Selections from Society for Science-Based Medicine Points of Interest with comments.

What’s the harm

Red Yeast Rice, Sold as Statin Alternative, Has Similar Risks.”

Those events were most commonly myalgia and/or increase in creatine phosphokinase (19 events), liver injury (10 events), or gastrointestinal reactions (12 events), but there was one case of rhabdomyolysis as well as nine cutaneous reactions and four “other” reactions. Among them, 13 required hospitalization.

Case Rep Gastroenterol. 2016 Nov 25;10(3):706-713. doi: 10.1159/000452209. “Drug-Induced Liver Injury Associated with Complementary and Alternative Medicines.”

The presented case took complementary and alternative medicine (LEVERCOL® and Jacko®) before every appearance of his liver dysfunction.

Natural does not necessarily mean safe and liver toxicity is one of the more common complications of herbal preparations.
An acutely dyspnoeic woman after acupuncture.” Bilateral pneumothorax (popped lungs) after thoracic acupuncture. The distance from the skin to the lung is not very far, as this video shows (although I do love the way he puts his bare hand where the needle went in, aka how to transmit infections).

Vaccination

Vaccine exemptions are on the rise in a number of US states.” 80,000 Kindergartners in the 2013-14 school year exempt from at least one vaccine.

…nonmedical exemptions have continued to rise. In 11 states — Connecticut, Florida, Iowa, Kentucky, Maryland, New York, North Carolina, North Dakota, Ohio, Oklahoma, and Virginia — the number of kids not being vaccinated for nonmedical reasons is higher than at any point in the past five years.

Given how these unvaccinated children are often clustered we are primed for outbreaks of vaccine-preventable diseases.
When we see these outbreaks, be sure to send congratulations to those who helped make it happen. See “The Shadow Network of Anti-Vax Doctors” for who to write. An interesting review in The Atlantic.

Naturopathy

The American Council on Science and Health summed it up best: “Massachusetts Becomes The 20th State Where Naturopaths Can Hurt You.” The Massachusetts legislature passed bill 2335, “An Act establishing a board of registration in naturopathy.” I am increasingly of the mind that we were overly optimistic choosing Sisyphus as our logo at SfSBM.
For Legislative Updates for your state, visit Summary Pending Legislation 2017.

Acupunctures

There were a tremendous number of articles touting acupuncture for infantile colic based on a poorly-done, unethical study. For the truth they don’t want you to know, see “Acupuncture isn’t the answer to a crying baby” by Professor David Colquhoun, and “No, torturing colicky infants by sticking them with acupuncture needles won’t calm them” by my favorite box of blinking lights.
In the acupuncture literature
Eur J Pain. 2017 Jan 20. doi: 10.1002/ejp.1001. “Acupuncture and electro-acupuncture for people diagnosed with subacromial pain syndrome: A multicentre randomized trial.

In the current investigation, neither acupuncture nor electro-acupuncture were found to be more beneficial than exercise alone in the treatment of subacromial pain syndrome.

So there is nothing special about acupuncture’s effect for pain. More theatrical placebo.
Why do we rarely see numerous articles when a SCAM fails, but, as in acupuncture and colic, innumerable articles when a SCAM ‘works’?
Anaesthesia. 2017 Jan 16. doi: 10.1111/anae.13785. “A randomised controlled trial examining the effect of acupuncture at the EX-HN3 (Yintang) point on pre-operative anxiety levels in neurosurgical patients.”

After measuring baseline anxiety levels, 128 patients were randomly allocated in a 1:1 ratio by a web-based computer program to receive either acupuncture at the EX-HN3 (Yintang) point (acupuncture group) or no intervention (control group). Participants were not blinded…

An intervention versus usual care will ALWAYS shows benefit for the intervention, no matter what the intervention is. This mythology methodology guarantees a positive outcome, is useless for determining efficacy, and should never be published.
Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders.” A report of abusing the mentally ill.
Medical school debt can be tremendous, an average of $167,000, but at least as real physicians have an earning potential based in reality that can actually help people. Acupuncturists? To learn their theatrical placebo, at Southwest Acupuncture College :

…graduates earn a median of $17,260. That school’s website says tuition runs from about $57,000 to just under $70,000 for a degree.

With that kind of debt to earnings (also an issue with DCs and NDs) you can understand the allure of selling supplements and other questionable products to mollify the financial burden.

Chiropractic

Ortop Traumatol Rehabil. 2016 Oct 28;18(5):409-424. doi: 10.5604/15093492.1224615. “Manual Therapy in the Treatment of Idiopathic Scoliosis. Analysis of Current Knowledge. ”

Conclusion: “1. Few papers verifying the efficacy of manual therapy, chiropractic and osteopathy in the treatment of idiopathic scoliosis have been published to date. 2. The majority are experimental studies with poor methodology or observational case studies. 3. At present, the efficacy of non-specific manual therapy in the treatment of patients with idiopathic scoliosis cannot be reliably evaluated. 4. It is necessary to conduct further research based on appropriate methods (prospective, randomised, controlled studies) in order to reliably assess the usefulness of non-specific manual therapy in the treatment of idiopathic scoliosis.

Sorry. These reviews always suggest further studies need to be done. They do not.

Yoga

Yoga treatment for chronic non-specific low back pain. The money quote from the Cochrane review:

There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months. Yoga may also be slightly more effective for pain at three and six months, however the effect size did not meet predefined levels of minimum clinical importance. It is uncertain whether there is any difference between yoga and other exercise for back-related function or pain, or whether yoga added to exercise is more effective than exercise alone.

Which is no surprise because Yoga is exercise with an added patina of Indian mysticism.
And of course, as with acupunctures reviews, they appear to assume every form of Yoga is equal, but:

The types of yoga varied between trials. The most common type of yoga was Iyengar yoga or a modification of Iyengar yoga. Study authors reported using Hatha yoga (2 trials), Iyengar yoga (4 trials), the ‘Iyengar style of Hatha yoga’ (1 trial), a combination of Iyengar and British Wheel of Yoga (described as Hatha yoga on the British Wheel of Yoga website) (1 trial), a combination of Iyengar and ‘traditional’ yoga (1 trial), Viniyoga (2 trials), or ‘Integrated Approach of Yoga Therapy (IAYT)’ (1 trial). All interventions included meditation, relaxation, or breathing exercises in addition to physical yoga poses.

They need to make it Yogas (Yogi?) plural and not use the singular form of the noun. The marked heterogeneity of Yogas suggests that whatever minimal effect there is, it is not specific to Yogi.

Weird therapies

Evid Based Complement Alternat Med. 2016;2016:6520475. doi: 10.1155/2016/6520475. Epub 2016 Dec 26. “Potential Health Benefits of Deep Sea Water: A Review.”

It (Deep Sea Water) is usually associated with the following characteristics: low temperature, high purity, and being rich with nutrients, namely, beneficial elements, which include magnesium, calcium, potassium, chromium, selenium, zinc, and vanadium. Less photosynthesis of plant planktons, consumption of nutrients, and organic decomposition have caused lots of nutrients to remain there. Due to this, DSW has potential to become a good source for health.

Curious statements

Gwyneth Paltrow’s toxic tampon advice. A couple of weeks ago GOOP suggested that parasites like milk, then that vaginal jade eggs are a good way to, among other things, balance hormones. They are not. Now GOOP suggests that tampons contain toxins. They do not. As Dr Jen Gunter, a board certified OB/GYN, notes:

Okay, let me science it up for you.
There are no toxins in tampons. Really. I can say this with 100% certainty as a toxin is a preformed poisonous substance made by an organism, think botulinum toxin or the bee venom that you have used to reset your humors. It’s shame [sic] Dr. Maggie Ney N.D., your naturopath, couldn’t set you straight on that lede.

GOOP is a site of endless pseudo-science and pseudo-medicine.
In the article “Holistic integrative medicine: the road to the future of the development of burn medicine,” the author notes:

Holistic integrative medicine is different from translational medicine, evidence-based medicine or precision medicine.

I don’t think that was meant ironically and may well be the biggest understatement I will read in 2017.
How To Get Rid Of Plantar Warts: Dr. Starbuck Explains. ”

The word “plantar”, spelled p-l-a-n-t-a-r, is an adjective describing things related to the sole of your foot.

I can see how it is spelled when it is placed in quotes, why add the s-p-e-l-l-e-d?

The Concept of Wind in Traditional Chinese Medicine.” Wind is one of the humors of traditional Chinese pseudo-medicine. There are eight kinds of wind: Great Feathery Wind, Scheming Wind, Hard Wind, Great Hard Wind, Ferocious Wind, Infant’s Wind, Feathery Wind and, yes, Breaking Wind. From the small intestine. You would think Breaking Wind would be associated with the large intestine, but that is Ferocious Wind, and, to judge from my teenage boys, perhaps more fitting. The whole article is breaking wind. Pure nonsense.

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.