A thousand points of pseudo-science.

A thousand points of pseudo-science.

Selections from Society for Science-Based Medicine Points of Interest a daily compendium of links of interest with comment.

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.

Vaccination

Outbreaks of vaccine-preventable diseases continue to occur as herd immunity fails due to declining vaccination. It doesn’t take much; get below 95% vaccination rates for some infections and spread becomes not only possible but inevitable. For mumps that threshold is around 87%.

Mumps continues apace. Now a hokey, er I mean hockey, team has been infected: “Mumps outbreak decks Medicine Hat Tigers, could massively spread, says AHS.” There were over 5,000 mumps cases last year. As a result the “Rise in mumps outbreaks prompts U.S. officials to weigh third vaccine dose.”

The US is not the only country where vaccine-preventable illnesses are increasing due to alternative facts: “Measles increasing in Croatia.” I always remember that the 1918-1919 influenza epidemic went around the world three times in an era where the fastest form of transportation was a train. Just imagine a kid with measles landing in Chicago and being taken through the warrens of O’Hare. Or visiting Disneyland. All of these infections are an airplane flight away.

Practitioners of one alternative medicine (perhaps a term that should have a comeback, a nice parallel with alternative facts) more often than not are proponents of other ideas divorced from reality, aka crank magnetism.

A homeopath, a naturopath, an anti-vaxxer, a reiki practitioner, and a conspiracy theorist walk into a bar. He orders a drink.

In England, where homeopathy is Prince, “Homeopaths are keeping Andrew Wakefield’s ‘anti-vax’ fantasies alive.” I would not be at all surprised if homeopaths also consider the world to be flat.

With the current President having strong anti-vaccine leanings, it is nice to see some push back against ideas that will eventually kill some children in the US if continued. In a rare bipartisan show of support for reality, some “Congressional Leaders Just Took a Stand Against Anti-Vaxxers.”

It is critical to recognize the importance of protecting public health against vaccine-preventable diseases.

Acupuncture

Department of Guaranteed False Positives. A recurring feature I am sad to say.

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.

Acupuncture studies in particular seem to love this methodology and the resultant studies often generate inordinate positive press. An example this week: “Electroacupuncture and cognitive behavioural therapy for sub-syndromal depression among undergraduates: a controlled clinical trial.”

Three interventions but no placebo control. A waste of time and resources and a ‘positive’ result that means nothing. I remain puzzled why these studies continue to be approved by IRB’s. It is not worth the paper it is printed on or, as I read all my papers electronically, they are not even worth the electrons to read the screen, of which there are 15 747 724 136 275 002 577 605 653 961 181 555 468 044 717 914 527 116 709 366 231 425 076 185 631 031 296 in the universe. SAD.

Sometimes I have a hint of a suggestion of a possibility of sympathy for our Presidents opinion of the press. When you read the reporting on, well, alternative medicine studies by the press, I get a twinge of sadness. I don’t think fake or false. But I do think gullible and remain impressed at the lack of critical thinking.

For example, “Acupuncture Lessens Migraine Attacks in Chinese Study” resulted in numerous hits to the effect that acupuncture prevents headaches. It doesn’t. At least the above press release mentions the critical editorial that notes:

…seriously limited by its lack of blinding, both among participants — who may have been able to tell whether they were in the real or sham acupuncture group based on pain intensity — and acupuncture practitioners.

This study has been nicely reviewed both by Dr. Novella and Dr. Ernst. My only comment on the study is to note that 4 standard points were used for each patient adding to the great variability of techniques used as ‘acupuncture‘:

The acupuncture interventions tested in the included trials varied to a great extent. Five trials (Allais 2002; Ceccherelli 1992; Li 2012; Wallasch 2012; Zhao 2014 ) standardized acupuncture treatments (all participants were treated at the same points); seven (Alecrim 2006; Diener 2006; Facco 2013; Linde K 2005; Linde M 2000; Linde M 2004; Wang 2015) semi-standardized treatments (either all participants were treated at some basic points and additional individualized points, or there were different predefined needling schemes depending on symptom patterns); and 10 trials individualized the selection of acupuncture points (Alecrim 2005; Alecrim 2008; Facco 2008; Hesse 1994; Jena 2008; Streng 2006; Vickers 2004; Vincent 1989; Weinschütz 1993; Weinschütz 1994). The number of treatment sessions was between six and 12 in 13 trials, and 16 or more in nine trials. Most trials reporting the duration of sessions, left needles in place for between 20 and 30 minutes; one trial (Hesse 1994) investigated brief needling for a few seconds. Electro-stimulation of needles was used in one trial (Li 2012). Agreement among acupuncturists on whether they would do acupuncture similarly to that used in the study assessed and whether they had confidence in the quality of the acupuncture was low (intra-class correlation coefficients -0.08 and 0.24). For two studies (Hesse 1994; Linde M 2004) both acupuncturists rating the study had 50% or less confidence that the acupuncture had adequate quality. For a further six studies (Ceccherelli 1992; Li 2012; Linde M 2000; Wallasch 2012; Weinschütz 1993; Weinschütz 1994) at least one acupuncturist gave a rating of 50% or lower. We could not assess four trials using individualized treatments not described in detail (Alecrim 2005; Alecrim 2008; Facco 2008; Jena 2008).

As I continually note, there is no standard intervention for any process that can be called acupuncture.

Chiropractic

There is a bill before the Oregon legislature that:

Allows chiropractic physicians and naturopathic physicians to provide release for athlete who sustained concussion or is suspected of sustaining concussion.

A bad idea given the lack of education and training of naturopaths and chiropractors in reality-based medicine. And the data suggests that chiropractors are not qualified to treat concussion and chiropractors lack insight into their lack of knowledge. This example of Dunning-Kruger is “Survey of Primary Contact Medical and Chiropractic Clinicians on Self-Reported Knowledge and Recognition of Mild Traumatic Brain Injuries: A Pilot Study.”

The majority claimed confidence in diagnosis of MTBI, but a lack of knowledge of many of the assessment tools and the international guidelines.

If the bill passes, it will be children who bear the brunt of their evaluations.

Maybe chiropractors will treat the concussion with a brain-stick. One chiropractor has come up with the oddest product in a field of odd products: a natural lip-stick that glues the labia together to keep menstrual flow contained: “A Male Chiropractor Wants Women To Use Controversial Methods To Contain Menstrual Flow.” Perfect media for S. aureus toxic shock or Clostridia sordellii. And since when did stupid become controversial? Sometimes it is the headline writers that do the most damage.

In the literature

Some papers of note.

Looking for a back door into guidelines is “An interpretive review of consensus statements on clinical guideline development and their application in the field of traditional and complementary medicine.” Even if the data is weak or nonexistent, other criteria should be used to make strong recommendations for inclusion of pseudo-medicine into guidelines:

In instances of very low quality or equivocal evidence of efficacy, guideline developers must consider the paradigmatic situations where nonetheless a strong recommendation can be made. Failing this, broader contextual information is often available for T&CM even when there is low quality scientific evidence regarding efficacy.

Such as:

Modifying factors such as burden of disease, magnitude of effect, current use, demand, equity and ease of integration should also be considered.

Always with the special pleading. I think I will stick with good evidence.

Homeopathy

Out of Australia comes “Majority of pharmacists stock CMS including homeopathic items.” Money for nothing, despite “Hundreds of Babies Harmed by Homeopathic Remedies, Families Say.” Although those deadly nightshade products have been sold in the US. Despite the potential for killing children, evidently the companies are not all that concerned, leading to the question “Why Is This Company Selling a Toxin For Children?”

The FDA has asked for a recall of homeopathic teething products that may cause seizures or worse—but consumers can still easily get their hands on the product.

Pseudo-medicine providers are NEVER interested in patient safety.

Quackademia

UA Center for Integrative Medicine receives $1M gift.” The center is the home of Dr. Andrew Weil, offering training and fellowships in Integrative Medicine and is perhaps ground zero for the movement.

I am so jealous.

Anyone out there with a cool million they are interested in donating, the Society for Science-Based Medicine is a worthy recipient.

The Department of Education is of the opinion that alternative medicine schools of acupuncture and traditional Chinese pseudo-medicine are not providing enough training to allow their graduates to work and then be able to repay their loans. As a result students at these schools do not qualify for federal financial aid. These schools account for:

11 percent of the total higher education population, but 44 percent of federal student loan defaults.

So it would be a reasonable conclusion that loans to these students would be liable to go unpaid. The school disagree and “Alt-Medicine Schools Challenge Their Failing Grades“:

…challenging a Department of Education “gainful employment” regulation that labels them as failing to prepare students for work.”

However, even if they do get a job after graduation, no alternative provider can be considered as having gainful employment.

I suspect the stress shows: “Acupuncture clinic fails to prove point before COA.”

An employee at an Indiana acupuncture and yoga facility who was repeated screamed at by the owner had good cause for quitting and is thus entitled to unemployment benefits, the Indiana Court of Appeals affirmed Friday.

Maybe the acupuncturists are overly stressed at not being able to make their student loan payments. Too bad the calming/centering effects do not seem to extend to its practitioners.

Legal and legislative

Wyo. acupuncture bill will harm patients, providers.” Who objects to licensing acupuncturists? It is an acupuncturist, being worried about public safety and the cost of licensing. As noted in the past, Wyoming is the home of rogue acupuncturists, those who ran afoul of the law in their home state, lost their license (just how bad do you have to be for that to happen) and skedaddled to Wyoming. The last thing these practitioners evidently want is even a bit of quality control.

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

Pseudo-medical weirdness

Pseudo-medicines are infinitely recombinable. There is no end of odd hybrids, mutants that should not survive birth but do. And as example: “Hypno-Reiki: A Way to Let Go of the Pain – The Mind Matters.”

The mind doesn’t know the difference between what is imagined and what is perceived as reality.

Sums it up for most pseudo-medical practitioners.

I suspect that I am unable to come up with a pseudo-medical combination that someone, somewhere, doesn’t offer.

Leading Integrative Medicine Institute Reveals the Single Unifying Cause of All Disease.” And the answer is…

Wait for it…

inflammation at the cellular level.

Huh? Well what is inflammation at the cellular level?

All cells need four basic elements to live and thrive. Oxygen in, water in, food in and waste products out. If these are done on a timely basis the cells will live very long… If there is a breakdown of any of these four at the cellular level, this is when inflammation, the precursor to all disease, begins.”

Makes no sense to me, but what do I know? Dr. Hall can add it to her list of 67 one true causes of all diseases.

And don’t let Deepak know, as “Deepak Chopra explains recent study that may revolutionize medicine“, as he has found:

the most fruitful discovery in medical science over the past two decades.

Or not. It is not inflammation at the cellular level. That one is taken.

And lastly, the bastion of weirdness, GOOP, gives us Why We Shouldn’t Dismiss Iodine. We shouldn’t. But we should dismiss this entire article as I think Wolfgang Pauli had it in mind when he said “”Das ist nicht nur nicht richtig; es ist nicht einmal falsch!” (That is not only not right; it is not even wrong).” For a wonderful deconstruction, see “Gwyneth Paltrow And GOOP Give Dangerous Info On Iodine. Their Expert Gets His Info From A Ghost.”

I know GOOP likes to point to their disclaimer that they “intend to highlight alternative studies and induce conversation,” but speaking with a spirit is not an accepted scientific method and the only thing I think they have induced with me is my gag reflex.

A writer after my own heart.

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.