Artist’s impression of a CAM star and its victim.

Artist’s impression of a CAM star and its victim.

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

Be there or be square.

What’s the harm?

Two weeks ago I noted an Australian who opted for alternative medicine instead of science-based medicine for her rheumatoid arthritis. Her disease progressed and she did not improve until she tried reality-based therapies. One of harms of pseudo-medicine: People delaying or avoiding effective therapy in favor of SCAM. I suspect it is an under-reported harm.

SCAM instead of SBM occurs the world over. For example, in Africa we have Ikenna Udeh, an artist, with pain from an incapacitating ‘cracked spine” and for him Not being able to paint is like dying – Buffalo. With regret in his voice he said.

I am not too keen on alternative medicine but they said let’s try and we did. Perhaps things would have been different if we had persisted with medical treatment,” the artist said. The talented artist has been incapacitated and has since been unable to express himself creatively.

And in China? “Use of complementary and alternative medicines is associated with delay to initiation of disease-modifying anti-rheumatic drug therapy in early inflammatory arthritis.” Not only was use of CAM associated with delay in effective treatment, but curiously it was in patients with more severe disease. The more symptomatic the arthritis, the more likely they were to rely on CAM.

At least the use of CAM for arthritis did not result in death. Not always the case, as “An autopsy case of fatal acute peritonitis complicated by illegal acupuncture therapy” demonstrates (errors in original):

The victim was a 55-year-old woman who had a recent history of chemo-radiotherapy due to breast cancer. She was collapsed three days after receiving acupuncture. She had symptoms of fever and chilling sensation, general myalgia, and vomiting during three days. The autopsy revealed several needle marks in the lower abdomen and 180ml of bloody exudate in the abdominal cavity. There was no visible intestinal perforation, but hemorrhagic foci in the mesentery and paracolic area of sigmoid colon were noted. The deepest portion was 13.5cm from the needle marks on the abdominal skin.

The acupuncturist had no license, as if being trained and licensed in fantasy makes it safer. And there is, among the innumerable forms of acupuncture, a form called long-needle acupuncture where the needles are pushed in 75–90 mm. Good god, look at this video from Perforations R Us. At least they are wearing gloves and a mask as they skewer the patient. I am not this aggressive with my kabobs for the grill.

Vaccination

The measles outbreak in Minnesota is now at 66. Still no deaths and, one hopes, no subacute sclerosing panencephalitis (SSPE) in the future.

In Italy they have had over 1,600 cases of measles, about 90% in the unvaccinated children, and to control the outbreak? The one intervention that is effective: “Italy makes 12 vaccines mandatory for school children in an attempt to combat ‘anti-scientific theories’“:

children will not be accepted into nursery or pre-schools without proof of vaccinations, while parents of children legally obliged to attend school will face hefty fines for noncompliance.

Texas, in an attempt to make sure every physician has an opportunity to see a case of measles in the most vulnerable population in the state, is working to prohibit vaccinations for foster children. The misnamed Child-Welfare bill will help ensure that children who have been physically and/or mentally abused now have an opportunity to get measles, mumps and more. Go Texas.

Acupuncture

Minnesota is on a roll. First measles, now “Shakopee Hospital Among First to Offer Acupuncture in ER“:

Doctors at St. Francis Regional Medical Center hope it will replace traditional opioid treatment in many cases.

Theatrical placebo in the ER for acute medical problems. I just broke my arm and I get acupuncture? Sign me up. The logical end result of the response to the opioid abuse problem. There are issues with airplanes, so we are going to rely on magic carpets.

Faith-based medicine

Maybe Shakopee will add prayer to their response to pain in the ER since “Health Secretary Tom Price Favors ‘Faith Based’ Approach To Opioid Crisis“:

Price, a medical doctor, claims faith-based treatment is better than medication-assisted treatment when treating opioid addiction, despite a great deal of scientific evidence to the contrary.

Since when does a great deal of scientific evidence make a difference for CAM?

In the literature

Some papers of note.

An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools“:

There was low-quality evidence that acupuncture improves pain compared to no treatment or standard treatment, but good evidence that it is no better than sham acupuncture.

Which means the good evidence shows NO EFFICACY. Sorry I shouted.

The evidence for homoeopathy (sic?!), spinal manipulation and herbal medicine was limited…No firm conclusions were drawn for efficacy of either spinal manipulation or homoeopathy (sic?!) for FM.

When it comes to spinal manipulation or homeopathy, knowledge of the basic sciences is perhaps enough to know that neither should have efficacy beyond the placebo effect.

While I am only peripherally involved with treating patients with chronic back and neck pain, I do have a dog in the fight. I had a herniated cervical disc a few years back that caused nine months of misery before surgical resolution and I continue to have mild to moderate back and neck pain issues. My take home from both personal experience (yeah, I know) and reading the literature is nothing really helps the pain except time. For example there is the recent Cochrane review, “Exercises for mechanical neck disorders“:

No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain. Using specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial. Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function. However, when only stretching exercises were used no beneficial effects may be expected

Looks like exercises doesn’t do much. Science-based or pseudo-science based, I think the only real option for most non acute pain is to keep calm and carry on. Nothing really relieves back and neck back.

Mindset for disease probably doesn’t alter the clinical trajectory of diseases, but it makes the disease tolerable, especially for processes, like back pain, that have to run their course. I wonder if much of the interaction with pseudo-medical providers can be characterized as a form cognitive restructuring based on fraud and fantasy. For example, in ‘“Placebo effect is probably what we refer to as patient healing power”: A qualitative pilot study examining how Norwegian complementary therapists reflect on their practice‘ they note:

A successful consultation was characterized by a fruitful relationship between the therapist and the patient. Moreover, the therapist needs to be humble and show the patient respect. Patients’ positive beliefs and expectations about the treatment play a significant role in the healing process. The more hope the therapist can bring about, the more easily the patient can start believing that it is possible to get well.

Changing patient perception without altering the underlying disease. Alt Med in action and Alt Med inaction.

Homeopathy

In India the money wasted on homeopathy is staggering, as is the belief in the ultimate nothing pseudo-medicine. Now “Government fund to find a homeopathic cure for cancer“:

The institute has assigned a project to a Cell Biology professor to screen out different homeopathic treatments for the cancer cure.

I’ll bet good money this goes nowhere.

Weirdness

Pseudo-medicine generates some of the weirdest forms of rat torture. This week we have “Comparison of the analgesic effects between electro-acupuncture and moxibustion with visceral hypersensitivity rats in irritable bowel syndrome.” Are you ready for this?

Rats in the normal group were stimulated through manual manipulation around the anus, while rats in the other groups were stimulated by distending the colorectum (CRD). Daily CRD using an inflatable balloon (constructed from a latex glove finger, length 4 cm, inflated with air) attached to an intravenous line connected via a Y connector to a manual pump and a sphygmomanometer. The balloon was inserted into the colon while the animal was sedated, and CRD was induced while animals were fully awake. The distention was repeated twice daily at a 30-min interval.

Somehow I suspect that:

All efforts were made to minimize the number of animals utilized and their suffering. All animal experiments in this study were performed under the guidelines approved by the Animal Ethics Committee of the China Academy of Traditional Chinese Medicine.

Is a wee bit of a farce. The only way animal suffering can be minimized is to stop doing dumbass pseudo-science on rats.

Legal and legislative

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.