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The Federal Trade Commission takes on homeopathy—maybe

FTC vs. homeopathy: Cage match?

FTC vs. homeopathy: Cage match?

Well, I’m back.

OK, returning from London isn’t nearly as epic as Sam Gamgee’s final words in The Lord of the Rings returning to his wife and daughter after having accompanied Frodo, Gandalf, Bilbo, and key elves of Middle-Earth to the Grey Havens, there to say goodbye to them as they boarded a ship to the undying lands. I just love the quote. It says something to me returning home after a long journey, even if it was just a vacation to J.R.R. Tolkien’s native land. It also suggests a bit of the exhaustion after a long day of traveling, complete with a long-delayed flight, a late arrival, and a state of utter exhaustion that accompanied it, plus an unfortunate lower gastrointestinal issue.

All of this is a way of saying that this post might actually be relatively brief for a post by me…no epics this week. [Addendum: Nope. Even lower GI annoyances and exhaustion couldn’t keep me from going over 2,000 words. At least I didn’t hit 3,000.] In its nearly eight year history, I’ve never missed more than one week at SBM, and I don’t intend to start now. Specifically, with the FTC workshop on homeopathy rapidly approaching, one week from today, I couldn’t resist adding my 2 pence to the mix, now that the agenda and list of participants have been announced.

Posted in: Homeopathy, Politics and Regulation

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Here be Dragons: Caring for Children in a Dangerous Sea of sCAM

Here be dragons large map

As a pediatrician working in a relatively sCAM-inclined region, it is not uncommon to find myself taking care of patients who are also being followed by so-called alternative medicine practitioners. This often creates a major obstacle to providing appropriate care and establishing an atmosphere of mutual trust in the provider-patient/parent relationship. It usually makes me feel like I’m battling invisible serpents in a sea of sCAM.

While these double-dipping parents utilize a variety of sCAM providers, including naturopaths, homeopaths, chiropractors, and a smattering of “holistic healers”, most are taking their children to one of a few “wellness” centers near my practice where they are seen by actual medical doctors practicing so-called “integrative medicine”. Many of these children have vague, chronic, usually non-specific complaints that are difficult to explain and thus to treat. Some have behavioral and mental health problems, or neurodevelopmental conditions such as autism for which parents are seeking explanations and treatments.

What I find to be a common theme with these patients is that they and their parents are summarily taken advantage of by their alternative care providers when they are given a fictitious diagnosis and treated with a variety of useless potions, elixers, and false hopes. Often, parents bring their children to these providers because they are frustrated by their child’s chronic complaints of fatigue, pain, or other somatic issues that have eluded a satisfactory diagnosis or treatment. Invariably, the diagnosis that has remained so elusive to me is quickly found and treated by these much more “holistic” and open-minded providers. In fact, I have never seen a consultation note from one of these providers indicating any uncertainty as to diagnosis or treatment regimen. Typically a large battery of expensive, inappropriate, and sometimes outright fraudulent lab tests is ordered, often from equally questionable laboratories. Again, there are invariably interesting findings prompting tailored and bizarre treatments. In typical red-flag sCAM fashion, some of these providers have their own supplement store, available online only to their patients, prominently displayed on their website. These providers are perceived as being more holistically informed about health and wellness then “conventional” doctors like myself, as if there are two distinct ways of treating illness and maintaining health…as if there is truly such a thing as alternative medicine.

It can be very difficult to manage patients who are being simultaneously “treated” by such providers. Sometimes the treatments complicate or confuse the picture, but it always indicates a failure of trust in the “conventional” method of practice, which is science and evidence based, and in science itself.

Below are a few examples of patients cared for by my practice and simultaneously followed by alternative medicine practitioners. They provide a good picture of just how problematic these co-practitioners can be. No names or identifying information are revealed. (more…)

Posted in: Diagnostic tests & procedures, Herbs & Supplements, Naturopathy, Pharmaceuticals, Science and Medicine

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Are guidelines for calcium and vitamin D rooted in evidence, or vested interests?

B0003853 Osteoporotic bone - fully focused image Credit: Professor Alan Boyde. Wellcome Images Scanning electron micrograph of osteoporotic bone. This sample shows the 4th lumbar vertebra of an 89 year old woman with osteoporosis showing very thin, and some fractured trabeculae. This SEM image has been reconstructed from a series of images in different focal planes to give a completely focused picture of the bone. This enables a much clearer picture to be gained of the osteoclast resorption activity within the bone. The field of view is 2.7mm wide. Scanning electron micrograph Published:  -   Copyrighted work available under Creative Commons by-nc-nd 2.0 UK, see

Osteoporotic bone. Are the mainstay treatments for osteoporosis prevention, calcium and vitamin D, truly useless?

Do osteoporosis guidelines overstate the benefits of calcium and vitamin D supplements? And is their continued presence due to vested interests and conflicts of interest? That’s the provocative argument made by Andrew Grey and Marc Bolland, two endocrinologists who recently detailed their analysis in The BMJ, in a paper entitled “Web of industry, advocacy, and academia in the management of osteoporosis” [PDF]. They introduce their case by noting:

For many years, recommendations for prevention and treatment of osteoporosis have included increasing calcium intake (by diet or supplements) and use of vitamin D supplements. Since the average dietary calcium intake in most countries is much less than that recommended by guidelines, many older people are advised to take calcium supplements to prevent osteoporosis. The recommendations have been implemented successfully: over half of older Americans take calcium and vitamin D supplements, either prescribed or over the counter, and bone health is the most common specific motivation for use of nutritional supplements. However, this behaviour does not reflect evidence that has emerged since 2002 that such supplements do not reduce the risk of fracture and may result in harm. Guideline bodies also continue to recommend calcium and vitamin D supplements. Here, we argue that change is made difficult by a complex web of interactions between industry, advocacy organisations, and academia.

Osteoporosis is a medical condition for which supplements have been considered an accepted part of conventional medicine for some time. Are conflicts of interest trumping good science? And are calcium and vitamin D supplements truly useless? Like many clinical questions, there is evidence to  support a range of opinions, and it’s very  difficult to state, with certainty, that one position is the correct one. Despite this, that’s the case that Grey and Bolland make in their analysis. (more…)

Posted in: Herbs & Supplements, Science and Medicine

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The Alternative Medicine Racket

ReasonTV just put out a new video called, “The Alternative Medicine Racket: How the Feds Fund Quacks,” Produced and edited by Todd Krainin. The video is a documentary about the rise of alternative medicine in the US, and is a must-watch for anyone interested in the issue.

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.”


Posted in: Book & movie reviews

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Lawsuit Alleges School Wi-Fi Harmed Child with Electromagnetic Hypersensitivity


My mother had a favorite saying that rhymed: “All you need from dawn to dawn is someone else to blame it on.” WiFi involves mysterious emissions that you can’t see and that sneakily permeate our environment, and they have become a popular target for blame.

A lawsuit has been filed against the Fay School in Massachusetts on behalf of a 12-year-old boy designated as “G,” alleging that the school violated his rights under the Americans with Disabilities Act and failed to use ordinary care for his safety. They allege the school was negligent in failing to make accommodations to protect the boy from extremely high levels of radiofrequency/microwave radiations. He allegedly suffers from Electromagnetic Hypersensitivity Syndrome (EHS). The family is seeking $250,000 in damages.

The symptoms

After the school upgraded its Wi-Fi system in 2013, G began to have headaches, itchy skin, rashes, nosebleeds, dizziness, chest pains, and nausea. He frequently went to the school nurse and had to leave school early. His symptoms would usually resolve after he had been home for several hours, and he did not experience “the intense symptoms” on weekends and holidays.


Posted in: Computers & Internet, Legal, Public Health

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The price of a naturopathic education

Editor’s Note: I’m on vacation in London and won’t be doing my regular Monday post this week. In its place, here’s another guest post from Britt Hermes of, about her extraordinary student debt from her abandoned naturopathy career. If you’re in London, join me at the London Skeptics’ Skeptics in the Pub on Monday night at The Monarch Bar at 7:30 PM! I won’t be giving a talk (I am, after all, on vacation), but after being in contact with some London skeptics I decided that this was the best way for me to meet as many SBM readers as possible without disrupting our vacation to the point where my wife would start to become irritated with me. :-) ~ Dr. David Gorski

Dr. Nick of Hollywood Upstairs Medical College

Dr. Nick graduated from Hollywood Upstairs Medical College

This morning, I checked my student loan balance from earning a doctorate in naturopathic medicine from Bastyr University. I owe a little over $333,000. Since graduation, my loans have accumulated interest while I deferred payments during my naturopathic residency and again after I quit practicing naturopathy.

To call this amount daunting or depressing is an understatement.

Since I thought an ND degree meant I’d have job prospects as a real primary care physician, I assumed I’d have no problem paying back my student loans, just like most medical doctors. I also thought I’d be eligible for federal loan repayment programs. I quickly learned, as have my former colleagues, that naturopathic doctors have dismal job prospects and earnings.

The average naturopathic doctor makes $60,000 a year in private practice. To put this in perspective, the average primary care physician income is about $186,000. Despite Bastyr insisting that naturopaths are trained as primary care physicians, their income certainly does not reflect it. (Nor does their training.)


Posted in: Science and Medicine

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Medicine in the Magic Kingdom of Cascadia

Beautiful Cascadia, where science goes to die.

Beautiful Cascadia, where science goes to die.

When the Pacific NW secedes from the Union it is to be part of a new country, Cascadia. The capital would be Portlandia, I suppose. Somehow, I think not. But when I watch the devolution of health care in Oregon, I think back to The Onion (?) when they reported that the United Kingdom was to be sold to Disney, being renamed as “The United Magic Kingdom.”

That is health care in Oregon due the steady insinuation of naturopathy and other pseudomedicine into real health care.

Oregon Health and Pseudoscience University

Growing up my alma mater was the University of Oregon Medical School. Since then it has undergone two name changes, first to Oregon Health Sciences University and then to the current Oregon Health & Sciences University (OHSU)—with, it should be noted, an ampersand. Not an ‘and’.

Perhaps they need one more name change, since they are not always that interested in the “Science” part of their name.

Some background is needed.

Portland has a trifecta of pseudoscience schools: Naturopathic (National College of Natural Medicine), Chiropractic (University of Western States) and ‘Oriental’ (Oregon College of Oriental Medicine).

Lucky us.

As an aside my kids let me know that the word ‘Oriental’ as used to describe people from the East, the term I grew up using, is persona non grata. I understand the reasoning. The proper term, they tell me, is Asian. So I have a mental cringe every time I see the name “Oregon College of Oriental Medicine”.

All three schools are steeped in pseudoscience and pseudomedicine, removed from known reality. As examples, the naturopathic school teaches homeopathy (and more), the chiropractic school teaches the subluxation complex, and the ‘Oriental’ (cringe) school teaches acupuncture. Reading the curricula of the schools suggests that there is no pseudomedical stone left unturned. (more…)

Posted in: Naturopathy, Politics and Regulation, Public Health

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Battle of the feds: FTC tells FDA to do its job regulating homeopathy

Two institutions duke it out: FTC vs FDA.

Two institutions duke it out: FTC versus FDA.

Last month, the Society for Science-Based Medicine submitted a comment to the Food and Drug Administration (FDA) in response to its request for public comments on the agency’s current regulation (actually, lack of regulation) of homeopathic drugs. As the SFSBM pointed out, the FDA has, without legal authority, exempted homeopathic drugs from the safety and efficacy requirements applicable to other drugs under the Food, Drug and Cosmetic Act (FD&C Act). Lax regulation has resulted in consumer confusion: consumers do not understand homeopathy, how the FDA regulates homeopathic drugs, and the lack of scientific evidence underlying claims made by homeopathic drug companies.

As it turns out, we were in excellent company. The Federal Trade Commission (FTC), the agency charged with preventing fraudulent and deceptive business practices, submitted its own comment to the FDA, making these same points. (The FTC is holding its own workshop on advertising homeopathic drugs later this month. We’ll get to that shortly.)

The FTC’s advertising substantiation policy requires that health-related efficacy claims be supported by competent and reliable scientific evidence. The FDA, despite federal law, does not require evidence of efficacy for homeopathic drugs prior to their being marketed. This creates a potential conflict between the two regulatory schemes, resulting in homeopathic over-the-counter (OTC) “drugs” on the market that both comply with FDA’s policy and violate FTC’s policy. This, says the FTC, can be harmful to consumers and create confusion for advertisers. The FTC “recommends that the FDA reconsider its regulatory framework for homeopathic medicines” and tells the FDA what it can do to remedy the situation. (more…)

Posted in: Clinical Trials, Health Fraud, Homeopathy, Legal, Politics and Regulation

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Helping the Paralyzed Walk

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…)

Posted in: Neuroscience/Mental Health

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The Science of Mom: A Science-Based Book about Baby Care

From the author's website: "Shameless use of cute baby to promote book"

From the author’s website: “Shameless use of cute baby to promote book”

When a baby is born, parents are often awed and alarmed to find themselves responsible for this tiny new person, and they desperately want to do their very best to keep their infant safe and healthy. New mothers worry about everything from SIDS to vaccines, from feeding practices to sleep hygiene, and they are bombarded with conflicting advice about caring for their babies. Myths and misinformation abound. Finally someone has written a truly science-based guide to the first year of life: The Science of Mom. The author, Alice Callahan, is a research scientist with a PhD in nutritional biology. When her first child was born, she had a lot of questions, and thanks to her background she knew how to look for reliable answers in the scientific literature. She started writing the Science of Mom blog and eventually turned her findings into a book.

Understanding science

Her first chapter covers the important concepts for understanding how to think about scientific studies:

  • Good science is a process that takes lots of experiments, time, and people.
  • Good science is peer-reviewed.
  • One study on its own isn’t worth much, but scientific consensus is trustworthy.
  • Some studies are more valuable than others (here she covers the various types of study from animal studies through observational studies in humans to RCTs and meta-analyses).
  • Numbers matter (sample sizes).
  • Don’t believe everything you read on the Internet (here she gives some practical tips for evaluating whether a website is reliable).
  • Correlation is not causation (she uses my favorite example of the correlation between autism diagnoses and the sales of organic food).
  • We can’t eliminate risks (but science can quantify the risks and benefits and families can use the information to decide what risks they are personally willing to take).
  • Find smart allies (experts and providers you can trust).
  • Forget about perfection and pay attention to your baby.


Posted in: Book & movie reviews, Nutrition, Vaccines

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