A thousand points of pseudo-medicine.

A thousand points of pseudo-medicine.

Selections from the Society for Science-Based Medicine’s 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.

Announcement

NECSS will be June 29-July 2, 2017 in New York City with an entire day, June 28, devoted to science-based medicine. Preliminary schedule (subject to change).

  • Britt Hermes: The naturopaths are coming! The naturopaths are coming!
  • Harriet Hall: Denialism in Medicine: Statin Denialists and Others.
  • Clay Jones: Cultural inertia and commonly promoted medical beliefs that are wrong.
  • David Gorski: TBA.
  • Steve Novella: TBA.
  • Two Panels: Science-Based Medicine. How are we doing? and Q&A.

Vaccination

We are heading into the end of the influenza season. Finally. Flu still kills. The CDC tracks pediatric deaths. In 2013, 111 children died of flu. In 2014 it was 148. In 2016, 89. This year, 61.

Numbers do not do justice to the tragedy of death from a vaccine-preventable illness. For that I suggest “How my daughter died from a simple case of flu.”

Something was horribly wrong.
When she leaned back in the tub and I saw her eyes, I knew she was dying.
I got behind her and lifted her out. I sat on the toilet with her sitting on my lap and she died.
There was nothing that could be done to save her.
Health care professionals — from ambulance EMTs to the mighty Mayo Clinic — couldn’t bring her back to me.
The flu destroyed her organs. She didn’t even know it.

If not flu, then measles. Infections kill.

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“Are you feeling all right?” I asked her.

“I feel all sleepy,” she said.

In an hour, she was unconscious. In twelve hours she was dead.

Deadly measles outbreak spreads in Europe as vaccinations fall.” Romania, with less than 90% of children vaccinated, has had 2,000 cases with 17 deaths. Why? The “Measles outbreak spreads across Europe as parents shun vaccinations, World Health Organisation warns.” And it will likely spread further, causing even more needless suffering and death.

The Anti-Vaccine Body Count for the US has not been updated since 2015 when it was at 9,028 preventable deaths. It was called the Jenny McCarthy Body Count. It should be renamed the “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children” body count, in ‘honor’ of the retracted Lancet article by Andrew Wakefield that launched the current measles epidemic. Autism has not declined with decreasing vaccination but it has been a boon for ICUs and morticians.

Acupuncture

The pseudo-medical world often operates under the twin delusions that healthy people can’t get infections and that their interventions are harmless.

As an infectious disease doctor I am all-too aware of how, with a perfect storm, perfectly healthy people can be fine in the morning and be dead the next day from an overwhelming infection. I remember a case as an intern of a patient who had an IV placed in the field during a cardiac arrest. The IV site got infected, the S. aureus from the infection seeded her aortic valve, which failed, and she died.

Needles are dangerous, not that acupuncturists are aware, given their cavalier approach to using gloves. That leads to “Man dead after acupuncture treatment“:

Four days after the acupuncture treatment to his hand in February 2015, the man began to feel poorly, he threw up, had diarrhea and also complained of pain in his hand.

A few days after he was admitted, the doctors decided to amputate his arm to try to save his life, but it was too late. The 64-year-old man died due to sepsis and multiple-organ failure.

Sounds like a S. pyogenes infection, also known as the flesh-eating bacteria. Paying with your life from a useless placebo.

And acupuncture is a useless placebo. The results from quality placebo-controlled studies will demonstrate that acupuncture is be no better than placebo, as in useless. Two examples this week. First, “Electroacupuncture Therapy in Nicotine Dependence: A Double Blind, Sham-Controlled Study.” Their conclusion?

This study showed that both TEAT (true EA therapy) and SEAT (sham EA therapy) have similar efficacy and safety profiles in patients with ND.

And:

This study showed that the effectiveness of EA in ND therapy is at the level of placebo.

Although they cannot quite make the leap to make the declarative sentence that therefore acupuncture does nothing.

Not in “Acupuncture for menopausal hot flashes: clinical evidence update and its relevance to decision making“, where they found that:

Acupuncture improves menopausal hot flashes compared with no treatment; however, not compared with sham acupuncture. This is also consistent with the evidence that a range of placebo interventions improve menopausal symptoms… Some women may choose acupuncture for hot flashes, a potentially disabling condition without long-term adverse health consequences. Yet, women should do so understanding the evidence, and its strengths and weaknesses, around both effective medical therapies and acupuncture. Likewise, cost to the individual and the health system needs to be considered in the context of value-based health care.

Just because acupuncture is a fiction doesn’t stop its practitioners from trying to validate it with science. Well, pseudo-science. Take “Acupuncture Meridian Energies in Patients Who Are Mentally Disturbed.” They used the AcuGraph, a meridian-energy measuring device. Not really. It measures skin conductance, like an E-meter, and measuring skin conductance is popular in the world of pseudo-medicine, adding a science-y patina to their practice.

That skin conductance changes with emotional states is well known, it is part of the basis of the lie detector. Interpreting this response as due to the pseudo-science of acupuncture meridian energies and publishing it in PubMed is appalling.

Department of Acupuncture Meta-Analysis. Same as it ever was.

Meta-analyses of acupuncture usually conclude with a version of ‘some effect, the studies are poor, more studies need to be done’. Well, two out of three are true. As examples, this week we have “Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis“:

In the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.

And “Acupuncture plus moxibustion for herpes zoster: A systematic review and meta-analysis of randomized controlled trials.

Acupuncture plus moxibustion may improve pain and cutaneous outcomes, although current evidence is limited by the number of studies and methodological shortcomings.

Chiropractic

Global Chiropractic Care Market Projected to be Worth USD 39.58 Billion by 2021: Technavio.” Global chiropractic care may cost $39.58 billion, but it is worthless.

Homeopathy

Homeopathy is water. You know that, I know that. Water only treats thirst. That studies are done on the efficacy of water, and that IRB’s will approve such studies, demonstrates that reality-based medicine doesn’t understand the world of pseudo-medicine.

Remember how I mentioned that flu kills? No often, but it can. So how do we get studies like “Effectiveness of preventive treatment by Influenzinum in the winter period against the onset of influenza-like illnesses“? Influenzinum in not an ancient Roman city but is a homeopathic remedy made from the influenza vaccine aka a nosode. Influenzinum didn’t work. Influenzinum shouldn’t work. And to evaluate it for a potentially fatal illness defines unethical.

And that is not the only trial to evaluate water for a disease that kills: “Homeopathic medicines for prevention of influenza and acute respiratory tract infections in children: blind, randomized, placebo-controlled clinical trial.” It amazes me that searching “homeopathy infection clinical trial” has 34 hits.

I wonder of Prince Charles noted “Randomized, blinded, controlled clinical trial shows no benefit of homeopathic mastitis treatment in dairy cows“?

The results indicated no additional effect of homeopathic treatment compared with placebo.

What a surprise. At least if a cow dies, you get dinner rather than a grieving family and a life cut short.

And homeopaths, taking their cue from acupuncturists, have the same template for their conclusions of a meta-analysis. In “Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis” they conclude:

There was a small, statistically significant, effect of non-individualised homeopathic treatment. However, the finding was not robust to sensitivity analysis based solely on the three trials that comprised reliable evidence: the effect size estimate collectively for those three trials was not statistically significant. There was significant evidence of publication bias in favour of homeopathy.

Legal and legislative

Science doesn’t seem to sway legislatures when they are evaluating pseudo-medicine, which is why, for example, at least 20 states have licensed naturopaths. But money talks and legislatures listen. “Arkansas senators reject Medicaid chiropractic services bill.”

A bill that would allow Medicaid recipients to seek chiropractic services without a physician referral failed Thursday in the Senate after opponents complained that it would add to the costs of the government-run health insurance program for the poor.

866 Medicaid recipients had physician referrals for chiropractic services in the prior year. Without the referral there might be 52,000 chiropractic visits a year costing $3.4 million. All for nothing.

Some of you may remember that Science-Based Medicine was sued and won. And in the process legal precedence was made: “No Scrubs Permitted: Eleventh Circuit Affirms Blog Post Is Not Advertising Actionable Under Lanham Act“:

the Eleventh Circuit held that a doctor’s blog post criticizing another doctor and his clinical practice could not form the basis of a Lanham Act claim because the blog posts were not commercial advertising or promotion.

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.