I was looking over a recent class catalog from my alma mater, University of Oregon. I see the Astronomy Department is having a day devoted to astrology, inviting astrologers to talk about their profession. And the Chemistry department is having alchemists give an overview on how to change base metals into gold. And, to green our energy, the Physics Department, where I acquired my undergraduate degree, is having a symposium on perpetual motion machines. I am so proud.
But not when it comes to SCAM (Supplements, Complementary and Alternative Medicine). Medicine is strange in that has no issues embracing pseudo-science. My medical school, OHSU, had an afternoon devoted to Integrative Medicine for the third year medical students, with lectures by a chiropractor, a traditional Chinese pseudomedicine practitioner, a naturopath and an integrative medicine practitioner. They also had a small group discussion of a case of irritable bowel syndrome where one of the discussion leaders was a……Qi……….Gong………..master. Really. I would be so pissed if I was going $166,000 in medical school debt and I was being taught about the approach to ANYTHING by a Qi Gong Master. It was a day to ignore that whole ‘science’ thing in the name of the school. (more…)
I had the pleasure of speaking on the topic of chiropractic and the newborn baby earlier this week at a meeting of the Boston Skeptics. There is a video of the talk online for anyone interested in learning more. And if you haven’t yet, please read yesterday’s post on chiropractic and babies by Sam Homola.
My introduction to pediatric chiropractic
Although I was aware of the existence of chiropractic well before beginning my medical training, I was blissfully ignorant of the full scope of what many chiropractors actually do on a daily basis. My belief that they practiced solely as “doctors of the back” was shattered early in my pediatric training at Vanderbilt while on a pulmonary medicine rotation when I was asked to consult on the child of a well-known musician who lived in the area. The patient, perhaps only hours from respiratory failure, had been brought to our emergency department only after chiropractic treatments had failed to manage a severe asthma exacerbation.
That encounter, as well as another around the same time involving a child with a throat abscess being treated with acupuncture, inspired me to dig deeper into the general concept of alternative medicine. I even went so far as to approach a local chiropractor who had set up a table at a Nashville YMCA to promote chiropractic prevention and treatment of the flu. Dr. Fakename happily allowed me to spend a day in his office, and even brought in his own child to demonstrate his approach pediatric care.
Needless to say, Dr. Fakename failed to convince me of the benefits or need for chiropractic involvement in pediatric healthcare. When the discussion turned to routine childhood vaccines, I heard the party line on the subject for the first of many times. Dr. Fakename was not against vaccines, he was in favor of giving families all of the facts. He gave me some reading material, and a book suggestion or two, which provided nothing but potential and unproven risks with no mention of the well-established benefits and proven safety of immunizations. I’ll never forget what his wife, who had brought their child in for the demonstration, whispered to me during a moment of distraction: “Don’t worry, we vaccinate our kids. I make sure.”
By the end of my residency I was a full blown skeptic of a variety of alternative medical modalities in addition to chiropractic, and had built a reputation as someone interested in and knowledgeable on the subject of quackery. I even gave a grand rounds on pediatric CAM with a focus on chiropractic which I’m proud to say drew a standing room only crowd that included folks from the community interested in alternative medicine as well as from the brand new integrative medicine center at Vanderbilt. I had even been asked to serve as a resident representative, however that invitation was quickly rescinded after my skeptical talk. (more…)
My article “Pediatric Chiropractic Care: The Subluxation Question and Referral Risk” was published in the 2016 February issue of the journal Bioethics. The abstract summarizes the message of the article:
Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a “vertebral subluxation” or a “vertebral subluxation complex” alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations─the International Chiropractic Association and the American Chiropractic Association─support chiropractic care for children, care that includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice.1
The first objection to my article came in a January 30 Facebook posting by Milehighchiro, a subluxation-based group: (more…)
As good a source of stem cells as any chiropractor.
My local newspaper is a constant source of topics to blog about. It regularly features ads for untested dietary supplements and for chiropractors who offer non-chiropractic treatments and don’t identify themselves as chiropractors. Recently, a full-page ad for NW Pain Relief Centers trumpeted “Stem Cell Technology Takes Joint Treatment to the Next Level.” It said stem cell treatments could heal and regenerate tissue in conditions such as knee osteoarthritis, carpal tunnel, peripheral neuropathy, spinal stenosis, hip pain, and tendinitis. A table titled “Consider these facts” compared stem cell therapy to surgery, saying stem cell treatments involve no known side effects, little or no pain, and immediate recovery; whereas surgery involves complications, poor outcomes, addiction to pain medications, severe pain for months, and a prolonged recovery over months and years. It said, “Call now if you experience any degree of joint pain or discomfort…Space is limited to the first 30 callers!”
A few days later there was another full-page ad for NW Pain Relief Centers, this time for hyaluronic acid injections into the knee for osteoarthritic knee pain. It reprinted the same table of comparisons with surgery, with an additional line comparing costs (that didn’t actually compare costs, but only vaguely mentioned insurance coverage, deductibles, copays, and time off work. It featured the same “Call now, space limited” ploy.
These ads reminded me so much of chiropractic ads that I had to wonder what was going on. They mentioned an “allied team of health professionals.” I guessed there must be at least one MD on their team if they were injecting stem cells and hyaluronic acid into joints. I guessed chiropractors were a prominent part of the team. I guessed right. (more…)
There is a bill before the Oregon Legislature, Senate Bill 1535, that:
Allows chiropractic physicians and naturopathic physicians to provide release for athlete who sustained concussion or is suspected of sustaining concussion.
Unfortunately, the Oregon legislature has already granted naturopaths primary care physician status, so I expect this may well pass, despite the fact neither chiropractors nor naturopaths have much reality-based education and training in medicine.
You may wonder, why you should care about what is going on in Oregon? Well, it is likely similar laws are being considered in your state. You might be surprised at the shenanigans going on in your legislature. I was when I looked. To keep informed, go to Legislative Update at the Society for Science-Based Medicine for weekly updates.
Let’s go through the issues: why is it a bad idea for the athletes of the state, most of whom will be children, to be cared for by NDs and DCs? (more…)
If you want money to pay for pseudoscience, but your pesky health insurance company is getting in the way, a Health Savings Account might be just the solution. And if the Health Savings Act of 2016, sponsored by the Big Supplement’s own Senator Orrin Hatch, becomes law, your opportunities will be greatly expanded.
First, let’s take a look at Health Savings Accounts and explore how they can be used to pay for quackery. Then we’ll see how Hatch’s Senate Bill 2499 (and companion House Bill 4469) would essentially force taxpayers to fund consumer purchases of unproven and potentially unsafe dietary supplements and “The One Quackery To Rule Them All,” homeopathy. Finally, we’ll look at how all of this might affect the presidential race.
What are Health Savings Accounts?
A Health Savings Account (HSA) is a personal account created exclusively to pay for current or future health care expenses. They have significant tax advantages:
- Contributions to HSAs are tax deductible;
- Withdrawals are tax-free as long as they are used to pay for qualified medical expenses;
- Interest earnings accumulate tax-free and the balance in the account at year’s end can be rolled over into the next year with no tax penalty.
Well, we’re back.
Yes, after having our WordPress database somehow borked to the point where no new posts could be added and no existing posts could be edited since Friday, Science-Based Medicine is back in business—finally! As a result, some of you might have seen this post elsewhere, as it was considered to be somewhat time-sensitive, and I didn’t want to delay, particularly given that I didn’t know how long SBM would be down. Fortunately, we’re back a bit sooner than I thought; so let’s look at something that was in the news over the weekend.
Katie May was a model, and by all accounts a very successful one, having appeared in Playboy, Sports Illustrated, and other magazines and websites. Self-proclaimed the “Queen of Snapchat,” she also had nearly two million Instagram followers and was a major social media force, having recently parlayed her modeling and social media career into entrepreneurship. She also died unexpectedly on Thursday night at the too-young age of 34, leaving behind a seven-year-old daughter. What makes May’s tragic death an appropriate topic for SBM is not so much her young age but rather the circumstances surrounding her death, particularly the cause. Basically, May died of complications due to stroke, as her family confirmed in a statement issued on Friday:
“It is with heavy hearts that we confirm the passing today of Katie May – mother, daughter, sister, friend, businesswoman, model and social media star – after suffering a catastrophic stroke caused by a blocked carotid artery on Monday,” the statement reads.
“Known as MsKatieMay on the Internet and the “Queen of Snapchat,” she leaves behind millions of fans and followers, and a heartbroken family. We respectfully ask for privacy in this this difficult time. Those wishing to contribute to the living trust being set up for the care of her young daughter may do so at her GoFundMe page.”
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…)
One of the main, but perhaps underappreciated, reasons quackery thrives in the United States is that the states legalize it by licensing practitioners of pseudoscience as health care providers. These practitioners are placed under the regulatory jurisdiction of, well, themselves. I call the whole deplorable process Legislative Alchemy, and you can see all posts on the topic here. It gives practitioners an underserved imprimatur of state authority and leaves public protection from harmful practices to the oversight of those who are themselves engaging in the very same conduct. Each year, dozens of bills are brought before the state legislatures to establish initial licensure or, once that goal is achieved, scope of practice expansion.
Most attempts fail, but CAM practitioners are a dogged bunch, and they will come back each year until they get what they want. It took chiropractors about 60 years to become licensed in all 50 states. Acupuncturists are almost there. Naturopaths lag far behind, but are slowly gaining ground each year, even if it is only via practice expansion in states where they are already licensed. 2015 was a losing season for all, but not without advancement toward larger goals.
Health care systems around the world are being pressured to “do more and spend less”, to make healthcare more cost effective. Owing to aging populations and the growing cost of providing health services, there’s more scrutiny than ever on the value of different health treatments, with the goal of reducing the use of treatments that don’t help. The Choosing Wisely initiative was establishing expressly for this purpose. Regrettably, while well-intentioned, Choosing Wisely hasn’t had as much of an effect as you might expect. Medicine can be slow to change, as David Gorski discussed earlier this week. Unless we ruthlessly scrutinize what we do for effectiveness, and are willing to act on what we learn, self-driven change is unlikely. One way that governments (and insurers) can dramatically reduce the use of a health service or treatment is to simply stop offering it, or paying for it. Yet stopping funding is something that is relatively uncommon in health care. It seems to be much more difficult to stop a practice, possibly owing to inertia, a reluctance to change, and the sometimes-vociferous protests that can emerge from patients or physicians that may feel that their preferred therapy is effective. The formidable challenge of stopping health care funding, once it has started, is one reason why this blog has been very critical of the expanding scope of practice being granted to alternative medicine purveyors – the legislative alchemy that is the first step towards insurance coverage. Because once that’s in place, it will be far more difficult to stop it. So it’s essential to understand the evidence. (more…)