Recently a correspondent asked me for advice about his parents. He said they use things like homeopathy, acupuncture, and copper bracelets. They use conventional medicine too, but it seems to be a 50/50 approach that gives each an equal weighting. He has tried to talk to them about things like homeopathy and the placebo effect, but the shutters come down hard and fast. He tries to criticize the alternative treatment itself without offending or attacking the person, but his mother still sees it as a personal attack. He worries that as they get older and in need of more medical care, his parents may not make the best decisions. He asks about how to tactfully have these conversations and perhaps change their point of view.
That’s a very tough question that gets asked a lot, and I don’t have any good answers; but I do have some thoughts and untested ideas that could serve as the starting point for a discussion, and I hope readers will pipe up in the comments and tell us what has or hasn’t worked for them. (more…)
Three weeks ago, I mentioned in a post that the week of October 7 to 14 was declared by our very own United States Senate to be Naturopathic Medicine Week, which I declared unilaterally through my power as managing editor of Science-Based Medicine (for what that’s worth) to be Quackery Week. One wonders where the Senate found the time to consider and vote for S.Res.221, which reads:
S.Res.221 – A resolution designating the week of October 7 through October 13, 2013, as “Naturopathic Medicine Week” to recognize the value of naturopathic medicine in providing safe, effective, and affordable health care.
I know, I know, it probably took all of five minutes to consider and vote for this, thanks to Sen. Barbara Mikulski (D-MD), who sponsored it. In any case, as October 7 approached, I thought about how I could keep my promise to blog about naturopathy this week, and I came up with a way to do it. It’s a bit roundabout, but I think it fits. The idea derives from a discussion I was having a while back about one of my “favorite” hospitals, namely the Cancer Treatment Centers of America, in which a colleague of mine questioned why there were so many CTCA ads on NPR and why CTCA is sponsoring shows on PBS such as the upcoming The Emperor of All Maladies by Ken Burns. Although I can’t wait to see this particular series, I am a bit worried that the infiltration of quackademic medicine will make an appearance, given that CTCA is a major sponsor. (more…)
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…)
Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older. Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur. This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients.
Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound. Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.) (more…)
Every so often, our “friends” on the other side of the science aisle (i.e., the supporters of “complementary and alternative medicine”—otherwise known as CAM or “integrative medicine”) give me a present when I’m looking for a topic for my weekly bit of brain droppings about medicine, science, and/or why CAM is neither. It’s also been a while since I’ve written about this particular subject; so it’s a win-win for all sides! I get a topic. A certain CAM journal gets extra traffic. And you get the benefit of my usually brilliant deconstruction of dubious science. What could go wrong? I mean, I might not be Mark Crislip, but I do enjoy a good dive into a pile of pseudoscience every now and then. It’s just a weird trait of mine.
How Does Acupuncture Work? The Science behind the Therapy Is Explored in a Special Issue of Medical Acupuncture
New Rochelle, NY, April 16, 2013—Even as medical acupuncture is increasingly being validated as an effective treatment for a broad range of medical conditions, what has been missing is an understanding of the basic science and mechanisms of action of this age-old method of healing. A special issue of Medical Acupuncture, a peer-reviewed journal published by Mary Ann Liebert, Inc., publishers presents a series of articles by authors from around the world who provide diverse and insightful perspectives on the science and physiologic responses underlying medical acupuncture. The issue is available free on the Medical Acupuncture website.
“Understanding acupuncture in the same manner that we understand the mechanism of action and pharmacokinetics of a particular drug will, similarly, enable us to match treatments better with conditions,” states Guest Editor Richard F. Hobbs, III, MD. “The net effect will be improved outcomes,” he writes in his editorial “Basic Science Matters.”
A recent systematic review in PLOS One raised the question whether acupuncture and other alternative therapies are as effective as antidepressants and psychotherapy for depression. The authors concluded
differences were not seen with psychotherapy compared to antidepressants, alternative therapies [and notably acupuncture] or active intervention controls
or put it differently,
antidepressants alone and psychotherapy alone are not significantly different from alternative therapies or active controls.
There are clear messages here. To consumers: Why take antidepressants with their long delay and uncertainty in showing any benefits–but immediate side effects and potential risks–when a few sessions of acupuncture work just as well? To promoters of acupuncture and alternative therapies: you can now cite an authoritative review in the peer-reviewed PLOS One as scientific evidence that your treatments is as effective as scary antidepressants and time-consuming psychotherapy when you make appeals to consumers and to third-party payers.
The systematic review had five co-authors, of whom three have been involved in previous meta-analyses of the efficacy of antidepressants. However, fourth author Irving Kirsch will undoubtedly be the author most recognizable to consumers and policymakers, largely because his relentless media campaign claiming antidepressants are essentially worthless, no better than placebo. For instance, in an interview with CBS 60 Minutes Irving Kirsch: The difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.
Irving Kirsch: The difference between the effect of a placebo and the effect of an antidepressant is minimal for most people. (more…)
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? (more…)
I realize that Steve blogged about this study earlier in the week, but since I also commented on this particular study as my not-so-super-secret alter ego, I figured it rated a place on SBM as well. I emphasized different aspects of the study and tried to quantify exactly why, under even the most charitable interpretation of the study possible, the effects are not clinically significant. Besides, if the level of comments and e-mails is any indication, there is sufficient interest in this particular study to rate a second post.
Not suprisingly, this study is about about acupuncture. Well, it’s not exactly a study, it’s a meta-analysis that aggregates a whole lot of acupuncture studies in which this most popular of woos is administered to patients with chronic pain from a variety of causes. It’s also being promoted all over the place with painfully credulous headlines like: (more…)
Editor’s Note:Dr. Gorski was on a rare vacation last week, recharging his batteries. As a result, there is no new material by him this week. Fortunately, Ben Kavoussi was ready with another in his series of posts on traditional Chinese medicine. Dr. Gorski will return next week; that is, if he doesn’t return even sooner because he can’t stand to be away from SBM for two whole weeks.
The established laws of nature do not support Oriental Medicine’s claim of Yin and Yang and Five-Phases Theory. Oriental Medicine’s main theory was constructed when our civilization had limited methods to understand our surroundings, and as such, it is only an ancient illusion.1
— Yong-Sang Yoo, MD, PhD, Chairman of the Committee for Medical Unification, Korean Medical Association, 2010
Yong-Sang Yoo is one of the strong and growing voices in Korea that is calling for an end to the national insurance coverage for Oriental Medicine.
Similarly, Professor Zhang Gongyao of the Central South China University petitioned the central government of China in 2006 to abolish support for Oriental Medicine because it has “no clear understanding of the human body, of the functions of medicines and their links to disease. It is more like a boat without a compass: it may reach the shore finally but it’s all up to luck.”2 Zhang Gongyao and fellow critics have consequently blasted China’s traditional medicine as an often ineffective, even dangerous derivative of witchcraft that relies on untested concoctions and obscure ingredients to trick patients, and employs a host of excuses if the treatments do not work.3
Bloodletting is used in Oriental Medicine to relieve excess “heat,” meaning fever, sore throat, joint pain, muscle sprain, as well as inflammation. It is often practiced in unsanitary conditions.
A Product of Archaic Thinking
The arguments of Yong-Sang Yoo and Zhang Gongyao are reminiscent of those of William R. Morse, Dean of Medical School at West China Union University, who wrote in 1934 that China’s traditional medicine was a “weird medley of philosophy, religion, superstition, magic, alchemy, astrology, feng shui, divination, sorcery, demonology and quackery.” Morse added that Chinese diagnostic methods “border on the ridiculous and possibly cross the line into absurdity.” Harvey J. Howard — a Dean at the Peking Union Medical College — also wrote in 1934 that “the great majority of these Chinese medicines reminds one of the list of remedies suggested by the third witch in Shakespeare’s Hamlet.”4
The U.S. Army Medical Command recently announced a job opening in the Interdisciplinary Pain Management Center at the San Antonio Military Medical Center at Fort Sam Houston, Texas. Two GS-12 positions were advertised for acupuncturists at a salary of $68,809 to $89,450. As a licensed acupuncturist, a candidate would be expected to
offer a full array of the most current and emerging evidenced based approaches in integrative medicine for patients with acute and chronic pain who have not responded well to conventional treatment modalities.
This is wrong on more levels than one. After giving lip service to the politically correct term “evidence based” they proceed to include clearly non-evidence-based modalities in the job description. Rigorous scientists do not classify acupuncture itself as evidence-based, since the evidence is compatible with the hypothesis that it is no more than an elaborate system to provide placebo and other nonspecific effects. And the described duties of the position make it even worse. (more…)