On SBM we often discuss the harm, both direct and indirect, that can be attributed to unscientific approaches to healthcare. Sadly, it seems as if there is an unending supply of cases to illustrate our concerns. In today’s post, I will discuss yet another example of how the belief in quackery can have an unexpected cost.

Death by live bee acupuncture

Earlier this month, two Spanish Allergy and Immunology specialists published a case report involving a 55-year-old woman who died from a severe allergic reaction (anaphylaxis) after undergoing live bee acupuncture. Although healthy in general, she had been going to this particular apitherapy clinic every month for the prior two years for treatment of musculoskeletal concerns and stress. She had never reported a reaction to the therapy in the past and there was no history of allergic conditions, and specifically no history of allergy to bites or stings from any related insects.

Unfortunately, the absence of prior allergy to a particular substance does not rule out the future development of allergy. It is not uncommon for people repeatedly exposed to bee venom, the classic example naturally being bee keepers, to develop an allergy. The patient discussed in the report had been stung a minimum of 24 times, but perhaps many more than that depending on how many stings took place per session. And yes, the first sign of allergy can be a severe reaction, even death.

After the sting, the woman developed wheezing and difficulty breathing, and she quickly lost consciousness, classic signs of anaphylaxis. An ambulance arrived 30 minutes after the development of symptoms, which is obviously unacceptable. Even worse is the fact that the clinic did not have epinephrine, the only medication that could have saved her life, or even an epinephrine autoinjector on site in case of just such a reaction.

This, in my opinion, is criminal negligence. I wonder if the patient was even made aware of the risk. None of the many news articles covering this report revealed if proper informed consent had been obtained. Though the clinic did not have epinephrine, the did have access to the IV steroid methylprednisolone, which is commonly included in acute management of anaphylaxis but has never been proven to actually improve any outcome, in particular restoration of normal blood pressure or the ability to breath.

Once the ambulance arrived, she was found to have a systolic blood pressure of 42, which is too low for a premature newborn let alone an adult, and an abnormally rapid heart rate, more classic signs of anaphylaxis. She was quickly given epinephrine and boluses of IV saline to improve her blood pressure, more steroids, and an antihistamine (really only helpful if you have itchy hives with your anaphylaxis). Her vital signs did stabilize but the damage had already been done.

The sudden and severe drop in blood pressure resulted in decreased blood flow to her brain and she suffered what is known as a “watershed stroke“. This occurs when the neuronal injury involves vulnerable regions of the brain that on a good day don’t get the best perfusion thanks to their anatomic position on the borders of cerebral blood supply. By the time the ambulance had arrived she had entered what would be a permanent comatose state, requiring the placement of a breathing tube to protect her airway, and would go on to develop multisystem organ dysfunction and ultimately die a few weeks later.

Wait, live bee acupuncture?

Several years ago Steven Novella wrote about bee venom therapy (BVT), which falls under the bogus umbrella of apitherapy, the general use of bee products such as honey, venom, and royal jelly for medicinal purposes. He specifically covered the purposeful exposure to bee stings as a possible treatment for MS, pointing out that while bee venom may be an interesting compound with potential therapeutic uses, evidence of clinical benefit was lacking. Six years later, nothing has changed.

The subject of the recent case report wasn’t simply allowing bees to randomly sting her, as described in the two posts by Steve. She was undergoing live bee acupuncture, where bees are manipulated by a practitioner so that they sting a patient in specific points on the body. It’s acupuncture, just with bees, like you might see in an episode of The Flintstones. And it has the same level of evidence in support of clinical benefit.

Live bee acupuncture is popular in China and Korea, and is apparently making headway in other countries, although I would still think of it as a fairly uncommon intervention. Proponents claim that it is an ancient technique, practiced by Hippocrates and Galen, that can reduce inflammation, treat MS, arthritis, even HIV and Lyme disease. They cite uncontrolled and unblinded studies like this one on the use of live bee acupuncture for depression, which involved 37 volunteers with moderate to severe depression who were not receiving any psychiatric care and were game for being stung by a bunch of bees.

Meanwhile, in reality, no good studies have shown that live bee acupuncture provides any benefit for any condition. And to make matters worse, it has been linked to high rates of adverse outcomes besides just the obvious issues with allergic reactions. Localized skin reactions are so common they have a name: live bee acupuncture dermatitis. There is a published case report where a session of live bee acupuncture caused a patient to develop a condition called Stevens-Johnson syndrome, which causes your skin to slough off and is treated in a burn unit.

Something something something dark side. Something something something goop

In 2016, Gwyneth Paltrow was interviewed for The New York Times Style section about, among other things, how she stays fit and healthy. The article included the following gem:

I’ve been stung by bees. It’s a thousands of years old treatment called apitherapy. People use it to get rid of inflammation and scarring. It’s actually pretty incredible if you research it. But, man, it’s painful.

It is incredible, if you research it. But I don’t think that Gwyneth, who was already a huge acupuncture fan, is using that word in quite the same way that I am. I wonder if the woman in Spain was influenced by reading about live bee acupuncture being used by ignorant celebrities who like to think of themselves as health gurus.

A refreshing conclusion: “Unsafe and unadvisable”

The authors of the case report are not believers, but are highly trained experts who saw the potential for horrific tragedy that comes along with bogus health remedies first hand. They point out the clear need for patients to be tested for bee venom allergy, and for proper informed consent to be obtained, prior to each treatment session. They also advise that all providers be capable of initiating treatment of anaphylaxis immediately upon recognition as well as ensuring rapid access to real medical care. Their ultimate conclusion is refreshing:

However, these measures may not be possible. Therefore, the risks of undergoing apitherapy may exceed the presumed benefits, leading us to conclude that this practice is both unsafe and unadvisable.

No call for more research. No begging the question of efficacy. No downplaying of risks. I would have gone further, however, and called for this practice to be better regulated. A woman died at the hands of a practitioner of an implausible and dangerous therapy lacking any evidence to support a favorable risk benefit assessment. Hopefully her tragic story will at the very least convince others to avoid it.

As if bees weren’t having enough problems, every sting incorporated into a live bee acupuncture treatment session kills the bee. This is yet another example of traditional Chinese medicine doing its level best to wipe out a species. And bees are kind of a big deal.

One last thing that I stumbled on looking for a picture to accompany this post. In the United States, the FDA has not approved the use of live bee stings as a treatment for any condition. At least one acupuncturist has lost his license for providing live bee acupuncture, primarily it seems because he didn’t have an epinephrine autoinjector on site.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician practicing at Newton-Wellesley Hospital in Newton, MA, and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @skepticpedi and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey.