Best of the blogs, March – on Science-Based Medicine, Mark Crislip critiqued the idea of acupuncture for coronary artery disease, while Scott Gavura concluded that there is no evidence that grapefruit seed extract is useful in fighting infections. Jann Bellamy criticized the American Journal of Public Health for an article about “potential public health benefits of homeopathy,” especially the “wholly unethical position that people should be vaccinated for infectious diseases with homeopathic ‘vaccines’.” Harriet Hall discussed testosterone treatments, concluding that “Testosterone may be useful when prescribed appropriately for symptomatic androgen deficiency, but it is clearly no Fountain of Youth; the hype has far exceeded the reality.” Steven Novella critiques a device which supposedly uses transcranial direct current stimulation (tDCS) to stimulate sports performance through “neuropriming.” “Using tDCS to enhance learning and training is plausible, and the early clinical studies are mixed but encouraging, but in my opinion we are not yet across the threshold of evidence where marketing claims to the public is justified.”
On Respectful Insolence, “Orac” deplored the growth of "functional medicine" at the Cleveland Clinic. Two other posts dealt with alternative cancer “cures.” One discussed how promoters blame the patient when their methods fail. The other is entitled "Cancer patients do not need or want suggestions for alternative cancer cures." He wrote, “…it might seem ‘empowering’ for people to think that they can cure their cancer with magic herbs, shooting coffee up their butts, thinking positive thoughts, or doing yoga, but it’s not. It tells people battling cancer and losing that they didn’t do enough, that they could have prevented this if only they had wanted it badly enough and had a positive enough attitude, that their impending death is at least partially their own fault.”
Edzard Ernst provided further comments on a study of acupuncture for menopausal hot flushes (see our Feb. 2 item). He also criticized an article supposedly showing the benefits of mindfulness-based stress reduction for chronic low back pain. In this “A+B vs. B” study design, the results are compatible with treatments that are “pure placebos.” He also reported that "NICE no longer recommends acupuncture, chiropractic or osteopathy for low back pain" (NICE is the National Institute for Health and Care Excellence, UK).
March – The March-April issue of Drug Testing and Analysis was focused on dietary supplements.
Marcus criticized the marketing of herbal medicines as “dietary supplements” (Drug Test Anal. 8, 410-412 (2016) Paper). “There is no scientific basis for calling herbals ‘supplements’. Authentic supplements, such as multivitamins or calcium, have nutritional value and are safe when used in recommended doses. Botanicals are used worldwide as medicines. They do not supplement the diet, and they may cause severe adverse effects…The marketing of botanical supplements is based on unfounded claims that they are safe and effective. Health professionals need to inform patients and the public that there is no reason to take herbal medicines whose composition and benefits are unknown, and whose risks are evident.”
The potentially dangerous compound yohimbine, promoted for enhanced sexual function, is banned in many countries but is available in many dietary supplements sold in the U.S. Cohen and others analyzed 49 supplement products containing yohimbine and found that some contained drug-like levels of the compound ((Drug Test Anal. 8, 357-369 (2016) Paper) News story.
An article by Eichner and Tygart was entitled “Adulterated Dietary Supplements Threaten the Health and Sporting Career of Up-and-Coming Young Athletes” (Drug Test Anal. 8, 304-306 (2016) Paper). “Sport or performance-enhancing supplements pose risks that are unique to the growing athlete. The developing endocrine and nervous systems are sensitive to the presence of hormones, anabolic-androgenic steroids, and stimulants…Pharmaceuticals, which are found surprisingly often in dietary supplements, can also have different toxicological effects on children than they do in adults, sometimes making their effects more severe, or at the very least unpredictable.”
Avula and others reported that vincopocetine and picamilon, which are unapproved drugs, are being marketed in dietary supplements (Drug Test Anal. 8, 334-343 (2016) Paper). Although these are prescribed in many countries, they have not been shown to be effective, and are potentially dangerous. Corresponding author P. Cohen commented on the work in a Letter (Mayo Clin. Proc. 90, 1455 (2015)).
March – A trial of the Alexander Technique found no benefit, compared to local heat, in the treatment of non-specific neck pain (Lauch et al., Clin. Rehab. 30, 247-258 (2016) Abstract).
March – Pilz and others reviewed “Vitamin D and Mortality” (Anticancer Res. 36, 1379-1388 (2016) Paper). They concluded, “Apart from observational data, it has been documented in meta-analyses of randomized controlled trials that vitamin D3 supplementation is associated with a moderate, yet statistically significant, reduction in mortality. This latter finding must be interpreted in light of some limitations such as incomplete follow-up data, but such a reduction of mortality with vitamin D3 supplementation as the finding of meta-analyses of randomized controlled trials strongly argues for the benefits and, importantly, also the safety of vitamin D.”
March – A study by Sun and others found that “taurine supplementation shows promise in the treatment of prehypertension through improvement of vascular function” (Hypertension 67, 541-549 (2016) Abstract).
March – A review and meta-analysis by Chiu and others concluded that acupuncture is useful in dealing with sleep disturbances in perimenopausal and postmenopausal women (Obstet. Gynecol. 127, 507-515 (2016) Abstract).
March – Another study of acupuncture concluded that it can reduce pain and fatigue, and improve quality of life, in cancer patients (Lau et al., Medicine 95, e2901 Paper).
March – Posar and Visconti reviewed the use of omega-3 polyunsaturated fatty acids in the treatment of autism (Pediatr. Ann. 45, e103-e107 (2015) Abstract). They concluded that “According to the criteria of evidence-based medicine (ie, randomized clinical trials), the data do not support the effectiveness of omega-3 treatment in children with ASD. However, based on anecdotal experiences and on nonrandomized trials, we cannot exclude that there might be a subset of people with ASD who do respond to this type of approach.”
March 3 – As noted in our Oct. 20, 2014 item (see the Jan.-Feb. 2015 News page, additions to earlier months), some experts have been critical of the value of “brain games” for improving mental function. This issue was address in a story by Makin (Nature 531, S10-S11 (2016)). Result have been conflicting, and depend on what aspect is measured. Quoting researcher Jacky Au: “’There is very good evidence that training on working memory tasks does improve on tests of fluid intelligence,’ says Au. But, he adds, it is not yet clear whether this translates to a meaningful, real-world increase in intelligence.”
March 9 – Wu and other reviewed “The Efficacy of Acupuncture in Post-Operative Pain Management” (PLoS One 2016, e0160627 (2016) Paper). They concluded that “Our findings indicate that certain modes of acupuncture improved postoperative pain on the first day after surgery and reduced opioid use. Our findings support the use of acupuncture as adjuvant therapy in treating postoperative pain.”
March 11 – In his blog at the Center for Inquiry, Joe Nickell criticized Newsweek for promoting the Brazilian “healer” “John of God” as a “miracle healer.” “John” employs “an old carnival sideshow stunt” in his “surgeries.”
March 15 – A radio podcast from The Thinking Atheist features Drs. Harriet Hall and Stephen Barrett addressing claims of “evil Western medicine” and the “charge that medical science should be distrusted in favor of unlicensed ‘healers’ who operate outside the checks and balances of regulatory agencies.”
March 15 – Zhu, Liew, and Liu published a review of “Chinese Herbal Medicine for Menopausal Symptoms” (Cochrane Database Syst. Rev., CD009023 (2016) Abstract). The found “insufficient evidence that Chinese herbal medicines were any more or less effective than placebo.”
March 22 – Another Cochrane review was on “Dietary Supplements for Pain During Menstruation” (Pattanittum et al., Cochrane Database Syst. Rev., CD002124 (2016) Abstract). They concluded that “There is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhoea, and evidence of safety is lacking. However for several supplements there was some low quality evidence of effectiveness and more research is justified.”
March 31 – Yet another study has shown that patients with so-called “chronic Lyme disease” do not benefit from additional antibiotic treatment (Berende et al., N. Engl. J. Med. 374, 1209-1220 (2016) Paper Editorial). Steven Novella provided commentary on Science-Based Medicine.
Best of the blogs, April – on Science-Based Medicine, David Gorski analyzed the 2016-2021 Strategic Plan of the National Center for Complementary and Integrative Health (NCCIH). “The NCCIH 2016-2021 draft strategic plan is evidence of just how narrow NCCIH’s purview has become. Over the last 20 years, it’s failed to validate a single alternative medicine intervention, and, one by one, the more quacky ones have become unsupportable, even by NCCIH. All that’s left now are rebranded SBM [science-based medicine] interventions.” Another post dealt with "functional medicine". “The problem with ‘functional medicine’ is that at its core it is close to being as nonsensical as the more ‘obvious’ forms of quackery. It just hides it better, given the number of fancy-sounding laboratory tests. It’s also incredibly difficult to pin down just what the heck it even is…” He also addressed two studies of acupuncture for menopausal symptoms. The first found no benefit. The second claimed to provide evidence of benefit, but did not control adequately for placebo effects. Harriet Hall discussed a review of the association between chiropractic and stroke. She wrote, “I certainly agree that there is no definitive evidence for causation, but I think there is evidence to support a strong enough probability of causation to constitute a good reason to avoid neck manipulation.” Dr. Hall also discussed a study of spinal manipulation for cervicogenic headache. “In my opinion, considering the evidence from previous studies, the possible risk of stroke, and the unanswered questions, this one study is not enough to justify adopting manipulation for CGH.” Additional posts by Samuel Homola and Mark Crislip discussed the dangers of neck manipulation in more detail. Steven Novella examined claims for a typical cancer “cure,” beetroots. Jann Bellamy lamented plans to force medical residents to receive training in integrative medicine, which includes modalities not supported by scientific evidence.
April – Three papers in Complementary Therapies in Medicine dealt with yoga. A review by Kumar and others found evidence in support of yoga (in addition to standard treatments) for type II diabetes (Complement. Ther. Med. 25, 104-112 (2016) Abstract), though problems with the methodology limits the strength of the conclusions. Goode and others (Complement. Ther. Med. 25, 170-177 (2016) Abstract) found that “Evidence suggests benefit of yoga in midlife adults with non-specific cLBP (chronic low back pain) for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain.” Cramer and coworkers found that the style of yoga was unimportant in determining its benefits (Complement. Ther. Med. 25, 178-187 (2016) Abstract).
April – An analysis of data from the 2012 National Health Interview Survey (Jou and Johnson, JAMA Intern. Med. 176, 545-546 (2016) Preview) found that 42% of users of complementary and alternative medicine did not discuss this use with their primary care physicians.
April – A scientific statement from the Endocrine Society concluded “The widespread availability of FDA-approved bioidentical hormones produced in monitored facilities demonstrates a high quality of safety and efficacy in trials; therefore, there is no rationale for the routine prescribing of unregulated, untested, and potentially harmful custom-compounded bioidentical HTs” (Santoro et al., J. Clin. Endocrinol. Metab. 101, 1318-1343 (2016) Paper).
April 4 – As reported in a Story by S. Kaplan,” Manufacturers of some dietary supplements have been using a stimulant in their products while falsely claiming it is a dietary ingredient, the Food and Drug Administration said Monday, as it announced new steps to crack down on the practice. The ingredient, methylsynephrine, acts similarly to amphetamine. It was first developed in Europe, and is not approved in the United States as either a drug or a dietary supplement.” Another Story by L. Roniger (April 26) describes how the FDA has sent warning letters to companies marketing methylsynephrine (also known as oxilofrine or “extract of Acacia rigidula).
April 5 – A Cochrane review of Ganoderma lucidum (Reishi mushroom) for cancer treatment (Jin et al., Cochrane Database Syst. Rev., CD007731 (2016) Abstract) concluded that “Our review did not find sufficient evidence to justify the use of G. lucidum as a first-line treatment for cancer. It remains uncertain whether G. lucidum helps prolong long-term cancer survival. However, G. lucidum could be administered as an alternative adjunct to conventional treatment in consideration of its potential of enhancing tumour response and stimulating host immunity.”
April 7 – A story by the Nightingale Collaboration reported a decline of 95% in homeopathic prescriptions by the British National Health Service over the last 20 years. “This will not be welcomed by homeopaths who businesses rely on the (undeserved and unearned) legitimacy that being provided on the NHS lends to homeopathy, but it's the inevitable result of the their own failure to provide robust evidence of its efficacy.”
April 14 Writing on Naturopathic Diaries, Britt Hermes argued that “Naturopathic Pediatrics is Not Safe.” Training is insufficient; “it is entirely possible that a naturopathic student could graduate without seeing any pediatric patients.” Moreover, some naturopathic training includes anti-vaccine material as well as pseudoscience such as homeopathic remedies.
April 16 – On Skepsis Blog, J.W. Nienhuys summarized a 1943 dissertation by David de Jongh on homeopathy. de Jongh analyzed the historical foundations of homeopathy and how its principles and practices changed over time. “It has become clear that the homeopathic theory is a hotchpotch of unproved, improbable and incorrect opinions, and as a whole it undoubtedly can be called objectionable. Furthermore, there is no intimate connection between the theory and the practice of the system.”
April 18-19 – Two Cochrane reviews dealt with acupuncture. Smith and others (Cochrane Database Syst. Rev., CD007854 (2016) Abstract) concluded that “There is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea.” Linde and others concluded that “The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches,” but since the quality of the evidence was moderate or low, further trials are needed (Cochrane Database Syst. Rev., CD007587 (2016) Abstract).
April 23 – Stephen Barrett published “A Skeptical Look at Dr. Nelson Kraucak and Sequenced Amino Acid Modulation Therapy” on Quackwatch. The method uses “solutions of peptides” (polymers of several amino acids) “that are supposed to be injected into a patient’s muscle at monthly intervals.” He concluded, “I am aware of no published evidence that SAM is safe and effective for the treatment of any health problem.”
Additions to Earlier Months
October, 2014 – David Gorski criticized the trend toward integrative oncology, the use of complementary and alternative medicine in cancer care (Nature Rev. Cancer 14, 692-700 (2014) Abstract). “Integrative oncology integrates unscientific practices into science-based medicine, and, worse, the pseudoscience at the heart of so many of the non-biologically based subdivisions of CAM is so pervasive, so embedded in the very fabric of integrative oncology, that it opens the door to clinical trials of dubious efficacy and the wasting of time and resources.” A response was published (Greenlee et al., Nature Rev. Cancer 15, 165 (2015)), stating that the article “selectively focuses on practices with the weakest mechanistic evidence base (for example, homeopathy and reiki), and, by doing so, ignores the current body of evidence that demonstrates where integrative oncology can be the most useful” and that Gorski “fails to acknowledge the public health significance of integrative oncology” with reference to usage and costs invested by patients. In response (Nature Rev. Cancer 15, 165-166 (2015)), Gorski replied that homeopathy and reiki illustrate “how integrative oncology frequently discounts infinitesimally low prior plausibility and how that oversight leads to the integration of pseudoscience into oncology.” Moreover, these methods “are offered to cancer patients in many academic medical centres.”
January, 2015 – Cooper and others reviewed “The effect of Omega-3 Polyunsaturated Fatty Acid Supplementation on Emotional Dysregulation, Oppositional Behaviour and Conduct Problems in ADHD” (J. Affect. Disord. 190, 474-482 (2015) Abstract). They concluded that moderate to large effects are not present, so this would not be a general treatment, but that there was evidence suggesting effectiveness in subgroups of children.
August, 2015 – C-reactive protein is a marker of inflammation and may predict chronic diseases, including heart disease. A review by Saboori and others (Eur. J. Clin. Nutr. 69, 867-873 (2015) Abstract) concluded that vitamin E supplementation may have a beneficial role in reducing C-reactive protein levels.
September, 2015 – Cicero and Colletti performed a meta-analysis of nutraceuticals and blood pressure control (High Blood Press. Cardiovasc. Prev. 22, 203-213 (2015) Abstract). They concluded that a “relatively large body of evidence support the use of potassium, l-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin, and aged garlic extract. However there is a need for data about the long-term safety of a large part of the above discussed products.”