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Australian review finds no benefit to 17 natural therapies


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…)

Posted in: Acupuncture, Chiropractic, Herbs & Supplements, Homeopathy, Naturopathy, Traditional Chinese Medicine

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US Department of Justice Goes After Supplements

The Robert F. Kennedy building in Washington, DC, headquarters of the United States Department of Justice

The Robert F. Kennedy building in Washington, DC, headquarters of the United States Department of Justice

It is shaping up to be a good year for those of us advocating more effective regulation of supplements and unproven therapies in the US. The Food and Drug Administration (FDA) is reviewing its regulation of homeopathy, and recently also announced it is taking public comment on its regulation of the term “natural.” The Federal Trade Commission (FTC) is also reviewing the claims made by the homeopathy industry, and even gave a nudge to the FDA to fix its regulation.

Now the US Department of Justice (DOJ) is getting in on the fun:

USPlabs, which sold the best-selling workout supplement Jack3d, and six of its executives face criminal charges for the unlawful sale of nutritional supplements, the U.S. Justice Department said Tuesday in announcing a larger probe by federal agencies aimed at stemming the sale of unproven products.

This action by the DOJ raises the stakes to a new level – criminal charges. While the FDA and FTC do the best they can, they often lack teeth when it comes to supplements. The FDA might issue a polite request and then escalate to a stern warning when companies step out of line. The FTC can issue fines which amount to little more than a slap on the wrist – the cost of doing business. Both agencies are playing whack-a-mole and losing.


Posted in: Herbs & Supplements, Legal

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“The Truth About Cancer” Series Is Untruthful About Cancer

The Truth About Cancer: A Global Quest is billed as “the documentary series the mainstream media refused to air.” It consists of eleven episodes and is produced by Ty Bollinger, an outspoken supporter of natural treatments for cancer. Episodes 1 and 2 are currently available online.

Ty Bollinger started his quest because several of his family members had died of cancer despite conventional cancer treatment. He believed they had died not of the cancer but of the cancer’s “so-called treatments” and “false treatments.” He doesn’t explain which cancers they had, what the treatments were, or why he calls them “false.” He was angry, and he wanted his relatives’ lives to matter; he thought he could give their deaths meaning by seeking out alternative treatments that would have saved them and could save others. He was a CPA and bodybuilder, untrained in science or medicine. He started out with the conviction that conventional cancer treatment was a fraud, and confirmation bias had a field day. Instead of learning about cancer from reliable sources, he avoided mainstream cancer experts and researchers and only interviewed alternative practitioners from all over the world who agreed with his premise. He eagerly swallowed everything they told him.

He says “You are about to learn the best treatments and preventions to cancer, protocols that won’t harm your body, from the world leading doctors across the globe.” He promises to show viewers science and documented evidence. He promises to expose the lies of conventional cancer treatment. He thinks he has information that will eradicate cancer once and for all. He couldn’t be more wrong. (more…)

Posted in: Book & movie reviews, Cancer

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On “integrative medicine” and walking and chewing gum at the same time

Walk and chew gum at the same time

I didn’t think I’d be discussing Dr. David Katz again so soon. In fact, when Mark Crislip (who clearly hates me, given how often he sends me links to articles like this) sent me a link to Dr. Katz’s latest article, “Cleaning the House of Medicine“, published—where else?—in The Huffington Post, that home for “reputable” quack-friendly bloviation since 2005, when I first read the article, my first reaction was that Katz must surely be trolling us here at SBM. At first, I wasn’t going to respond to him again. However, Katz’s article represents a very common misconception about science-based medicine that is worth refuting. It is not my intention to be arguing back and forth with Dr. Katz every couple of weeks, but I did think it worth one more round. I think you’ll understand why by the end of this post.

First, however, a brief recap is in order for readers who might not have been following the discussion over the last month or so. It all started a couple of weeks ago, when Jann Bellamy, in response to a special issue of the American Journal of Preventative Medicine edited by Katz and dedicated to making the case for integrative medicine in preventive medicine training, quite correctly discussed how “integrative medicine” is always all about the “potential.” Indeed, after having spent considerable sums of federal grant money studying the “integration” of pseudoscience into medicine with respect to preventive care, the journal couldn’t come up with any concrete examples how integrative medicine adds anything (other than quackery) to medicine. Dr. Katz, who is well-known in the world of quackademic medicine for his infamous 2008 speech in which he asserted that physicians need to use a “more fluid concept of evidence” in evaluating treatments, particularly “complementary and alternative medicine” (CAM), responded with another HuffPo article entitled “Science and Medicine, Fools and Fanatics: The ‘Fluidity’ of Woo“. In lieu of reasonable, science-based arguments, Dr. Katz’ article was little more than a rant that consisted mainly of outrage that mere mortals lacking his awesome academic credentials had had the temerity to question his awesomeness and dedication to science coupled with an accusation that we are just too rigid and simplistic in our thinking to understand the subtle complexities of how different standards of evidence must be applied to complex patients. Steve Novella and I both responded that we understand just fine, explained how doctors do this all the time without using quackery like naturopathy and homeopathy (both of which Katz has advocated), and pointed out his argumentum ad ignorantiam with respect to energy medicine.

There’s where I thought it would end. Unfortunately, I was mistaken. On Friday, Katz launched another broadside at us, couched in the form of an argument that medicine must “clean its own house” before worrying about his quackademic medicine. It’s something I hear often enough that I thought it would be worth responding to, even if Dr. Katz was indeed trolling us.

Posted in: Critical Thinking, Medical Academia, Science and Medicine, Surgical Procedures

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Acupuncture/TCPM Crapfest

Acupuncture needling

Look Ma! No gloves!

As I get older I get more grumpy. Issues that at one time I was rather sanguine about, now irritate the hell out of me. It is not like it was when I started practice. Information was hard to come by. Going through the Index Medicus, with the world’s tiniest font, wandering the stacks looking for papers, sending off for reprints, getting a precious Xerox (or even a mimeograph) of a classic paper from an attending.

You understood the value of eminence-based medicine, as it took a career to acquire and master the literature. You relied on the wisdom of old geezers like me who had decades of experience and reading.

That was then. Now? The world’s information is available almost instantaneously. You may not be able to master a new topic spending a day on Google and Pubmed, but you can acquire a reasonable understanding, especially of you have some background.

Because of Google and Pubmed, the only reasons for ignorance of your area of expertise in medicine are time, laziness, or stupidity. As a specialist, only time is an excuse. It is my job to keep up with infectious diseases, although with over 10,000 articles a year in ID, it is impossible to read everything. But if I have a question concerning patient care, I need to look it up. I have another blog whose raison d’être is looking up answers to the daily questions that arise in practice.

On the characteristics of a useful clinical trial

So the characteristics of a useful clinical trial are not hard to determine: Randomized, double blind, placebo controlled, adequately powered. Because you want to avoid spending time and money on a study only to end up with no useful conclusions. This is especially important with acupuncture where it not does matter what kind of acupuncture is used, if needles are used, where the needles are placed or even if you mime acupuncture or perform acupuncture on a rubber hand. The key features for success in acupuncture are belief that the patient is receiving acupuncture and that the patient believes the acupuncture will be effective. And the stronger the belief, the better the subjective response. (more…)

Posted in: Acupuncture, Clinical Trials, Traditional Chinese Medicine

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The DC as PCP: the battle resumes

Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.

Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.

It has been almost five years to the day since I wrote my first post in “The DC as PCP” series. These posts (listed here) chronicle the continuing battles among various factions within the chiropractic profession over the subluxation and its many iterations, educational requirements for chiropractic colleges, their legal scope of practice, and whether chiropractors are – or are not—primary care physicians (PCPs). At its heart, the controversy boils down to this essential issue: what is “chiropractic” and what is it that chiropractors do? Or, perhaps, should do.

At one end of the spectrum is the straight chiropractor, who wants to make his living detecting and correcting subluxations for all manner of problems. These are the chiropractors who claim newborns need adjustments for “birth trauma” and maintenance care is necessary to good health. At the other end are those promoting the idea that chiropractors are primary care physicians capable of seeing the undifferentiated patient, form a differential diagnosis, and either treat the patient or coordinate the patient’s care with other health care professionals.

Neither has any basis in reality. The subluxation is a chiropractic fiction. And the notion that chiropractors have the necessary education and training to act as primary care physicians is no less a fiction.

Apparently unrepresented in this battle is the chiropractor who wants to see the profession as evidence-based spine care specialists based on a model of specialty care like podiatry and dentistry. (more…)

Posted in: Chiropractic, Politics and Regulation

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Low Energy Sweeteners and Weight Control

artificial-sweetenersA new systematic review published in the International Journal of Obesity looks at the totality of evidence investigating whether consuming low energy sweeteners (LES), such as aspartame, sucralose, or stevia, is a net benefit or detriment for weight control. In addition to providing some clarity on the answer, the review also provides some insight into how different kinds of evidence address such questions.

LES vs sugar or water

The question may at first seem obvious – if you consume a beverage sweetened with an LES instead of sugar you will be avoiding up to several hundred calories. Those calories add up quickly. Twelve ounces of cola with sugar has 138 calories, for example. These are foods that people generally consume on a daily basis, and so avoiding these unnecessary calories should reduce total energy intake and help reduce or maintain weight.

The human body, however, is a complex system, as is human psychology, and so we have to consider the law of unintended consequences. It is possible, for example, that when people drink a diet beverage they feel they have earned the right to consume more calories elsewhere. This phenomenon is called compensation, and there is evidence for this effect.


Posted in: Nutrition

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This Book Won’t Cure Your Cancer, But It Will Help You Think More Clearly About It

cancerGideon Burrows has an inoperable brain cancer that is slow growing but is inevitably going to kill him. He has written a remarkable book about his experience, This Book Won’t Cure Your Cancer. A professional wordsmith, he is able to describe his experience of illness so vividly that the reader enters into his life, feels what he feels, and shares his suspense about what the next scan or doctor’s visit will reveal. Along with him, we suffer through the panic and fear, the chaos, the agonies of delays and uncertainty, the unpleasant hospital environment, and specialists with poor bedside manners. We follow him through difficult decisions about how to share the bad news with friends, relatives, and his young children; and we understand why this engenders guilt feelings. The story is as engaging as a detective story; we can hardly wait to see what the next scan will show and how the story of his illness will play out. It puts a human face on the cancer experience, and it would be valuable for that alone, but it is much more. The gradually unfolding episodes of his personal story are interwoven with what amounts to a primer on how to think critically about science-based medicine vs. alternative treatments. I can’t recommend this book highly enough.

Posted in: Book & movie reviews, Cancer, Critical Thinking

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To debate or not to debate: The strange bedfellows of Andrew Weil

Andrew Weil

To debate or not to debate, that is the question.
Whether it is nobler in the mind to suffer
The slings and arrows of outrageous quackery
Or to take arms against a sea of quackademia,
And, by opposing end them.

Hamlet, Act III, Scene 1, paraphrased badly.


The question of whether it is worthwhile to debate cranks, quacks, and advocates of pseudoscience has long been a contentious issue in the skeptic community. Those of you who’ve been reading my posts for a while know that I’ve always come down on the side that it is not a good idea One thing I’ve learned in my more than a decade of blogging, both here and at my not-so-super-secret other blog, is that advocates of pseudoscience love public debates. Indeed, whenever you see a skeptic agree to a public debate with an advocate of pseudoscience, it’s a damned sure bet that it wasn’t the skeptic who proposed it. I suppose it’s possible that there have been such instances that I’m unaware of, but I do know of a lot of instances where it was the other way around. I’ve even witnessed one myself, when our fearless founder Steve Novella debated antivaccine quack Julian Whitaker about vaccine safety at FreedomFest in Las Vegas while we were at TAM three years ago. Steve mopped the floor with Dr. Whitaker so dramatically that it almost changed my mind about the value of debates with quacks because, witnessing the debate, I saw that the arguments Dr. Whitaker marshaled were such hackneyed antivaccine talking points that I knew I could also have demolished them. Still, in the end, no minds were likely to be changed, and the question of vaccine safety was clearly being used as a tool to oppose school vaccine mandates or, as antivaccinationists like to call them deceptively, “forced vaccination.” Whether vaccines are safe and effective or not is a separate question from whether the government should mandate certain vaccines as a precondition for attending school or being in day care.

Over the years, I myself have been “challenged” to similar debates myself. Perhaps the most bizarre example occurred when someone claiming to represent HIV/AIDS denialist Christine Maggiore contacted me claiming that she wanted to arrange a debate between us. Maggiore, unfortunately, died a mere two years later of—you guessed it—AIDS-related complications. Although occasionally the ego gratification of being asked to participate in such events vied with my longstanding belief that debating cranks doesn’t sway anyone, sharing the stage with a real scientist does unduly elevate the crank in the eyes of the public. Besides, whatever the seeming outcome of the debate, you can count on the crank to declare victory and his believers to agree. In any event, science isn’t decided by the metrics used to judge who “wins” a public debate, which rely more on rhetoric and cleverness rather than science to decide the outcome. Finally, such debates are not without risks. Although Julian Whitaker, for example, was terrible at it, other cranks are adept at the Gish Gallop, and an unprepared skeptic or scientist can be made to appear clueless in front of a crowd that is almost always packed with supporters of the crank, not the skeptic.

Just last week, there was another “debate” challenge that led me to question my resolve not to debate cranks. It came from a most unexpected source.

Posted in: Medical Academia, Medical Ethics, Science and the Media

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The suffering the search for “natural immunity” inflicts on children

Yes, there are people out there who believe that there are "natural" remedies for pertussis and willing to let their children suffer the consequences.

Yes, as hard as it is to believe, there are actually people out there who believe that there are “natural” remedies for pertussis and willing to let their children suffer the consequences.

I realize that Scott Gavura has already covered this particular case (and quite well), but it’s so egregious that I couldn’t resist discussing it myself because it is one of the most horrifying examples I’ve seen in a long time of the consequences of the sorts of beliefs that fall under the rubric of naturopathy. Quite frankly, reading the story angered me to the point that I didn’t feel it would be unduly repetitious to discuss it again. The result in this case was the prolonged and unnecessary suffering of three children, while the mother believed she was helping them.

Naturopathy is a cornucopia packed to the brim with virtually every quackery known to humankind, be it homeopathy, much of traditional Chinese medicine, vitamin C for cancer, or basically any other pseudoscientific or prescientific treatment for disease that you can imagine. I feel obligated to start most of my posts about naturopathy with a statement like this not just because it’s true but because I want to remind my readers that it’s true. I particularly want to remind my readers when I see naturopaths revealing their true quack selves when they think no one’s watching, but I want to remind them even more when I see a post like the one by a naturopath named Heather Dexter entitled Natural Remedies for Whooping Cough: Getting Through It IS Possible. The post has been disappearing and reappearing with new edits for the last few days, but it seems to have disappeared for good. Fortunately the Internet never forgets, and in addition to the versions captured by Scott, the original text can still be found on Reddit, although it takes some scrolling to find it, and, for now, a Google cache version still exists.

If you want anecdotal evidence of the depths of quackery to which naturopaths can descend, read this post now. Because the link to the original post was removed once, I saved the text and will quote it liberally, but, for whatever reason, the post appears to be up again at Like-Minded Mamas, which promises “easy, natural answers for every mama’s journey.” What Dexter sees as natural treatment of her children with whooping cough, I see as child abuse. Worse, Dexter is practicing in my own state in Grand Rapids, MI.
Dexter describes herself thusly:

Heather Dexter is a Board Certified Naturopathic Doctor, Certified Affiliated Bradley Method Instructor, Certified Holistic Doula, Certified Usui Reiki Master Practitioner.

Here’s an indication: If you believe in reiki enough to practice reiki, you are a quack.

More importantly, if you treat your children the way Dexter describes, you are a child-abusing quack, in my not-so-humble opinion. Why do I say this? Because in her post Dexter describes how she tortured her children by letting them “get through” pertussis. Let me repeat that again in a different way. She let her children suffer through the natural course of a pertussis infection in order to acquire “natural” immunity. She even brags about it near the end of her post:

Posted in: Naturopathy, Vaccines

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