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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.

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Baby Translating Technology: Revolutionary Parenting Tool or Confirmation Bias Bonanza

stupidbaby
Caring for a young infant, although a potentially rewarding means of producing a labor force for chores and minor home repairs, can be a trying ordeal for both new and experienced parents. The peaks and valleys of parental experience can leave a caregiver both exhilarated and agonizingly frustrated during a single hour of childcare, let alone the first few months. It is not an uncommon experience for a parent to rapidly alternate between extreme states of emotional arousal, one minute gazing down at their sleeping baby with seemingly limitless feelings of joy and love, and the next panicking at the perception that it has been too long since their baby’s last breath.

Babies, especially stupid ones, require near constant attention during the first several weeks of life, and that’s if it is going well. There is no user manual for the care of the newborn human that could possibly describe every situation and how to effectively respond to it in each individual child. A trial and error approach is always necessary to some degree, and it tends to result in a lot of sleepless nights, with many parents finding themselves more exhausted than they ever dreamed possible. So it shouldn’t be surprising that parents are a particularly vulnerable population when it comes to the marketing claims of bogus technology aimed at making their lives even the slightest bit easier. (more…)

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Don’t drink hair bleach

H2O2-hydrogen-peroxide-meme-small-480x636

One of the most satisfying parts of being a health professional is the opportunity to help people make better health decisions. In between the emails suggesting I’m a paid lackey of the Pharmaceutical-Industrial Complex™ for not endorsing coffee enemas, vitamin C, or homeopathy, I do receive the occasional note thanking me for my advocacy, or for writing about a subject in a way they found helpful. I’m also sent questions – too many to answer, but occasionally opening my eyes to new “concepts” in alternative medicine. And while I spent years working in a pharmacy with a huge “holistic” health section, containing products that, if they worked, would have defied one or more laws of physics or chemistry, I can still be surprised at novel alternative-to-medicine approaches to health care. Last week I was sent a questions about hydrogen peroxide – not for first aid use (where it may not be as useful as thought), but for oral consumption, as some sort of health “cure-all”. I was baffled, but the concept does exist – and the Big Pharma Overlords apparently don’t want you to know about it. There must be a rule 34 of alternative medicine – if it exists, there is an (inappropriate) alternative medicine use for it. The active ingredient in hair bleach and teeth whitening strips is no exception. (more…)

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Lyme Testing

The little burrowing bacteria that bores into your pores to cause Lyme disease, EEEEEWWW!!!

The little burrowing bacteria that bores into your pores to cause Lyme disease, EEEEEWWW!!! Darkfield 400x microscopy image of the 10-25µm long Borrelia burgdorferi spirochaete which causes Lyme disease (1993). Provided by the CDC’s Public Health Image Library (PHIL #6631) via the Wikimedia Commons

I hate those oh hell moments. I was up way too late last night, but who can pass up the opportunity to see Patti Smith playing Horses (and more) for the 40th anniversary of the album. Only 44? Behind the Eagles? No way. I would nudge it up a few more spaces. Hard to believe I was 18 when that album came out. Horses is one of the few albums that made the transition from vinyl to CD. It was a tremendous show, and at 69 Patt performs with the energy and passion of a 29 year old. And she sure can spit. I had the evening off, so food and drinks at Swine until well past midnight. First time my wife and I closed a bar. I am too old for this.

But as I was blearily drinking my a.m. coffee on a dreary PDX morning, I opened the browser to SBM and there was a post by Jann. Oh hell. That means I have a post due tomorrow and I had lost track of the time over the holidays. I thought my next post was next Friday. Oh. Hell. So unlike most posts which I write over a week, this one was done in about 4 hours. And I am sure it will show.

How do you diagnose an infection?

Not always so simple. You always start with a history and, for infectious diseases, an exposure history is paramount. People get what they are exposed to, so you want to know travel, animals, diet, water, sex etc. If you have ridden a horse to have sex in an Indian lake while drinking raw milk (not really an unusual history in my practice; people do the darndest things) you have exposure risks for a variety of infections. If you have not left the Willamette Valley it is unlikely that the cause of the illness is malaria, although you always have to consider that the infection came to the patient rather than the other way around. (more…)

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Colonoscopy: More Misinformation from Mercola

colonoscopy
Joseph Mercola, D.O., runs the website mercola.com which is full of misinformation, advocates all kinds of questionable alternative treatments including homeopathy, and discourages vaccination and other aspects of conventional medicine.

Like Dr. Oz and Andrew Weil, he is more dangerous than easily recognizable quacks in that he combines some good medical information with egregious misinformation, and readers who know he is right about the good information are likely to wrongly assume everything else he says must be equally true. He’s right about some things, but the safest course is to assume that anything on his website is false unless you can verify it as true by consulting other sources that are reliable. I tried to verify the information in his recent article on colonoscopy. I found outright errors along with fear-mongering and bias. (more…)

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Science-Based Medicine’s Not-So-Psychic Predictions for 2016

May your epididymitis be treated with acupressure!

“May your epididymitis be treated with acupressure by André the Giant!”

The new year is upon us, and with it comes a unique opportunity for the Science-Based Medicine team to look deep into our crystal balls, to channel our Atlantean spirit guides, and to ride the waves of cosmic consciousness in order to bring to you our predictions for 2016. But before you scoff at our collective powers of prognostication, know that we have never made a prediction that has not come to pass. We’ve also never made any official predictions before, but that’s neither here nor there.

In the process of discussing what will become of this new alternative medicine fad (have you heard of it?) in the coming year, I have discovered that the contributors to SBM are all extremely pessimistic. Sadly, the vast majority of the responses to my request for predictions were focused on the future advances of pseudoscience in medicine and the steady decline of our ability to tell the difference between reality and medical fiction. But I agree with each and every one. (more…)

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Guess who pioneered chemoprevention through diet?

Listen to your science: Eat your vegetables.

This is an expansion of a post I did over on the Society for Science-Based Medicine blog about this time last year. The original post, which got far more traffic than is usual for the SFSBM, is a good example of how science works and the good that it can do. The hard work of real science illustrated here serves as a striking counterpoint to the slap-dash system of pseudoscience, which churns out fake diseases, causes, and cures by the dozen based on a fuzzy understanding of real science fueled by a healthy dose of imagination.

Naturopaths and “functional medicine” practitioners would have the public believe that they are the true experts on nutrition and health. Even though their nutritional advice contains a large serving of hooey and a big helping of dietary supplements, which they are happy to sell to patients.

So it was with great interest that I read the obituary of Dr. Lee Wattenberg in the New York Times.

Dr. Wattenberg published a landmark paper in the journal Cancer Research that reviewed 36 years of animal studies on the effects that certain compounds had on the development of cancer. The paper laid the framework for understanding how these compounds work. . . .

He showed that cabbage, brussel sprouts, cauliflower and broccoli inhibit the development of carcinogens. He isolated a compound in garlic that decreased “by a factor of three” the chances that animals injected with cancer agents would develop that cancer. He found two chemicals in coffee that neutralize free radicals, which are harmful chemicals commonly implicated in the onset of cancer.

(more…)

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Is scientific peer review a “sacred cow” ready to be slaughtered?

Peer Review

I’ve frequently noted that one of the things most detested by quacks and promoters of pseudoscience is peer review. Creationists hate peer review. HIV/AIDS denialists hate it. Anti-vaccine cranks like those at Age of Autism hate it. Indeed, as a friend of mine, Mark Hoofnagle, pointed out several years ago, pseudoscientists and cranks of all stripes hate it. There’s a reason for that, of course, namely that it’s hard to pass peer review if you’re peddling pseudoscience, although, unfortunately, with the rise of “integrative medicine,” it’s nowhere near as difficult as it once was.

Be that as it may, peer review, the process by which scientific papers are evaluated by scientific “peers” to look for problems with the science and decide if the paper is appropriate for publication in a scientific journal, is a concept that dates back hundreds of years. However, for the most part, before the middle of the 20th century, the ultimate determination of whether a paper was appropriate for scientific publication was made by editors or editorial committees. Opinions of external reviewers were sometimes sought when deemed appropriate by journal editors, but by no means was this the practice for most manuscripts. Over the last six or seven decades, external peer review by scientists chosen by the journal editor evaluating a submission has become the standard. Similarly, decisions regarding whether or not to fund grant applications are now generally made by a panel of external reviewers. In the case of the NIH, these panels are called study sections and consist of scientists with expertise in the types of applications being referred to the study section for evaluation, along with (usually) a statistician or two and officials from the NIH who take care of organizing and running the meetings of the panel. The scientific members of a study section usually include “permanent” members, who are assigned to fixed terms on the study section, and ad hoc members, called in for one or a few meetings as needed and deemed necessary by the NIH.
(more…)

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Of Mice and Men…and Coconut Oil

Editor’s note: This post is a collaborative effort between Grant Ritchey, a Science-Based Medicine semi-regular, and Stephanie Tornberg-Belanger, a co-author of the research paper discussed below and who brought the study to Grant’s attention. We are pleased to welcome Stephanie as a guest contributor to SBM.


Infographic listing the benefits of coconut oil.

That amazing coconut oil! What can’t it do?

In his last SBM post, Grant reported on a systematic review of the literature that undermined just about everything dentists had been taught in dental school and have been preaching to patients since The Olden Times: flossing, as it turns out, is not the be-all, end-all that we’ve been led to believe with regard to cavity and gum disease prevention. While the message itself was interesting and relevant, the meta-message in that piece is that we all must be willing to slay our own sacred cows when the evidence demands it, even if it requires shedding long-held, cherished beliefs. This is difficult for any human being to do, and skeptics who are presumably open minded are no different (and can sometimes be worse, because we are often overconfidently convinced of our “rightness”).

So with that in mind, gather ’round children, because we have another meta-message for you. This one deals with coconut oil.

(Pause for gasps.) (more…)

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Influenza Eye Roll

Look!  A metaphor!

Look! A metaphor!

I don’t know the best metaphor. What comes around goes around. The more things change, the more they say the same. Sisyphus. Whack-A-Mole.

So what to do when the same old same old rears its head yet again? There are 2,545 posts on this blog, and I suppose I could just point to prior posts. But a blog entry that consists of links to prior posts would make the managing editor irritable. And we don’t want him irritable. Although those links are at the end of the post.

And WordPress is not a good format for reference material. I have trouble finding my own articles even when I know they exist and search for them using what I think are relevant terms.

It being the start of the flu season the same ole same ole nonsense is back about flu vaccines and influenza treatment. Influenza seasons vary, the nonsense does not. On the assumption that most of the readers of the post have no prior knowledge of what I have written on the topic, I thought I would tackle influenza yet again. (more…)

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