurvedic treatments of gout have you seen? There are exceptions, of course, the most notable being the nearly ubiquitous anti-immunization stance among IMC promoters.

Anesthesiology and Implausible Claims

In my day job I specialize in anesthesiology, a non-surgical field whose methods are so obviously effective that little is heard from the IMC crowd. Consider: is it likely that even the slickest of the current crop of snake oil salesmen, if they had the bad sense to try, could talk many people into accepting an implausible method for rendering the body insensible to pain? No, that would require a more effective form of persuasion, such as that used in China to promote “acupuncture anesthesia” from the mid-1950s until the end of the Cultural Revolution in 1976. That’s a story I’ll tell another time.

A few other implausible claims have crept into the broader realm of anesthesiology. Stimulation of the “pericardial 6″ acupuncture point on the ventral aspect of the wrist is said to prevent post-operative nausea. There is little basis for this, the Cochrane Review notwithstanding. Verbal messages, given to a patient under general anesthesia, are said to result in “faster healing.” The major proponent of this claim is Peggy Huddleston, a self-described psychotherapist with an M.T.S. (Master of Theological Studies) degree from the Harvard Divinity School. Ms. Huddleston appears to have parlayed the “faster healing” claim into a successful entreprenurial venture, featuring a website, workshops, CDs, and a book:

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Posted in: Book & movie reviews, Science and Medicine

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The Importance and Limitations of Peer-Review

Peer-review is a critical part of the functioning of the scientific community, of quality control, and the self corrective nature of science. But it is no panacea. It is helpful to understand what it is, and what it isn’t, its uses and abuses.

Overview

When the statement is made that research is “peer-reviewed” this is usually meant to refer to the fact that it has been published in a peer-reviewed journal. Different scientific disciplines have different mechanisms for determining which journals are legitimately peer-reviewed. In medicine the National Library of Medicine (NLM) has rules for peer-review and they decide on a case by case basis which journals get their stamp of approval. Such journals are then listed as peer-reviewed.

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Posted in: Clinical Trials, Science and Medicine

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Misleading Ads for Back Pain Treatment

There was a full-page ad in my local paper today for Back in Action Spine and Health Centers, targeted at sufferers from almost any kind of chronic back pain. It started with “Are You Ready to Throw in the Towel and Just Live with Hurting So Bad?” It went on to make a number of claims:

  • Doctors can fix the problem.
  • Breakthrough medical technologies.
  • Treatments are FDA cleared.
  • Treatments are scientifically proven.
  • No side effects.
  • Best kept secrets for healing “bad backs.”
  • Corrects scoliosis.
  • Corrects compressed discs.
  • Several university studies at Johns Hopkins, Stanford and Duke have confirmed that these treatments work.
  • Medical researchers have reported these methods up to 89% effective.
  • Treatments work for back and neck pain, sciatica/numbness, herniated and/or bulging discs, degenerative disc disease (arthritis), spinal stenosis, facet syndromes, spondylolisthesis.
  • Their questionnaire can determine who will benefit – if you fit even one criterion like “does your back feel out of alignment?” or “do you have arthritis?” you should call right away.

The ad offers a “Free Qualifying Exam” but you “Must Not Wait” because appointments are limited and they can only honor this free offer for 3 weeks. To encourage you to call, they sweeten the pot with a FREE $49 gift bag.

Are you suspicious yet? You should be. (more…)

Posted in: Chiropractic, Health Fraud

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“Patient-Centered Care” and the Society for Integrative Oncology

Should Medical Journals Inform Readers if a Book Reviewer can’t be Objective?

At the end of last week’s post I suggested that book reviewer Donald Abrams and the New England Journal of Medicine had withheld information useful for evaluating Abrams’ review: that he is the Secretary/Treasurer of the Society for Integrative Oncology (SIO), the organization of which Lorenzo Cohen, the first editor of the book that Abrams reviewed,* is President. I also promised to look at material from the book and from the Society’s website in order to discover “data that will allow even the most conventional oncologists to appreciate [the value of 'integrative' methods].”

There is little question that Abrams and Cohen know each other, or at least that Abrams couldn’t have been expected to write an entirely objective review of Cohen’s book. Abrams is the Program Chair for the Society’s upcoming 5th International Conference, sponsored by the American Cancer Society. He and Cohen will be sharing the stage for the “Intro/Welcome.” Does it matter that most NEJM readers wouldn’t have learned of this association by reading the review? Probably not, in the case of readers who are well-versed in the misleading language of “CAM.”

I believe that most readers of medical journals are not so sophisticated. Otherwise, how could it have been so easy for “CAM” literature to seep through the usual evaluative filters, not only in medical schools and government but in the editorial boardrooms of prestigious journals? For anyone from the Journal who might be following this thread, Dr. Sampson’s satirical but deadly serious account of “how we did it” is obligatory reading.

Do “Integrative Oncology” Methods have Value?

Now let’s take a look at what Dr. Cohen’s book and the SIO are up to. The book’s introduction and table of contents are available on Amazon.com. The introduction contains the usual, misleading assertions and falsehoods that are ubiquitous in “CAM” promotions. I’ve added a few hyperlinks:

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Posted in: Book & movie reviews, Cancer, Energy Medicine, Medical Ethics

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Attitudes and Public Health

Increasingly there is a cultural trend toward health care freedom and empowerment. This trend is partly a reaction to the paternalism of the past, and reflects an overall change in attitude by the public toward all institutions and authority. Within medicine there has also been a move toward the partnership model of practice – where patients are well-informed full partners in the decision-making process. But this trend has also been fueled by providers who want the public to have the freedom to choose their unconventional treatment, even if it does not meet reasonable standards for evidence or even ethics.

In addition the public must deal with an increasingly free health care market with an expanding array of products, and claims to back them up. The internet has served to facilitate and accelerate this process.

Therefore public education about common health matters is more important than ever. Part of the mission for this blog is to improve public health education, to correct common misconceptions, help put recent research into proper perspective, and to counter false or misleading propaganda or marketing claims. There seems to be an intense need for such correction, and mainstream media and the internet are full of misinformation. News outlets are a mixed-bag, sometimes providing helpful information, but more often emphasizing unusual or dramatic health risks while ignoring far more important but less interesting ones.

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Posted in: Public Health

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Trick or Treatment

I’ve just finished reading Trick or Treatment: The Undeniable Facts about Alternative Medicine by Simon Singh and Edzard Ernst. I’d been looking forward to the publication of this book, and it exceeded my expectations.

Edzard Ernst, based at the University of Exeter in England, is the world’s first professor of complementary medicine, a post he has held for 15 years. An MD and a PhD, he also embraced alternative medicine and used to practice homeopathy. He has done extensive research and published widely. His stated objective is “to apply the principles of evidence-based medicine to the field of complementary medicine such that those treatments which demonstrably do generate more good than harm become part of conventional medicine and those which fail to meet this criterion become obsolete.” His most important accomplishment has been to “demonstrate that complementary medicine can be scientifically investigated which, in turn, brought about a change in attitude both in the way the medical establishment looks upon complementary medicine and in the way complementary medicine looks upon scientific investigation.”

Simon Singh is a science writer with a PhD in particle physics. As a team, he and Ernst are uniquely qualified to ferret out the truth about alternative medicine and explain it to the public. (more…)

Posted in: Book & movie reviews

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Threats to science-based medicine: When clinical trials for new drugs are designed by the marketing division

ResearchBlogging.orgTHREATS TO SCIENCE-BASED MEDICINE

The theme of this blog is science-based medicine. It’s even the name given the blog by our fearless leader, Steve Novella. By “science-based” medicine we generally mean medicine that is both grounded in scientific plausibility based on our best understanding of human physiology and disease as well as in strong evidence from well-designed clinical trials, both of which are extremely important We SBM bloggers tend to concentrate mainly on so-called “alternative,” “complementary and alternative,” or “integrative” medicine because it does indeed represent a major threat to the consensus among medical professionals that medicine should be science- and evidence-based. Moreover, the infiltration of pseudoscientific and antiscientific woo into medical schools, academic medical centers, and medicine at large, coupled with large amounts of money going to promote CAM, both from the government and wealthy private foundations, does represent an extremely worrisome trend that makes all of us, who range from mid-career to retired physicians, fear for the future generation of physicians and their ability to apply science and critical thinking to the evaluation of implausible health claims, such as reiki, homeopathy, applied kinesiology, and the large variety of woo that falls under the rubric of CAM. Worse, this trend began not long after a concerted push to make medicine more science- and evidence-based and less dogma- and authority-based.

Unfortunately, though, the antiscience of implausible health claims is not the only threat that science-based medicine faces. We bloggers here at Science-Based Medicine concentrate on it because its resurgence and infiltration into the very heart of academic medicine represent a sea change in the culture of scientific medicine, which once rightly and without reservation rejected much of what CAM represents as quackery. Also, I can’t speak for others, but pseudoscience interests me; it brings up questions of why people believe irrational and clearly false propositions. That being said, at the risk of ruffling a few feathers among my co-bloggers, I have observed that, if there is one thing that this blog has not to this point emphasized sufficiently, it’s that the commerce of medicine, the very manner in which we develop new therapies, can, if not carefully observed and regulated, represent a threat to science-based medicine even more potent than Andrew Weil, David Katz, and their all-out assault on the very foundations of scientific medicine and drive to return medicine to the days of anecdote-based rather than science-based medicine.

I’m talking about pharmaceutical companies. I’m also about to destroy any opportunity I might ever have to work for or receive any funding from Merck & Company. C’est la vie. A skeptical doc’s got to do what a skeptical doc’s got to do. Not that I won’t at least partially protect myself by adding the disclaimer that the following represents my opinion, and my opinion alone. It does not represent the opinion of my university, cancer institute, or partners.

Now that that’s taken care of, let’s start with a little primer on a pernicious phenomenon known as the “seeding trial.”
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Posted in: Clinical Trials, Medical Ethics, Pharmaceuticals, Politics and Regulation

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