Pictured: A better source of health information than "About Herbs".

Pictured: A better source of health information than “About Herbs”.

Medicine has an intellectual hierarchy. Supposedly the best and the brightest are in the academic medical centers and are the thought leaders in their field.

Those of us lower in the hierarchy are well aware of some of the warts present on our betters, but I would expect those at the top would adhere to the highest intellectual and ethical standards. People being, well, people, expecting exceptional standards is admittedly an unrealistic expectation.

It would appear that many academic centers are doing their best to avoid meeting my expectations, attempting to abandon all standards.

I mentioned over at SfSBM that Dana-Farber is spending 2 million dollars on a renovation to, in part, offer the unmitigated steer manure that is reiki and reflexology to their cancer patients. Yes. Reiki. Reflexology.

Those are not fracking earthquakes in Kentucky, those tremors are the result of the tremendous kinetic energy of Flexner spinning in his grave as his life’s work becomes a farce.

Dana-Farber is just one of many academic medical centers who are putting their imprimatur on nonsense.

Memorial Sloan Kettering Cancer Integrative has released “About Herbs”, an iPad/iPhone guide to Botanicals, Supplements, Complementary Therapies and More. Spoiler alert: the ‘More’ does not include critical thinking. This guide is not anywhere as ludicrous as offering reeky, sorry, reiki, but at times it comes close.

Let’s take a look at our first contestant

My bias does kick in looking at the Sloan Kettering guide. I have my own compendium of infectious diseases, so I have strong opinions about what does and does not make for a good medical guide.

In my opinion a good medical guide should take a complex topic and interpret the evidence. A given study is often within the context of a broader literature and needs to be understood in context.

The “About Herbs” approach to evidence seems to be if there is any evidence, good, bad or indifferent, then mention and reference it. But don’t explain or advise. The approach renders the guide next to useless.

For example, Zhong Jie Feng.

It is a traditional Chinese-pseudo-medicine used for:

bruises, bone fractures, arthritis, nausea, internal pain, and cough.

Those are six processes with similar physiologies. I can see how Zhong Jie Feng would work for all six. That, btw, is sarcasm.

But Zhong Jie Feng is “hepatoprotective and cytotoxic.”

Hmm. It protects cells and it kills cells. What exactly are they referring to?

The hepatoprotective is:

against D-galactosamine-induced toxicity in WB-F#44 rat hepatic epithelial stem like cells

And the cytotoxicity was:

some of the new isolates exhibit significant cytotoxicities when tested against a small panel of tumor cell lines.

But probably not liver tumor.

So for a patient, or a clinician, a fundamentally useless hodgepodge of unrelated information once the references are reviewed.

Zhong Jie Feng is perhaps useful for idiopathic thrombocytopenia purpura AND protective against viral pneumonia. In mice.

And Zhong Jie Feng relieves fatigue in cancer patients AND decreases mucositis. In non-blinded, non-placebo controlled trial with a p of <0.05 if you hunt down the reference. Hardly impressive data.

It sounds like Zhong Jie Feng is the wonder drug that works wonders from the text until a look at the supportive literature yields an unimpressive result.

It seems they just throw whatever material is available at the wall and see what sticks. But if you go to the references the ‘evidence’ is not impressive and my interpretation of Zhong Jie Feng is that if it contains bioactive compounds the evidence to support its effects in vivo are minimal and in vitro even less.

That is all from the “Professional” side of the app, as if patients are not going to go through this laundry list of poorly reported information. The “Consumer” side is not referenced, but gives similar, if watered down, information on its purported uses with no final recommendations.

I would tell patients to save their money on Zhong Jie Feng, but “About Herbs” is no Consumers Reports.

But I knew nothing going in about Zhong Jie Feng. How about the entries for products about which I know something?

And behind doors number two through four?

Shark cartilage? “About Herbs” suggests shark cartilage has no effect on any process for which it has been tested. Yet nowhere do they explicitly say don’t take it, it is leading to the decimation of shark populations.

Echinacea? It doesn’t prevent colds and it doesn’t have any clinically relevant effects on cold symptoms. Sure, patients had their cold symptoms shortened by 0.16 days, or 3 hours, 50 minutes, and 24 seconds. Anyone besides me think this is noise in the data? Not the authors of “About Herbs”.

Saw palmetto? The best study and meta-analysis shows no benefit for the symptoms of benign prostatic hypertrophy, a result echoed in the Cochrane Reviews.

Of course, that’s if you look at all the data. If you a cherry pickin’ daddy, like “About Herbs”, you report on some data, as is disingenuously noted in:

Several clinical trials and meta-analyses have shown that saw palmetto improves urinary tract symptoms associated with BPH

And, of course, several have not. That the better quality studies and meta-analysis point to lack of efficacy isn’t mentioned.

All three of these products have a “Mechanism of Action” section. But the products don’t do anything, so how can they have a mechanism of action? I suppose the title is shorter and more to the point than the more descriptive “Random Results of Pointless Studies by Those Who Use Why Most Published Research Findings Are False as a ‘How To’ Rather Than a Warning.”

Besides herbs they also report on a hodgepodge of other SCAMS.

The rest of the doors all go into the basement…

Magnets? They recognize as bunkum.

The Gonzalez Metabolic Therapy is noted to be dangerous and useless. Which is nice. As in many of the analyses inside, “About Herbs” itself offers no recommendations or analysis. Instead they note:

The American Cancer Society urges cancer patients not to seek treatment with metabolic therapies.

But not “About Herbs”? I would wonder if those who mistrust modern medicine could construe these weasel words as, if not an implicit approval, then at least a ‘do as you want, you will anyway’ shrug.

Vitamin O? They note it to be nonsense.

Qigong?

Proponents of Traditional Chinese Medicine contend that qigong works to promote a healthy, balanced flow of energy – called “qi” – within the body. Many believe that a disturbed or blocked flow of qi produces discomfort and illness within an individual; conversely, with a balanced, free flow of qi, one is believed to be in better health.

“About Herbs” is nonjudgemental, failing to suggest this explanation is gibberish.

Acupuncture?

They repeat every canard about this useless theatrical placebo. For every assertion about acupuncture, there is probably an SBM article that refutes it. They ignore the vast contradictory literature on acupuncture as well:

There is evidence that acupuncture can reduce symptoms such as depression, facial pain, headache, peripheral neuropathy, lower back pain, nausea and vomiting, neck pain, postoperative pain, shortness of breath, chronic fatigue, hot flashes and side effects caused by radiotherapy and/or chemotherapy. It may also assist with lifestyle changes such as smoking cessation.

Not mentioned is the evidence is all biased and of poor quality whose efficacy vanishes as the quality of the study improves.

It is as if the entire acupuncture literature were put into a Nutri-Matic machine and it produced an analysis of acupuncture that that is almost, but not quite, entirely unlike the truth.

Unlike other interventions, they downplay acupuncture complications with only three references, unlike other entries were every complication is often noted.

And then.

Then?

…And the basement is flooded

There is the entry on homeopathy.

There is some evidence that homeopathy may benefit individuals with chronic conditions.

Homeopathy, developed more than 200 years ago, is based on the Law of Similars, or “like cures like.”

Clinical studies have been conducted to evaluate benefits of homeopathy, but data are limited and results, inconclusive. More research is needed.

No, no a thousand times no. Maybe I should have started with homeopathy, as any guide that finds homeopathy even remotely reasonable is produced by those who evidently have no understanding of reality-based medicine. And that the Australians and English both have produced extensive analysis that demonstrate the worthlessness of homeopathy is somehow not mentioned.

If you judge a article by the company it keeps, these articles hang out with medical unicorn tears.

I looked at the Sloan Kettering Integrative Medicine website. They offer acupuncture, reflexology and reiki, what I would consider fraudulent magic. They charge a pretty penny for the acupuncture. I can’t see it in their interest to be critical of the practice.

Conclusion: “About Herbs” is a mixed bag

Some good information, some sketchy, some positively BS. And if you do not have the background in medicine, critical thinking, and SCAM, how are you going to know which is which? Much of the information is presented in a shruggie’s Gish Gallop of often-cherry picked information and the occasional lie by omission.

For consumers? It isn’t worth the price. Look elsewhere.

For health care professionals? “About Herbs” does not contain enough explanation to allow you to separate the good from the bad from the ugly. Every referenced statement needs to be evaluated for veracity and context as they can’t be trusted or even understood.

For SBM advocates? It is an excellent example of how not to present pseudo-medical information. Or any information for that matter.

“About Herbs” will appeal most to true believers in pseudo-medicine who wish for the patina of scientific validation without the need for a real understanding and who cannot or will not apply Feynman’s admonition. That would be Integrative Medicine practitioners and Naturopaths I suppose.

 

 

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.