Best of the blogs – beginning January, 2016, we have been following three blogs dealing with critical examination of the claims of alternative medicine, and will be noting items of special interest in these news pages. These three sites are: Science-Based Medicine, Respectful Insolence, and Edzard Ernst.
On Science-Based Medicine, both David Gorski and Harriet Hall wrote concerning a book (Cure: A Journey into the Science of Mind Over Body) and articles by Jo Marchant, dealing with meditation and the placebo effect (Marchant was the subject of an interview on National Public Radio’s Fresh Air). Gorski criticizes Marchant’s understanding of placebo effects and the extent that they are beneficial. Hall is more favorable, writing “I found myself agreeing with much of what Marchant says,” but also writes: “Overall, it [the book] gives the impression that we know much more than we do. The studies described are very preliminary and far from ready for prime time; we know that preliminary studies are often overturned by larger, better-designed studies.” Scott Gavura explained how the use of internal hydrogen peroxide not only provides no benefits, but is potentially harmful, and addressed deficiencies in the regulation of dietary supplements. Steven Novella wrote concerning the possible dangers of antioxidant supplements, referring to a new study with mice showing antioxidants led to increased metastasis. “This suggests that if you have cancer and you take antioxidants, your chance of developing metastases is greater. Keep in mind most solid tumor are usually present for 2-3 years before they are diagnosed, so the risk potentially exists even for those who have not yet been diagnosed with cancer.”
On Respectful Insolence, “Orac” attacked research funding by NCCIH (the National Center for Complementary and Integrative Health). Projects of real value have “little or nothing to do with CAM…this thin research portfolio indicates that NCCIH has no real scientific rationale to continue to exist.” Another post asks, "Will 2016 be the Year When the FDA and FTC Finally Crack Down on Homeopathy?"
Edzard Ernst presented Five Ways to Mislead People With Seemingly Rigorous Trials: fraud, prettification, omission, statistics, and trial designs that cannot generate a negative result (the last refers to the “A+B versus B” design). In another post, he criticized such a study, concerning the supplement Inner Power for cancer-related fatigue.
January – An editorial by Simmer was entitled “Fish-oil supplementation: the controversy continues” (Am. J. Clin. Nutr. 103, 1-2 (2016)), describing three papers on supplementation with long-chain omega-3 polyunsaturated fatty acids published in the same issue. Catena et al. (pp. 115-127 Abstract) found no benefit of supplementation in pregnancy related to attention (measured at age 8.5). Molloy et al. (pp. 268-275 Abstract) found no benefit for visual processing (measured at school age) for preterm infants during the early weeks of life (corresponding to the last weeks of normal pregnancies). However, a review by Best et al. (pp. 128-143 Abstract) found that supplementation late in pregnancy appeared to reduce allergic disease.
January – Two other papers dealt with fish oil supplements. Hill and others compared two doses of fish oil for knee osteoarthritis (Ann. Rheum. Dis. 75, 23-29 (2016) Paper). A high, anti-inflammatory dose provided no benefit compared to a low dose. Muldoon and others found that fish oil “did not reduce common markers of systemic inflammation in healthy adults” (C-reactive protein and interleukin-6) (J. Intern. Med. 279, 98-109 (2016) Paper).
January – Corey and others reported “Acute Liver Failure Associated with Garcinia cambogia Use” (Ann. Hepatol. 15, 123-126 (2016) Contents page with link to full text (pdf file)). Garcinia products, containing hydroxycitric acid (HCA), are used for weight loss.
January – The findings of a study by Kim, Vance, and Chun (Nutrients 8, 15 (2016) Paper) “support the hypothesis that an antioxidant-rich diet and intake of supplements are beneficial to reduce CVD [cardiovascular disease] risk.”
January - Gagnier and others performed a Cochrane Collaboration review of “Herbal Medicine for Low Back Pain” (Spine 41, 116-133 (2016) Abstract). They concluded that “Capsicum frutescens (cayenne) reduces pain more than placebo. Although Harpagophytum procumbens (devil's claw), Salix alba (white willow bark), Symphytum officinale L. (comfrey), Solidago chilensis (Brazilian arnica), and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best.”
January 5 – The creators of the Lumosity “brain training” program have agreed to a $2 million settlement over charges by the Federal Trade Commission (FTC) that “they deceived consumers with unfounded claims that Lumosity games can help users perform better at work and in school, and reduce or delay cognitive impairment associated with age and other serious health conditions” Press release. A story in Science by Underwood (351(6270), 212-213 (2016) Abstract) notes that although psychologist Susanne Jaeggi is skeptical of the claims of Lumosity, “she says ‘we have to be careful not to overgeneralize.’ There is ‘growing evidence’ that brain-training games related to skills such as working memory…’can be beneficial for a variety of tasks,’ she says.”
January 8 – Trivedi et al. performed a trial of chitosan, which reduces fat absorption, for weight loss in overweight and obese subjects (Nutrition J. 15, 3 (2016) Paper). Subjects lost more weight than controls over the 90 day study.
January 17 – Bega and Malkani reviewed “Alternative Treatment of Restless Leg Syndrome” (Sleep Med. 17, 99-105 (2016) Paper). They concluded that “Insufficient evidence exists for yoga, acupuncture, PCDs [pneumatic compression devices], near-infrared light therapy, CBT, valerian, or Chinese herbs, but preliminary studies on each of these suggest that high-quality randomized controlled trials may be warranted to support and verify the data presented.”
January 19 – The PBS documentary series Frontline, along with the New York Times and the Canadian Broadcasting System, produced a 54-min. video entitled "Supplements and Safety." The video examines “the hidden dangers of vitamins and supplements, a multibillion-dollar industry with limited FDA oversight.” The web site includes a transcript of the program.
January 24 – Stephen Barrett has published, on Credential Watch, “Some Notes on the Pastoral Medical Association and other ‘Private Membership Associations’.” Patients receive services from providers (mostly chiropractors) after signing agreements “intended to shield the providers from government regulation and civil court lawsuit… the agreement calls for patients assume all of the risks of a provider-patient relationship without any government protection.”
February – On Science-Based Medicine, Jan Bellamy noted that pseudoscientific treatments such as acupuncture, acupressure, and chiropractic adjustments had been included in Ohio guidelines for non-drug pain treatment, and wrote of efforts to include pseudoscientific approaches such as homeopathy and naturopathy as allowable expenses in Health Savings Accounts. Scott Gavura wrote concerning "Genomic Testing at Your Pharmacy." Such testing is unlikely to provide useful information.
On Respectful Insolence, Orac attacked Bill Maher for presenting an interview with Sam Chachoua, who employs unscientific treatment of HIV. He also wrote of the conviction of Robert Young, author of The pH Miracle, of two counts of practicing medicine without a license (Quackwatch also updated its article on Young).
Edzard Ernst wrote "A Risk of Herbal Medicine That Has So Far Been Neglected," commenting on a paper by Martins and others (Int. J. Clin. Pract. 70, 254-260 (2016) Abstract). The paper found that elderly patients using herbal remedies had poorer adherence to their conventional medications.
February – An issue of Bioethics (30(2) (2016)) dealt with “Complementary & Alternative Medicine’ (CAM): Ethical and Policy Issues.” Homola wrote concerning pediatric chiropractic care (pp. 63-38 Abstract). He stated, “I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice.” He also discussed the subject on Science-Based Medicine. A related post on Science-Based Medicine, by Jones, was entitled "Chiropractic and the Newborn Baby." “The bottom line when it comes to newborn chiropractic care is that there is no role for it under any circumstances.”
Also in this issue, Shahvisi wrote “No Understanding, No Consent: The Case Against Alternative Medicine” (Bioethics 30, 69-76 (2016) Abstract). “So in order for a patient to have given informed consent, she must understand the treatment…If this interpretation of informed consent is correct, it is unethical for medical professionals to offer or endorse ‘alternative medicine’ treatments, for which there is no known causal mechanism…” McDonald and Gavura wrote “Alternative Medicine and the Ethics of Commerce” (Bioethics 30, 77-84 (2016) Abstract). “Market interactions, in order to be considered ethical, need to involve products that actually work, that are advertised honestly, and that do not have undue effects on innocent third parties. Many examples of CAM fail on one or even all of these counts.” Gavura also discussed these points in a post on Science-Based Medicine.
February – Evans and others wrote “Cancer Patients' Experiences of Using Mistletoe (Viscum album): A Qualitative Systematic Review and Synthesis” (J. Alternat. Complement. Med. 22, 134-144 (2016) Abstract). They concluded that “Given the variation in context of MT delivery across the articles, it is not possible to ascribe changes in patients' quality of life specifically to MT.” In commenting on the article, Ernst wrote that “This might be a polite way of saying that there is no good evidence to suggest that MT positively affects patients’ experiences of side effects and the acceptability, tolerability, and perceived benefits.” He also noted that there is little or no evidence in support of mistletoe in treating cancer.
February – A trial found that vitamin D supplementation provided beneficial effects for patients with major depressive disorder (Sepehrmanesh et al., J. Nutr. 146, 243-248 (2016) Abstract).
February – A review of “Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care” by Chung and others (Medicine 95, e2793 (2016) Paper) concluded that “CHM may be considered as an add-on to conventional care in the management of pain in cancer patients. CHM could also be considered as an alternative to conventional care for reducing constipation. Evidence on the use of CHM for treating anorexia and fatigue in cancer patients is uncertain…”
February 2 – A trial of acupuncture for menopausal hot flashes found that it provided no benefit compared to sham acupuncture (Ee et al., Ann. Intern. Med. 164, 146-154 (2016) Abstract Summary for patients). As discussed by Ernst, the results indicate that “acupuncture is nothing but a theatrical placebo.”
February 5 – Model Katie May suffered a fatal stroke after chiropractic neck manipulation News story. Quackwatch describes the danger of strokes from chiropractic treatment.
February 8 – A Story by McFarling was entitled “FDA Moves to Crack Down on Unproven Stem Cell Therapies.” In recent years many Americans have gone to foreign countries to obtain stem cell treatments with little or no evidence supporting them. Now hundreds of American companies are also promoting such therapies, with costs of tens of thousands of dollars.
February 9 – H. Hall and S. Barrett provided a critique of Puritan’s Pride’s “Vitamin Advisor” on Quackwatch. The Advisor has an online questionnaire, but “no matter how you answer the questions, you will be advised to buy at least one product. EVERYONE is advised to buy a multivitamin…All of these products include some ingredients that are unnecessary and others that exceed standard recommended amounts. Most people should not take multivitamins…no questionnaire can be customized to make appropriate supplement recommendations, either for dietary improvement or treatment.” Dr. Hall provided additional commentary on Science-Based Medicine.
February 10 – Hu and others reviewed “Acupuncture for Pain Management in Cancer” (Ev. Based Complement. Altern. Med. 2016, 1720239 (2016) Paper). They concluded, “Acupuncture plus drug therapy is more effective than conventional drug therapy alone for cancer-related pain. However, multicenter high-quality RCTs [randomized controlled trials] with larger sample sizes are needed to provide stronger evidence for the effectiveness of acupuncture in cancer-related pain due to the low data quality of the studies included in the current meta-analysis.”
February 22 – An Article in Newsweek by T. Wilner was entitled “Cancer ‘Visionary’ Stanislaw Burzynski Stands Trial for Unprecedented Medical Malfeasance.” The Texas Medical Board is seeking to remove Burzynski’s license for practices related to his treatment with the scientifically-unsupported antineoplastons therapy. “Orac” provided further comments on Respectful Insolence.
February 23 – The Canadian government has issued an Advisory concerning the online marketing of Novodalin B17 for cancer treatment. The product supposedly contains amygdalin (which in modified form is known as laetrile). Despite the name “B17,” it is not a vitamin, and it is not useful in treating cancer. The product presents serious risk to consumers because it can produce cyanide in the body.
Additions to Earlier Months
January, 2015 – Reid published “Effects of Vitamin D Supplements on Bone Density” (J. Endocrinol. Invest. 38, 91-94 (2015). He concluded, “…vitamin D is critically important for the maintenance of normocalcaemia and normophosphataemia…A daily vitamin D dose of 400-800 IU can achieve this goal without need for monitoring of serum 25(OH)D concentrations. Dose escalation beyond these levels is unnecessary in most subjects, and possibly dangerous. Monitoring of serum 25(OH)D, except in the context of specific diseases or risk factors, is unlikely to be helpful and incurs a cost much larger than that of the vitamin D supplements themselves.”
October, 2015 – Raspberry ketone has been marketed for weight loss, even though there is no evidence that it is effective. Bresodorff and others pointed out that even though it is present naturally in raspberries and is approved as a flavoring, levels in supplements are far in excess of these uses and raise safety concerns (Regul. Toxicol. Pharmacol. 73, 196-200 (2015) Abstract).