Last week a Hawaiian woman living in Las Vegas, Chelsea Ake, was found dead in a cryotherapy chamber where she works. Apparently she was using the chamber unsupervised and accidentally locked herself in or passed out, and was found 10 hours later. Her death, of course, is tragic and we have nothing but sympathy for her and her family.
The event, however, was the first time many people heard of whole body cryotherapy (WBC) and prompted many questions. Three months ago Zachary Hoffman published a guest post on SBM about cryotherapy, showing that the science is just not there. He focused mainly on using ice packs to treat sprains and sports injuries (which is surprisingly not evidence-based, but also perhaps not unreasonable), I am going to focus on using WBC for general health.
What is whole body cryotherapy?
As is often the case, perfectly legitimate or perhaps preliminary medical procedures are hijacked by entrepreneurs and hyped into a bogus “spa” therapy, snake oil, or medical device. Preliminary evidence or legitimate uses are then used to justify the pseudoscientific extrapolations. Stem cells are a legitimate area of medical research, but I would not go to a stem cell clinic in China to treat your ALS.
A new study looked at clinical trials for neuropathic pain over the last 23 years and found that the response of subjects in the placebo group has been increasing over time, but only in the United States. The cause of this increase is unknown, and has provoked a fascinating discussion about the nature of placebos and their role in medical research.
What is the placebo effect?
We have discussed the placebo response at length here at SBM because the concept is critical to understanding clinical science, and it is largely misunderstood. Most often it is presented as a mind-over-matter response to the expectation of benefit. Proponents of worthless treatments often hype the placebo response as if it can have real healing power, when the evidence shows it does not.
In reality, there are a large number of placebo effects and the phenomenon is quite complex. In clinical trials “the placebo effect” is whatever happens in the placebo group of the study, the group receiving an inactive treatment. This is not one effect, however, but a complex combination of many effects.
When skeptics hear the term “vibration” a red flag goes up, because that is a common term used in pseudoscientific jargon. Vibrations are often used to refer vaguely to energy or some physical or even spiritual property that cannot be detected, and is used in a hand-waving manner to explain extraordinary claims.
Vibrations, however, are also a real thing, referring to physical oscillations. Whole body vibration therapy (WBVT) refers to these legitimate physical vibrations. It is being offered as a treatment for balance, back pain, neurological disorders, and also simple fitness. Does it actually work, however, for the indications claimed?
What is WBVT?
WBVT is considered a passive exercise modality, in which something is being done to the person, rather than the person actively engaging in an activity, such as walking, weight lifting, or swimming. With WBVT users lay, sit, or stand on a platform that vibrates rapidly in one or more directions. The idea is that the rapid vibrations force the muscles of the body to contract in reaction, providing a form of exercise.
The overall goal of science-based medicine is to maintain and improve the standard of science in the practice of medicine at every level. At the heart of the scientific basis of medical knowledge and practice is a process known as peer-review. We have occasionally written about peer-review on SBM, and once again the process is under the microscope over a specific question – should peer review be open or blinded?
What is peer review
The term peer-review refers to a pre-publication process in which a journal editor will send a submitted manuscript to 2-3 experts in a field relevant to the paper to carefully examine every aspect of the paper. They then provide a detailed analysis of the paper: is the research question relevant and appropriate, did the study design properly address the question, were the methods rigorous, was the statistical analysis appropriate, was the data presented fairly, are the conclusions supported by the data, did the authors account for other publications addressing the same issue, and did they address every possible question or objection?
The reviewers’ reports will make specific recommendations for changes that would be necessary to improve the paper, and also make their bottom-line recommendation: accept as is, accept with revisions, or deny. The journal editor(s) then rely upon those reviews, plus their own assessment, to make a final decision.
The entire segment is premised around a false dichotomy, between excess use of opioids and unproven alternative treatments. It is clear that the reporters didn’t even speak to a pain specialist who relies upon science-based treatments, or if they did the specialist was completely ignored because a SBM approach did not fit into the narrative of the report.
Non-opioid options for pain control
The problem addressed by the segment is real – the current technology of pain control is limited. I don’t want to sell pain management short, we have an array of powerful and effective treatments. There are limitations, however, and many patients are inadequately treated.
Stephanie Seneff first came to skeptical attention when she published a study claiming that vaccines were linked to autism. She trolled through the VAERS database and, as David Gorski noted, “tortured the data until it confessed.” Last year she published a paper in which she claimed glyphosate caused autism, claims which I addressed almost a year ago. Gorski also deconstructed this paper, noting, “In fact, if you look at the slides for Seneff’s talks (e.g., this one, available at her MIT web page), you’ll find a tour de force of confusing correlation with causation…”
Seneff is a computer scientist who apparently is anti-vaccine and anti-GMO. In a stunning example of the Dunning-Kruger effect, she feels she can take her computer expertise and export it to biology. She nicely demonstrates that expertise is not so easily transferable.
From autism to concussions
Last year she also published a paper, which escaped my attention until it was recently pointed out to me, claiming that glyphosate, GMOs, and other modern lifestyle factors are responsible for the recent increase in concussions. Her co-author on the paper is Wendy Morely, who is a “Registered Holistic Nutritionist” specializing in the nutrition of concussion. Neither author has any neuroscience background.
The documentary does well what a good history documentary is supposed to do – put a topic into clear historical and cultural perspective. It is amazing how quickly we collectively forget how things were just a generation ago. Twenty to thirty years is apparently all that is necessary for clever marketing to completely change the way the public looks at an issue.
The origins of integrative medicine
Krainin starts appropriately by reminding the viewer of that historical context. A 1984 congressional report concluded that con artists selling “alternative medicine” were swindling the public out of 10 billion dollars a year. They preyed upon the old, the sick, and the desperate. The situation was considered a “scandal.”
One of our primary goals at SBM is to advocate for high standards of science in medicine. This means that we spend a lot of our time discussing claims and practices that fall short of this standard. This is very useful – exploring exactly why a claim falls short is a great way to understand what the standard should be and why.
An unfortunate consequence of this approach, however, is that many of our articles tend to be negative. We focus on what doesn’t work, on what needs to be fixed, and on why people fail.
But there is a positive side to the story as well that we should not neglect – science is powerful and it works. That is why we are such enthusiastic advocates of science in medicine and why it is so important to get it right. We shy away from overhyping scientific advances in medicine, because the mainstream media does that so well, but every now and then it’s good to acknowledge awesome medical and scientific advances. (more…)
Even more interesting to me than the question of whether or not acupuncture is effective for any particular symptom is the meta-question of how acupuncture proponents have managed to promote a treatment with systematically terrible scientific data. A new study provides a fresh example of this, which I will discuss below.
I think the behavior of acupuncturists reflects the fact that there are subcultures within science, where each community has its own standards, culture, and typical practices. You see this reflected in how they conduct their research and support their claims. Chiropractors, for example, have what is in my opinion a very unscientific culture. Their treatments are not science-based; science is an afterthought cherry-picked to support what is ultimately their philosophy.
The culture of acupuncture
The world of acupuncture has its own culture as well. Within this world there are special, very permissive rules of science that allow acupuncture to work for almost anything. One trend is to look for anything that happens locally in the skin when you stick a needle into it and then declare that a “mechanism for acupuncture.” The rules of the acupuncture culture also allow for a shifting definition of what acupuncture actually is, allowing the definition to conform to whatever the evidence shows. It’s a neat and subtle trick that allows acupuncture proponents to completely subvert the purpose of science.
Science functions best when it is free from any bias or conflict of interest. All those engaged in the process should value what is actually true more than anything else. Unfortunately, there are many sources of bias in science.
Researchers may want their pet theory to be supported. Journal editors want to publish research that will have a high impact. And of course, corporations would prefer that the results of scientific research favor their products and services. A recent round of editorials accuses the Coca-Cola company of trying to put its thumb on the scale of science in order to deflect attention away from sugary drinks as a source of obesity and overweight. What are they doing and what does the science actually say?
According to The New York Times:
The beverage giant has teamed up with influential scientists who are advancing this message in medical journals, at conferences and through social media. To help the scientists get the word out, Coke has provided financial and logistical support to a new nonprofit organization called the Global Energy Balance Network, which promotes the argument that weight-conscious Americans are overly fixated on how much they eat and drink while not paying enough attention to exercise.