A thousand points of Pseudo-Medicine.

A thousand points of Pseudo-Medicine.

Running a bit late this week, as I was on call and worked the weekend and my eldest came home for spring break.

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.

NECSS will be June 29-July 2, 2017 in New York city with an entire day, June 28, devoted to science-based medicine. More information to follow.
If you are in need of something to do to help in the battle against pseudo-medicine, “Canada’s Bad Science Watch wants to know if purveyors of “natural” health products are following the law.” They want to know:

Are manufacturers of natural health products (“NHPs”) marketing/advertising their products in ways that do not align with their Health Canada licenses as permitted under the Food and Drugs Act, 1985 (“FDA”)?

Volunteers are needed and information can be found on their website.

Vaccination

Why You Should Skip That “Chickenpox Party”.” Chickenpox parties are still a thing? Who knew. Chickenpox parties are where parents take their children to be exposed to chickenpox. In the old days, the pre-vaccine days, I can kind of sort of see why you might have your child go to a chickenpox party. Everyone got chicken pox growing up and you might as well get it out of the way at a time of your choosing to make the infection less disruptive.

With the availability of the vaccine, which is very effective in preventing chickenpox, what you are offering you child from said party is an acute and unpleasant illness as well as the risk of complications:

  • Bacterial infections of the skin and soft tissues in children including Group A streptococcal infections
  • pneumonia
  • Infection or inflammation of the brain (encephalitis, cerebellar ataxia)
  • Bleeding problems
  • Blood stream infections (sepsis)
  • dehydration

Some people with serious complications from chickenpox can become so sick that they need to be hospitalized. Chickenpox can also cause death.

Plus the joys of shingles as an adult. Party, or child abuse?

Animal Abuse

I always feel sorry for animals and children as they have no choice when pseudo-medicine is inflicted upon them. If you look at “Behind the scenes at Denver Zoo” you will find penguin acupuncture. I know it is silly to apply a consistent rational approach to pseudo-medicine, but how do they know where the meridians and acupoints are on a descendent of dinosaurs? And Traditional Chinese Pseudo-Medicine uses pulse and tongue analysis to make a diagnosis; that is a process I would like to see applied to a penguin. But it is the animal who suffers as:

We’ve been able to reduce dancer’s medication by half in the past 6 months,

With, I would assume, a concomitant increase in pain.
And the ‘Cincinnati Zoo uses chiropractic on tiger cub, adjusting spine to cure “failure to thrive”‘ by adjusting the cub’s cervical spine. Hope they don’t cause a stoke. And it looks like they were using the useless activator in the video, a spring-loaded plunger, on the cub. The DC says:

There is a lot of science behind what really happens with the chiropractic adjustment

And follow up with the pseudo-science that by adjusting the top vertebra:

You restore the nerve flow to the rest of the body.

Thane Maynard, head of the Zoo, considers this “terrific stuff”, expressing an enthusiasm for abusing, er, I mean adjusting, dogs and horses as well. Sigh.

And I wonder how all the DCs translate their vertical spine pseudo-science to the horizontal spine of quadrupeds. He appears to adjust the spine side to side but in a four legged shouldn’t the subluxations be up and down? The poor tiger had ‘birth trauma’ as the reason for its need for adjustments, another favorite DC pseudo-diagnosis.

Medicine

There is an old saying in medicine: “do not be the first to try the new nor the last to abandon the old.” But that is easier said than done: “When Evidence Says No, But Doctors Say Yes.” They note:

Medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof.

It is a long standing problem, less to do with medicine and more due to the ways humans think. Doctors, to state the obvious, are as prone as the next person to all the cognitive biases that define human cognition. I can affirm that it is hard to change ingrained practice and it is easy to rationalize why the negative studies do not apply to my practice. It is difficult to change. But at least medicine slowly changes. In the world of pseudo-medicine, nothing ever changes or is abandoned by its practitioners.

For example there was a recent review of “156 Medical Practices That Are All Failures<.” 10 out of the 156 bad medical practices involved acupuncture: labor, uterine fibroids, irritable bowel syndrome, otitis media with effusion, lower urinary tract symptoms in men, hyperbilirubinaemia, laser acupuncture for carpal tunnel syndrome, depression, osteoarthritis and Bell’s palsy.

I would argue that acupuncture has been a failure for any process for which it has examined. But I wonder. Is there an acupuncturist anywhere that has abandoned any of the above? Bet not.

Acupuncture/traditional Chinese pseudo-medicine

In medicine we often use simulators to learn, for example, how to respond to a cardiac arrest. Better to learn CPR on a dummy than a real person. Simulators allow providers to learn new skills without having to learn on real people. No one, I suspect, is going to volunteer to be a cardiac arrest patient and no one wants to be any providers first of anything. But “Study on the Depth, Rate, Shape, and Strength of Pulse with Cardiovascular Simulator” leads only to a smirk. In traditional Chinese pseudo-medicine (TCPM) they make their fanciful diagnoses on the basis of evaluating the tongue and pulse. The authors devised a machine to simulate the pulses of TCPM because, well, they can. The result? They made the string-like pulse, the slippery pulse, the vacuous pulse and the replete pulse. It is not unlike making a bicycle for a fish, because pulse diagnosis is not reliable. “Reliability of Manual Pulse Diagnosis Methods in Traditional East Asian Medicine: A Systematic Narrative Literature Review.”

Poor reliability was related to unclear definitions and terminology existing within the classical definitions, and with standardized systems to persisting imprecise descriptions that can be interpreted differently.

No, poor reliability was related to the fact that pulse diagnosis in TCPM is nonsense. Or maybe they just need more training on a simulator.

And why do people use acupuncture? In “A cross-sectional survey of pain catastrophising and acupuncture use among breast cancer survivors” it was:

High levels of pain catastrophising, and specifically the processes of rumination and magnification, were associated with greater acupuncture use.

Which is an interesting reason. It was people who worry about developing horrible pain who used acupuncture. I would wonder if this is more widely applicable to pseudo-medicine use.

Chiropractic

‘”After 155 Years, the Cause of Meniere’s Disease has Finally Been Discovered,” Burcon Chiropractic.’ Huzzah! And the cause of Meniere’s (which, by the way, is unknown to medicine)?

Ligaments are damaged allowing an upper cervical subluxation complex to slowly develop over time. Additionally, the brain slips lower into the foramen magnum, slowing the flow of cerebrospinal fluid out of the skull, creating normal pressure hydrocephalus. Since the skull acts as a closed hydraulic system, less blood flows into the head.

That strikes me as nonsense, if for no other reason (but there are many others) than vertigo is not a symptom of normal pressure hydrocephalus.
I would still be inclined to avoid any chiropractic manipulation of the cervical spine as it will treat nothing and can cause a stroke. For a more reasonable explanation of a pathologic process than above, see “How spinal manipulation could cause a stroke.”

Herbs and supplements

Herbs are touted for virtually everything, expect for herb overdose. Herbs, unlike most pseudo-medicine, do not necessarily have a prior plausibility of zero. An herb may contain a substance, like digitalis in foxglove, that is effective cardiovascular disease. But as “Herbal Medications in Cardiovascular Medicine” notes:

Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking.

Naturopathy

Years ago, as a fellow, we were in line at a restaurant in Palm Springs and the elderly lady in front of us, when asked if they had a reservation, announced loudly, ‘Yes, DOCTOR and Mrs. Smith’. My wife and I just rolled out eyes. I never want to be the diminutive of Richard who uses my title outside of the hospital. Not so with some pseudo-medical providers. Naturopaths and homeopaths refer to themselves as “doctor” more than doctors.

The researchers also used hidden microphones at numerous dinner parties attended by the three groups and found that on average, naturopaths and homeopaths averaged just under 4 seconds of conversation before mentioning they were “doctors”. Many of the medical doctor group did not mention it at all.

4 seconds! That’s premature ejaculation (in the Dr. Watson sense of the word).

Note: See comment.

Homeopathy

What Homeopathic Medicine Offers to People with Lead Poisoning and Other Environmental Exposures.” Well nothing. Literally. Giving diluted lead to treat lead poisoning wins the Wolfgang Pauli ‘That is not only not right; it is not even wrong’ award. The Huffington Post is publishing a worthless intervention for a very serious disease, by Dana Ullman. Of course. Someday someone may die as a result of this kind of nonsense. I don’t suppose those other exposures include Ayurvedic nostrums, not that homeopathy would help.

Not that major universities care. For example “Oxford University college accused of ‘lending credibility to quackery’ by hosting homeopathy conference.” The Good Thinking Society says that by hosting the AGM of the Society of Homeopaths, Lady Margaret Hall, Oxford, is “adding gloss to a pseudoscientific event”. Oxford or the Cleveland Clinic, pseudo-science continues to advance in the age of alternative facts.

Sometimes there is at least a bit of unintended humor. In “Serious mistakes in meta-analysis of homeopathic research“:

[ The authors of t]he article discussed the immanent problems of meta-analyses selecting a number of independent trials in homeopathy…The main flaw was that trials reflect the point of view that the treatment with a specific remedy could be administered in a particular disease.

That is main flaw with all pseudo-medicines, not of those evaluating them.

Legal and legislative

Chiropractic under siege in Texas: what’s happening and how you can help.” Written by the Palmer College of Chiropractic, they fret that:

Current legislation and lawsuits in Texas have the potential to drastically reduce the chiropractic scope of practice

Including:

Current legislation seeks to remove diagnosis from the scope of chiropractic, even after the Texas 3rd Court of Appeals ruled doctors of chiropractic can diagnose…Lawsuits have been filed to limit the scope of practice of non-medical providers. Recent lawsuits have succeeded in removing diagnosis and treatment of neurological conditions from the scope of care, including diagnosis and treatment of subluxation.

Appears to be a good thing to me.

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

SCAM Weirdness

Veteran OKC chiropractor teaches techniques, treats children worldwide.”And what is she teaching?

“With gentle realignments of the spine, the life force — or the vibrations that hold every cell in the body together — flows freely into the tissue, which has been so tight for these children for so long, restoring life,” she said. In chiropractic, this life force is known as “innate intelligence,” Doscher said, “but it has many other names including the Holy Spirit and Chi.”

No better argument for restricting chiropractic practice than their own words.

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.