A thousand points of pseudo-medicine.

A thousand 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.

A short one this week. It is both a call weekend and a holiday weekend (ie BBQ) so not a lot of time.

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?

Kidney failure is one of the unexpected complications traditional medicines, the most notorious example may be “Chinese herbs containing aristolochic acid associated with renal failure and urothelial carcinoma” (the Aristolochia incident was discussed here by Steve Novella). A nice review of the topic can be found in Traditional Medicines and Kidney Disease in Low- and Middle-Income Countries: Opportunities and Challenges. The issue is made more complex given the complete lack of standards for what may be in these concoctions and they are often adulterated with real medications, ratcheting up the risk for harm.

Plus as Dr. Ernst notes in “The harms of alternative medicine: what we see is just the tip of the iceberg“, medicine is a balance of risk and benefit. We often do not know if there is benefit and:

On the safety side of the equation, things are even worse. There is no post-marketing surveillance of alternative therapies, and all we know about their risks comes from the occasional case report published in the medical literature. This means that under-reporting of harms is huge, and our data are just the tip of the iceberg.

We simply do not have any understanding of the risks associated with pseudo-medicine.

Vaccination

We are now up to 68 cases of measles as Minnesota’s measles outbreak about to exceed total 2016 U.S. cases. Go Minnesota.

The Germans are not messing around with vaccines, “New German Law To Impose Hefty Fines On Anti-Vaxxer Parents Who Refuse To Get Their Kids Vaccinated.” As of June 1:

Parents found in violation of this upcoming law may be fined up to 2,500 euros, or about $2,800 in U.S. currency.

Not a bad idea.

Acupuncture

A trifecta of pseudo-science can be found in “Effect of Lotus Posture on Acupuncture Meridian Energies: A Controlled Trial.” They used the Acugraph, a device that measures skin conductance and is touted as able to measure merde-idians. And they found:

those sitting in Lotus Posture for 30 min showed increases in subtle energy levels (E_Ls) in all acupuncture meridians; those sitting in chair produced universal decreases.

Research is getting closer and closer to The Onion.

Yet another in the endless variations of acupuncture: “Sanfu acupoint herbal patching for stable asthma: A systematic review and meta-analysis of randomised controlled trials.” The usual conclusion: maybe some benefit but poor quality studies so better research needs to be done.

But what is Snafu, er, I mean Sanfu?

Sanfu refers to the hottest period of the year, from July to August, and is considered to be the richest time for Yang Qi [16]. Therefore, the Sanfu period is of special significance for TCM in treating AR to gain more Yang Qi from the environment.
The Sanfu herbal patch (SHP) is a treatment method in which processed Chinese herbal preparations are applied directly to specific acupoints during the Sanfu period. This is done in order to produce therapeutic effects through the combination of herbal infiltration absorption, acupoint stimulation, and time effect [16]. The herbs with a nature of warm or hot are used to cause irritation on the skin such as local redness, hotness, and/or even blisters [17]. Therefore, skin absorption and stimulation of the meridians and/or acupoints are enhanced to generate a greater effect on patients.

Sure sounds to me like a reasonable basis for a therapeutic intervention for bronchospasm.

And acupuncturists are working hard to prevent physical therapists from getting a piece of their pseudo-medical pie: “Is dry needling a safe acupuncture replacement, or a shortcut around years of essential training?”

Trick question or false equivalents? I would take my theatrical placebo from a physical therapist since PTs, at least, have a reality-based background. And years of training in magic makes the magic neither safer nor more efficacious.

Naturopathy

You might remember the young man in Florida who set himself up as a natural doctor? He is going to jail for fraud, but not medical fraud. He tried to buy a car with one of his patient’s checking accounts. He has yet to be tried for medical fraud, which will be hard to prove given the nature of ND practice. Perhaps practicing medicine without a license, although Florida doesn’t license NDs.

Chiropractic

Department of Enthusiastic Conclusions.

This time it’s “The Effectiveness of Manual Therapy for Relieving Pain, Stiffness, and Dysfunction in Knee Osteoarthritis: A Systematic Review and Meta-Analysis“:

The preliminary evidence from our study suggests that manual therapy might be effective and safe for improving pain, stiffness, and physical function in KOA patients and could be treated as complementary and alternative options. However, the evidence may be limited by potential bias and poor methodological quality of included studies. High-quality RCTs with long-term follow-up are warranted to confirm our findings.

Same as it ever was.

In the literature

Some papers of note.

Evaluation of complementary and alternative medicine trials registered in clinicaltrials.gov database“:

CAM research in patients with cancer is currently limited, both in terms of quantity and quality.

I guess it is the CAM cancer providers who have information THEY don’t want you to know.

Best way to keep in business is not to do disconfirming research or have lousy studies that prove nothing.

Herbs and Supplements

Usefulness of nutraceuticals in migraine prophylaxis“:

There is a growing body of research on nutraceutical use for migraine prophylaxis.

The research is always growing, just not a quality research that demonstrates efficacy and safety.

Legal and legislative

Pseudo-medical providers continue to worm their way into the medical system. They want to be licensed and be paid. “Reimbursement for integrative health care suggests violation of non-discrimination law.”

Pseudo-medicine is more likely to be paid for if it done by an MD instead of a pseudo-medical provider. The problem is not that pseudo-medical providers are denied payment but that real doctors are being paid to do magic.

Vitamin Shoppe class action says ‘weight loss’ pills don’t work.” What? Taking a pill doesn’t lead to weight loss?

Vitamin Shoppe falsely states that its Garcinia Cambogia is “an effective aid in ‘weight management’ and ‘appetite control’ despite that the Product’s only purportedly active ingredients, Hydroxycitric Acid (‘HCA’) and chromium are scientifically proven to be incapable of providing such weight-loss benefits,” the class action asserts.

Didn’t he read the disclaimer before purchasing the product?

These products are dietary supplements and are not intended to diagnose, treat cure or prevent any disease. Reviews are not intended as a substitute for appropriate medical care or the advice of a physician or another medical professional. Actual results may vary among users. Vitaminshoppe.com makes no warranty or representation, expressed or implied, as to the accuracy or validity of the information contributed by outside product review submissions, and assumes no responsibility or liability regarding the use of such information. The information and statements regarding the dietary supplements have not been evaluated by the Food and Drug Administration. If you have a medical condition or disease, please talk to your health care provider. If you are currently taking a prescription medication, you should work with your health care provider before discontinuing any drug or altering any drug regimen, including augmenting your regimen with dietary supplements. Do not attempt to self-diagnose any disease or ailment based on the reviews and do not use the information contained herein for diagnosing or treating a health problem or disease. Proper medical care is critical to good health. If you have a health concern or suspect you have an undiagnosed sign or symptom, please consult a physician or health care practitioner.

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

Weirdness

Future of Alternative Medicine May Lie in Microdosing of Hallucinogens, Advocates Say.”

I suppose a little LSD would make alternative medicine appear more reasonable.

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.