JULY-AUGUST 2016 NEWS

Best of the blogs, July – on Science-Based Medicine, Mark Crislip discussed a proposal to reform chiropractic: “An admirable list of goals. Good luck as their application will be close to impossible…I just do not see that the field as a whole has what it takes to change for the better.” (Edzard Ernst also commented, “The 10 points are not realistic and woefully incomplete.”) Crislip also found little evidence for the frequent claim that acupuncture causes release of endorphins: for electroacupuncture, “the answer is often a yes, but electro-acupuncture isn’t acupuncture…Almost all of the data suggests that for the more traditional forms of acupuncture, feel-good hormones have nothing to do with its alleged analgesic effects.” Harriet Hall reviewed claims for diatomaceous earth as a dietary supplement, and could find no evidence in support. She also addressed past life regression therapy: “There is no such thing as reincarnation…There is no evidence that past life regression therapy offers anything that reality-based therapies like CBT [cognitive behavioral therapy] don’t offer, and we do know it can harm patients.” David Gorski wrote that the expansion of “Complementary and Integrative Health” in the Veteran's Administration is “integrating pseudoscience into the care of veterans.” Jann Bellamy followed by discussing new legislation that furthers this trend. Gorski also found serious flaws in a paper on the use of acupuncture in the emergency room. Steven Novella called on pharmacists to “stop selling health care products that have no evidence of efficacy or evidence of lack of efficacy…This means a refusal to sell any homeopathic product.”

On Respectful Insolence, “Orac” discussed dangers of cupping, “among the silliest of alternative medicine therapies…it’s all risk for no benefit.” (See additional items on cupping below in August entries.) He discussed the dangers of stem cell tourism, when patients go abroad to seek unproven treatments: “Why are so many of these clinics located in countries like Kazakhstan, China, Mexico, and Argentina? It’s not because the scientific facilities are so much more advanced there. It’s because regulatory oversight protecting patients is lax to nonexistent.” (See August 4 item below for a discussion of stem cell clinics in the U.S.) He criticized articles portraying Kris Kristofferson as a victim of so-called "chronic Lyme disease," which, unlike genuine Lyme disease, is a fake disease diagnosed by unreliable tests. He complained of the growth of “quackademic medicine” at the University of Michigan Medical School, including a study of acupressure which he said was not properly controlled. Finally, he addressed the so-called “big idea behind integrative medicine”: it is not, as claimed, that it has concern for “prevention and regard for the whole person,” because these are parts of conventional scientific medicine. Rather, “what it really does is to claim that you need to integrate pseudoscience into medicine to accomplish this end.”

Edzard Ernst published a five-part series, “The Tricks of the quackery trade”: Part 1: treat a non-existing condition, maintenance treatment, it must get worse before it gets better. Part 2: a cure takes a long time, it’s due to the poisons your doctor gave you, think holistically. Part 3: detox, the test of time, treating the root cause of the disease. Part 4: natural is good, energy, stimulating the immune system. Part 5: critics don’t understand, research is being suppressed, critics are bought and corrupt, even Nobel Prize winners agree with us. He discussed four facets of informed consent, and explained why “in alternative medicine, fully informed consent can rarely, if ever, be provided. In turn, this means that the current practice of alternative medicine cannot be in line with the most fundamental requirements of medical ethics.” He discussed proposals for how acupuncture works. The question is interesting but first we need to know if acupuncture does work. “The most plausible theory still is that it works largely or even exclusively via a placebo effect.”

July – Allan and others published “Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs” (J. Gen. Intern. Med. 31, 780-791 (2016) Abstract). The authors concluded, “The evidence shows that vitamin D supplementation provides some benefit in fracture prevention…and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms.” Scott Gavura discussed the findings on Science-Based Medicine.

July – A review of chromium supplements in type 2 diabetes (Costello, Dwyer, and Bailey, Nutr. Rev. 74, 455-468 (2016) Paper) concluded that “On the basis of the low strength of existing evidence, chromium supplements have limited effectiveness, and there is little rationale to recommend their use for glycemic control in patients with existing T2DM.”

July – Schlichte, Vandersall, and Katta reviewed dietary supplements for atopic dermatitis (Dermatol. Pract. Concept. 6, 23-29 (2016) Abstract). They wrote, “Based on trials to date, no dietary supplements can be recommended for routine use in the treatment of AD. However, some promising results have been noted from the use of probiotics and prebiotics taken in combination…Studies of vitamin D have been limited and have produced conflicting results, although further trials in selected subsets of patients may be indicated. Very limited data is available on fish oil supplements, while future studies on Chinese herbal medicine would require evaluation of comparable herbs and formulations. Finally, multiple trials of evening primrose oil and borage seed oil have shown improvement similar to placebo, and neither is currently recommended in eczema therapy.”

July 7 – Stephen Barrett posted “ZYTO Scanning: Another Test to Avoid” on Device Watch. The handheld device measures skin resistance to electric currents, and the readings are used diagnose health conditions and recommend dietary supplements. Barrett states that “Skin resistance to an electric current has no value in the diagnosis or treatment of disease.”

July 22 – A Story by J. Schwarcz discussed Brazilian “healer” John of God [João Teixeira de Faria], who claims to use spiritual healing to cure patients of cancer and other diseases, sometimes using a carnival trick of sticking a clamp up the patient’s nose. Schwarcz notes that John had his own cancer treated with surgery and chemotherapy.

July 25 – The Australian group Friends of Science in Medicine has published a review entitled “Is There Any Place for Acupuncture in 21st Century Medical Practice?” pdf file. The conclusion is “Acupuncture has been studied for decades and the evidence that it can provide clinical benefits continues to be weak and inconsistent. There is no longer any justification for more studies. There is already enough evidence to confidently conclude that acupuncture doesn’t work. It is merely a theatrical placebo based on pre-scientific myths.”

July 27 – Consumer Reports published "15 Supplement Ingredients to Always Avoid" (also in the September print edition). The ingredients are: aconite, caffeine powder, chaparral, coltsfoot, comfrey, germander, greater celandine, green tea extract powder, kava, lobelia, methylsynephrine, pennyroyal oil, red yeast rice, usnic acid, and yohimbine. A related article by J. Interlandi was entitled "Supplements Can Make You Sick." Bioethicist Arthur Caplan is quoted: “There are real risks involved [in supplement use] and very little evidence that any of this stuff works.”

Best of the blogs, August – on Science-Based Medicine, Jann Bellamy wrote "Kratom: Another Dangerous 'Natural' Remedy." Derived from a tropical tree, kratom can function as either a stimulant or depressant depending on the dose. It can cause “psychosis, seizures, and deaths,” and the FDA has banned its import. The use of cupping by Olympic athletes provoked many articles, such as one by Steven Novella (“The bottom line of all of this is that research into cupping is mostly negative or of poor quality and with high bias. There is no good compelling evidence for any real physiological effect from cupping…Cupping is no different than acupuncture, bloodletting, phrenology, or any other medical pseudoscience. The treatment is based in pre-scientific superstitions, and has simply been rebranded to more effectively market the treatment to modern customers.”). “Orac” provided two Respectful Insolence posts (Aug. 9 Aug. 10), and Edzard Ernst wrote three (Aug. 9 Aug. 12 Aug. 16). Scott Gavura called on the pharmacy profession to reject the selling of homeopathic products. Clay Jones criticized the expansion of integrative medicine, including pseudoscience such as reiki and reflexology, at the Dana-Farber Cancer Center. He also wrote "An Unexpected Miscellany of Medical Malarkey," dealing with the use of an acupuncture point locating device to determine if neonates are suffering from withdrawal (“no different than using an EMF meter to hunt for ghosts”); a doctor who recommends cupping for children (not “simply a waste of time but a possible cause of serious injury to a child’s skin”); and kinesio taping for premature infants (no reason to think it “would be any more likely to work in children than it is in adults, where there is considerably more available evidence showing its lack of clinical usefulness.”) Harriet Hall reviewed the book Quackery: The 20 Million Dollar Duck, by Tony Robertson. Steven Novella provided a rebuttal to an article in defense of homeopathy, as did “Orac” on Respectful Insolence. James Thomas considered two of what might be considered the stronger arguments for complementary and alternative medicine (CAM), electroacupuncture and valuable placebo effects, and found them unconvincing. David Gorski criticized proposed "right to try" laws, which would give “terminally ill patients the ‘right to try’ experimental treatments without interference by the FDA…Proponents often ask, ‘What does a terminally ill patient have to lose?’ The answers are simple. They can lose money, perhaps their life savings, given that accessing right-to-try could easily cost tens or hundreds of thousands of dollars. That’s because, when you come right down to it, ‘right to try’ is a misnomer. It’s really ‘right to buy’.”

On Respectful Insolence, “Orac” asked, "Why Does Dr. Mercola Sell Supplements?" Orac found unconvincing the argument that selling supplements to support the site “would be less likely to result in bias in the content of Mercola.com than advertising.” He also criticized the Cleveland Clinic for "Promoting Dubious Diet Advice on Twitter and Beyond."

Edzard Ernst criticized a review of acupuncture for amnestic mild cognitive impairment; he characterized it as “rubbish in, rubbish out.” He discussed a Cochrane review which found a lack of evidence in support of Chinese herbal medicine for the symptoms of menopause. He noted that “most of the primary studies failed to mention adverse effects…In my view, this is a breach of research ethics.” He discussed the fact that numerous web sites promote homeopathy for dengue even though there is no evidence of effectiveness. He criticized the conclusion drawn in a paper on craniosacral therapy: “The primary outcome measure failed to show an inter-group difference; in other words, the results of this RCT were essentially negative. To use secondary endpoints – most of which are irrelevant for the study’s aim – in order to draw a positive conclusion seems odd, if not misleading. These positive findings are most likely due to the lack of patient-blinding or to the 200 min longer attention received by the verum patients.”

August – Reilly published “The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad” (J. Pediatr. 175, 206-210 (2016)). She wrote, “…there are no data supporting the presumed health benefits of a GFD. In fact, the opposite may be true in certain cases…There are no data to support the theory of an intrinsically toxic property of gluten for otherwise-healthy and asymptomatic adults and children…”

August – In his Skeptic column in Scientific American (p. 75), Michael Shermer lamented the appearance of facilitated communication in a commercial for World Autism Awareness Day. “…dozens of controlled studies have unequivocally concluded that FC ‘doesn’t work’.”

August – A review of herbal medicine for asthma (Shergis et al., J. Asthma 53, 650-659 (2016) Abstract) concluded that “Herbal medicines combined with routine pharmacotherapies improved asthma outcomes greater than pharmacotherapies alone.” However, the studies were only of low to moderate quality, and were not blinded, casting doubt on this conclusion.

August 2 – On the Center for Skeptical Inquiry site, William London criticized advertisements for the City of Hope cancer hospital, referring to “miracles.” “Reputable scientific and medical organizations such as City of Hope don’t belong in the mass media miracle mongering business... City of Hope should be able to advertise truthful, non-misleading messages of hope.”

August 3 – Blanchette and others published “Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies” (PLoS One 2016, e0160037 Paper). The authors concluded that “Moderate evidence suggests that chiropractic care for LBP appears to be equally effective as physical therapy. Limited evidence suggests the same conclusion when chiropractic care is compared to exercise therapy and medical care although no firm conclusion can be reached at this time…Our review was also unable to clarify whether chiropractic or medical care is more cost-effective.” The review was discussed by Edzard Ernst. While he felt the “results are transparent and clear,” the conclusions should have noted that “the decision which approach to use should be based on a more comprehensive analysis of the therapeutic risks…Hundreds of serious adverse events have been reported after chiropractic spinal manipulations; to these we have to add the fact that ~50% of all chiropractic patients suffer from transient, mild to moderate adverse effects after spinal manipulations.”

August 4 – Turner and Knoepfler published “Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry” (Cell Stem Cell 19, 154-157 (2016) Abstract). They wrote, “Direct-to-consumer marketing of unapproved stem cell interventions is a well-known phenomenon in countries with lax medical regulations. However, an examination of Internet-based marketing claims revealed widespread promotion of such interventions by businesses based in the United States…We are particularly concerned that we found many advertising claims related to ALS, Alzheimer’s disease, Parkinson’s disease, and many other conditions for which there is no established scientific consensus that proven safe and efficacious stem cell treatments now exist.” David Gorski provided two related posts on Science-Based Medicine. In his July 4 post, he wrote that what the clinics are doing is “injecting stem cells and hoping they do their thing without knowing how the body induces them to do their thing, all while charging patients large sums of money for the privilege of being in what is in essence a poorly designed, poorly regulated clinical trial.” In his August 22 post, he discussed how the treatments are promoted at seminars, using “deceptive hard sell techniques that would make a used car salesman hesitate.”

August 5 – A story by J. Kaiser (Science 353, 527-528 (2016) Summary) discussed clinical trials of the injection of young blood into older patients as an antiaging treatment. Many scientists are critical of the trials both because of their scientific design and ethical issues; patients will be charged to participate. Stanford neuroscientist Tony Wyss-Coray is quoted: “There’s just no clinical evidence [that the treatment will be beneficial] and you’re basically abusing people’s trust and the public’s excitement about this.”

August 10 – The Federal Trade Commission sent “Warning Letters to Online Sellers Making Zika Virus-Protection Claims” Press release. “It appears that some online marketers may be trying to take advantage of consumer concerns about the mosquito-borne virus. The letters warn the recipients that Zika protection claims must be supported by competent and reliable scientific evidence in the form of well-controlled human clinical testing. The products of concern include wristbands, patches, and stickers that purportedly can repel the mosquitos that carry Zika or otherwise protect users from the virus.”

August 26 – An updated Cochrane review on acupuncture for stroke rehabilitation found “inadequate evidence to draw any conclusions about its routine use” (Yang et al., Cochrane Database Syst. Rev., CD004131 (2016) Abstract).

Additions to Earlier Months

January, 2016 – A review of vitamin D supplementation for chronic heart failure (Jiang et al., Clin. Cardiol. 39, 56-61 (2016) Paper) concluded that “Vitamin D supplementation may decrease serum levels of parathyroid hormone and inflammatory mediators in CHF patients, whereas it has no beneficial effects on improvement of left ventricular function and exercise tolerance.”

May, 2016 – Grollman and Marcus published “Global Hazards of Herbal Remedies: Lessons from Aristolochia” (EMBO Rep. 17, 619-625 (2016) Preview). The authors note that “Aristolochia is just one of several widely used herbs that later proved to have serious, chronic toxicities” and that “many herbs commonly injure the liver.” They conclude that “empirical knowledge based on tradition should not be permitted to ‘trump’ the scientific method in matters of public health. Basic and clinical scientists, as well as public health officials, have a moral and legislated responsibility to take actions that will evaluate both long- and short-term safety, as well as the efficacy of botanical products in widespread use.” In a related post, Kabat (Slate, Sept. 7) wrote: “The World Health Organization has failed to apply scientific rigor to traditional medicines” and “has launched an ambitious program that flies in the face of the scientific evidence the organization demands elsewhere and shamelessly promotes the use of traditional medicines, including herbal treatments, that could be considered dangerous” (Grollman and Marcus also noted that “The WHO monograph [on traditional medicine], financed in part by traditional/herbal medicine groups of several nations, appears to have been created by advocates for traditional medicine with little input from the biomedical community.”).