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SCAMlandia

I quite like Portlandia. I find it funny and it captures a part of Portland. I recognize large swaths of the city’s culture in the show. Other representations of the city I recognize less. Sunset publishes beautiful photographs of the NW, but when I look at the photos I think, that section of the city never looks that good. It is quite wonderful how Photoshop can improve on reality.

Like most major cities, Portland has a monthly magazine, Portland Monthly. The city represented in that magazine is mostly alien to me. I look at the advertisement, the articles, the photographs, and wonder when did Portland become a city with an average 7 figure income? The Portland in which I grew up and currently live is rarely found in the pages of Portland Monthly. If you are extremely well to do, I suppose you are in the demographic Portland Monthly. But when I flip through the pages of the magazine, I see little I recognize, but I have never completely abandoned the hippie/grunge aesthetic of my younger days.

Every January they have the best Doctors issue* and this year, for the first time, they offer The Portland Alternative Medicine Guide. Well, less a guide and more an extended infomercial filled with ‘facts’ that deserve the quotes.

It is a difficult balance for a writer. I would like to be fresh with every entry, display new insights, find undiscovered territories in the terra incognita of SCAM (Supplements, Complementary and Alternative Medicine) and put up signs that say hic sunt dracones, and above all have new ‘jokes’ preferably at the expense of, oh, yeah, never mind. Do not want to inadvertently offend any readers, oh no, uh huh. This entry will fail those goals big time, since the Portland Monthly guide, from an SBM perspective, is one big pile of SOS DD.  We have been there, we have done that, we are going there again and doing it again.

The Preface

They start by noting Portland has three SCAM schools (with apologies to Brian Brushwood):

The city is home to three nationally revered institutions: the National College of Natural Medicine (NCNM), the Oregon College of Oriental Medicine, and the University of Western States (which graduates chiropractors, massage therapists, physical therapists, and nutritionists).

Right off the language lets you know the focus of the article.
Revered. By whom? Supplement manufacturers? Pas moi.

All three institutions offer a curriculum that is not based on reality but upon a fictional understanding of the human body in health and disease. The underlying silliness of naturopathic education has been discussed at length on the blog, but I will reiterate that (as always, in my opinion) homeopathy, chi, hydrotherapy, acupuncture and chiropractic are a phantasm. I find the fact the Oregon is home to three such institutions an embarrassment.

At the turn of the century Flexner took medical education off of its ‘anything goes including magic’ approach and grounded medical education in the sciences and reality. As the Bravewell report clearly demonstrated, our major medical centers are embracing non-reality based medicine at a depressing rate, including OHSU:

Our leading medical research center, Oregon Health & Science University, has also fully embraced the trend, routinely collaborating with all three schools on studies that have proven everything from fish oil’s ability to quell depression in people with MS to the positive effects of yoga for seniors.

Or are they? They are, but not with the studies mentioned above, which is the classic SCAM bait and switch where variations of standard medicine (diet and exercise) are defined as ‘alternative’ and used as a gateway supplement to transition into a justification of the fantastical alternative modalities.  It gets to the definition of ‘alternative’. Diet and excise are not ‘alternative’ in the same way acupuncture or homeopathy are ‘alternative.’ The former is based on reality, the latter on fantasy.

There is an association between omega-3 fatty acids and depression in MS patients, but not a very strong association and, as we all know, association is not causation. There is also a variable literature on the association an treating depression with omega-3 fatty acids, some references favorable, some not.

There may be physiologic validity to the concept and OHSU did indeed have a study: Fish Oil for the Treatment of Depression in Patients With Multiple Sclerosis that has been completed.  4 years ago. As best I can determine it has not yet been published in any journal. All I can find is the abstract:

Lynne Shinto, MD (Oregon Health & Science University) and colleagues administered 6 grams/day of omega-3 fatty acids (fish oil) or inactive placebo (soybean oil) to 31 people with MS who had mild to moderate depression for three months. Both groups improved on the depression scale; there were no significant differences. However, the omega group did improve significantly more than the placebo group on a measure of cognition (PASAT). Further study is necessary to confirm this finding.

That’s proof? Seriously? An abstract where the data shows no differences for depression?  Ah, but that is one of the continual differences between SBM and SCAM: SBM has a commitment to truth, evidently not a high journalistic priority as well. Having taken fish oils in the past, I would be most curious how effective the placebo at mimicking the fish oil was I was always belching up the taste of old tuna.

Yoga is a form of physical activity that should have benefits, although the article I found from OHSU was not that impressive:

Healthy seniors participating in a 6-month yoga or exercise class showed no differences in cognitive function compared to a wait-list control group. The yoga intervention produced improvements in quality-of-life measures not seen in the exercise group and also improvements in physical measures related to the intervention itself (eg, timed 1-legged standing and forward-bending flexibility).

It is a really weird paper. They say

There was no effect of assignment group on any of the cognitive function or alertness measures, which included the primary outcome measures for this study.

and show the data. Then they say

The SF-36 quality-of-life measure demonstrated a significant yoga assignment group effect on vitality/energy and fatigue (P = .006), role-physical (P = .001), bodily pain (P = .006), social functioning (P = .015), and the physical composite scale (P = .005). There were no effects on mood as assessed with POMS or CESD-10. On the MFI, reduced activity was better in the yoga group (P = .015), but there was no difference in the other subscales.

Fine. But they do not publish the data that lead to the p values to know if the statistical significance actually represents clinical significance. We have to take their word for it, so I can’t really say they have ‘proven’ anything about yoga in the elderly. But again, the only thing alternative about either diet or exercise is the advertising.

Note I am only in the first paragraph and with a wee bit of digging, more than the author evidently did,  I find errors. My confidence in the veracity of Portland Alternative Medicine Guide is fading fast.

“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.”  The worlds first consulting detective would be aghast.

The third paragraph states

With 40 percent of American adults using some form of natural medicine—and a naturopath or acupuncturist seemingly on every Rose City block—we thought it was high time to provide a local primer.

That old trope. Sigh. The percentage always relies on defining various forms of diet and exercise and relaxation techniques as ‘alternative.’ According to NCCAM,  the big three are ‘natural products” (supplements), deep breathing and meditation. Use of alternative therapies is primarily for self limited problems or pain and very few use alternative therapies for serious or life threatening problems. But outside of chiropractic at 8.6% most Americans are apparently not using the non-reality based therapies that make up much of our ‘revered’ schools curriculum.

Chinese Medicine

They start with Chinese Medicine and show an ungloved hand approaching needles inserted along someones spine. Work has been progressively slow over the last decade as my health system has been very aggressive at instituting policies and procedures to eliminate hospital acquired infections, with great success. It is nice that acupuncturists continue to use sloppy technique so that I might have an MRSA infection or two to take care of.

They note that Americas interest in acupuncture started in 1972:

…a press-corps reporter named James Reston suddenly felt a stabbing pain: appendicitis. His surgery at Beijing’s Anti-Imperialist Hospital went smoothly, but for the severe abdominal pains that followed, which the Chinese treated with acupuncture. Reston praised the ancient technique in the New York Times, and American doctors took notice.

What did Mr Reston actually write about his experience?

I was in considerable discomfort if not pain during the second night after the operation, and Li Chang-yuan, doctor of acupuncture at the hospital, with my approval, inserted three long, thin needles into the outer part of my right elbow and below my knees and manipulated them in order to stimulate them and relieve the pressure and distention of the stomach.

That sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach. Meanwhile, Dr. Li lit two pieces of an herb called ai, which looked like the burning stumps of a broken cheap cigar, and held them close to my abdomen while occasionally twirling the needles into action.

All this took about 20 minutes, during which I remember thinking that it was rather a complicated way to get rid of gas on the stomach, but there was a noticeable relaxation of the pressure distension within an hour and no recurrence of the problem thereafter.

The Portland Monthly gets it wrong again. “Considerable discomfort if not pain” is not quite the same as “severe abdominal pains”. Post operative gas is unpleasant and a self limited problem. Treat a problem that gets better on its own, then credit the intervention.

They note that “Traditional Chinese Medicine” (TCM) includes the

…use (of) acupuncture, herbs, dietary therapy, moxibustion (burning herbs near certain points on the body), cupping (using heat and a glass cup to create a suction on the skin), and other practices to restore the qi (or “life force”) of the body.

They do not mention that all of the above have no basis in reality and none have benefit for any objective findings and barely have any effect for the subjective endpoint of pain and that the entire subjective effect of acupuncture can be accounted entirely by bias on the part of the patient and the practitioner. Someone mentioned that my ‘humor’ is somewhat repetitive. Can an article on acupuncture avoid needle puns? Nope.

TO THE POINT
Puncturing skepticism about acupuncture

Naysayers have long criticized acupuncture studies for being inconclusive. But last October, an overview published in Archives of Internal Medicine concluded that acupuncture outperformed over-the-counter pain relievers and other standard meds for people suffering osteoarthritis, migraines, and chronic back, neck, and shoulder pain”.

Again with the language.  Naysayer is not a positive term.  Define naysayer: someone who carefully reads the medical literature with an understanding of the various biases and methodological errors that can severely compromise the results of a clinical trial. Yeah. I’m a naysayer.  The well done studies are not inconclusive, they demonstrated that acupuncture does nothing.  The trajectory of acupuncture clinical trials, like all the clinical trials for treatments not based in reality, is increasingly well done studies demonstrate decreasing effect until excellent studies (those that remove all potential bias) reveal no effect.

The most critical factor in clinical trials is blinding: if the patient or the practitioner knows they are receiving acupuncture or placebo, then acupuncture works. If the trial is blinded, it doesn’t. To quote Dr. Novella 

The Vickers acupuncture meta-analysis (referred to by Portland Monthly), despite the authors’ claims, does not reveal anything new about the acupuncture literature, and does not provide support for use of acupuncture as a legitimate medical intervention. The data show that there is a large difference in outcome when an unblinded comparison is made between treatment and no treatment – an unsurprising result that is of no clinical relevance and says nothing about acupuncture itself.

The comparison between true acupuncture and sham acupuncture shows only a small difference, which is likely not clinically significant or perceptible. More importantly, this small difference is well within the degree of bias and noise that are inherent to clinical trials. Researcher bias, publication bias, outlying effects, and researcher degrees of freedom are more than enough to explain such a small difference. In other words – this data is insufficient to reject the null hypothesis, even if we don’t consider the high implausibility of acupuncture.

Further, meta-analysis itself is an imperfect tool that often does not predict the results of large, rigorous, definitive clinical trials. The best acupuncture trials, those that are well-blinded and include placebo acupuncture, show no specific effects.

A classic example of the problem with a meta-analysis: when you collect separate cow pies into a big pile, you do not get gold.

They note that

Ear acupuncture (also called auricular therapy) has long been used to help wean people off of addictive drugs, including nicotine.

It may be used, but that does not mean it is effective. Clinical trials assessing ear acupuncture show no efficacy for smoking, cocaine , or alcohol and I can find no good clinical trials for heroin addiction. The NADA (National Acupuncture Detoxification Association) has not been demonstrated to be effective either. As is always the case, the better the study is controlled potential bias, the less the effect. What probably matters is the of relationship with the patient and not the particular SCAM, even since a staple in the ear has subjective effects.

Staplepuncture, which is the manipulation by hand of a surgical staple implanted in the concha of the ear, was reported to relieve withdrawal symptoms at least partially in approximately 40 percent of subjects.

And why they give short shrift to hand, tongue, foot, Japanese and the German MAP (MikroAkuPunktSysteme) acupucnture I do not know. Maybe, like trying to decide on the valid form of astrology (Indian, European, Mayan), the real answer is they are all bunkum.

Infomercial follows for a local acupuncturists and an ear acupuncturist.

Naturopathy.

NATUROPATHY is based on a simple premise: your body has the ability to heal itself …Today, naturopathic medicine encompasses a wide array of modern and traditional therapies including nutrition, herbal medicines, homeopathy, hydrotherapy, massage, and even Chinese medicine.

It is a simple premise until you realize that humans have used the bodies ability to heal since the beginning of time and the result has been endless early death and needless suffering. Large section of the world still rely on the ability of the body to heal itself. Show of hands: who wants to get their health care in Uganda? I thought so. I have posed the question before: have there been any SCAM therapies that have led to any improvement of the human condition? Or any quality initiatives to improve outcomes and increase patient safety? Or have ever changed as a result of clinical investigation? No, no, and no.

However, naturopaths are trained in ineffective therapies and, as discussed in a prior posts, usually have no post graduate experience. Most are poorly trained medical students set loose upon the world to fiddle about with no supervision. It makes the next section, how to choose an alt doc all the more depressing.

I do feel sympathy for others when trying to choose a doctor. There is no way the average person knows what the skill sets of the doctor are and there is the issue as to whether you will get along with your doc. Not all personalities mesh. They suggest a variety of essentially useless approaches for determining an alt doc. As opposed to a Western doctor, as reality based physicians referred to in the text. Since homeopathy and hydrotherapy are invented in the west, are naturopaths Western docs? I still prefer the term reality based doctor, and would suggest that a simple question be asked. Do you use homeopathy? If the answer is yes then the practitioner is divorced from a science based practice of medicine and should be avoided.

Then follows an infomercial for an herbalist shop and a naturopath who (surprise) sells her own line of supplements. Many alternative providers are their own Big Pharma.  No potential conflict of interest there, is there? Part of the infomercial is a moving story of a women with high grade cervical dysplasia who was cured by a natural concoction of herbs:

After less than three months of taking daily supplements (folic acid, selenium, vitamin C, green tea extract, and DIM, a concentrated nutrient that’s found in broccoli and other cruciferous vegetables) and a suppository treatment that included vitamin A and green tea, her dysplasia had disappeared completely. “My gynecologist’s jaw dropped,” Allen says. “She couldn’t believe it.”

Sounds like an impressive triumph of the natural approach, right? Well, not so much, although one has to wonder about her gynecologist since

In women who are immuno-competent, many low-grade, or CIN1 lesions, will nonetheless eventually regress without intervention (1, 2). Reported rates of regression range up to 58% over 24 months (3). A very small percentage (~2%) will progress to high-grade lesions.

In contrast, most high-grade, or CIN2/3 lesions are thought to be much more likely to persist than to regress. However, reported rates of spontaneous regression vary from 6% to 50%, depending on diagnostic criteria, and length of follow-up (4). The risk for progression to invasive cancer at 24 months in women with high-grade lesions is ~1% to 2%.

So the natural triumph over cancer is much more likely watching a spontaneous resolution and taking the credit.  That is cunning medical practice.  When patients get better, always take the credit.  When they do not, blame someone else.

Touch Therapy

Human touch is important. Monkeys who are groomed relax as a result of being touched and everyone likes a good massage. Monkeys, at least, do not need to add a layer of nonsense to the mix:

But beyond traditional massage to relieve pain, heal sports injuries, and quell stress and depression, there are other touch treatments, like craniosacral therapy for musculoskeletal imbalances and Reiki, a light-touch energy healing for the body’s so-called biofield.

What follows is a paean to craniosaccral therapy, sciency sounding but all sound and fury signifying nothing. Unlike Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity, it is not meant as a hoax:

The cranial system, Jackson explains, is just like your respiratory system and circulatory system: it has a certain rate and cycle. “All the fluids expand and contract according to this rhythm,” he says, referring to the fluid that surrounds, protects, and nourishes the brain and spinal cord. Jackson’s job is to find the disruptions in this rhythm—the places where disease and discomfort usually lie—and “palpate” them (i.e., examine them by pressing with the palms and the fingers).

We have covered both reiki and craniosacral therapy in prior posts. Both modalities are nonsense. The ‘so-called biofield’ should be the ‘non-existent biofield’. If we can detect the Voyager spacecraft, over 7 billion miles from earth broadcasting with the power of a refrigerator light bulb**, I think we could pick up a biofield, don’t you?

And did you know that the twists in yoga are good for detoxing? No wonder Chubby Checker looks so fit.

Chiropractic

CHIROPRACTORS, who like naturopaths are licensed as primary care doctors in Oregon, receive extensive training in nutrition. Students at the College of Chiropractic at University of Western States take 90 hours of nutrition instruction—far more than MDs.

Perhaps they have more training in nutrition. They also receive extensive training in adjusting nonexistent subluxations that have nothing to do with health and disease. And they have no practical training in cardiology, pulmonology, dermatology, gastroenterology, neurology, gynecology, obstetrics, infectious disease, pediatrics etc etc. What doctors learn during residency, after graduating from medical school. That they are licensed to be primary care doctors is a triumph of the political process to the detriment of patients everywhere.

HOLISTIC DENTISTRY

They interview a dentist who thinks mercury fillings are a toxin, despite all the data to demonstrate otherwise. He makes the statement about fillings that

They go in your mouth at 50 percent mercury, and when you take them out it’s 20 percent mercury.

I cant find this anywhere as true or not; perhaps my google-fu is weak. Our readers will certainly set me straight.

The same dentist thinks fluoride is toxic:

The studies that exist aren’t well designed. Most dentists say, “That’s what the ADA says and you gotta use it.” Personally, my take is that fluoride is quite toxic.

Again all the data suggests otherwise.

He then notes the best approach to good dental hygiene is “eat whole foods, eat only three meals a day, and drink only water between meals.” Which is not bad advice. Diet certainly has effects on dentition, but then he wanders into the naturalistic fallacy:

For millions of years, our ancestors did not get tooth decay—and they did not floss and they did not brush.

Besides the fact that people tended to die young utilizing natural medicine (life expectancy 25 to 40 years), making it harder to develop caries, they did get tooth decay, although much less which is interesting .

The percentage of the occurrence of dental caries based on the individuals was 77.8%, whereas the frequency of dental caries on tooth type and class was 17.1% (18.0% maxillary decay; 16.2% mandibular decay). A comparative study of the frequency of caries in certain periods indicates the following: in the hunting–gathering period it was 1%–2%, in the Early Neolithic it was 3%–5% (Catal Hoyuk), in the Neolithic (beginning of agriculture) it was 5.6% (Cayonu), in the Chalcolithic it was 11.7% (Norsuntepe), in the Roman period it was 11.1% (Panaztepe), and 16% (Datca), in the Late Byzantine it was 10.9% (Iznik) and in the Medieval it is 14.2% (Arslantepe). These findings contribute to understanding how dietary change and life conditions are interrelated with the changing patterns of dental diseases in Anatolian populations.

NATURAL MEDICINE AND HEALTH CARE REFORM

The issue has been discussed by both Jann Bellamy and myself.

The statement “Naturopaths are known for their focus on preventive medicine.” Like most statements of fact in the primer, are, upon evaluation, not true when you look for supporting information.

As discussed a few entries back, those under the care of a naturopath get less screening, fewer vaccine and more vaccine preventable illnesses.  Naturopaths most often prevent the imaginary diseases they diagnosis. Perhaps it is a typo and they meant: Naturopaths are known for their focus on preventing medicine.

Oregon needs to use every available provider in order to meet the needs of the giant influx of people the Affordable Care Act will bring to the system.

Alternative providers lack the training and experience to  prevent and manage real diseases. The basis of their education is neither science or reality. I will quote me:

Health care in the US is a mess. I have no clue what the solution is. I hope for a single payer system. I came to the conclusion long ago that sometimes there are sometimes no good solutions to some problems, just the least bad solution. Right now health care is a mess in innumerable ways; a single payer system will make it a mess in one way.

If you have a problem in astronomy, you do not call an astrologer. Sure, he knows the names of the planets and the stars and has a good patter about how his system works. But astrology is nonsense. If you have a shortage of pilots, you don’t hire a transcendental mediation practitioner to levitate the plane. At least not a plane I would get on. And if you have a shortage of primary care providers, perhaps including those with inadequate training in real medicine, extensive knowledge of fanciful fields who treat cancer with alkaline water and misdiagnose asthma as a blood stream bacterial infection, might not be the best choice to improve the health of the population.

I grew up when Woodward and Bernstein were the height of what defined a good journalist: the information was accurate and exact. It has been a long time since All the Presidents Men.  As was mentioned at the time:

I’m sick and tired of hearing things
From uptight, short-sighted, narrow-minded hypocrites
All I want is the truth
Just gimme some truth

I’ve had enough of reading things
By neurotic, psychotic, pig-headed politicians
All I want is the truth
Just gimme some truth

No short-haired, yellow-bellied, son of Tricky Dicky
Is gonna mother hubbard soft soap me…

All I want is the truth now
Just gimme some truth now
All I want is the truth
Just gimme some truth
All I want is the truth
Just gimme some truth

John was unlikely to get what he wants from the Portland Monthly.

Notes

*No, I am not listed this year, thank you for asking, although I have been several times in the past. I guess you can’t really fool all the people all the time. I guess I will not make the list next year.

** not an original observation, I cannot find where I first read it.  An English source I do believe,

Posted in: Acupuncture, Chiropractic, Dentistry, Energy Medicine, Homeopathy, Legal, Naturopathy, Politics and Regulation, Science and Medicine, Traditional Chinese Medicine

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