Medicine is constantly changing, and like most health professionals, I am required to maintain my competency to practice. I doubt pharmacists are unique in being inundated with offers of continuing medical/pharmacy education. Some courses are free, some cost hundreds of dollars, and it can be difficult to distinguish the high-quality programs from the biased or low-quality education that furthers a agenda, rather than seeking to truly educate. You can consider the reputation of the provider, or the author, and sometimes the sponsorship gives a clue. When it comes to determining if a program’s content is science-based or not, I find the learning objectives may be all I need to read. One program I saw recently referred to “integrative” approaches to the treatment of an illness. Another claimed it would teach you a “holistic” approach to managing complex medical condition. Both programs set off skeptical alarm bells. I realized then I’d found the science-based medicine equivalent of a brown M&M. And I have the band Van Halen to thank for that association. (more…)
Behold my power, quacks, and despair! Mike Adams publishes several defamatory articles about yours truly…
I decided to write this post for Science-Based Medicine because I’ve taken notice of recent posts Mike Adams has written about me, mainly because they are riddled with misinformation, fabrications, and lies. Even though at least two of his claims about me made me laugh out loud because of their utter ridiculousness, much of the rest of his recent writing about me has been downright defamatory, libelous even.
The stupid stuff
Before I get into the really nasty stuff, let’s look at the stupid stuff. It’s not that the nasty stuff isn’t also stupid, but here I arbitrarily decide to divide the discussion into parts about when Adams amuses me and when he disgusts me. If there’s one lesson I’ve learned from Adams’ attacks on me, it’s that, apparently, I have incredible power—possibly even superhuman! I mean, seriously. Adams really does seem to think that I have massive power over what Wikipedia does and does not publish about vaccines and medicine! Indeed, as I thought last night about what to write and even ended up staying up until 2 AM to do so (mainly because I was so exhausted after a day in the operating room that I crashed on the couch between 8 and 11 PM), I was half-tempted not to disabuse him of his apparent delusions about my overwhelming power. After all, if Adams really does think that I have so much power, why would I want to reveal to him the truth that I do not? On the other hand, far less amusing are Adams’ attempts to link Karmanos Cancer Center and me to the criminal Dr. Farid Fata, a lie by insinuation that is despicable even by his low standards. What should I expect, though, from someone who’s been running scams since Y2K and posting threats against GMO scientists?
Of course, I am not naïve enough to believe that Adams doesn’t actually know damned well that I don’t have that level of influence on Wikipedia. Rather, it’s all a sham, a con man’s patter, to convince his readers that I’m a major player in a conspiracy to manipulate health articles on Wikipedia from behind the scenes. He uses such fabricated stories as tools to fire up his gullible and stupid followers. Does Adams even realize how ridiculous his articles come across with their overwrought language? In fact, I laughed out loud when I read that Arianna Huffington and I “are not directly murdering children, but they are doing everything in their power to kill any truthful discussion about vaccine damage (that might save children)” and then this:
It is almost inevitable that whenever we post an article critical of the claims being made for a particular treatment, alternative philosophy, or alternative profession, someone in the comments will counter a careful examination of published scientific evidence with an anecdote. Their arguments boils down to, “It worked for me, so all of your scientific evidence and plausibility is irrelevant.”
Both components of this argument are invalid. Even if we grant that a treatment worked for one individual, that does not counter the (carefully observed) experience of all the subjects in the clinical trials. They count too – I would argue they count more because we can verify all the important aspects of their story.
I want to focus, however, on the first part of that statement, the claim that a treatment “worked” for a particular individual. Most people operationally define “worked” as, they took a treatment and then they improved in some way. This, however, is a problematic definition on many levels.
Much of the disagreement about how to define “works” comes down to placebo effects. The generally-accepted scientific approach is to conclude that an intervention works when the desired effect is greater than a placebo. When all other variables are controlled for, the intervention as an isolated variable is associated with an improved outcome. That is the basic logic of a double-blind placebo controlled trial.
Six years ago I wrote about the evidence for breastfeeding. I questioned an article that claimed 900 babies’ lives could be saved every year in the US if 90% of mothers breastfed for at least 6 months. I didn’t think that was true, but I did think the evidence supported the claim that breastfeeding was clearly better for babies. Now I’m not so sure we can trust that evidence.
A new study reevaluated the evidence from previous studies and found that the studies hadn’t adequately ruled out significant confounders. There are social, cultural and economic factors that contribute to the choice to breastfeed, factors that may have skewed the results of those studies to favor breastfeeding. The new study tried to correct for these issues.
Results from standard multiple regression models suggest that children aged 4 to 14 who were breast- as opposed to bottle-fed did significantly better on 10 of the 11 outcomes studied. Once we restrict analyses to siblings and incorporate within-family fixed effects, estimates of the association between breastfeeding and all but one indicator of child health and wellbeing dramatically decrease and fail to maintain statistical significance. Our results suggest that much of the beneficial long-term effects typically attributed to breastfeeding, per se, may primarily be due to selection pressures into infant feeding practices along key demographic characteristics such as race and socioeconomic status.
Arguably, one of the most popular forms of so-called “complementary and alternative medicine” (CAM) being “integrated” with real medicine by those who label their specialty “integrative medicine” is acupuncture. It’s particularly popular in academic medical centers as a subject of what I like to refer to as “quackademic medicine“; that is, the study of pseudoscience and quackery as though it were real medicine. Consider this. It’s very difficult to find academic medical centers that will proclaim that they offer, for example, The One Quackery To Rule Them All (homeopathy). True, a lot of integrative medicine programs at academic medical centers do offer homeopathy. They just don’t do it directly or mention it on their websites. Instead, they offer naturopathy, and, as I’ve discussed several times, homeopathy is an integral—nay, required—part of naturopathy. (After graduation from naturopathy school, freshly minted naturopaths are even tested on homeopathy when they take the NPLEX, the naturopathic licensing examination.) Personally, I find this unwillingness of academic medical centers that offer naturopathy to admit to offering homeopathy somewhat promising, as it tells me that even at quackademic medical centers there are still CAM modalities too quacky for them to want to be openly associated with. That optimism rapidly fades when I contemplate what a hodge-podge of quackery naturopathy is and how many academic integrative medicine programs offer it.
If you believe acupuncturists, acupuncture can be used to treat almost anything. Anyone with a reasonable grasp of critical thinking should recognize that a claim that an intervention, whatever it is, can treat many unrelated disorders is a huge red flag that that intervention is almost certainly not science-based and is probably quackery. So it is with acupuncture; yet, that hasn’t stopped the doyens of integrative medicine at the most respected medical schools from being seduced by the mysticism of acupuncture and studying it. I can’t entirely blame them. I must admit, there was a time when even I thought that there might be something to acupuncture. After all, unlike so many other CAM interventions, acupuncture involved doing something physical, inserting actual needles into the body. However, as I critically examined more and more acupuncture studies, I eventually came to agree with David Colquhoun and Steve Novella that acupuncture is nothing more than a “theatrical placebo.”
Bleh. I turned from a short trip to the city of angles with a bad man cold that just isn’t going away. Those who do primary care all tell me that whatever is going around lasts 2-3 weeks. Great. I am not sick enough to get out of work but I am not well enough to have any enthusiasm to do anything. I look at the key board and sigh. I just want to binge watch something mindless.
I know Harriet covered “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation” last week. But it is one thing to read the evaluation of a paper and quite another to evaluate a paper on your own. It is the latter process where you, and by you I mean me, actually learn something. I write mostly for my edification, not yours. Sorry. It is all about me. I will likely read Harriet’s post this weekend.
The issue at hand is whether chiropractic manipulation can cause a stroke. (more…)
“Integrative medicine” (IM) is an ideological movement within medicine driven in large part by those whose livelihoods depend on its continued existence. This includes both those with positions in academic medicine and individual practitioners who use the IM brand to attract patients.
Despite IM and its antecedents (alternative, complementary, alternative and complementary, complementary and integrative) having been around for about a quarter century, we still do not have a working definition of integrative medicine or have any idea whether it positively affects patient outcomes. And, despite the lip service given to IM being evidence-based, or “evidence-informed” or incorporating “appropriate” services into conventional medicine, there does not seem to be any standard for determining which modalities are appropriate for inclusion. We can infer, however, that evidence of effectiveness is not a criterion, as reiki, cranial sacral “therapy”, and homeopathy are standard fare.
In fact, the prospect for actually improving patient outcomes by importing CAM treatments (such as acupuncture) into medical practice would seem to be decreasing over time, as more and more fail to hold up under the scrutiny of well-designed and conducted clinical trials. Perhaps the dearth of evidence for “alternative” treatments is the impetus behind the importation of conventional modalities, such as nutrition and exercise, into the IM fold, treatments that were never viewed as CAM when the whole enterprise started. It has also led to special pleading demanding that research standards be loosened, most recently by the NCCIH, its director’s promise to ensure “rigorous science” notwithstanding.
There is no standard delivery model for integrative medicine or, importantly, an agreed-upon role for the various practitioners who bring the “integrative” to integrative medicine, such as chiropractors, naturopaths and acupuncturists. For example, should they be allowed to practice independently or should the medical doctor have final say on patient care? And, if they differ in their proposed diagnoses and treatments, how are those issues to be resolved? (more…)
Alternative medicine, like all good marketing, is largely about creating a narrative. Once you have sold people on the narrative, products essentially market themselves. That narrative has been evolving for literally centuries, although it seems to have accelerated with the advent of mass media and now the internet. It is optimized to push emotional buttons in order to sell products.
There are countless examples available on the internet, with many peaking above the crowd for their 15 minutes of fame. In my feed this morning came this typical example: “Cancer Cells Die In 42 Days: This Famous Austrian’s Juice Cured Over 45,000 People From Cancer And Other Incurable Diseases!“
The story has many of the typical alternative medicine narrative talking points: natural is good, a healthful diet can cure anything, anti-inflammatory, anti-oxidants, and detoxification are all good.
NOTE: Today we offer a double feature on the treatment of cervicogenic headache: this post and Dr. Harriet Hall’s post, “When Headaches Are a Pain in the Neck: Spinal Manipulation vs. Mobilization for Cervicogenic Headache.” They complement each other, as well as Dr. Hall’s post from last week on the possible risk of stroke with neck manipulation.
A cervicogenic headache has been defined as a secondary headache (beginning in the suboccipital area) caused by nerve pain referred from a source in the upper cervical spine. According to the American Migraine Foundation, “To confirm the diagnosis of cervicogenic headache, the headache must be relieved by nerve blocks….Treatment includes nerve blocks, physical therapy, exercise, Botox injections, and medication. Physical therapy and an ongoing exercise regime often produce the best outcomes.”1
There are a number of published studies advocating use of upper cervical manipulation as a treatment for cervicogenic headache,2 often without adequate consideration of the danger of such treatment. While upper neck manipulation might sometimes be an effective treatment for a cervicogenic headache, care must be taken to avoid upper cervical manipulative techniques that may pose risk of stroke by damaging vertebral and internal carotid arteries.
Most headaches are of the tension-type variety, often originating in the myofascial structures of the head and neck. There are many other types of headache, some of which can be life-threatening or unbearably painful, none of which are neck related. Headache caused by a leaking brain aneurysm may portend possible rupture of a swollen blood vessel. A migraine or a cluster headache is less serious but can cause agonizing pain. Sudden appearance of neck pain with headache can be a symptom of spontaneous vertebral artery dissection, which can result in a full-blown stroke if aggravated by neck manipulation. When a headache is sudden, severe, or persistent, it is important to have a medical evaluation before concluding that you have a neck-related headache or before submitting to neck manipulation, especially upper cervical manipulation that involves rotation of the atlas on the axis. (more…)
When Headaches Are a Pain in the Neck: Spinal Manipulation vs. Mobilization for Cervicogenic Headache
NOTE: Today we offer a double feature on the treatment of cervicogenic headache. My article is about a study that compared manipulation to mobilization; it is followed by retired chiropractor Sam Homola’s guest article on manipulation for cervicogenic headache. The two posts complement each other and also complement my post from last week on the possible risk of stroke with neck manipulation.
Cervicogenic headache (CGH) refers to headaches that are caused by problems in the neck, as opposed to headaches of non-neck etiology that may be accompanied by neck pain. There is controversy over whether CGH is even a valid diagnosis. Diagnostic criteria usually include unilateral headache triggered by head/neck movement or by pressure on the neck, headache that spreads to the neck, shoulder or arm; and often limited range of motion in the neck. If a nerve block in the neck relieves the headache, that would confirm that the pain originates in the neck, but nerve blocks are not routinely done and are not required for diagnosis.
Is manipulation effective for CGH?
There is controversy over whether spinal manipulation is an effective treatment for CGH. A 2005 systematic review concluded that “A greater number of well-designed, randomized, controlled trials are required to confirm or refute the effectiveness of spinal manipulation.” (more…)