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The faint glow of a 1000 points of pseudo-medicine

Selections from 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: Whither the antivaccine movement in the age of Trump
  • Steve Novella: TBA. He is the International Skeptic of Mystery. Skeptics want to be him.
  • Two Panels: Science-Based Medicine. How are we doing. Q&A

What’s the harm?

What pseudo-medical harm was reported this week? There is “Garlic Dermatitis on the Neck of an Infant Treated for Nasal Congestion.” The title says it all. At least the child was protected from vampires. Over the years I have seen a variety of examples of contact dermatitis mistaken for cellulitis from a number of different natural products: aloe vera, tea tree oil, and lavender oil have been the big three.

Pop pop. I am amused by the contention that licensed acupuncturists are safe. Practitioners of pseudo-science often have only a vague understanding of anatomy and physiology. With acupuncture that can lead to needles being pushed too deep, as in “Safety Concerns with Thoracoabdominal Acupuncture: Experience at a Tertiary-Care Emergency Department“:

There were 10 cases of pneumothorax (one combined with pneumomediastinum) and two cases of pneumoperitoneum induced by acupuncture.

The authors suggest:

To maximize the safety of acupuncture, adequate competency-based training should be provided.

How can you become competent in a useless pseudo-medicine with no basis in reality? It is like suggesting becoming a unicorn wrangler.

You don’t have to go to Flint for heavy metal toxicity. Yet another Ayurveda nostrum filled with a deadly metal: “Lead Poisoning Due to Herbal Medications.” Stay away from Ayurveda.

And finally there was “Back pain in the emergency department: Pathological fracture following spinal manipulation“:

Following initial presentation to the family physician, the patient underwent three treatments of spinal manipulation from his local chiropractor, which resulted in worsening lower back pain. A re-examination and new radiographs in the hospital revealed multiple compression fractures and an underlying diagnosis of multiple myeloma.

Ouch. Tough way to make a myeloma diagnosis. Poor guy.

Vaccination

Outbreaks continue apace. In Minneapolis anti-vaccine advocates told the local Somali community that vaccines were linked to autism and that autism was more common in Somalis. Now only 42% are vaccinated and as a result there is a measles outbreak.
Now 12 cases.

Not to be outdone, Italy has over 1,600 cases and the CDC has issued travel warnings for Italy. It is a good thing there is no international travel between Italy and the rest of the world. Oh wait.

48.6 million tourists a year (2014), Italy is the fifth most visited country in international tourism arrivals.

Anti-Vaxxers Are Furious With Sesame Street “Normalizing” Autism.” Julia is a puppet with autism and the anti-vax folks are not happy with ‘normalizing autism.’ As one mother with an autistic child notes:

I can’t express this sentiment deeply enough: Anti-vaxxers are the scum of the earth.

Everything about them is horrible on every level. As the parent of an autistic child, their crusade to make my son a pariah infuriates me. As a parent in general, their efforts to spread preventable diseases is a threat to the lives of my children. As a liberal, their selfishness is rivaled only by the very worst of Republicans. As an educated thinking human, their reliance on verifiably fake science disgusts me.

Works for me.

Acupuncture

Acupuncture for back pain? Not in Daneland. In the Danish National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy they recommend against acupuncture and NSAIDs among other interventions. I only had access to the abstract. I would love to know more about the content, but these national guidelines are behind a paywall and cost $39.95 to access. That is just wrong. National guidelines should be freely available and not used to generate profits for journals.

Naturopathy

Pseudo-medical providers continue using the opiate problem as their Trojan rabbit for legitimization and reimbursement. Over at the HuffPo we have “Naturopathic medicine’s role in fighting the opioid crisis“, where an ND continues with the alternative fact that NDs have legitimate training. They argue that ND care is cost effective for back pain based on a study that has the classic methodology that always leads to a positive result: treatment compared to standard care. Part of that care was acupuncture, so it will be a no-go in Daneland.

But science-based medicine is slowly being eroded by the drip drip drip of pseudo-medical lobbying. Once licensed by the state, pseudo-medical providers want insurance reimbursement. In “Maine Naturopaths Rally Behind Bill to Guarantee Insurance“:

Naturopaths in Maine are rallying behind a bill designed to prevent insurers from discriminating against health care providers who are licensed by the state.

NDs are arguing that:

We need patients to have access to the health care that will best suit them, whether it’s for their annual exam or for alternative options to pain management.

Pain management again. I don’t think it is discrimination to avoid paying for pseudo-medical ND care.

Colorado might be next, despite warnings about their capabilities and training. Legislatures never seem to see or care about the naturopathic quackery that kills.

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

Chiropractic

Looks like Big Chiropractic is every bit as evil as Big Pharma. In Canada there was a government report reviewing the cost effectiveness of publicly-funded chiropractic services. The report was not favorable and recommended limiting funding to low back pain and suggested, among other things, that DC’s not be allowed to do X-rays in their offices. This was in 2003. The report was suppressed for 14 years because…? No good reason I can find. If only I were of a conspiratorial bent. But chiropractors have continued to bilk the government out of taxpayer dollars:

In 2016, the province paid out $11.9 million for claims from 166,897 patients.

Not to mention the DCs with misleading information on vaccines, autism, and the benefits and training of chiropractors on their websites.

Manitoba is the:

only province in the country that universally covers a portion of chiropractic treatments for all residents, to a limit of 12 visits per year.

Money down the toilet.

Supplements

When do supplements work? When they have real medications as part of their ingredients. Following in the footsteps of Viagra, female libido booster Addyi shows up in supplements.

Adulteration with pharmaceuticals is the secret behind the efficacy of many supplements.

Critical thinking

Scientists, Stop Thinking Explaining Science Will Fix Things.” A nice review on why the whole skeptical/science-based medicine approach is a waste of time:

The takeaway is clear: Increasing science literacy alone won’t change minds. In fact, well-meaning attempts by scientists to inform the public might even backfire. Presenting facts that conflict with an individual’s worldview, it turns out, can cause people to dig in further. Psychologists, aptly, dubbed this the “backfire effect.”

Our motto? Sisyphus had it easy.

Department of Goofiness

I can’t make this stuff up. The titles speak for themselves.

First: “Chiropractor Discovers The Cause Of Diabetes.”

And:

Can Tea Bags Help With a Vaginal Tear? Here’s How To Use Them.”

For real. Not The Onion.

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.