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 in 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.

Vaccination

I have said before that infectious disease is like birding, only interesting. ID has a life list, although there are diseases I never want to see: smallpox, plague, and measles to mention a few. Oregon is one of the top states for vaccine exemptions. Go us. As a result I may get to see an actual case of measles before I retire or die. Other states are trying hard to catch up, as an example: “Religious vaccine exemptions on the rise in New Jersey“:

The number of state religious exemptions among children in primary school more than doubled within a six-year period.

There is a mumps outbreak in Washington with over 400 cases. Maybe we will all get to see a case of a vaccine-preventable infection in the future as exemptions keep increasing. Herd immunity is a fragile thing.

It is nice that there are ongoing difficulties in spreading the alternative facts by the anti-vaccination proponents. “Homeopathic College Pays Heavy Price for Helping to Screen VAXXED.”

In England they had troubles finding a theater (or, as they call it, a cinema) to screen VAXXED. The Centre for Homeopathic Education decided to offer a screening, but snuck the film in, telling no one what the film was about. The administration of Regents University, under whose auspices the Centre for Homeopathic Education exists, were none too happy with the subterfuge and:

severed their contract with the Centre for Homeopathic Education (CHE). They are now homeless. A heavy price indeed to pay for this underhand works.

Not that any reality-based university should have been offering degrees in magic, er, I mean homeopathy, in the first place.

Acupuncture

In Friday’s entry on chiropractic I mentioned the problem with comparing an intervention to standard care rather than to a placebo/sham intervention.

As Dr. Ernst points out, it is ‘A trial design that generates only “positive” results.’

We conclude that the ‘A + B versus B’ design is prone to false positive results

Where A is an intervention (acupuncture, chiropractic, reiki, homeopathy) and B is standard care.

Yet the hits just keep on coming: “Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain” which, as would be predicted, demonstrated benefit for contralateral manual acupuncture compared to a wait list.

But most amusing was the rationale for the study:

Several randomised controlled trials (RCTs) have investigated the effects of acupuncture for the treatment of shoulder pain, with different combinations of acupuncture points, treatment protocols and methods of needle stimulation, all of which potentially influence the therapeutic outcome of acupuncture treatment. While most acupuncture trials have involved acupuncture needling close to the site of pathology, with or without addition of distal or contralateral acupuncture points, many Chinese medical practitioners purely use acupuncture points contralateral to the site of pain to treat unilateral limb pain, such as that arising from the shoulder or leg. However, there is little scientific evidence to validate the clinical effects of contralateral acupuncture in morbid subjects, despite there having been several studies in animals and healthy human volunteers.

As I keep harping on, there is no such thing as acupuncture as a distinct entity. Every acupuncture study uses a different intervention and is further evidence that the acupuncture is nothing but placebo. At its core the purpose of this study is to see if yet another style of acupuncture placebo has effects. It does. A placebo effect.

And pseudo-medical providers cannot wrap their heads around the idea that if their intervention is no better than placebo it doesn’t work. Take “Acupoint Stimulation on Weight Reduction for Obesity: A Randomized Sham-Controlled Study“:

The results showed significant differences in body mass index, blood pressure, total cholesterol, triglyceride, and leptin or adiponectin over time within the group, but not between the groups.

Sham acupoint stimulation was no better than real acupoint stimulation. So it doesn’t work. Why?

This study could not exclude the effect of placebo and dietary consultation.

Well, I would quibble over the uncertainty over the placebo effect. These results define the placebo effect. But no, they want to make sure in the future that there is an effect with a study methodology that will guarantee a positive result.

Further study that adds a control group receiving no treatment is therefore needed to confirm the effects of auricular acupressure.

Such is the power of belief over science, they will continue until they can declare victory, no matter how flawed.

Herbs and supplements

Last week I mentioned five cases of invasive mold with a death that were associated with marijuana use. Now its toxins: “Medicinal marijuana users skeptical of product safety after recalls for banned pesticides.” There was the:

presence of myclobutanil – a banned pesticide that produces hydrogen cyanide when heated (aka smoked)

The myclobutanil was being used to control a mildew outbreak on the crops.

Having a career in the treating infections associated with various drugs, it does not surprise me that the producers of these substances are less then punctilious in producing their product. Somehow I suspect their driving main motivation in making weed is not safe product.

Doctors, it appears, are not the only allegedly science-based practitioners who should know better than to suggest useless pseudo-medicines. “Unproven alternative medicines recommended by third of Australian pharmacists“:

Choice survey finds therapies with little to no evidence of their benefits, including Bach flower remedies and homeopathic products, being suggested to shoppers…Fifty-nine per cent of people were just told the complementary and alternative product recommended to them worked, and 24% were told the product was scientifically proven.

Not encouraging, and why Sisyphus is the logo of the Society for Science-Based Medicine.

But alternative medications have efficacy, just as long as they contain real drugs: “Health dept cracks down on alternative meds containing sildenafil citrate.”

Sildenafil is better known as Viagra. I guess it is better than the lead and other toxic chemicals in Ayurvedic Indian medications. Barely.

In the literature

Some papers of note.

I was under the impression that exercise was of benefit for depression, but when I reviewed the topic I found that the evidence is modest at best:

The evidence was limited regarding the benefits and adverse effects of various other MDD interventions—alone or in combination with SGAs—when compared with SGAs alone. These interventions included… Exercise therapy

Yoga is a form of exercise, often with a patina of mysticism. Like acupuncture, it has many forms, but unlike acupuncture, at its core the yogas are exercise and I would doubt that the particular style makes much difference for efficacy. Do the yogas help depression? A systematic review of yoga for major depressive disorder” results in the standard pseudo-medical conclusion that poor studies show a modest effect:

This review found some evidence for positive effects beyond placebo and comparable effects compared to evidence-based interventions. However, methodological problems and the unclear risk-benefit ratio preclude definitive recommendations for or against yoga as an adjunct treatment for major depressive disorder. Larger and adequately powered RCTs using non-inferiority designs are needed.

But I am still biased towards the overall benefits of exercise so even if the yogas do not help with depression, it should be better than staying home, sitting on the couch and exacerbating depression by watching the news.

Homeopathy

Years ago at a conference one of the drug reps was detailing a new antibiotic with my attending and she commented that it was popular in Europe. He responded, “So was Hitler for a while”. A pre-internet version of Godwins Law. I always remember that bon mot when popularity is used as a reason for justifying a pseudo-medicine: “Millions of Italians use homeopathic remedies.”

Of the 13 million Italians who use pseudo-medicines, 76.1% use homeopathy. And this despite the complete lack of efficacy for any product, a pattern that continues with “Homeopathy for Allergic Rhinitis: A Systematic Review.”

The low or uncertain overall quality of the evidence warrants caution in drawing firm conclusions about intervention effects. Use of either Galphimia glauca or a homeopathic nasal spray may have small beneficial effects on the nasal and ocular symptoms of AR. The efficacy of isopathic treatment of AR is unclear.

The efficacy of the homeopathic nostrum is as clear as water for me.

Legal and legislative

And, better late than never, the “Burzynski ruling is in: Stan saddled with an overseer.” The Texas Medical Board has found his practice wanting and has added the following stipulations to his practice.

Revocation of license. Unfortunately, this was stayed assuming he follows the rest of the requirements. But he was put on probation and given a public reprimand.
The Burzynski clinic’s billing practices will be monitored and the records reviewed.
Burzynski must complete a Physicians Ethics program and undergo continuing education to obtain credits of completion in several topics of medical research.

I suspect this one may doom him to failure; I believe the saying is you can’t teach an old duck new ethics. It would be like requiring me to shoot under par at Augusta.

Informed consent forms must be submitted to the Board for review to demonstrate they comply with rules and laws. Each patient must now get these new forms and sign them before treatment.
Ownership interest disclosure must be submitted to the Board for review and all patients must be informed (that he owns the pharmacy he is making them use).
He must pass a Medical Jurisprudence Exam.
He must pay a 360,000 penalty based on the incidents shown to have occurred with patience [sic]. (The false billing really got him here, constituting a huge portion of the assessment.) And, he must pay restitution of $20,125 to the American Cancer Society.

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

And that’s it. 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.