It is no secret that we at SBM are not particularly fond of the National Center for Complementary and Integrative Medicine (NCCIH; formerly, the National Center for Complementary and Alternative Medicine). We’ve lamented NCCIH’s use of limited public funds for researching implausible treatments, the unwarranted luster NIH/NCCIH funding bestows on quack institutions, the lack of useful research it has produced, and its failure to shoot straight with the public when discussing alternative/ complementary/ integrative medicine. Nor does NCCIH’s research appear to affect CAM practice. Lack of evidence of safety or effectiveness is no impediment to use among CAM practitioners or “integrative” physicians.
So I shouldn’t have been surprised (NCCIH’s promise to “do some real science for a change” notwithstanding) when, a few days ago, I ran across a study of which I was previously unaware (for good reason, as you’ll see) on clinicaltrials.gov:
The goal of this study is to assess the feasibility of the approach, conduct a dose-finding investigation, and obtain pilot data on hyperthermia via sauna to apply in follow-up trials in the assessment of human chemical body burden reduction, for general wellness, detoxification, and pain reduction.
The investigators wish to determine if a hyperthermia-based detoxification protocol is feasible to conduct: including assessment of recruitment, enrollment, retention, protocol adherence, adverse events, and changes in serum polychlorinated biphenyls (PCBs).
The purpose of this study is to determine the impact of sauna use on polychlorinated biphenyls (PCB) in the blood of healthy human adults, as well as to assess safety, feasibility, and tolerability, and effects on quality of life and wellness. We hope to determine if there is a link between lower PCB levels in blood and sauna use.
The studies were conducted at Bastyr University, which awards degrees in pseudoscientific fields of study like naturopathy, TCM, and ayurvedic medicine, and funded by NCCIH to the tune of $736,938 between 2011 and 2013, under an award titled “Complementary and Alternative Medicine Detoxification: Safety and Efficacy.”
And the rationale for this?
According to our nationwide survey of Naturopathic Physicians regarding use of detoxification, approximately 80 percent of NDs (Naturopathic Doctors) use some type of detoxification interventions in clinical practice on a regular basis. Of the interventions used, 66% of respondents reported using sauna therapy. Of the conditions treated, over 80 percent of practitioners use sauna-based detoxification for “general cleansing/preventive medicine.” This protocol will utilize a sauna as the primary method of detoxification. . . . Previous studies on hyperthermia-based protocols for detoxification have been methodologically challenged and are not readily reproducible. Furthermore, there are no studies in the literature that identify how long of a protocol is tolerated, is feasible in the general population, or how long is needed to observe PCB (or other pollutant reduction).
So, the survey confirms what we’ve long known: Naturopaths are nuts for detoxification, despite the lack of evidence that it is of any benefit whatsoever to patients. They love to scare the willies out of patients by claiming our enviornments are full of disease-causing “toxins,” which must be eliminated posthaste via saunas, supplements, and other concoctions, colonics and restrictive diets. Otherwise, as one naturopath advised,
If you don’t detoxify, you’ll blow up!
This survey of naturopathic detoxification practices was published in the Journal of Alternative and Complementary Medicine and also funded by NCCIH. The lead author is the principle investigator, Bastyr naturopath Jason Allen. He and the other authors, one of whom is naturopath Wendy Weber, an NCCIH employee and recently the subject of a post by David Gorski, try to put a positive spin on the fact that the survey showed widespread use of detoxification despite the lack of evidence of benefit:
The wide variety in responses regarding age, patient populations/conditions, and therapies may reflect the philosophy of “comprehensive, multidisciplinary, and individualized interventions,” typical of the naturopathic profession.
The only problem being, of course, that these “comprehensive, multidisciplinary, and individualized interventions” are a hodgepodge of quackery, detoxification being one of the interventions the authors admit has no basis in evidence.
The authors note that environmental chemicals can have deleterious health effects, which is true. Yet, having just established that there is no evidence supporting the various “detoxification” treatments as an effective therapy and that naturopaths nevertheless use them willy-nilly for all sorts of things, the authors make a gigantic leap to the conclusion that:
Detoxification therapies used by NDs may serve as an adequate means to reduce the body burden of synthetic chemicals found today in humans; however, scientifically rigorous research is needed to determine the safety and efficacy of these therapies.
They don’t come close to suggesting any plausible means by which “detoxification therapies used by NDs” could possibly “reduce the body burden of synthetic chemicals” sufficient support a trial of sauna “detoxification.” But that is the beauty of NCCIH-sponsored research: if CAM practitioners are doing it, we must spend money studying it, to heck with all those pesky interim requirements other scientists have to jump through, like animal studies, scientific plausibility and such.
Sweating it out, or not
I did find one article on Bastyr’s website explaining the basis for Allen’s belief that a few turns in the sauna would get rid of “toxins:”
While subjects may literally sweat out small amounts of chemicals, the heat treatment’s chief benefit will most likely come from lipolysis — breaking down fat, where toxic substances are stored. That would allow them to move through the bloodstream to the kidneys and liver, which are the primary organs of excretion . . .
That sweating won’t really accomplish anything useful, though, and it can be detrimental.
Dr. Dee Anna Glaser, a professor of dermatology at St. Louis University and founding member of the International Hyperhidrosis Society, a medical group dedicated to the study and treatment of heavy sweating, says sweat does contain trace amounts of toxins. But, she says, sweating has only one function – cooling you down when you are overheated.
Sweating for the sake of sweating has no benefit . . . Sweating heavily is not going to release a lot of toxins.
Dr. Glaser points out that heavy sweating can actually impair your body’s natural detoxification system. We count on the liver and kidneys — not the sweat glands — to filter toxins from our blood. If you don’t drink enough water to compensate for a good sweat, dehydration could stress the kidneys and keep them from doing their job. So, “if you’re not careful, heavy sweating can be a bad thing.”
Sweating definitely won’t help clear the body of mercury or other metals, according to Donald Smith, a professor of environmental toxicology at UC Santa Cruz, who studies treatments for metal poisoning. Almost all toxic metals in the body are excreted through urine or feces, he says. And less than 1% are lost through sweat. In other words, according to Smith, you’ll do far more detoxifying in the bathroom than you ever could in a sauna.
Here’s what Smith said about one sauna company’s claim that “sweat carries toxins out of the body and pushes [them] out of the pores, . . washes away pesticides and industrial chemicals but is especially effective in removing heavy metals such as lead, mercury and arsenic.”
But will a sit in the sauna break down fat and cause toxins to exit the body? If that’s a viable theory, it is apparently not well known in the field:
Roger Clemens [is the] director of an analytical laboratory at the University of Southern California that evaluates environmental toxins in the food supply. Clemens remarked that the most efficient system for detoxification is not an infrared sauna but rather the kidneys, liver, gastrointestinal tract and immune system. ‘Except when one of the major organs breaks down, there isn’t a medical device or any diet that can accelerate the body’s natural process of detoxification,’ he says.
I couldn’t find anything supporting what Allen says on PubMed, but just to be sure, I ran it by my own panel of experts. Dr. Hall assures me that this doesn’t make any sense and Dr. Crislip finds that it is indeed “nonsense.” Dr. Jones notes that if the sauna’s heat is high enough to break down fat, it’s going to cook your skin also. That’s good enough for me.
But, despite these substantial flaws, what if the study showed an association between using saunas and a reduction in PCBs in the blood? Would that be worthwhile information? Not really. While PCBs are known to be harmful and their manufacture has been banned, blood testing for PCBs isn’t likely to yield useful health information. And because most of us have a measurable level of PCBs in our bodies, trial participants will be alarmed for no good reason when their tests prove positive.
Tests are available to measure the levels of PCBs in the blood and breast milk. Because PCBs are common in the environment, most people will show some level. The problem, though, is that there are no reference values that define a “normal” level of exposure to PCBs. Thus, your physician will not be able to tell you the meaning of a PCB level in your blood or breast milk beyond the fact that it is present. A test that shows PCBs in your blood will not explain how long the exposure lasted or if there will be health effects from the exposure.
In other words, based on our current state of knowledge, we don’t know that reducing PCBs in the body will produce beneficial health effects, so there is no known value in reducing their level. Nor does testing predict treatment. If that is the case, what’s the point of studying whether saunas are associated with reduced level of PCBs?
If saunas don’t work, it’s not for lack of trying. Allen described his protocol thusly in one newspaper article on the study:
What I’m proposing is a little more aggressive protocol, it’s like spring cleaning . . .
Boy, he wasn’t kidding either. In the pilot feasibility study, “low dose” participants got 1 hour of sauna a day, 3 days a week, for 3 weeks, or 9 sessions. The “high dose” participants got a whopping 30 hours of sauna over the 3-week period, coming in for 2 hours of sauna 5 days a week. (From the description provided, it is not clear to me how many hours of sauna participants in the Phase I trial endured, only that their visits to the Bastyr clinic lasted 3.5 hours.)
And the results are?
We don’t know. No results are posted for the pilot study. The Phase I trial, which was to have been completed in April, 2014, was terminated for reasons that are not explained. I can find no published results on PubMed and no study results on the Bastyr or the NCCIH website. Bastyr, contrary to clinicaltrials.gov, says the study is “completed;” NCCIH doesn’t mention the study at all. In fact, the NCCIH’s page on “‘Detoxes’ and ‘Cleanses'” doesn’t even mention sauna detoxification.
So, history repeats itself and the NCCIH has apparently blown almost three-quarters of a million dollars on a questionable study of “detoxification” conducted at an institution that teaches its students rank quackery like homeopathy, promotes anti-vaccination ideology, and misrepresents naturopathy education and training to the public. To add insult to injury, Bastyr uses this NCCIH funding in PR to promote itself, giving it undeserved legitimacy and the false appearance of scientific rigor. Yet, it will continue to teach “detoxification” to its naturopathic students despite its admitted lack of evidence of safety and effectiveness and practicing naturopaths will continue to “detox” their patients, all to the benefit of their bottom lines.
And one more thing
While we are on the subject of naturopaths and NCCIH, it is interesting to note that the NCCIH website has completely sanitized its description of naturopathy, a development I wrote about last year on SfSBM and worth repeating here. NCCAM’s description of naturopathy used to be refreshingly frank, with statements like:
Although some of the individual therapies used in naturopathy have been studied for efficacy and safety, naturopathy as a general approach to health care has not been widely researched.
‘Natural’ does not necessarily mean ‘safe.’ Some therapies used in naturopathy, such as herbal supplements and restrictive or unconventional diets, have the potential to be harmful if not used under the direction of a well-trained practitioner.
Some beliefs and approaches of naturopathic practitioners are not consistent with conventional medicine, and their safety may not be supported by scientific evidence. For example, some practitioners may not recommend childhood vaccinations. The benefits of vaccination in preventing illness and death have been repeatedly proven and greatly outweigh the risks.
Naturopathy is not a complete substitute for conventional care. Relying exclusively on naturopathic treatments and avoiding conventional medical care may be harmful or, in some circumstances (for example, a severe injury or an infection), have serious health consequences.
Even though none of these warnings has proven false, all of them are gone.
The public now learns only about the education and training of naturopathic “physicians” at 4-year “medical schools” and the fact that they have “continuing education requirements.” As well, “some U.S. states and territories have licensing requirements for naturopathic physicians; others don’t.” The public doesn’t learn the fact that they are licensed or registered in only a handful of states. And, if they’re not (and NCCIH doesn’t tell you this either) naturopathic “physicians” better not be calling themselves “physicians” or trying to pretend they can practice as “physicians,” as that would be illegal. To be fair, some of this information was in the former information page on naturopathy, but it was tempered by appropriate warnings.
The public is now told that “people visit naturopathic practitioners for various health-related purposes, including primary care, overall well-being, and treatment of illnesses.” Of course, to the average member of the public, unaware of the total nonsense that comprises a good portion of naturopathic practice, this probably implies that seeing a naturopath for “primary care” or “treatment of illnesses” is perfectly sensible. And the NCCIH isn’t going to discourage anyone from thinking otherwise.
The naturopathy page does link to the study showing an association between lower vaccination rates and children seeing a CAM practitioner, and the association between use of naturopathy and significantly more vaccine-preventable disease diagnoses. It also says, however, that we don’t know if these associations are simply because parents who are anti-vaccination seek out CAM practitioners, or whether they are actually getting anti-vaccine advice. That is true, but studies confirm the anti-vaccination ideology of naturopaths, and that should be clearly stated. It is a fact. This is particularly disappointing in light of the NCCIH director, Dr. Josephine Briggs, agreeing with David Gorski, Steve Novella and Kimball Atwood that anti-vaccination ideology in CAM providers should not be tolerated.
At the time I wrote the SfSBM post, in October of last year, if you dug around you could still find the original information on naturopathy in the form of a pdf. Now, that link doesn’t work and I can’t find the pdf anywhere on the website. Consequently, the benign impression of naturopathy presented by NCCIH goes unchallenged.
Back when he was posting on SBM, Kimball Atwood opined that
For a number of reasons, well-argued many times here on SBM, it would be beneficial to American citizens if the National Center for Complementary and Alternative Medicine (NCCAM) were abolished.
Six years later, NCCIH is carrying on the tradition of annoying SBM posters to the point of their calling for its closure. Count me among them.