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.

There is not enough time to write a complete blog post on the thousand points of pseudo-medicine that show up in my feeds. But some stars 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 details to follow but registration opens this week.

What’s the harm?

Behaviors have consequences, sometimes fatal consequences. As an example, “Infection fears grow in Byron Shire, the ‘home of the anti-vaxxers’.” Seven years ago in the Australian city a 4 week old baby died because the mother refused a Vitamin K shot on the advice of a community health nurse. Not the kind of community health that I recommend. But the area has become the epicenter of the anti-vaccination movement Down Under, with:

lowest immunisation rates in Australia. According to the latest figures, only half of all five-year-olds are vaccinated in Mullumbimby and only 60 per cent are in nearby Byron Bay.

It is only a matter of time for some vaccination preventable illness to rip through the community, perhaps killing another child or two, especially if measles is the first infection. With infection, it is not if, but when.

Sometimes the harm is filled with sadness when there seems to be no good options for the patient as in this Thai example: “Boy, 2, WON’T have surgery to remove huge cancerous tumour because his parents hope alternative medicine will offer a cure instead.” The accompanying photographs are awful and I would not be sure surgery would be helpful at this point, but I doubt any alternative therapy will fulfil the mothers wish that

We don’t want our son to go through any more painful procedures. He has suffered enough already.

A lose-lose situation.

Other complications of pseudo-medicine are less serious. Or so one hopes if the patient doesn’t hit their head on a cement floor. In “Case report: fainting during acupuncture stimulation at acupuncture point LI4” there was a:

clinical trial aiming to observe a relationship between acupuncture stimulation at LI4 acupuncture point and EEG in healthy adults.

This is, of course, a relationship no one needs to understand. More tooth fairy science, like much of the pseudo-medical literature. And a patient fainted from acupuncture. I love the dry clinical description of what happened:

A sterilised single-use acupuncture needle (0.3 × 30 mm, Dongbang medical, Korea) was inserted into the acupuncture point large intestine 4 (LI4, Hapgok) of right hand of participant approximately in depth of 1.8 cm by licensed KMD who has a 10 year’s career and 4 year of the career was as a [sic] assistant teacher of acupuncture practice at the university, after 30 min of rest. The EEG data were recorded for approximately 5 min before the acupuncture needle was inserted, and researchers noticed the fainting approximately 4 min after needle insertion. The participant did not report any symptoms or uncomfortable feelings. The researchers heard the sound of some objects falling down and saw participant falling at that time. The EEG electrodes were separated from the participant’s body due to the impact of falling down.

Fainting during acupuncture is not uncommon, but rather than research on the topic, perhaps the useless procedure should not be done?

Or, in the case of “Inappropriate ICD Discharge Related to Electrical Muscle Stimulation in Chiropractic Therapy: A Case Report” you can try and kill the patient:

We present a 63-year-old female who presented to the emergency department after an ICD [Implantable cardioverter defibrillator] shock while undergoing electronic muscle stimulation in chiropractic treatment, during which light electrical pulses were sent through skin electrodes. (TENS) Our case highlights the importance of recognizing methods used by alternative medicine doctors, including electrical muscle stimulation that may cause electromagnetic interference and inappropriate ICD discharge and therefore, a higher overall mortality risk.

Chiropractors want to be treated like real doctors, as if they know what they are doing. When it comes to electricity and defibrillators, evidently not.

And pseudo-medicine can result in a triple tragedy as “Widower: Slain Naturopath Said ‘Chemotherapy Is for Losers’” demonstrates. The patient had cancer and she went to a naturopath who:

told them that “chemotherapy is for losers,” and guaranteed he could cure her within three months.

She instead died of her cancer, or perhaps more accurately her ND killed her, after avoiding real medicine, leaving behind a husband and two children. Then her husband shot and killed the naturopath. A double murder.

I have mentioned before the first case of naturopathic care I witnessed, a young female with a soft tissue cancer of the leg who took naturopathic ‘treatment’ instead of a curative amputation. She died after her tumorous leg became gangrenous. Except for the shooting of the naturopath, I expect to see an uptick in similar cases now that naturopathy is getting the false imprimatur of legitimacy from state legislatures. More on this from Dr. Gorski.

Vaccination

Vaccines save lives and due in part to the discovery of the human WI-38 cell line, in which many viruses are grown to be processed into vaccines. What has been “The Role of the WI-38 Cell Strain in Saving Lives and Reducing Morbidity?” Tremendous. From this one immortal human cell line the:

… estimated total number of cases of poliomyelitis, measles, mumps, rubella, varicella, adenovirus, rabies, and hepatitis A averted or treated in the U.S. alone due to the introduction of vaccines developed with the WI-38 cell strain, is 198 million. The estimated total number of deaths averted from these same diseases in the U.S. is approximately 450,000.

Acupuncture and traditional Chinese Pseudo-Medicine

Department of Guaranteed False Positives:

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.

And the worthless studies just keep coming. This week we have “The effect of acupuncture on chemotherapy-associated gastrointestinal symptoms in gastric cancer“:

A cohort of 56 patients was randomly divided into an experimental group and a control group…Patients in the experimental group received 30 minutes of acupuncture therapy daily for 2 weeks.

Acupuncture compared to standard care will likely result in a false positive. Which it did. With that methodology the authors really cannot claim:

Acupuncture, a safe technique, could significantly reduce gi symptoms induced by chemotherapy and enhance quality of life in patients with advanced gastric cancer.

And we have “Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial“:

These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65])

With:

Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P < 0.001) at both short and long follow-ups. Deep dry needling and passive stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.

No no no. With no sham dry needling comparator you can make zero claims of efficacy.

And finally we have “Integrative Acupuncture and Spinal Manipulative Therapy Versus Either Alone for Low Back Pain: A Randomized Controlled Trial Feasibility Study.”

They kicked it up a notch, perhaps the wrong directional metaphor, with three, yes three, interventions and no adequate control:

Participants with acute or chronic LBP were randomized to (1) acupuncture, (2) SMT, or (3) integrative acupuncture and SMT groups.

And they all got better:

Participants in all 3 groups experienced clinically meaningful improvements in the primary outcome measures; however, no between-group differences in outcomes were apparent.

And with no sham controls, a meaningless efficacy study but a classic placebo response.

It is always remarkable how pseudo-medicine trials just can’t bring themselves to report the simple idea that if a drug/procedure has the same outcome as a placebo/sham procedure the drug/procedure does nothing.

And a real drug or intervention in the reality-based medical world would never be approved on the basis of a negative study. But pseudo-medical providers cannot come to grips with the fact that their interventions do nothing.

A case in point, “Out of Sweden comes Reduced Need for Rescue Antiemetics and Improved Capacity to Eat in Patients Receiving Acupuncture Compared to Patients Receiving Sham Acupuncture or Standard Care during Radiotherapy.”

The title is a very Kellyanne Conway and suggests that acupuncture is better than sham acupuncture.

In the abstract’s conclusion, all that many will read in passing, they say:

Patients receiving acupuncture had lower consumption of antiemetics and better eating capacity than patients receiving standard antiemetic care, plausible by nonspecific effects of the extra care during acupuncture.

So acupuncture works…?

Nope.

They compared ‘real’ aka verum acupuncture, sham acupuncture (telescoping needles), and a control for effects on vomiting and eating on patients receiving radiation therapy for cancer.

The dense abstract obfuscates the findings:

Results. More patients in the verum ( of 89 patients still undergoing radiotherapy; 82%, Relative Risk (RR) 1.23, 95% Confidence Interval (CI) 1.01–1.50) and the sham acupuncture group ( of 95; 83%, RR 1.24, CI 1.03–1.52) did not need any antiemetic medications, as compared to the standard care group ( out of 63; 67%) after receiving 27 Gray dose of radiotherapy. More patients in the verum ( of 89; 56%, RR 1.78, CI 1.31–2.42) and the sham acupuncture group ( of 94 answering patients; 62%, RR 1.83, CI 1.20–2.80) were capable of eating as usual, compared to the standard care group ( of 63; 39%).

Let me simplify:

Results. More patients in the verum (82%), and the sham acupuncture group (83%) did not need any antiemetic medications, as compared to the standard care group (67%). More patients in the verum (56%) and the sham acupuncture group (62%) were capable of eating as usual, compared to the standard care group (39%).

Simple. Acupuncture was no better than sham acupuncture.

You do not need a 1,636 word discussion to try and make a silk purse out the sow’s ear trying to find efficacy from acupuncture. You need 7.

Acupuncture is ineffective for the conditions studied.

But but but:

That the consumption of emesis-related care did not differ between the verum and sham acupuncture group may be interpreted as that verum acupuncture does not affect consumption of emesis-related care during radiotherapy, or that a “floor-effect” was seen.

No no no. It may be interpreted that way. It should be interpreted as doing nothing. Although at the very end they grudgingly recognize the fact:

Since nonspecific antiemetic treatment effects during the needling caring situation seem to have achieved the fact that both patients receiving verum and sham acupuncture needed less antiemetics and had larger capacity to eat compared to patients receiving standard care, further studies should evaluate the effect of contextual caring factors for strengthening the quality of care and reducing side-effects such as emesis during cancer therapy.

But pseudo-medical providers just cannot call a negative study what it is: negative.

And “How to tell the difference between acupuncture and dry needling methods.” That’s easy. Unlike dry needlers, acupuncturists don’t wear gloves as the picture in the article shows. Otherwise there is no substantive differences I can find.

I have discussed the catastrophic effects on traditional Chinese pseudo-medicine (TCPM) on plant and animal populations. TCPM may be second only to climate change for driving species extinction. Now it is donkeys. “The donkeys Kenyan families need to survive are heading to China for medicine promising longer life“:

…a global trade in donkey skins has emerged as ejiao has become popular among middle-class Chinese who prize it as an anti-aging agent, an aphrodisiac, a cure for insomnia or poor circulation, among other health benefits. At least 1.8 million donkey hides are traded a year, according to a report last month from the Donkey Sanctuary, a British nonprofit. China’s own donkey population has more than halved since the 1990s,

Yeah, I can see how all those problems would all respond to processed donkey hide, the wonder drug that works wonders. In Africa the donkey decline is increasing the hardships on humans who can no longer afford an important beast of burden. And it isn’t so good for the donkey either. Any species in decline thanks to worthless TCPM.

Department of Tooth Fairy Science

The ability of the Chinese to waste time and resources throwing modern technology at TCPM is truly amazing. As an example we have “Proteomic analysis of tears following acupuncture treatment for menopausal dry eye disease by two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry” where they took:

Tear samples from the AC AT group were subjected to two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry (2D nano-LC-MS/MS). Western blot analysis was also performed on tear samples from both groups.

In future studies they will apply the same analysis to unicorn tears, with the same applicability to reality. Such a study makes me want to cry.

Did you know that:

According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine.

I knew that often in TCPM they often blow it out their…um…no I did not. Well, in “Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study” they set out to prove it. And did. By showing:

patients with COPD have a higher likelihood of having hemorrhoids

Really. COPD patients are more likely to have hemorrhoids. And so they conclude that:

This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.

I think the blowing out their, um, well, you know, is more applicable than I realized. Medicine (Baltimore) was a valuable journal when I was a resident. It is sad to see how far they have fallen.

In the literature

Some papers of note.

How do medical students engaging in elective courses on acupuncture and homeopathy differ from unselected students? A survey“:

Students participating in elective courses had much more positive attitudes towards CAM, somewhat lower science and status orientation…

Somehow I am not surprised the medical students interested in homeopathy and acupuncture were less science-orientated.

Legal and legislative

What does the FDA do? And not do? “Is It Really ‘FDA Approved?’” Here is the list, at least for now. Who knows what will happen to the FDA the next few years.

  • FDA doesn’t approve companies.
  • FDA approves new drugs and biologics.
  • FDA doesn’t approve compounded drugs.
  • FDA uses a risk-based, tiered approach for regulating medical devices.
  • FDA uses a risk-based approach for human cells and tissues.
  • FDA doesn’t approve tobacco products.
  • FDA approves food additives in food for people.
  • FDA approves color additives used in FDA-regulated products.
  • FDA approves animal drugs and approves food additives for use in food for animals.
  • FDA does not approve cosmetics.
  • FDA doesn’t approve medical foods.
  • FDA doesn’t approve infant formula.
  • FDA doesn’t approve dietary supplements.
  • FDA doesn’t approve the food label, including the Nutrition Facts panel.
  • FDA doesn’t approve structure-function claims on dietary supplements and other foods.

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

Pseudo-scientific weirdness

Gwyneth Paltrow drank only goat milk for a week (and the results are annoyingly impressive) (She is thin. Or photoshopped). She drank the goat’s milk get rid of ‘parasites’. She said:

I’m really interested in the impact of heavy metals and parasites on our bodies… I think they’re two of the biggest culprits in terms of why we feel bad. I’m knee-deep in figuring out ways to clear them from the body, looking at all sorts of potentially weird modalities.

Some NDs love parasites, usually invisible, undiagnosable parasites never seen before by modern science. That kind of parasite. Not the parasites I see in an Infectious Disease practice. And not a ‘person who habitually relies on or exploits others and gives nothing in return’. Oh no, not that. Nothing that meets that definition here.

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.