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“Functional medicine” in practice

Functional Medicine practitioners like to make patients think that this diagram actually means something.

Functional Medicine practitioners like to make patients think that this diagram actually means something.

I’ve frequently written about a form of medicine often practiced by those who bill themselves as practicing “complementary and alternative medicine” (CAM) or “integrative medicine” (or, as I like to refer to it, “integrating” quackery with medicine). I’m referring to something called “functional medicine” or, sometimes, “functional wellness,” which Wally Sampson first introduced to readers of this blog way back in 2008, and continued to educate our readers over multiple posts. Over the years, I’ve tried to explain why the term “functional medicine” (FM) is really a misnomer, how in reality it is a form of “personalized medicine” gone haywire, or, as I like to refer to it, as “making it up as you go along.” Unfortunately, thanks largely to its greatest popularizer, Dr. Mark Hyman, FM is popular, so much so that Bill and Hillary Clinton count Hyman as one of their medical advisors and the Cleveland Clinic, not satisfied with embracing prescientific traditional Chinese medicine, has gone “all in” for FM by hiring Dr. Hyman two years ago to set up a functional medicine clinic. Unfortunately, it’s been “wildly successful” there.

Unfortunately its success is not deserved, at least from a scientific standpoint.
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Posted in: Acupuncture, Basic Science, Diagnostic tests & procedures, Science and Medicine, Traditional Chinese Medicine

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Phenibut Is Neither Proven Nor Safe As A Prosocial Wonder Drug

Editor’s note: With Mark Crislip away on yet another vacation, we present an inaugural guest post from Abby Campbell, a practicing MD, Ph.D and contributor at HealthyButSmart.com. Welcome Abby!

Ball-and-stick diagram of the phenibut molecule

Ball-and-stick diagram of the phenibut molecule

On average for the past year, phenibut has been typed into google 49,500 times a month. Phenibut is a supposed wonder drug that claims to promote sociability and lessen anxiety.

When people run that search in Google, they find stores that sell phenibut, as well as blogs and forums where people discuss and make recommendations for the use of phenibut. The main qualification of these people is that they themselves have taken the drug.

What a searcher doesn’t find is any reference to any credible research. Yet another supplement market has been born driven by anecdotal social marketing, and no one seems to care about the evidence.

What is phenibut?

Phenibut is a designer drug which was synthesized by a group of Russian scientists in the 1960s. Perekalin and his colleagues in St. Petersburg added a phenyl ring to butyric acid to make what we now call phenibut. The addition of the phenyl group to the butyric acid enables the compound to cross the blood-brain barrier and enter the brain.

This basic chemical structure of the compound explains the origins of the name ‘phenibut’. Phenibut is also known as fenibut and is sold under the brand names of Noofen and Citrocard.

Phenibut is structurally similar to the neurotransmitter GABA (gamma amino butyric acid). GABA occurs naturally in the human nervous system and has a calming effect on the brain.

GABA itself does not cross the blood brain barrier and so is not viable as a drug or supplement to reduce anxiety. The addition of the phenyl ring by the Russian scientists overcame the problem of penetration into the brain. However this means that phenibut is not totally identical to human GABA which means that we can’t just extrapolate information on GABA to phenibut, as some websites have done. (more…)

Posted in: Basic Science, Herbs & Supplements, Science and Medicine

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Medical science policy in the U.S. under Donald Trump

When Dr. Oz met Donald Trump: Somehow this photo just seemed appropriate for this post.

When Dr. Oz met Donald Trump: Somehow this photo just seemed appropriate for this post.

Last week, in an unexpected upset, Donald Trump won the Presidential election in the Electoral College while losing the popular vote and is now President-Elect. Regular readers of my not-so-super-secret other blog know my opinion of this; so I won’t belabor it too much here. If you’re curious, I have written about Donald Trump’s antivaccine views here before in the context of last year’s Republican debates, and, amusingly, I’ve even been at the receiving end of criticism from an “integrative medicine” activist in which my snark was compared to that of Donald Trump and my criticism labeled “Trumpism.” As you might imagine, I was not pleased.

Leaving all that aside and leaving aside how we’ve now had two Presidential elections out of the last five in which the candidate with fewer popular votes became President (no, I’m not a fan of the Electoral College), Donald Trump won fair and square and will be our next President. As an advocate of science-based medicine, naturally I wondered: What can we expect in terms of medical science under President Trump next year? Jann Bellamy already began the discussion on this blog by undertaking a fairly comprehensive overview of the disturbing anti-science positions Donald Trump and many now coming into his new administration espouse. I’m going to do a bit of the same, but I’m going to drill down and focus solely on medical science. While I agree that Trump’s position on human-caused climate change and his stated intent to pull out of important climate treaties and, in essence, cease any attempt to mitigate the effects of human activity on climate change is a looming disaster that our grandchildren and great-grandchildren and beyond will likely curse our generation for, this blog is Science-Based Medicine.
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Posted in: Basic Science, Clinical Trials, Medical devices, Pharmaceuticals, Politics and Regulation

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Blue Light. Special?

blaulicht
I do not sleep as well as I used to. Perhaps it is being tormented by guilt and worry combined with profound existential angst.

Or maybe it is my iPad. I gave up on most dead tree editions. I miss the smell and feel of books and magazines, but nothing is better than being able to increase the font size to 18. So I usually finish the day reading on the iPad.

I have noted programs that will remove the blue light from computer screen to aid in sleep. There is a night mode in iOS 9.3 and a program for the Mac I have on now that filter out the blue. Makes the screen oddly colored but it more restful on the eyes. I think. I am more in need of existential angst filter. (more…)

Posted in: Basic Science, Medical devices, Science and Medicine

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Stem Cell Tourism for Eye Disease: No Passport Required

all-seeing-eye

Stem cell clinics outside the United States, and outside the jurisdiction of the U.S. regulations, have flourished and the pursuit of treatment at these centers has been called “stem cell tourism.” Seekers of unproven stem cell therapies no longer need to look outside the U.S. Paul Knoepfler, a stem cell researcher and leading advocate for the responsible use of stem cell technology, wrote an SBM post on the regulatory aspects of stem cell treatment, a highly recommended read. He also coauthored an article highlighting the direct-to-consumer stem cell industry in the United States. For now, the article is behind a paywall. Fortunately, David Gorski summarized the article here. The authors found a shocking 351 businesses advertising stem cell treatment at 570 locations in the U.S. The problem is that the proliferation of for-profit facilities far outpaces the science on stem cell therapies. Most of these facilities are selling treatments without proven value and with mostly unknown safety.

Clearly, there is no shortage of “experts” prepared to sell you expensive, unproven stem cell treatments for a multitude of diseases. So who can you trust? If I wanted a source of reliable information about stem cell treatment, I might be tempted to seek out the world’s leading homeopathic ophthalmologist!

Introducing: the World’s Leading Homeopathic Ophthalmologist

How do I know Dr. Edward Kondrot is the world’s leading homeopathic ophthalmologist? It says so, right on his website. But it would be an injustice to simply characterize Dr. Kondrot as a homeopathic ophthalmologist. Dr. Kondrot is a Renaissance man of alternative medicine. He is a Board Certified Ophthalmologist, author, radio show host, Fellow of the College of Syntronics, Research Chairman for the College of Syntronics, Adjunct Professor Department of Research at Southwest College of Naturopathic Medicine, President of the Arizona Integrative and Homeopathic Medical Association and member American Academy of Ozonotherapy, just to name a few of the credentials listed on his bio. If you Google Dr. Kondrot’s name you will find he has quite a presence on the internet. I find this video to be particularly endearing. (more…)

Posted in: Basic Science, Science and Medicine

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Infectious Diseases and Cancer

coley

Dr. William Coley. Not a brain surgeon.

With apologies to my colleagues, but infectious diseases really is the most interesting specialty in medicine. There are innumerable interesting associations and interactions of infectious diseases in medicine, history, art, science, and, well, life, the universe and everything. ID is so 42.

A recent email led me to wander the numerous interactions between infections and cancer.

There are the cancers that are caused by infection. HPV and cervical and throat cancer. EBV and lymphoma. HHV8 and Kaposi’s Sarcoma. I certainly hope I am not reincarnated as a Tasmanian Devil. (more…)

Posted in: Basic Science, Cancer, Clinical Trials, Epidemiology, Science and Medicine, Vaccines

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Parkinson’s Disease: A Detective Story

brainstorms
I didn’t intend to review Jon Palfreman’s book Brain Storms: The Race to Unlock the Mysteries of Parkinson’s Disease, but after reading it I decided it was too good not to share. Palfreman is an award-winning science journalist who has Parkinson’s himself. He has done a bang-up job of describing Parkinson’s disease, its impact on patients, and how science is working to understand and treat it.

The disease

Parkinson first described the disease in 1817. It is characterized by shaking, rigidity, slowness of movement, and difficulty with walking. There is a decrease in dopamine in the basal ganglia in the brain. One million Americans have Parkinson’s disease. The incidence increases with age; by age 80 one in fifty people are affected.

Some very strange phenomena have been observed. Parkinson’s disease is less common among smokers and coffee drinkers. When a patient becomes frozen and unable to take the next step, if you draw a line on the floor they will step over the line and walk on. Patients who can’t walk can run, ride a bike, or ice-skate. Some patients appear to have strong responses to placebos, with reversal of symptoms for long periods. Exposure to vibration seems to decrease symptoms; in the late 1800s patients were treated with vibrating chairs until controlled studies showed they didn’t work. (more…)

Posted in: Basic Science, Book & movie reviews, Neuroscience/Mental Health

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Chronic Fatigue Syndrome/Systemic Exertion Intolerance Disease Speculcation

Enlarged_c_elegans

I knew humans could resemble worms, but this?

My wife and I are entering an age where our aches and pains are becoming a major ongoing topic of conversations. The pain of raising kids has transitioned into the pains of growing older. These aches and pains are, in the scheme of things, minor and intermittent.

At work I get to see real suffering and it keeps my own in perspective. And there are a lot of people who feel awful, some for obvious reasons such as cancer or AIDS, and some from ailments that are more enigmatic, such as systemic exertion intolerance disease (SEID), the illness formerly known as chronic fatigue syndrome.

Worst. Gateway disease. Ever.

In the context of SBM, SEID is a gateway disease into the world of pseudo-medicine.

A syndrome with no known cause and few effective therapies at best, those who suffer from it are easy pickings for SCAM practitioners. When you feel like crap month after month with no improvement or even an explanation for your suffering, you keep looking until you find an answer. (more…)

Posted in: Basic Science, Chronic Fatigue

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The Cancer Moonshot: Hype versus reality

Joe Biden promotes the Cancer Moonshot initiative.

Joe Biden promotes the Cancer Moonshot initiative.

The Cancer Moonshot. It’s a topic that I’ve been meaning to address ever since President Barack Obama announced it in his State of the Union address this year and tasked Vice President Joe Biden to head up the initiative. Biden, you’ll recall, lost his son to a brain tumor. Yet here it is, nearly eight months later, and somehow I still haven’t gotten around to it. The goal of the initiative is to “eliminate cancer as we know it,” and to that end, with $195 million invested immediately in new cancer activities at the National Institutes of Health and $755 million proposed for FY 2017. My first thought at the time was that that wasn’t nearly enough money to achieve the ambitious goals set out by the President. That has now become particularly clear now that the National Cancer Institute has released the report from the initiative’s blue ribbon panel suggesting ten ways to speed up progress against cancer.
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Posted in: Basic Science, Cancer, Clinical Trials, Politics and Regulation

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3-Bromopyruvate: The latest cancer cure “they” don’t want you to know about

3-BP: A "safe" and "nontoxic" cancer cure targeting the Warburg effect that quite possibly killed three cancer patients in Germany.

3-BP: A “safe” and “nontoxic” cancer cure targeting the Warburg effect that quite possibly killed three cancer patients in Germany.

I’ve not infrequently written about various dubious and outright quack clinics in different parts of the word with—shall we say?—somewhat less rigorous laws and regulations than the US. Most commonly, given the proximity to the US, the clinics that have drawn my attention are located in Mexico, most commonly right across the border from San Diego in Tijuana for easy access by American patients. Sometimes, in the case of dubious stem cell clinics, they are located in countries like China, Argentina, or Kazakhstan. That’s not to say that there aren’t a lot of quack clinics right here in the US (particularly for stem cell treatments), but, by and large, the clinics doing the truly dangerous stuff tend to be less common in the US.

There is, however, another country where alternative medicine clinics, particularly for cancer, are common and thriving, specifically Germany. I first learned of these clinics when the story of Farrah Fawcett’s battle with anal cancer hit the news nine years ago. Ultimately, she died of her disease at age 62, but before she did she sought treatment at a clinic in Germany, which administered alternative treatments as well as radioactive seed implants, the latter of which, despite sounding nice and “conventional,” were not standard-of-care for recurrent anal cancer. What this led me to learn is that German alternative cancer clinics tend to use both alternative medicine and experimental “conventional” medicine that has not yet been shown to be safe and effective in clinical trials.

I thought of Farrah Fawcett when news about a German cancer clinic hit the news again beginning more than a week ago, when two patients from the Netherlands and one from Belgium died shortly after having undergone treatment at the Biological Cancer Centre, run by alternative practitioner Klaus Ross in the town of Brüggen, Germany. Two others were hospitalized with life-threatening conditions. I didn’t blog about them at the time because the only reports I could find were those sent to me by readers, and they were in German or Dutch. They also didn’t have a lot of detail. Both reported that on July 25, a 43-year-old Dutch woman went to the Biological Cancer Center in Brüggen-Bracht for treatment of breast cancer and that she unexpectedly died on July 30 of unknown causes. The Dutch report stated that the death occurred under mysterious circumstances and that there were two other deaths, that of a Belgian woman the week before, and a Dutch man.

Elsewhere, Irish newspaper TheJournal.ie reports:

Dutch police, who are supporting the inquiry, appealed for information from other patients, as newspapers reported the clinic had been using an experimental transfusion.

Concern was first raised when a 43-year-old Dutch woman with breast cancer complained of headaches and became confused after being treated at the clinic on 25 July.

She later lost the ability to speak, and died on July 30 although the “cause of her death remains unclear,” the German prosecutors said in a statement earlier this week.

Later, it was learned that the identities of the suspected victims were Joke Van der Kolk, age 43; Leentje Callens, age 55; and Peter van Ouwendorp, age 55.

Unfortunately, the early reports were fairly basic, without much detail, and only a couple with any names. Fortunately, now there is an article in Science that reports more. It turns out that the suspected cause of death is an experimental cancer drug known as 3-bromopyruvate (3-BP) that has not yet been approved for use in humans. So what happened?
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Posted in: Basic Science, Cancer, Clinical Trials, Health Fraud

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