Local points of pseudo-medicine.

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

What’s the harm?

Maybe it is just confirmation bias, but it seems there are far more headlines in my feeds of harm due to people in other countries impersonating alternative practitioners rather than impersonating real doctors.

Perhaps it is due to the fact that in the US we license those who impersonate doctors: the NDs and DCs and LAcs.

But in India, where homeopathy is remarkably popular and state supported, we have “Youth dies after ‘fake doctor’ administers medicines in Kalwa; fir lodged.”

A young man died from receiving some sort of injection from a fake homeopath:

“We checked his clinic and found his BHMS degree along with other papers. However, on further investigation, it was clear that the college mentioned on his degree doesn’t exist and even his address, mentioned on several government documents, was incorrect. Currently, he is absconding,” Sayyad informed Mirror.

He then lodged an FIR against the bogus doctor for allegedly committing medical negligence and duping people on the pretext of providing medical help. “He had a homeopathic degree but he was administering allopathic medicines. He clearly had no expertise in what he was doing. We are looking for him earnestly

“He clearly had no expertise in what he was doing.” Which, tragically, is true of real homeopaths as well.

And then there was “Man in icu after quack ‘treats’ piles with knife” where

an ayruvedic doctor specialising in piles, left a 39-yr-old man bleeding from his back, in a semi-comatose state.

A quack and his associate are on the run after risking a patient’s life by operating on his haemorrhoids ad-lib, with a knife and without anaesthesia. While the patient was left bleeding heavily from the back and had to undergo a corrective surgery that closed with 40 sutures, the fake doctor and his aide decamped even as the police mounted a hunt for them.

I do love how they routinely use the word quack in India, where they call a कुदाल a कुदाल.

Botulism, a toxin medicated disease that causes paralysis, is one of those rare diseases in the US. Home canned goods are the most notorious source of botulinum toxin (outside of plastic surgery offices I suppose), but other sources include snorting cocaine, eating beached whales, and my favorite, drinking prison hooch aka pruno. Now add deer antler tea to the list: “Tea made from deer antlers may cause botulism; health officials issue alert.”

Deer antler tea is part of Traditional Chinese Pseudo-Medicine, used to

replenish yin and essence, tonify qi, and strengthen yang. It is used for deficiency of kidney yin and yang, deficiency of blood and essence in the penetrating and conception vessels, with symptoms of weakness of the lower back and legs, impotence, blurred vision…

and blah blah blah. As if that means something. Some wild Sika deer, one the preferred sources of deer horn, are also severely endangered:

The species is heavily depleted in the wild in China, and two of the Chinese subspecies may be extinct (mandarinus and grassianus), and others are threatened. However, large herds exist in captivity in China to meet the demand for velvet antlers used in traditional Asian medicine.

Yeah TCPM, perhaps the most environmentally damaging pseudo-science ever invented.

Chronic illnesses, such as rheumatoid arthritis (RA), can cause horrible for pain and disfigurement. We have a lot of disease-modifying treatments that have lessened the impact of RA, and similar diseases, on people. The only time I get to see the natural history of these processes is when people forgo modern medicine in favor of alternatives, as in an alternative to effective. “‘I was in horrific pain’: Alternative remedies for rheumatoid arthritis backfire“:

For two and a half years, Ware tried a variety of alternative remedies, including herbs from naturopaths and an alkaline-based diet, to manage the autoimmune disease that causes pain and swelling of the joints.
Her well-intentioned approach only saw her deteriorate.

She was told:

you really need to try these immuno-suppressant drugs’,” Ware recalls. “Reluctantly I did.”
Despite her reluctance, the medicine helped.
“They gave me a lot of mobility back and freedom and it gave me a sense of hope again,” she says.

Alternative medicine doesn’t work even when you believe it will, and science-based medicine will work even when you don’t believe. Such is reality.

The funny thing is she still uses the CAM even after the 2.5 years of unneeded suffering CAM provided. People just can’t let go.

Vaccination

They are up to 41 cases in Minneapolis as “Measles outbreak rages after anti-vaccine groups target vulnerable community.” Almost all the cases are in the unvaccinated but, so far, no deaths.

For a great graphic on the benefits of vaccination: “Here’s the visual proof of why vaccines do more good than harm.” Pass it on.

Acupuncture

I just returned from a trip to Las Vegas where we did a hike in the tremendous Red Rock Canyon where we saw wild tortoises. Add the tortoise the list of animals abused by acupuncture: “Vets Use Electro-Acupuncture To Help Tortoise Recover From Injuries.”

So now we will connect electrical leads,” said veterinary acupuncturist Dr. Carolina Medina from Coral Springs Animal Hospital. “This is going to send a mild electrical current.

If there was ever an animal that could not escape by running away, it would be a tortoise. And she is pregnant. Poor thing.

Another horrible study this week: “Acupuncture in Patients with Allergic Asthma: A Randomized Pragmatic Trial.” If you look up Pragmatic Trial in the OED, the first definition you will find is “worthless”. It is the classic A vrs A B methodology where

Patients with allergic asthma were included in a randomized controlled trial and randomized to receive up to 15 acupuncture sessions over 3 months or to a control group receiving routine care alone.

The type of study Dr. Ernst calls:

Yet, it is arguably also unethical, perhaps even fraudulent, to do this. In my view, such RCTs amount to pseudoscience and scientific misconduct.

Why do a study that will only be positive?

Under increasing budgetary pressure, the Federal Committee of Physicians and Health Insurers in Germany recommended that large research projects (so called “Modellvorhaben Akupunktur”) should be conducted to evaluate the effectiveness of acupuncture in specific chronic diseases, especially in pain diseases. Initially, chronic asthma was included in the research. Therefore, acupuncture could only be reimbursed by insurance companies if patients were treated with acupuncture by physicians who participated in one of the studies.

Money of course. Acupuncture was provided by:

physicians who were reimbursed by the participating health insurance companies.

Anyone see bias brewing here?

But what was striking about this study is they only looked at subjective endpoints, quality of life, and did not even do simple objective endpoints like checking a peak flow, an easy measurement of lung function in an asthmatic.

If you remember back to the classic NEJM article, “Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma,” asthma patients always reported feeling better if they had an intervention, but only real medicine led to an objective change in lung function.

Not including simple objective measurements makes this study even more ethically suspect, especially as there was no difference in either group for the use of real medications:

use of additional prescribed medication for allergic asthma in the acupuncture group (83.2% of patients) was similar to usage in the control group (83.8%, p = 0.896).

Suggesting that the treatment was actually doing nothing. As best I can tell, patients were given a useless placebo in a study whose methodology was useless for the sole purpose of justifying reimbursement for an unneeded procedure.

It is not often a SCAM provider actually publishes a real live scam.

What is lost in the acupuncture trial when using a sham intervention?” More rationalization. Not only are they using the No True Scotsman fallacy, arguing that the acupuncture used in a hot flash trial was not ‘real’ acupuncture, and certainly not the ‘real’ acupuncture they use in the real world, but:

Using sham acupuncture in an attempt to blind participants and thereby assess the specific effect of acupuncture can produce another limitation for clinical acupuncture trials by potentially attenuating the effects of ‘real’ acupuncture.

One of the many manifestations of the inability of acupuncturists to conclude that they have wasted their professional life on a useless placebo. That would be a tough deer antler to swallow.

In the literature

A paper of note.

Laser acupuncture versus reflexology therapy in elderly with rheumatoid arthritis.” Comparing two pseudo-medicines. What a study. Whose quackery reigns supreme? Laser therapy! I bet it would work even better if mounted on a shark.

Chiropractic

Feds reach $1 million settlement with Kansas City area chiropractor.” That may not be much money for Dr. Evil, but I thinks that’s a lot of money for a chiropractor to cough up. What did he do? He did:

procedures that the government contended were not medically necessary

Which defines all of chiropractic. They better beware.

Legal and legislative

You might remember that child in Australia who died of his diabetes after slap therapy back in 2015? Well, “Healer arrested over boy’s alleged ‘slap therapy’ death.” My big question, why isn’t healer also in quotes in the headline?

Evidently the ‘healer’ skipped out but was arrested in the UK this week and is now facing extradition and a trial for manslaughter.

The ‘healer’ invented:

an alternative medicine technique known as a paidalajin

Which:

involves stretching, fasting and slapping the body to the point of bruising.

And now he is heading for justice.

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.