A thousand points of pseudo-medicine.

A thousand points of pseudo-medicine.

Selections from Society for Science-Based Medicine Points of Interest, a daily compendium of links 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

We always begin with harm. Many pseudo-medicines have the unique combination of no potential benefit and only the potential for harm, unlike the alternative assertions by pseudo-medicine providers that their interventions have only benefits and no harm. At the forefront of the only harm not benefit approach is chiropractic. So I assume, as usual, chiropractors will ignore “Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: A systematic review” (emphasis added):

Most patients were treated by chiropractors (66%). Manipulation was reported in 95% of the cases, and neck pain was the most frequent indication. Cervical arterial dissection (CAD) was reported in 57% (P = 0.21) of the cases and 45.8% had immediate onset symptoms

Of course, association is not causation and chiropractors suggest that the cervical arterial dissection was already in progress when their patients sought care, which begs the question, why can’t chiropractors recognize the cervical arterial dissection and why would they treat CAD with manipulation? So either chiropractors have no idea what they are are doing or they are causing CAD. I wonder which conclusion chiropractors would prefer? As I think about, the two are not mutually exclusive.

The article also suggests that:

There seems to be under-reporting of cases.

Many hospitals have stroke programs. Some researcher should insert a few questions about neck manipulation in to the voluminous data that is already being collected. It may give an interesting clue as to the frequency of chiropractic associated CAD and stroke.

From the perspective of an infectious disease doctor, the world is covered in microorganisms, most of them non-pathogenic. But organic material is often covered in bacteria and mold and that can have serious consequences: “Contaminated medical marijuana believed to have killed cancer patient.” The patient, 1 of 5, died of a rare fungal infection. Which fungus I cannot tell. The link in one article points to Candida auris, but I cannot find a specific organism mentioned. I would expect Aspergillus or Penicillium, but who knows.

Inhale the joint and with it comes the mold on the leaves.

The marijuana isn’t contaminated; to be a plant, especially a dead plant, is to be covered with mold. Contaminated suggests that the marijuana accidentally or deliberately acquired the mold. Marijuana is no more contaminated than the usual mulch pile. It’s perfectly natural that:

The team also commonly found fungi and bacteria in the products.
‘It’s pretty startling just how dirty a lot of this stuff is,’ LaFrate said.

No.

One quote was of zero help:

Dr. Michael Hirt specializes in integrative medicine and says that the fungus that was in the man’s body was equivalent to what is on rodent droppings.

I have no idea what that could refer to. Penicillium marneffei? Got me.

Bottom line? Brownies may be the way to go.

No real harm except aesthetic: A “London woman releases images of bump after tumour removal.” She was diagnosed with a fibroid and decided to treat it with with herbal medicines, acupuncture and exercises. Over the years the fibroid grew to 6 lbs and she looked like she was expecting. Fortunately fibroids are benign, so minimal harm except to her bank account as I suppose she will have to get a new, nonmaternity, wardrobe.

Hopefully the herbs were the safe kind; in the US we never really know what is in herbal products. In Australia they have a similar problem. “What risks do herbal products pose to the Australian community?” Many.

Some traditional herbal preparations contain heavy metals and toxic chemicals, as well as naturally occurring organic toxins. The effects of these substances can be dire, including acute hepatic and renal failure, exacerbation of pre-existing conditions and diseases, and even death. The content and quality of herbal preparations are not tightly controlled, with some ingredients either not listed or their concentrations recorded inaccurately on websites or labels. Herbal products may also include illegal ingredients, such as ephedra, Asarum europaeum (European wild ginger) and endangered animal species (eg, snow leopard). An additional problem is augmentation with prescription medications to enhance the apparent effectiveness of a preparation. Toxic substances may also be deliberately or inadvertently added: less expensive, more harmful plants may be substituted for more expensive ingredients, and processing may not be adequate. The lack of regulation and monitoring of traditional herbal preparations in Australia and other Western countries means that their contribution to illness and death is unknown.

That sounds worse than Twinkies.

Vaccination

You might remember a few weeks back the brouhaha over the antivaccine screed by the Cleveland Clinic’s Daniel Neides, M.D., medical director and chief operating officer of the Cleveland Clinic Wellness Institute. Dr Neides is part of the staff the Cleveland Clinic Center for Integrative & Lifestyle Medicine staff, purveyors of a wide variety of pseudo-medicines.

But perhaps Dr. Neides is an outlier, not representative of those who specialize in integrative medicine. While crank magnetism (the tendency to accumulate more crank beliefs over time) would appear to be the parsimonious explanation for the standard make up of an integrative medical clinic, it doesn’t mean that a given crank idea is necessarily representative of a whole medical specialty, a form of crank homeopathy, like attracting like.

Except that it does: “Vaccination Attitudes and Practices of Integrative Medicine Physicians” which evaluated:

the attitudes and practices regarding vaccination of members of the American Board of Integrative and Holistic Medicine (ABIHM).

They surveyed:

(1) use of and confidence in the vaccination recommendations of the Centers for Disease Control and Prevention (CDC) and of medical-specialty associations,
(2) confidence in the manufacturing safety of vaccines and in manufacturer’s surveillance of adverse events, and
(3) attitudes toward vaccination mandates.

And it wasn’t purty.

Integrative medicine physicians were less likely to administer vaccinations than physicians in traditional allopathic medicine.

Among the 44% who provide vaccinations, 35% used alternative schedules regularly.

Integrative medicine physicians showed a greater support of vaccination choice, were less concerned about maintaining herd immunity, and were less supportive of school, day care, and employment mandates.

Toxic chemical and viral contaminants were of greater concern to a higher percentage of integrative medicine physicians.

Integrative medicine physicians were also more likely to accept a connection between vaccinations and both autism and other chronic diseases.

When you think of an ND or DC, it should also suggest an anti-vaccine practice informed by pseudoscience. Add ABIHM and Integrative Medical doctors to the list.

Acupuncture

The Cochrane Library published “Acupuncture for acute hordeolum.” A hordeolum is a creature from the original Star Trek… no, sorry, it is a sty, an acute infection of the eye lid, usually from S. aureus and usually self limited.

Of course the reviewers write like acupuncture is a thing, but different studies used different points or bloodletting !?!?!?!?!  At least four different interventions were lumped together as if the same:

Four RCTs used bloodletting methods at the ear apex, that is ipsilateral or bilateral Erjian (EX-HN6) (Pang 2009; Qi 2013; Xu 2004; Yang 2014). Two RCTs used needling acupuncture at other body points such as points at upper back (i.e. Du 13 and Du 12) or at upper arm (i.e. ipsilateral LI 14) (Li 2006a; Zhang 1991).

In addition to an intervention being divorced from reality (bloodletting!?!?!?!?!?!?!) they noted:

The certainty of the evidence was low to very low mainly due to small sample sizes, inadequate allocation concealment, lack of masking of the outcome assessors, inadequate or unclear randomization method, and a high or unreported number of dropouts.

But still hint at benefit:

Low-certainty evidence suggest that acupuncture seems to have an additional benefit when used along with conventional treatments such as warm compresses and topical antibiotics

And they suggest avoiding bloodletting if the patient is on blood thinners. Outside of hemachomatosis, I can think of no rational reason for blood letting.

Ear bloodletting for an eye infection. Sure. We are not just post fact in medicine, we are now post reality. The Cochrane Collaboration really is doing its best to lose all respect.

And they say:

All RCTs were conducted in China, which may limit their generalizability to non-Chinese populations.

What does that mean? Eye infections are different in China? Only the Chinese respond to acupuncture? A sly hint that Chinese biomedical research may be rife with fraud? A very odd statement.

As of today there are 25,777 hits on Pubmed for acupuncture, with clinical trials dating back 1970. During this time the methodologic issues with clinical trials, especially the importance of a good sham controls, has been repeatedly mentioned. Do acupuncture trials care? Do journal publishers care? More importantly, do the review boards that are responsible for not wasting a patient’s time and money give a moldy rats ass? Nope. The garbage keeps on a comin’.

We have “Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial.”

It can’t rule out the effect of psychological factors during treatment process, because no blind procedure or sham control was used due to availability.”

And:

Impact of acupuncture on stress levels of professionals working with maltreated children.”

However, given the lack of an appropriate control group, we cannot exclude the potential contribution of the placebo effect, non-specific needling effects or even the natural history of stress or regression to the mean.”

So why even bother? They prove NOTHING and that result should have been known before the trials even started. Why were these total wastes of time and money approved? When it comes to pseudo-medicine, oversight is broken.

And remember how I mentioned earlier that there is no acupuncture, but acupunctures? For more of the same see “Comparing the Effectiveness of Electroacupuncture with Different Grades of Knee Osteoarthritis: A Prospective Study.”

Of course, with no placebo/sham control so worthless. Again. They used:

three treatment groups, including two-point group, four-point group and six-point group. Patients in the six-point group received treatment at six-points including ST34, SP10, SP9, ST36, ST35 and EX-LE4. Patients in the four-point group received treatment at ST34, SP10, ST35 and EX-LE5, while patients in the two-point group received treatment at ST35 and EX-LE4.

All ‘worked’ for osteoarthritis since it ever matters where you put the needles and, as would be expected, more needles equals a larger placebo response.

And finally, “Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.” Another example of GIGO, garbage in, garbage out:

We identified very low QoE indicating significant differences favoring acupuncture (versus any comparator) at post-intervention on PTSD symptoms

And, as is always the case, despite:

No significant differences were observed between acupuncture and comparators at post-intervention for depressive symptoms (SMD = −0.58, 95% CI [−1.18, 0.01], 6 RCTs, very low QoE), anxiety symptoms (SMD = −0.82, 95% CI [−2.16, 0.53], 4 RCTs, very low QoE), and sleep quality (SMD = −0.46, 95% CI [−3.95, 3.03], 2 RCTs, low QoE).

They suggest more time and money needs to be wasted on pseudo-medicine:

To increase confidence in findings, sufficiently-powered replication trials are needed that measure all relevant clinical outcomes and dedicate study resources to minimizing participant attrition.

Because this kind of nonsense only leads to the Man Who Stare At Goats approach to medicine: “Battlefield Acupuncture Introduced at Naval Health Clinic Corpus Christi.”

Eleven doctors and nurses learned how to reduce pain with semi-permanent needles during the first Battlefield Acupuncture (BFA) training at Naval Health Clinic (NHC) Corpus Christi Jan. 27.

Army major general Albert Stubblebine, the man behind the army’s psychic warfare research, passed on this week, but his spirit continues thanks to Richard Niemtzow.

And the nonsense spreads.

Naturopathy

Why do we have Sisyphus as the logo of the Society for Science-Based Medicine? “Institute for Natural Medicine Launches Public Outreach Campaign.”

The Institute for Natural Medicine (INM; Washington, DC), a non-profit organization dedicated to increasing access to care by licensed naturopathic doctors, announced last week that it has launched the INM Ambassador Program to increase public awareness around the value of naturopathic medicine.

Should not take long to increase a value of zero. And then we have A NEW DOC IN TOWN.

Dr. Pais is a Naturopathic Doctor – which means he has gone through an equally rigorous medical training as a regular MD, or Medical Doctor.

Except without the whole focus on basic science, two years of medical clinical rotations and, most importantly, the internship, residency and fellowships where MD’s really learn the profession. For more information I point you to the Naturopathic Diaries.

Homeopathy

Homeopathy is huge in India, perhaps one of the holdovers from when they were part of the British Empire? A shame they did not send homeopathy back when the British left. It leads to the unbelievably awful “AIDS body rubbishes govt. hospital’s claim on HIV cure.”

A government-run homeopathy hospital in Hyderabad has been treating over 10,664 HIV positive patients with a homeopathy pill as an experimental treatment.

The natural history of HIV in the era of effective treatment. Tuskeegee moves to India. A fatal illness treated with water. I must channel my inner Trump tweet: SAD!

In the literature

Some papers of note, this time on why reality based health care workers offer pseudo-medicine. For “Nurses’ attitudes towards complementary therapies: A systematic review and meta-synthesis” it is because:

Some nurses promote complementary therapies as an opportunity to personalise care and practice in a humanistic way. Yet, nurses have very limited education in this field and a lack of professional frameworks to assist them.

For cancer doctors it is “The influence of spirituality and religiosity on the personal use and practice patterns with complementary and alternative medicine (CAM): A national survey of US oncologists.”

This is the first study to identify self-reported spirituality as a significant factor among US oncologists’ decision to use CAM and recommend CAM to patients.

Legal and legislative

Nothing to report this week, but remember to go to Summary Pending Legislation 2017 to keep abreast of the pseudo-scientific legislative shenanigans in your state.

Weirdness

Pseudo-scientists are still wiggins over accurate classification. ‘Furor in China After Wikipedia Calls Acupuncture “Pseudoscience”.’ If the shoe fits…

It is weird what will be used as a medication. I ran across “10 Health Benefits of Shilajit: Alternative Medicine Remedies For Anti-Aging, Healing, Cognitive Strength, More.” What is Shilajit? It looks to be compost or mulch oozing from Himalayan rocks, a pre-oil.

As the mountains formed, tropical forests were crushed and compacted between massive boulders. The compressed forests gradually transformed into a nutrient- and mineral-rich biomass loaded with medicinal humic and fulvic acids. Now, every summer as the mountains warm, India’s most prized herbal remedy literally oozes from these biomass resins in the high mountain crevasses.

Probably mold and bacteria central. At least don’t smoke it.

And I never realized just how fragile homeopathic products can be: “While Consuming Homeopathy Medicines Take Care Of These 7 Basic Things, Or Results Won’t Be Effective.” Besides having a clean mouth, not consuming coffee, tea, fruits or real medications, they suggest:

Do not put the medicine balls on your palm. The spirit in them vaporizes, and this renders the medicines ineffective.

Which is how everyone takes a pill: from bottle to palm to mouth. The perfect excuse for a therapeutic failure.

See you next week.

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.