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Curse Removal from the Annals

A short post this week. Last weekend was a busy call weekend and as I type this I am heading for Palm Springs for a long weekend of hiking in the desert. If there is no entry in 14 days, look for my bleached bones somewhere in Joshua Tree.

Some observations about a recent article in the once respected Annals of Internal Medicine, whose recent articles  on acupuncture suggest their motto should be “The Annals. We have one too many n’s.”

First there was, Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial (discussed here) and now Acupuncture for Menopausal Hot Flashes: A Randomized Trial.

Why do the study? Why do any acupuncture study? Negative studies will not change practice.  There are no reality based reasons to think that acupuncture would be effective for any process. All the high quality studies show no efficacy.

As of the last Cochrane review, the data suggested for hot flashes that

When acupuncture was compared with sham acupuncture, there was no evidence of any difference in their effect on hot flushes. When acupuncture was compared with no treatment, there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than HT.

Treatment is no different than placebo, so for any real therapy it would be concluded that the intervention is not effective.

And the results continue in  this study?

Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs.

Nicely said.  Avoided the proper and rigorous interpretation of the study, acupuncture is not effective.  For once the take on the web was correct:  acupuncture doesn’t work for hot flashes.  This probably suggests the authors of the study never learned to spin their results.  So often when acupuncture is equal to placebo, acupuncture is declared effective since it has the “power of the placebo”. You probably do not remember, but two years ago there was a similar study where acupuncture and sham acupuncture were equal for reducing hot flashes.  Then the spin was Acupuncture may reduce severity and frequency of menopausal hot flashes.  

The lead author needs to get her SCAM speak down better, instead saying

“Acupuncture has been shown to be more effective than placebo for a number of conditions, specifically chronic pain,” said the lead author, Dr. Carolyn Ee, a family physician trained in both Western and Chinese medicine. “To say that it doesn’t work for hot flashes is not the same as saying it doesn’t work.”

Chronic pain is singular, so I guess the number of conditions specifically is one.  The loneliest number as I remember.  And while I agree it isn’t the same, acupuncture still doesn’t work.

It would be an interesting sociological study. Do a test of acupuncture vrs sham acupuncture vrs wait list. Doesn’t matter the symptom as long as there is a subjective endpoint. Real and sham will be equal in symptom relief and superior to doing nothing. Then send out two identical press releases except one that concludes acupuncture does nothing and one concludes it is effective.

It would be interesting to see if anyone actually cognates on the releases.

And why would the Annals publish an article that says the study was using

Chinese medicine needle acupuncture designed to treat kidney yin deficiency

My first google hit using “kidney yin deficiency” as a search term suggests kidney yin deficiency

usually presents as lumbar soreness

and

follows the rules of yang vacuity internal cold; therefore it usually presents cold symptoms, e.g. cold and pain in the lumbar area and cold limbs. Kidney qi deficiency is a common clinical diagnosis and does not usually present with cold symptoms. When the kidney’s astringent or storage functions are poor with a kidney qi deficiency, associated symptoms appear, e.g. frequent urination, copious amounts of clear urine, incontinence, enuresis, seminal emission, abortion, or miscarriage

Nowhere on the search result do they mention hot flashes.

Next hit. Menopause hot flashes? Nope

The next? Nope.

So I searched for menopause and kidney yin deficiency and found it.

When hot flashes or sweating are the major complaints, TCM regards these as internal damage problems due to such things as blood and qi deficiency, kidney yin deficiency, spleen and heart deficiency, phlegm stagnation, heat or phlegm irritating heart.

It goes to the heart of Traditional Chinese Pseudo-Medicine. They have zero standards and  basically make stuff up as they go along.

When I see kidney yin deficiency as a rationale for a clinical intervention, I wonder if the Annals would have published a similar trial using the Traditional European Pseudo Medicine of 4 humors as the basis of a study and bleeding as the treatment. It would have the same result. It is a hoax that needs to be played.

One last thought about acupuncture. I like the concept of acupuncture as a complex therapeutic ritual. But the longer I am in the SCAM world, the more I think this gives acupuncture, and other pseudo-medicines, too much benefit of the doubt.

Occasionally there is an article about the arrest of a fortune teller. The fortune teller has convinced someone that they or their material goods are cursed and the curse is the source of problems or discontent in the household. In modern times the curse is sometimes referred to as negative energy.

The fortune teller then helps lift the curse. It may be money to help perform a ritual to lift the curse or remove the negative energy. Sometimes the valuables are cleansed and then disappear.  Magic? In the legal system this behavior is considered fraud and theft and the fortune teller, if caught, often goes to jail.

I cannot find if the victims of the curse scam feel better after their curse has been lifted or the negative energy banished. There are no studies I could locate on the topic. At least I could find no studies outside of the literature for pseudo-medicines.

Is the practice of acupuncture, reiki, homeopathy, chiropractic and the other pseudo-medicines any different from the practice of curse removal? Not that I can see.  They have the same basic principles, just different language. Barely. ‘

Acupuncture is a ritual, it is a curse removal ritual.  At it’s center, so is most of CAM.

Does the ends justify the means? It depends on the ends and the means. But in medicine there are those who consider it OK to do the equivalent of the curse removal, fraud and theft,  as long as the patient reports benefit.

There is little information on curses as a cause of illness outside of the bible references, so it would appear to an area with the potential for growth.

It would be simple enough to do. Get an online pseudo-medical degree like ND, DC or Lac.  Then you can do virtually anything and call it  therapy. Then set up a clinic to remove the negative energies and curses for medical purposes. The authorities will never look twice. And in a year or two you will probably be hired by the local University Medical Center’s Integrative Medical Clinic.  I bet the Cleveland Clinic will be the first.

Now my seat back needs to be in the upright and locked position and my computer stowed under the seat in front of me.  Later.

Posted in: Acupuncture, Clinical Trials, Science and Medicine

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Pseudoscience sneaks into Ohio guidelines for non-drug pain treatment

Legitimately prescribed drugs can be stolen from a medicine cabinet a few at a time, usually without notice. From the Iowa Governor's Office of Drug Control Policy.

Legitimately prescribed drugs can be stolen from a medicine cabinet a few at a time, usually without notice. From the Iowa Governor’s Office of Drug Control Policy.

Ohio recently issued Acute Pain Prescribing Guidelines as part of an effort to reduce the epidemic of opioid abuse and death from overdose. They were drafted under the auspices of the Governor’s Cabinet Opiate Action Team (GCOAT), assisted by medical organizations and other groups.

The guidelines include recommendations for non-pharmacologic treatment, a typical feature of pain treatment guidelines and a worthy effort to avoid prescribing opioids for pain. Unfortunately, the guidelines include treatments that are not evidence based and potentially harmful. We’ll return to that issue shortly.

But first, a brief look at the extent of the opioid problem. According to the CDC, opioids are used to treat moderate-to-severe pain and are often prescribed following surgery, injury, or for painful health conditions, like cancer. In the past few years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis. From 1999 to 2013, opioid prescription and sales in the U.S. have nearly quadrupled, and overdose deaths have quadrupled right along with them. (more…)

Posted in: Acupuncture, Chiropractic, Guidelines, Pharmaceuticals, Politics and Regulation

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Laws Limiting Vaccine Exemptions Work

VaccineIt’s nice when a question can be resolved with objective numbers of unequivocal outcomes. Subjective outcomes give scientists a headache.

In this case we are talking about the effect of vaccine exemption laws on vaccine compliance rates. The question here is not the ethical one, the rights of parents to determine the fate of their children vs the right of the state to protect the health of children and the public health. I think the latter trumps the former, but some disagree.

Regardless of what you feel about the ethical question, we need to know if the laws we pass to achieve our goals actually work, or if they don’t work, or even have unintended consequences. Having an admirable goal is not enough; when you make actual decisions (practice decisions, policy decisions, healthcare decisions for you and for family) you want to know that those decisions are having the desired effect.

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Posted in: Legal, Public Health, Vaccines

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Prenatal Multivitamins and Iron: Not Evidence-Based

prenatal-vitamins small
When I was pregnant, I obediently took the iron pills and prenatal vitamins prescribed by my obstetrician. And I prescribed them for every pregnant patient I took care of as a family physician. I never questioned the practice. It seemed intuitively obvious that it was a good thing; we know pregnancy makes extra nutritional demands and depletes iron stores. It never occurred to me to question what I had been taught, because it seemed perfectly logical. I did question other things I was taught that didn’t seem so logical. In my internship, we were ordered to do episiotomies on every patient (the rationale was that it made birth less traumatic for the baby and prevented uncontrolled perineal tearing in the mother). I was severely chastised for omitting an episiotomy on a patient who begged me not to do one. She had had several babies and was stretchy enough to deliver easily without an episiotomy. In this case, my common-sense clinical judgment was vindicated by further research in the years after my internship; new evidence showed that routine episiotomies were of no benefit, practice changed in response to the new evidence, and episiotomies are no longer done routinely.

That was a long time ago. I have long since learned that even the most reasonable assumptions can be wrong. I happened to be right about episiotomies, but I might just as well have been wrong; and the only way to know whether a belief is true is to test it in controlled scientific trials. As Will Rogers said, “It isn’t what we don’t know that gives us trouble, it’s what we know that ain’t so.” It turns out that routine multivitamin and iron supplementation is not supported by any convincing evidence from scientific studies. And practice is changing. Recently, when one woman asked her OB what she should do about prenatal vitamins he pulled his wastebasket out from under his desk and said “put them there.” (more…)

Posted in: Herbs & Supplements, Nutrition, Obstetrics & gynecology

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When antivaccine pseudoscience isn’t enough, Bill Maher fawns over Charlie Sheen’s HIV quack

Bill Maher (right) expresses admiration for HIV quack Samir Chachoua (right), who claims to be able to cure people of HIV and cancer using milk from arthritic goats.

Bill Maher (right) expresses admiration for HIV quack Samir Chachoua (left), who claims to be able to cure people of HIV and cancer using milk from arthritic goats.

I know I must be getting older because of Friday nights. After a long, hard week (and, during grant season, in anticipation of a long, hard weekend of grant writing), it’s not infrequent that my wife and I order pizza, plant ourselves in front of the TV, and end up asleep before 10 or 11 PM. Usually, a few hours later, between midnight and 3 AM one or both of us will wake up and head upstairs to bed, but not always. Sometimes it’s all Friday night on the couch.

Last Friday was a bit different. It wasn’t different in that I did fall asleep on the couch sometime around 10 PM. However, unlike the usual case, when I woke up around 1:30 or 2 AM to head upstairs I was stone cold wide awake, feeling like Alex in A Clockwork Orange, eyes held wide open. So I did what I do when insomnia strikes. I popped up the computer and checked my e-mail and Facebook. Immediately, I saw messages asking me if I had seen Real Time With Bill Maher that night and, oh boy, I really should watch Maher. Apprehensive but curious, I fired up the DVR and watched.

And, shortly after the monologue, was totally appalled by this;

Funny, how the segment hasn’t yet been posted to Bill Maher’s YouTube page, as many of his interviews are. If he ever does post it, I’ll switch out the video above for the “official” source. Somehow, though, I doubt that the video will ever be posted, the reason being that it contains an embarrassingly fawning 10 minute interview with “Dr.” Samir Chachoua, better known (at least to skeptics) as Charlie Sheen’s HIV quack. Somehow, when Charlie Sheen was on The Dr. Oz Show a couple of weeks ago, other things were going on and I didn’t blog about it. Fortunately, Steve Novella did. Now, with Sheen’s very own quack who failed him being fawned over by Bill Maher, it gives me a chance to take down three birds with one stone: Bill Maher, Dr. Oz, and, of course, Sam Chachoua. Sadly for Bill Maher, America’s Quack Dr. Mehmet Oz comes off looking a lot better than he does, and that’s saying something.
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Posted in: Basic Science, Cancer, Health Fraud, Vaccines

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Mercury amalgam fillings and you

Filling removal dentistry small

Dentists removing an old plutonium-based filling.

Note this special guest post submitted by Maddaz A. Hatter, D.D.S. Thanks Dr. Hatter!

Also, on an almost-completely-unrelated note, skeptical dentist, haberdasher extraordinaire, and sometime-guest-blogger Grant Ritchey recently moderated debate between SBM regular Clay Jones, and pediatrician-who-has-yet-to-be-coerced-into-blogging-with-us Raymond Cattaneo, about the pros and cons of firing families who refuse to vaccinate according to the recommended schedule. I’m told Clay wins the debate through a swift blow to the throat, but it happens at the very end so you’ll have to listen to the whole thing! Located at the Prism Podcast via this tasteful and refined link.

In England during the 1700s and 1800s, felt hats – very fashionable at the time – contained trace amounts of mercury, and many of the workers in the hat factories that produced them succumbed to mercury poisoning over time. Symptoms of mercury poisoning include dementia and other neurological complications, from whence came the term “Mad as a Hatter.” We’ve known for quite a while that quicksilver in large enough quantities does not do a body (or brain) good.

This brings up a point. It seems that a recurring theme at Science Based Medicine is that we are always defending what legitimate health care providers want to put into a human body to prevent, cure, or manage disease, or to improve health or quality of life. Conversely, we critique those who want to put things in us that are of no demonstrable benefit or which may cause harm. To wit: vaccines – good, coffee enemas – not good. Fluoride (at appropriate doses) – good, colloidal silver – not good. This is an ongoing tug-of-war that will likely continue until our sun supernovas and consumes our planet, after which all arguments will probably be moot.

In the dental field, the two biggest battles we seem to continually wage deal with the safety of fluoride and the use of dental amalgam. Fluoride and fluoridation has been written about many times before on Science-Based Medicine. I have also discussed it several times on my podcast, The Prism Podcast, but I’ve never written about amalgam fillings before. Harriet Hall wrote an excellent SBM post on the matter way back in 2008, but after all these years it’s probably time to revisit the topic. (more…)

Posted in: Dentistry

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The consumer lab rat: More questions about supplement safety

Laboratory Rats
Do you take a vitamin or dietary supplement? Over half of all American adults do, making this a $30 billion dollar business. Many of us even take supplements in the absence of any clear medical or health need. I’m often told it’s a form of nutritional “insurance” or it’s being taken for some presumed beneficial effect – like Steven Novella outlined in yesterday’s post on antioxidants. We love the idea of a risk-free magic bullet that improves our health and wellness. Especially one that avoids what are presumed to be toxic, unnatural drugs. Supplements are marketed as safe, natural and effective, and there is no question that messaging has been effective.

I used to take supplements. For me it was multivitamins. But as I’ve taken a closer look at the evidence for supplementation, my personal behaviors changed. The primary reason is a lack of evidence. There is no evidence to suggest that vitamins offer any health benefits in the absence of deficiency. The balance of evidence suggests that routine multivitamins are unnecessary for most people. Vitamins should come from your food, not from supplements. More generally, looking at the broader category of supplements that range from probiotics to herbal remedies, there is little evidence to support most of them. With a few exceptions, the research done on dietary supplements is unconvincing and largely negative. If you don’t supplement, you don’t seem to be missing out on any tremendous health benefits.

Going beyond the lack of evidence, there’s an even more compelling need for consumers to be wary of them. The safety of supplements is increasingly being called into question. Evidence has emerged demonstrating that quality standards for supplements sold in many countries are erratic and unpredictable. The root cause seems to be regulatory systems that prioritize manufacturer interests ahead of consumer protection. With supplements, products are effectively being tested for safety after they are marketed, and the consumer is the unwitting research subject. (more…)

Posted in: Herbs & Supplements, Politics and Regulation

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More Trouble for Antioxidants

Antioxidants are better acquired through food than pills.

Antioxidants are better-acquired through food than pills.

Antioxidants are now an iconic example of premature hype making its way into marketing and the public consciousness long before the science is adequately understood. There are multiple lessons to be learned in this story, and a new study just emphasizes those lessons further.

A brief history of antioxidants

One of the unavoidable consequences of metabolism (burning food for energy) is the creation of oxygen free radicals, or reactive oxygen species (ROS). These are molecules that are highly reactive. They essentially contain oxygen with an extra electron, which can react with another molecule, breaking bonds and causing damage.

As you might expect, the body has natural antioxidants which react with ROS to form benign molecules.

In the 1990s it became increasingly apparent that oxidative stress was playing an important role in cell damage, even sometimes triggering apoptosis, or programmed cell death. Many degenerative diseases, like Alzheimer’s disease, were shown to be driven in part by oxidative stress. In addition, it seemed that ROS play a role in aging.

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Posted in: Herbs & Supplements, Nutrition

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Cure Is About Caring, Not Curing: Placebos, Alternative Medicine, and Patient Comfort

cure
In a recent post, Dr. Gorski criticized two articles by Jo Marchant on placebos and alternative medicine. He mentioned that she had a book coming out and suggested I might want to review it. The title is Cure: A Journey into the Science of Mind Over Body.

I don’t know of any evidence that the mind has ever cured a disease, so I would have been prejudiced against this book just from its title, and Dr. Gorski’s post prejudiced me even more. But I was willing to give it a fair trial. The publisher sent me a review copy of the book and I read it. I was expecting to hate it, but I was pleasantly surprised. I enjoyed reading it. I found it fascinating. I found myself agreeing with much of what Marchant says, and I was intrigued by some of the recent research she reports that I was not yet aware of. Preliminary studies, to be sure, but thought-provoking. The book challenged me to think more deeply about placebos, alternative medicine, and patient comfort. (more…)

Posted in: Book & movie reviews

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Science-based medicine versus the Flint water crisis

This is exactly the sort of cover story you don't want to see about your city in TIME.

This is exactly the sort of cover story you don’t want to see about your city in TIME.

One aspect of science-based medicine that is not covered frequently on this blog, aside from vaccines and antivaccine pseudoscience, but perhaps should be, is the intersection of SBM and public health. Unfortunately, living as I do in southeast Michigan right now, I’ve been on the receiving end of an inescapable lesson in what happens when the government fails in its mission to enforce science-based public health issues. I’m referring, of course, to what has become known worldwide as the Flint water crisis. The Flint water crisis has become so famous that unfortunately it now has its very own Wikipedia page. That is not an “honor” I like to see for my state, and I’m sure the residents of Flint, which is an hour’s drive north of where I live, would agree. This crisis provides an unfortunate illustration of what can easily happen when multiple layers of government fail in a science-based public health task as basic as providing clean water to the citizens they ostensibly serve.

For those of you who haven’t heard of it yet, the Flint water crisis refers to the ongoing contamination of the tap water in Flint, MI with unacceptably high levels of lead that resulted from change in its water supply nearly two years ago to Flint River water. Because river water is more corrosive than the previous supply that came from Lake Huron (why I’ll explain later) and Flint river water was not properly treated to decrease that corrosiveness, the new water leached lead from old pipes. This resulted in the contamination of the drinking water with dangerous levels of lead in many homes in the city. In addition, there has been a marked increase in the number of cases of Legionnaires’ disease thought to be linked to the new water supply.

I was born and raised in Detroit. My parents didn’t move to the suburbs until I was ten years old, and I stayed in southeast Michigan until I graduated from medical school and ended up in Cleveland for my surgical residency and, ultimately, my PhD work. From there I bounced to Chicago and New Jersey. Then, in 2008, nearly twenty years after I had left my hometown, I ended up back in the Detroit area. The point of this story is that my roots in the Detroit area run deep. Michigan is my state, for better or for worse, which is why I get annoyed when bad things happen here. I particularly become outraged when a preventable tragedy occurs here, one that science told us how to prevent but the government went ahead and did anyway. It’s a horrific tale of how science was basically ignored because of politics, and legitimate scientific concerns about a policy that changed the water source for an entire city were downplayed, derided, and even denied by state officials at every level of government. The story has now gone international. Indeed, our state and the city of Flint are featured on the cover of this week’s TIME Magazine.
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Posted in: Politics and Regulation, Public Health

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