Starry_Night_at_La_Silla duty calls

A 1,000 Points of Pseudo-Medicine


Selections from Society for Science-Based Medicine Points of Interest with comments.

Not every article and study that pops up my feeds in the world of pseudo-medicine is worthy of a complete blog post. But they need to be noticed and commented upon. Duty Calls.

What’s the harm?

The harm continues.

Two chemists walk into a bar
The first one says “I’ll have some H2O.”
The second one says, “I’ll have some H 2O2.”
Then he dies.

Back in 2012 I wrote “Blonde Blood: Hydrogen Peroxide (H2O2 )Infusions” about using H2O2 intravenously. Hydrogen Peroxide is also a recommended as an oral nostrum for treating cancer and a variety of other diseases, thanks in part to:

The growing naturopathic health industry has promoted the use of hydrogen peroxide in treating a wide variety of medical conditions.

I mean, hydrogen peroxide is just water with an extra-oxygen, right? Just like Drano is half salt (Na) and half water (H0). How could that understanding of chemistry lead to any harm? Or so saith the hydrogen peroxide providing pseudo-medical provider. Hydrogen peroxide is just a concentrated source of oxygen. And oxygen is good for you.

Nope.

It is not such a good idea to ingest hydrogen peroxide, as chemist number 2 referenced above failed to realize and is confirmed in “Outcomes After High-Concentration Peroxide Ingestions.” Hydrogen peroxide kills:

In the 10-year study period, 41 of 294 patients (13.9%; 95% confidence interval 10.2% to 18.4%) with symptoms after high-concentration peroxide ingestion demonstrated evidence of embolic events, and 20 of 294 (6.8%; 95% confidence interval 4.2% to 10.3%) either died or exhibited continued disability

The embolism is from H2O2 producing gas resulting in a gas embolism, and gas where it doesn’t belong is a known complication of drinking H2O2 .

Patients also had damage to the esophagus and stomach due to the caustic nature of hydrogen peroxide that was not fatal but can be very debilitating.

29.3% were drinking the H2O2 for therapeutic reasons, the rest were unintentional or for self-harm.

Good rule of thumb: anything that can bleach hair is unlikely to be good for you.

FDA Finds Poison In Homeopathic Teething Remedies.”

The FDA confirmed this week that variable levels of deadly nightshade (you might guess from the name it is a poison) in some children’s teething nostrum that may have killed 10 children. The result?

I have noted many times in the past that pseudo-medical providers never respond to the potential of patient harm by altering practice. They ignore the precautionary principle.

that if an action or policy has a suspected risk of causing harm to the public, or to the environment, in the absence of scientific consensus (that the action or policy is not harmful), the burden of proof that it is not harmful falls on those taking that action.

Almost every time.

The song remains the same. One company that makes the product is NOT doing a recall and National Center for Homeopathy called the FDA’s warnings “arbitrary and capricious” and due to:

groups interested in seeing homeopathy destroyed continue to hammer away at the system – making exaggerated claims that create misunderstandings about and limit consumer access.

Suggesting children not take deadly nightshade is arbitrary and capricious. Welcome to CAM world.

If you under the impression that pseudo-medical providers are interested in the safety of you and yours, think again.

You learn in medical school that licorice root contains:

Glycyrrhetic acid, the active metabolite in licorice, inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect and the tendency towards the elevation of sodium and reduction of potassium levels.

Resulting in a rare form of hyperaldosteronism. I would never expect to see a case, as who can consume that much licorice, a vile flavor at best? People taking supplements, that’s who:

Liquorice-induced apparent mineralocorticoid excess presenting in the emergency department..”

A 65-year-old woman with a background of myalgic encephalitis, who was taking alternative medicines and dietary supplements, presented with hypokalaemia and hypertension. After a thorough history it became apparent that this was most likely secondary to regular consumption of liquorice tea.”

Myalgic encephalitis, by the way, is an English term for chronic fatigue syndrome.

Acupuncture

More information to support the overwhelming studies that point to acupuncture being no better than placebo aka worthless was released this week with “Moderators of acupuncture effectiveness in breast cancer survivors: Randomized clinical trial (RCT).”

Although acupuncture produced significant improvements from baseline to follow-up in insomnia symptoms, fatigue, and QOL, these improvements did not differ from sham.

Although there was the suggestion of efficacy in subgroup analysis, if you look up worthless in the OED you will find one definition to be subgroup analysis. Also, gullible is not in the dictionary.

Interestingly the less severe the patients’ depression, the better their response to acupuncture. They say it was due to more available serotonin. Uh huh.

Turns out, the less severe the depression, the greater the response to placebo.

A more appropriate conclusion would not be it is because of serotonin but that acupuncture is placebo.

Still, as is always the case, they suggest more studies need be done. No.

Another recurrent theme is that there is no acupuncture, a unique intervention, but there are as many acupunctures as there are practitioners. Since acupuncture is a placebo, it doesn’t matter where the needles are placed or the style used. Yet another example in A comparative study on the effects of systemic manual acupuncture, periauricular electroacupuncture, and digital electroacupuncture to treat tinnitus: A randomized, paralleled, open-labeled exploratory trial.”

They were all the same; the kind of acupuncture doesn’t matter as acupuncture is all placebo.

Some other acupuncture studies of note:

Evidence-based therapy for tendinopathy of the knee joint : Which forms of therapy are scientifically proven?”

No reasonable data are available for the treatment of tendinopathy in the knee region by acupuncture, fascial therapy or cryotherapy.

Reasonable data. I love the term, especially as the methodologies of acupuncture studies, and other pseudo-medicine, usually results in unreasonable data. As an example this week may I offer “a href=”https://www.ncbi.nlm.nih.gov/pubmed/27502820″>The effect of auricular acupressure on nausea and vomiting caused by chemotherapy among breast cancer patients.”

As is so often the case, intervention vs usual control. A study that guarantees a positive result. And it was. People are apes and are a calmed by touch and compassionate interaction, as long as in deference to a million years of evolution, you will not attempt to pick fleas off him. You do not to add pseudo-scientific ear pressure to be a good nurse and provide patient support.

Supplements

Unlike most pseudo-medicines, there is not necessarily zero prior plausibility that herbs will be ineffective. Still, there is often no reason to suggest they should be effective. The indications for herbs are many and the rational(e) lost in the mists of time. This shows up in the almost random way herbs are evaluated. And often found wanting.

In “Herbal medicines in children with attention deficit hyperactivity disorder (ADHD): A systematic review” they found.

Limited evidence could be found for pine bark extract and Gingko biloba. The other herbal preparations showed no efficacy in the treatment of ADHD symptoms and …no concrete recommendations for use can be made so far.

Vaccination

It is always a nice reminder that vaccines work. Middle school vaccine mandate cut whooping cough 53%. It is good to vaccinate the vectors and those most at risk for infection.

And not just for the benefit the person receiving the vaccination. Use of the HPV vaccine has been associated with the decrease in vaccine strains in unvaccinated women. That benefit has now been demonstrated in the HPV vector, er, I mean unvaccinated men: “Human Papillomavirus Prevalence in Unvaccinated Heterosexual Men After a National Female Vaccination Program“:

A 78% lower prevalence of 4vHPV genotypes was observed among younger male subjects. These data suggest that unvaccinated men may have benefited from herd protection as much as women from a female-only HPV vaccination program with high coverage.

Herd immunity. It works.

Homeopathy

Denial. More than a river in Iran.

In “Effect of Homeopathy on Pain Intensity and Quality Of Life” they found

This study could not show any significant effect of homeopathy on primary dysmenorrhea in comparison with placebo. Considering the possible effect of the homeopath and the homeopathic remedies prescribed on the results of such interventions, further studies are needed to help us arrive at a conclusion.

LOL. No, I do not think we need further studies to know that water will not help any symptom but thirst. And, as I mentioned above, you do not need to add pseudo-science to be a compassionate provider.

Despite being useless and even dangerous, homeopathy use is expected to grow: “Global Homeopathy Product Market: Increasing Demand for Dilutions to aid Revenue Rise at 18.2% CAGR 2016–2024, says TMR.” They say:

Of the key product varieties in the market, the segment of dilutions is expected to achieve the most promising share in the market’s valuation by the end of forecast period, retaining its dominant position with over 35% of the market by 2024

As I understand it, water is anticipated to be the kind of homeopathic product with the biggest growth potential. As in:

Homeopathy Product Market (Product Type – Tincture, Dilutions, Biochemics, Ointments, and Tablets.

The homeopathy theme song? Money for Nothing by Dire Straits

Now look at them yo-yo’s that’s the way you do it
You make you dilutions at Borion
That ain’t workin’ that’s the way you do it
Money for nothin’ and checks for free

In the literature

Some papers of note:
A systematic review and meta-analysis of complementary and alternative medicine in asthma.”

…there was limited evidence on the effectiveness of CAM in adult asthma as most CAMs were only assessed in a single trial. CAMs with multiple trials provided null or inconsistent results.

You know the rule, over time studies with better methodologies show decreasing effect. Reproducibility is even more a problem when the intervention is based on a fantasy.

It is curious how culture can result in the most curious of studies, such as “Effect of Vocalization of the Holy Quran With and Without Translation on Pregnancy Outcomes: A Randomized Clinical Trial.”

Why do such a study?

The harmonious tone of the Holy Quran is a type of mystic music, which contributes to the secretion of endorphins by affecting the brain and stimulating alpha waves. Therefore, it enhances the stress threshold, removes negative emotions, creates a sense of relaxation, and improves the immune system.

And so help with the stress of pregnancy. Did it work? Nope.

Based on the results of this study, despite the lower prevalence of preterm labor and caesarean section in the intervention groups as compared to the control group, no statistically significant effect was seen. This was apparently due to the small sample size.

Small sample size? Or perhaps an ineffective intervention.

Legal and legislative

Physical therapists are winning their suit for the right to practice their form pseudo-science, dry needling:

A North Carolina federal judge on Monday denied a bid to dismiss a lawsuit against the North Carolina Acupuncture Licensing Board accusing it of trying to stifle competition from physical therapists, saying the therapists’ antitrust claims were sufficient to proceed.

Acupuncturists are under the delusion that there is something special about their intervention and want to prevent others from doing it. There isn’t. But with most of the major medical institutions wallowing in the pseudo-medical integrative clinics, why shouldn’t physical therapists get their piece of the magical pie?

Remember to go to Summary Pending Legislation 2017 to keep abreast of the pseudo-scientific legislative shenanigans in your state.

Saudi Arabia bans training on Reiki therapy.” Why ban reiki? Not for religious reasons like Catholics.

The Saudi National Centre for Complementary and Alternative Medicine warned early in January of the negative effects of Reiki on patients who could neglect their modern medical treatment and face serious health complications for believing that such alternative medicine could heal serious illnesses.

Weird. Doesn’t the Saudi National Centre for Complementary and Alternative Medicine know they are supposed to promote pseudo-medicine? It is what the NCCIH does. Talk about not understanding their job. Perhaps Betsy DeVos has a Saudi Arabian twin?

Weirdness

Perspectives from Patients and Healthcare Providers on the Practice of Maternal Placentophagy.” Placentophagy. Eating placentas. Not for vegans, I would suppose. They conclude”

Most providers and patients have heard of placentophagy but are unsure of its benefits and/or risks. Further research examining the potential therapeutic efficacy and/or risks of placentophagy is needed.

Benefits. Of auto-cannibalism? There aren’t any. Placentophagy is touted for postpartum depression, based on anecdotes. Still, the most disgusting clinical trials are suggested:

Despite these challenges, Marraccini and Gorman underscore the importance of continued research on human placentophagy, as well as the importance of clinician awareness and openness in discussing placentophagy with their patients. Given the growing interest, further studies investigating the physiologic response and related benefits or adverse effects to hormones and minerals present in placenta capsules is warranted.

Ewwwwwwww. Placenta capsules.

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.