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A liquid that was almost, but not quite, entirely unlike tea. On Naturopathy.

A coffee enema - almost, but not quite, totally unlike tea.

A coffee enema – almost, but not quite, totally unlike tea…and some sort of complex analogy involving naturopathy and science.

Those of you in the know recognize the title from the Hitchhikers Guide to the Galaxy, among the funniest and most quotable books of all time. If you have not read the five books in the trilogy, get to work. Consider it a homework assignment.

I bit off more than I can chew for this entry. I usually plan on about 8–10 hours over 4 –5 days to write these entries. So I had this idea. Now that naturopaths have been declared primary care providers by the Oregon legislature I thought it would be good to look over all the websites in Portland to see, in their own words, what naturopaths were offering. I figured there would not be that many sites to review. How many naturopaths could be in Portland?

So I went to the Oregon Board of Naturopathic Medicine Licensee Directory and entered Portland into the search box. And?

578 hits.

There is not enough beer time in the world

Holy Cannoli. I thought there would be 30, which is the number infesting Eugene, the second most naturopathed city in Oregon. There is no way that I could do a comprehensive review of that many websites in the limited time I have to devote to the blog. But my brain is not unlike an oil tanker with blog entries, it takes a long time to change direction and I had nothing else mentally lined up to write about. (more…)

Posted in: Naturopathy

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More Lyme ‘Guidelines’

The black-legged tick responsible for spreading the bacteria that causes Lyme disease

The black-legged tick responsible for spreading the bacteria that causes Lyme disease

I noted with understanding that the Doubtful News can’t take it anymore. The relentless tsunami sewage slurry of pseudo-science (who says I can’t alliterate?) has worn her down. She is:

currently experiencing a phase in which I can’t seem to bring myself to promote another ridiculous story in the media about a haunted location, scary sounds from the sky, or the latest outrage fueled by ancient superstition. You might call that… jaded. It’s been over four years now of nearly daily effort to keep track of the weird world of woo. It can wear one down when virtually or literally the same thing appears and reappears over and over as if it hasn’t already been passed around a million times.

I sympathize. I have had a touch of SCAM ennui of late. It is a bit due to the repetitiveness of the SCAMs. I still find the variations on the theme of pseudo-sciences curious. It is like infectious diseases where every case has unique and subtle diversity so no two SCAMs are the same. But there are almost 4,000 clinical trials on acupuncture and I would wager that they all have several of the same half-dozen fatal errors. It is like hand hygiene at work. We have known for, oh what, 160 years, that hand hygiene prevents the spread of disease but people still can’t do it right. We know how to do a good clinical trial but the SCAMsters just can’t seem to figure it out.

The ennui is not the seeming futility of the endeavor. I have always been comfortable with futility, secure, as an example, in the knowledge that someday I will be consumed by the bacteria I spent a career killing. Unless, of course, they get me cremated right away. I keep looking for a motto for the SfSBM; I am attracted to “Sisyphus had it easy.” (more…)

Posted in: Guidelines, Lyme, Politics and Regulation, Quality Improvement

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The Worst Homeopathy Study. Ever

A rare double-face palm, so you can't see the tears

A rare double-face palm, so you can’t see the tears

I run across a lot of information in my feeds that I need to save for further evaluation. The study “Does additional antimicrobial treatment have a better effect on URTI cough resolution than homeopathic symptomatic therapy alone? A real-life preliminary observational study in a pediatric population“, I saved with the file name, ‘jaw droppingly stupid’.

The worst homeopathy clinical trial ever doesn’t spring full formed like Athena from the head of Zeus. No. The worst homeopathy clinical trial ever started with a seed. The seed is “Homeopathic medicine for acute cough in upper respiratory tract infections and acute bronchitis: A randomized, double-blind, placebo-controlled trial, which is a standard lousy homeopathic study. (more…)

Posted in: Clinical Trials, Ethics, Homeopathy

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Medicine in the Magic Kingdom of Cascadia. On Naturopathy.

Beautiful Cascadia, where science goes to die.

Beautiful Cascadia, where science goes to die.

When the Pacific NW secedes from the Union it is to be part of a new country, Cascadia. The capital would be Portlandia, I suppose. Somehow, I think not. But when I watch the devolution of health care in Oregon, I think back to The Onion (?) when they reported that the United Kingdom was to be sold to Disney, being renamed as “The United Magic Kingdom.”

That is health care in Oregon due the steady insinuation of naturopathy and other pseudomedicine into real health care.

Oregon Health and Pseudoscience University

Growing up my alma mater was the University of Oregon Medical School. Since then it has undergone two name changes, first to Oregon Health Sciences University and then to the current Oregon Health & Sciences University (OHSU)—with, it should be noted, an ampersand. Not an ‘and’.

Perhaps they need one more name change, since they are not always that interested in the “Science” part of their name.

Some background is needed.

Portland has a trifecta of pseudoscience schools: Naturopathic (National College of Natural Medicine), Chiropractic (University of Western States) and ‘Oriental’ (Oregon College of Oriental Medicine).

Lucky us.

As an aside my kids let me know that the word ‘Oriental’ as used to describe people from the East, the term I grew up using, is persona non grata. I understand the reasoning. The proper term, they tell me, is Asian. So I have a mental cringe every time I see the name “Oregon College of Oriental Medicine”.

All three schools are steeped in pseudoscience and pseudomedicine, removed from known reality. As examples, the naturopathic school teaches homeopathy (and more), the chiropractic school teaches the subluxation complex, and the ‘Oriental’ (cringe) school teaches acupuncture. Reading the curricula of the schools suggests that there is no pseudomedical stone left unturned. (more…)

Posted in: Naturopathy, Politics and Regulation, Public Health

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Medical Theater: Vaccines and Ebola

Me and my wife, in a very small number of years from now. YOU KIDS GET OFF MY LAWN!

Me and my wife, in a very small number of years from now. YOU KIDS GET OFF MY LAWN!

And all the men and women merely players;

They have their exits and their entrances,

And one man in his time plays many parts,

His acts being seven ages. At first, the infant,

Mewling and puking in the nurse’s arms.

Then the whining schoolboy, with his satchel

And shining morning face, creeping like snail

Unwillingly to school. And then the lover,

Sighing like furnace, with a woeful ballad

Made to his mistress’ eyebrow. Then a soldier,

Full of strange oaths and bearded like the pard,

Jealous in honor, sudden and quick in quarrel,

Seeking the bubble reputation

Even in the cannon’s mouth. And then the justice,

In fair round belly with good capon lined,

With eyes severe and beard of formal cut,

Full of wise saws and modern instances;

And so he plays his part. The sixth age shifts

Into the lean and slippered pantaloon,

With spectacles on nose and pouch on side;

His youthful hose, well saved, a world too wide

For his shrunk shank, and his big manly voice,

Turning again toward childish treble, pipes

And whistles in his sound. Last scene of all,

That ends this strange eventful history,

Is second childishness and mere oblivion,

Sans teeth, sans eyes, sans taste, sans everything.

As You Like It, Act II, Scene VII

This summer my wife and I have been transitioning somewhere between stage 5 and 6. My eldest left Tuesday for law school in Boston and my youngest leaves for college next week in LA. So we will soon be empty nesters. As part of the change we have been making a point of going out, to dinners, bars, concerts and theater. (more…)

Posted in: Science and Medicine, Science and the Media, Vaccines

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Do You Believe in Magic? Oregon Does. Chiropractic and Acupuncture for Pain.

Pictured: OHP and HERB picking "evidence-based treatment options"

Pictured: OHP and HERB picking “evidence-based treatment options”

Do You Believe in Magic?

Do you believe in magic for a back pains fix

How the needles can free her, where ever it pricks

And it’s magic, if the chi is groovy

It makes you feel happy like an old-time movie

I’ll tell you about the magic, and it’ll free your soul

But it’s like trying to tell a CAM ’bout randomized control

If you believe in magic don’t bother to choose

Although subluxation is simply a ruse

Just go and get adjusted on the table

It won’t wipe off the pain no matter how hard you try

Your wallet is empty and you can’t seem to find

How you got there, so just blow your mind

If you believe in magic, come along with me

We’ll CAM until morning paid for by the OHP

And maybe, if the CAM is right

I’ll meet you tomorrow, sort of late at night

And we’ll go dancing, baby, then you’ll see

How the magic’s in the CAM and the CAM’s in me

Yeah, do you believe in magic

Yeah, believe in the magic of a back pains fix

Believe in the magic of CAM

Believe in the magic that can set you free

Oh, talking ’bout magic

Do you believe like I believe… Do you believe in magic

Do you believe like I believe… Do you believe, believer

Do you believe like I believe… Do you believe in magic

The Lovin’ Spoonful. Sort-of.

Maybe not my best lyrics.

More Oregon magic

It continues.

Oregon has a problem with prescription pain pills. Oregon leads the nation in the abuse of such drugs, federal statistics show, with Oregon’s rate of prescription drug abuse 39 percent higher than the national average. Go us.

Why that is, I do not know. As an Infectious Disease doctor I prescribe a narcotic about once a year. There are real problems with the treatment of chronic pain and while I am aware of the issues and the changes over the last 25 years, it does not impact my practice, so my knowledge of the issues is basic.

I am also well aware of the Oregon Health Plan (OHP). The OHP was intended to make health care more available to the working poor, while rationing benefits. They were fairly transparent that resources were fixed and not everything would be covered.

Given limited resources, part of the plan has always included a prioritization of treatments and diagnostics, paying for care that give the most bang for the buck. Not a perfect way to ration care and as is always the case, no good deed goes unpunished. (more…)

Posted in: Acupuncture, Chiropractic, Legal, Medical Academia, Naturopathy

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Naturopathic Medical Magic in the NW

Me and my lovely wife Phyllis Schlafly, amazed at what naturopaths will believe. From the Wikimedia Commons, because we're that famous.

Me and my lovely wife Phyllis Schlafly, amazed at what naturopaths will believe.
From the Wikimedia Commons, because we’re that famous.

As regular readers know, I live in the great Pacific Northwest, specifically Portland, Oregon. I am at home in the organic/hippy/environmental mind-set. It is what I grew up with. It is a relaxed, informal place to live. It is not much of an exaggeration to say that formal attire is tucking your tee shirt into your jeans. At least the metro area, and perhaps much of the state, is relatively tolerant of the actions of others. A real what’s the harm/shruggie approach to life, the universe and everything.

I will admit that the irrational/shruggie/emotional/Oregonian/goateed part of my brain is often at odds with my more rational brain, which wants me to give a rat’s ass about issues I think are just wrong. It showed up strongly with fluoridation in Portland, where my rational brain knew adding fluoride to the water was a great idea and my Oregonian nature said water should be pure, man, like nature intended. I keep my inner Oregonian under tight control as his approach often sounds good until you carefully examine how his ideas are implemented. Except at the pub of course. Bring on the hops, man, like nature intended beer to be.

Naturopathy is well tolerated in Oregon, with two schools in the NW producing NDs. We have a Board of Naturopathic Medicine, whose vision is to:

To protect the health, safety and welfare of the public in the matters of care provided by Naturopathic physicians in Oregon.

(more…)

Posted in: Legal, Naturopathy, Politics and Regulation

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Ethical Failures

 

M

Me, ten minutes after the end of this post.  EXTREME!

 

It is summer vacation for me in Eastern Oregon at Sunriver. Unbelievable geology, fantastic hikes, great biking, wonderful golf, delicious beer and good food. The thesaurus fails me for superlatives. It is hard to get too riled up about all things SCAM to produce a blog entry when I could be doing one or all of the above. I really don’t want to do this. Sadly, David keeps threatening me with the video he has of me touting the benefits of Integrative Medicine with its holistic approach to health care, and I just can’t have that published on the ‘net. So some brief speculation to fill the time between golf and a pint of IPA overlooking the Sisters.

Ethics, and the purpose of SBM

Steve started this blog in 2008 in part because he realized that evidence-based medicine was inadequate for the task of evaluating pseudo-medicines. He coined the term ‘science-based medicine’ with the realization that for fantastical therapies like acupuncture or homeopathy, all the potential biases and flaws in the evidence from clinical studies could result in pseudo-medicines appearing effective when at heart they are all Oakland California.

I do not suppose there could be science-based ethics. One person’s ethical certainty is another’s belly laugh. I remember a grand rounds on human cloning years ago and they had, among others, a priest discussing the ethics of human cloning, and I thought at the time there would be few speakers with less legitimacy. And really, I can see no harm in cloning an army of zombie super soldiers, especially if they were under my control.

Still, one of the issues I remain amazed at is how many clinical trials testing pseudo-medicines are approved by institutional review boards (IRB). (more…)

Posted in: Clinical Trials, Ethics

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Chiropractic and Stroke: The question is not answered

Extreme rotation of the atlas on the axis (at the atlantoaxial joint) stretches the vertebral artery. In layman's terms, 40% of a hanging.

Extreme rotation of the atlas on the axis (at the atlantoaxial joint) stretches the vertebral artery. In layman’s terms, 40% of a hanging.

I am off to Chicago for 5 days to wow the SMACC crowd with my ID/SBM acumen. I hope. Given that most of my multiple-personalities do not seem to be able to get any work done, I am forced to write a brief post this week, limited by the battery life on my MacBook Air. Whatever I get down on paper? pixels? RAM? before the battery dies as I fly over the Rockies will be the post. It is times like this I wish I had Gorskian typing skills.

SBM has discussed the many limitations of chiropractic: the low grades for entry into chiropractic school, the inadequate training, their reason d’être, subluxations and their adjustments being divorced from reality, the lack of efficacy of chiropractic for any process beyond low back pain (and even that is no better than safer interventions), the fondness of chiropractors for other useless pseudo-medicines, and their opposition to vaccines.

Hm. When I put it like that chiropractic does appear a little sketchy. But is chiropractic safe? It is a hands-on intervention, for a brief period of time applying the same force to the neck as about 40% of hanging from the neck until dead. So there is certainly the potential for chiropractic to cause harm. (more…)

Posted in: Chiropractic, Clinical Trials

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Leaky Bowel

Pictured: Something you might need if you actually had a leaky gut.  Click to embiggen.  Weirdo.

Pictured: Something you might need if you actually had a leaky gut. Click to embiggen. Weirdo.

We are at a disadvantage. We have to rely on reality to validate the practice of medicine. Anatomy, physiology, pharmacology, chemistry, the basic sciences that made up the first two years of medical school education and a huge chunk of pre-med. And we have to rely on the truth, as slippery a concept as that can be. I can’t just make up a disease or a therapy.

It would be so much easier to not have to worry about reality in deciding on a disease and treatment for people with symptoms.

I came across “Healthy Life: Leaky Gut Syndrome” in my feeds. I am always attracted to exclamation marks! They must mean something important! Or surprising to the author!

It’s called “leaky gut syndrome” and patients say it can wreak havoc on everyday life, but some doctors say there’s no such thing!

Some doctors. Must be that pesky 10% percent or so of obstructionist doctors who don’t recommend Tylenol or Advil. (more…)

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

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