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 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: Homeopathy regulations, with the FDC and FTC reviews
  • Two Panels: Science-Based Medicine: How are we doing? Q&A

What’s the harm?

Pseudo-medical providers tout their interventions as safe to the point where they never alter care to increase patient safety. Given the lack of efficacy of the interventions covered in this blog, all pseudo-medicine has to offer is harm, either the nocebo effect or physical injury.

Young mom in critical condition after stroke” after getting neck adjusted by a chiropractor:

doctors at the University of Iowa Hospitals and Clinics are being very specific as to what caused her to spiral into critical condition, saying it was neck manipulation by chiropractor that triggered her stroke.

With similar forces to being hung by the neck, I would especially avoid chiropractic manipulation of the neck. University of Iowa has no chiropractor on staff, although their Integrative Medicine Clinic will:

refer patients to licensed holistic practitioners, such as acupuncture, chiropractic, or massage therapy providers.

One hopes not those who manipulate the neck.

And then there is acupuncture. Usually it is trauma from the needles, but sometimes they leave the needles behind. It’s the advanced training they receive. My favorite example was the former South Korean President who had an acupuncture needle found in his lung:

“I can’t figure out how the needle got into there,” Dr Sung Myung-whun said at the hospital after the operation. “It is a mystery for me, too.”

Oopsie. Now we have “Acupuncturist told to ‘smarten up’ after leaving 40mm needle in man’s stomach without advice“:

A complaint after a man received treatment for a shoulder injury. The acupuncturist inserted a 40mm long needle in the man’s abdomen, but did not tell the man it would be left there for a few days to extend the effects of the treatment.

The man discovered the needle a day after it was inserted and removed it.

It took the patient a day to notice a needle in his abdomen?

On the day the indecent happened, the acupuncturist said she had experienced an unusually high number of telephone calls – distracting her throughout the man’s treatment.

Gives one confidence in that acupuncturist.

The harm that CAM sometimes causes can be from what doesn’t happen, the dog that doesn’t bark. In “Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia” they found:

The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.

Vaccination

There is an outbreak of measles in Minnesota. 32 cases and spreading. Public health wants at-risk children vaccinated. The response? “Minnesota Health Officials Face Opposition From Anti-Vaccine Activists Over Measles Vaccination“:

The activists will hold a meeting on Sunday, April 30, in the Brian Coyle Community Center in Minneapolis to spread the message “epidemic is autism, not measles”.
The activists also posit that the state’s health department was withholding information regarding the safety of the vaccines.

No deaths from measles. Yet. I wonder if the ‘activists’ will attend the funeral when a child does die.

Acupuncture

Acuwhatever, perhaps a better term for the pseudo-medicine since no two acuwhatevers are ever the same. But acuwhatever is tried for every process known to man. Labor? You bet: “The effect of acupressure on the initiation of labor: A randomized controlled trial.” In this waste of time and effort they had:

3 groups; acupressure, sham acupressure and control. Acupressure points SP6, BL 60 and BL 32 were pressured bilaterally. The intervention was done by the researcher every other day between 9 am and 11 am

Pushing on the leg, the foot and the back is going to induce labor how? Well, it didn’t. What a surprise.

it seems that acupressure treatment was not effective in initiating labor as compared with the sham acupressure and the routine care groups.

I love the tepid ‘it seems’. No declarative sentences for acuwhatever practitioners. Not that acuwhatever practioners can admit that their pseudo-medicine does nothing, as in “Self-Acupressure for Older Adults with Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial“:

There were no significant differences between verum and sham acupressure groups in any outcomes.

No difference means no efficacy everywhere but pseudo-medicine, as they conclude:

Self-administered acupressure is superior to usual care in pain and physical function improvement for older people with KOA. The reason for the benefits is unclear and placebo effects may have played a role.”

Ya think? I suspect that pseudo-medical researchers never, ever read the relevant literature.

And pseudo-medicine leads to the damnedest things in the medical record as if it is meaningful. In “Acupuncture for Pain and Nausea in the Intensive Care Unit: A Feasibility Study in a Public Safety Net Hospital“:

The most common single TCM diagnosis was Qi and blood stagnation.

I have also seen that diagnosis in the medical record. When I searched “icd 10 qi stagnation”, the third hit was, really “Borderline intellectual functioning.” While practitioners can bill for the procedure, it looks like they have to bill according to the ‘western’ diagnosis. The ‘western’ diagnosis has little to do with the TCPM diagnosis. Would it not be fraud to diagnosis qi deficiency, do the acuwhatever, but then bill for low back pain? Seems sketchy to me.

Department of Guaranteed False Positives

Clinical trials that compare an intervention to standard care are often useless.

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.

As Dr. Edzard Ernst notes:

We have been over this so many times… that I am almost a little embarrassed to explain it again: it is fairly easy to design an RCT such that it can only produce a positive result. The currently most popular way to achieve this aim in alternative medicine research is to do a ‘A B versus B’ study, where A = the experimental treatment, and B = routine care…

As I stated above, it is fairly easy to design an RCT such that it can only produce a positive result. Yet, it is arguably also unethical, perhaps even fraudulent, to do this. In my view, such RCTs amount to pseudoscience and scientific misconduct.

Here is this week’s likely false positive study, a fraudulent, unethical waste of time and resources:

The Effect of Reflexology on the Pain-Insomnia-Fatigue Disturbance Cluster of Breast Cancer Patients During Adjuvant Radiation Therapy.” And it wasn’t even a randomized study (emphasis added):

Women were allocated upon their preference either to the group receiving reflexology treatments once a week concurrently with radiotherapy and continued for 10 weeks or to the control group (usual care).

So do you think those with predilection for pseudo-science responded favorably to the pseudo-science?!?

The reflexology treated group demonstrated statistically significant lower levels of fatigue after 5 weeks of radiation therapy (p < 0.001), compared to the control group.

A methodology that really is fraudulent. The only thing that can be concluded from this study is that Israeli Institutional Review Boards are every bit as defective in protecting patients from worthless studies as in the US.

In the literature

A paper of note.

Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials.” Betteridge’s law of headlines (“Any headline that ends in a question mark can be answered by the word no”) yet again.

Three trials in this meta, all compared to usual care. And from this they conclude:

Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction.

Such a compelling conclusion. A meta of BS studies results in a BS meta.

Naturopathy

Naturopathy in action:

For years, one of my patients took a daily high-dose vitamin B6 supplement at the recommendation of a naturopath. She trusted the scientific-looking genetic test he based this recommendation on, and never questioned whether she was actually deficient in vitamin B6 before buying and taking the expensive product, which contained a dose 3,800 percent of the daily recommended intake. After a few years, she started experiencing pain and tingling in her arms and legs, and finally sought care from a credentialed medical doctor. The diagnosis? Irreversible nerve damage (neuropathy) caused by toxic levels of vitamin B6. To add insult to injury, she learned there was never a medical reason for her to have been taking vitamin B6 to begin with.

From “What Your Alternative Health Provider Might Not Tell You About Megadosing Supplements.” Probably any worthwhile information.

And the pseudo-medical privileges for NDs are increasing. Oregon is leading the charge, as “Oregon bill shows full impact of allowing naturopaths to practice primary care” demonstrates.

In Maine, NDs want to make sure they get insurance payment for their pseudo-medicine,”Bill to Guarantee Insurance for Naturopaths Held for Review.” And to not pay NDs for their worthless pseudo-medicine is somehow discrimination. By that standard, it would be discrimination not to hire me as starting center for the Portland Trailblazers. Like NDs, I have none of the skills required for the job.

The article describes naturopathy as follows:

Naturopathy’s an alternative medical system that focuses on diet, herbs and vitamins instead of pharmaceuticals.

Naturopathy is so winning the PR battle.

Homeopathy

Ridgecrest Herbals to Phase out Homeopathics in Their Formulas, Beginning with ClearLungs Extra Strength.” Why the good news? The company:

feels that in the current hostile regulatory atmosphere it is safer as a company to remove homeopathy from their products.

Clear Lungs contains, for the ‘active’ ingredient,

(Homeopathic/HPUS 30C each) Antimonium Tartaricum, Carbo Vegetabilis, Natrum Sulphuricum, Phosphorus.

At 30 C, nothing. 30 C is the:

Dilution advocated by Hahnemann for most purposes: on average, this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.

It will be easy to remove nothing from the product moving forward, they will just have to change the label. And Clear Lungs also has the following:

Inactive Ingredients: Cellulose capsule, ClearLungs herbal blend, 750 mg/cap (chinese asparagus root, chinese licorice root, chinese skullcap root, dong quai root, gardenia fruit, luo han guo fruit, ophiopogon root, platycodon root, poria fungal body, schisandra fruit, tangerine mature peel, white mulberry root bark, zhejiang fritillary bulb), microcrystalline cellulose.

The active ingredients are nothing and the inactive ingredients are something. So pseudo-medicine. So in the future will the product contain only inactive ingredients?

Legal, legislative, and regulatory

FDA Takes Action Against Fraudulent Cancer Products“, having sent letters of warning to companies that are:

illegally selling more than 65 products that claim to prevent, diagnose, treat, mitigate or cure cancer. The products are marketed and sold without FDA approval, most commonly on websites or social media platforms. They have not been reviewed by FDA for safety and efficacy, and can be dangerous to both people and pets.

On the list are a variety of intravenous liposomal products, including curcumin aka turmeric, the herb that killed a young lady this month.

Probably a drop in the anti-cancer pseudo-scientific bucket.

24 states allow chiropractors to do school exams despite a complete lack of education and training in medicine and a mythical understanding of the musculoskeletal system. Now Wisconsin wants to join the crowd. “Bill would let chiropractors do physical exams for student athletes.” The bill is opposed by the Medical Association of Wisconsin and for Wisconsin readers it is ASSEMBLY BILL 260. Follow up the March for Science with Letter to Representative?

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

Department of Goofiness

Acuwhatever. “Development of an Economical DNA Delivery System by “Acufection” and its Application to Skin Research“:

To perform acufection, mouse skin was first infused with DNA in phosphate-buffered saline (PBS) and then pricked lightly with a bundle of acupuncture needles to facilitate the absorption of DNA and transfection into cells.

Why acupuncture needles? No reason.

Acufection

Acufection

In the video it is just a cluster of needles on a plastic grip. Nothing acupuncture about it. But they get to call it acufection. I assume they were trying to be cute. Fail.

Acustupidity. It never ends.

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.