A thousand points of pseudo-medicine in motion.

A thousand points of pseudo-medicine in motion.

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.

NECSS will be June 29-July 2, 2017 in New York City with an entire day, June 30, 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 various commonly promoted medical beliefs that are wrong
  • David Gorski: TBA
  • Steve Novella: TBA
  • Two Panels: Science-Based Medicine. How are we doing. Q&A

What’s the harm?

Outbreaks of vaccine-preventable illnesses keep popping up. The Texas Department of State Health Services is investigating multiple outbreaks of mumps and they are on track to have the highest mumps incidence in 22 years with 221 cases.

Manitoba has had 290 cases of mumps and public health authorities are worried they may reach 600 cases. And there are outbreaks of mumps at Penn State with at least 68 cases and Kansas State which has had 15 cases of mumps.

There were also five cases of measles in unvaccinated children in Minneapolis and two cases in Ann Arbor.

I wonder when he looks in the mirror if Andrew Wakefield is proud of what stares back.

Vaccination

Outbreaks of vaccine-preventable illnesses are not inevitable. It’s why we call them “vaccine-preventable”. “In ‘stealth move,’ Michigan refines vaccine waivers, improves rate among kids.” What they did was genius, requiring:

families to consult personally with local public health departments before obtaining an immunization waiver.

Public health departments are unlikely to have a low bar to meet to get a waiver. Good move.

But it would be nice if there were a way to sway the vaccine hesitant, and there may be a way. In “The Immunity Community: A Community Engagement Strategy for Reducing Vaccine Hesitancy“:

The program successfully engaged parent volunteers to be immunization advocates. Surveys of parents in the intervention communities showed statistically significant improvements in vaccine-related attitudes: The percentage concerned about other parents not vaccinating their children increased from 81.2% to 88.6%, and the percentage reporting themselves as “vaccine-hesitant” decreased from 22.6% to 14.0%.

Not bad.

Acupuncture and TCPM

More negative studies this week, although not always spun as such. In “Clinical Evaluation of Acupuncture as Treatment for Complications of Cerebrovascular Accidents: A Randomized, Sham-Controlled, Subject- and Assessor-Blind Trial“, they found:

Reduction in pain was significantly greater in the acupuncture group than in the control group (p value = 0.04). There were no significant differences in the other measures between the two groups.
Conclusions. Acupuncture provided more effective poststroke pain relief than sham acupuncture treatment. However, acupuncture had no better effect on neurological, functional, and psychological improvement.

I would be skeptical that the 0.04 was meaningful, even if ’statistically significant’. I have been persuaded that significant is at least 0.005 and better if 0.001 especially for interventions with a prior plausibility of (almost) zero. The study was out of Asia, where all the women are strong, all the men are good looking, all the children are above average, and all the acupuncture studies are positive. Plus, they do not report if blinding was successful in the patients – a fatal flaw since the acupuncturists were not blinded and could have been giving cues to the patients, the Clever Hans effect.

There are all sorts of acupunctures, including injecting bee venom, a form no better (i.e. worthless) than any other of the endless forms of acupuncture. But the nice thing about bee venom is it a potent allergen. In “Safety of essential bee venom pharmacopuncture as assessed in a randomized controlled double-blind trial” they noted:

frequent occurrence of allergic reactions during the treatment process is burdensome for both practitioner and patient.

You think? So they decided to modify the bee venom:

isolated and purified essential BV (eBV) pharmacopuncture filtered for phospholipase A2 (PLA2) and histamine sections.

And found it was less allergenic but, as would be expected for a placebo, it had similar effects. So now there is a less toxic formulation of a placebo. If they really want to make it non-allergenic, might I suggest using homeopathic bee venom? Same placebo, even less toxicity. Except for the bacterial and mycobacterial contamination.

What is the problem with using sham acupuncture? From a science-based medicine perspective, nothing. From an acupuncturist’s perspective, the problem is that when done correctly, acupuncture is not better than sham acupuncture, aka no effect. Acupuncturists, like other pseudo-medical providers, just cannot handle the truth that their intervention is a placebo and are always looking for an out. In “The U.K. NICE 2014 Guidelines for Osteoarthritis of the Knee: Lessons Learned in a Narrative Review Addressing Inadvertent Limitations and Bias” they whinge and suggest:

Given the problems with sham acupuncture, perhaps now is the time to embrace pragmatic studies and employ comparative effectiveness studies instead.

Yep. Embrace the methodologies that confirm your bias rather than inform your understanding of medicine. Hear no science, see no science, speak no science, the pseudo-medical motto. Denial is more than a river in Egypt. Same as it ever was.

The Chinese are worried that they are losing the C in TCPM. In “Others profit from our medical lore” they complain that:

Japan and South Korea together hold 70 percent of herbal medicine patents, while China “holds an embarrassing 0.3 percent.” … In the past decade, South Korea and Japan have aggressively marketed their products not only in their own countries, but also in China and even the West… “Apart from the name,” there is no longer anything Chinese about Chinese traditional medicine.

Boo hoo. Everyone is co-opting TCPM. Now we can call it Modern Asian Pseudo-Medicine?

Homeopathy

The reports on deaths and seizures for homeopathic teething products began in January of this year, although the first FDA warning was in 2010. So four months, or perhaps seven years, later, “Homeopathy company launches nationwide recall of tablets blamed for infant seizures.” About time.

I have said many times that pseudo-medical providers care nothing for patient safety. I am waiting for a counter example.

In fact, their delusions lead to harmful, and perhaps fatal, interventions. If you celebrate “World Homeopathy Awareness Week: Try homeopathy for these 7 diseases that usually need surgery, suggests an expert“, make sure all your affairs are in order. Surgical diseases where homeopathy was suggested instead of surgery included nasal polyps, uterine prolapse, umbilical hernia, and tumors. Evidently the author an expert in lunacy. Or a mortician looking for business.

Critical thinking

Doctors have decades of experience fighting “fake news.” Here’s how they win.’ A nice review, except for the whole ‘win’ thing, at least to judge from the growth of Integrative Medical Clinics, the continued legitimizing of NDs, DCs and LAcs as real medical providers by legislatures, and the declining vaccination rates. Except for that, we have certainly been winning the war against fake news.

A case in point: “‘pH Miracle’ Author Admits He’s No MD, Microbiologist or ‘Trained Scientist’.”

The defendant also admitted that he was not a microbiologist, hematologist, medical doctor, naturopathic doctor or trained scientist.”

Why is naturopathic doctor on this list? The drip drip drip of pseudo-medical legitimization continues, with at best rare wins.

Sigh.

Legal and legislative

Acupuncture has no efficacy for pain or withdrawal, but these problems continue to be the Trojan rabbit for pseudo-medicine to enter the mainstream aka get insurance reimbursement. “Progress on health coverage for acupuncture” in Vermont, where a legislator is proud to say

I am happy to report that many measures the Legislature enacted to address the opiate crises have started to move us toward universal access to acupuncture.

Mandating fraud payment. Great. What pseudo-medical providers cannot get with science they get through the legislature. I am reminded that the opposite of progress is Congress.

In New Jersey, a “Legal opinion could curb ‘dry needling’ practice by physical therapists.” The:

Attorney general [decided] physical therapy does not include treatments that break the skin; acupuncturists applaud opinion

Acupuncturists complained that physical therapists were endangering patients by performing a type of acupuncture they are not trained to provide.

As if acupuncturists are any safer. At least dry needlers wear gloves.

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

Department of Goofiness

This week we have “Heart-conscious chiropractic: ‘He works magic,’ say patients of Grass Valley’s John Mayfield.”

Mayfield began attending seminars where he learned each organ is part of a person’s total consciousness.

I have patients with any number of removed organs: spleens, kidneys, bowel, lungs, and they do not lack for consciousness, although I did have the patient who had a hand transplant from a murderer. That ended badly. At first glance I thought the title of the movie with that plot was The Hands of Orac. LOL.

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.