Best of the blogs, March – on Science-Based Medicine, Jann Bellamy discussed health savings accounts and how they can be abused to give taxpayer support of unscientific methods. She also denounced CVS selling homeopathic remedies. Scott Gavura discussed melatonin supplements. He notes that “the clinical evidence to support the use of melatonin is really not all that impressive.” Amounts in supplements may be much less or much more than what is stated on the label. Some are adulterated with serotonin, which “could potentially lead to serious adverse reactions.” David Gorski wrote about sanctions imposed on alternative cancer doctor Stanislaw Burzynski: “sadly, they were not enough.” (See also Respectful Insolence item below.) He discussed the extent to which the Accreditation Counsel for Continuing Medical Education was cracking down on unscientific courses, and the larger problem of medical school curricula incorporating such ideas. He was skeptical of the claim (presented in the book The Boy in 7 Billion), that cannabis oil cured a boy of cancer. Harriet Hall found no reason to think that various magnet products provide health benefits. She provided an “Update on Testosterone Supplementation”: it “is a legitimate treatment for properly-diagnosed androgen deficiency, but it is being overprescribed by doctors who make exaggerated claims for it. New evidence clarifies its modest benefits and worrisome risks.” She discussed the tragic effects of stem cell treatments for macular degeneration performed outside of clinical trials. David Weinberg also discussed this case in an April 15 post: “it turns out there was a body of literature that predicted the tragic outcomes, but did not seem to have informed patient care.” Steven Novella discussed the conspiracy theories of anti-vaccine activists. He reported on how a “CBC News investigation reveals the common pseudoscientific claims and quackery of Manitoba chiropractors.” “Far from moving toward being more science-based, chiropractors (as a profession) continue to embrace pseudoscience, or at least do not oppose it within their own profession. Their efforts are aimed not at becoming more science-based and legitimate, but at expanding their scope of practice.”
On Respectful Insolence, “Orac” published another critique of the Cleveland Clinic (see our Jan.-Feb. 2017 News), this time focusing on functional medicine. He analyzed the idea that saunas can activate longevity genes. Another post dealt with the murder of a Kentucky naturopath, allegedly by the husband of the victim of a quack cancer remedy; naturopaths blame the tragedy on the lack of licensure in Kentucky. He attacked the spread of "battlefield acupuncture" in the military and VA medical system.
Edzard Ernst discussed a paper showing that a significant fraction of physicians practicing integrative medicine hold anti-vaccination views. He analyzed claims for "Foods that will naturally clean your arteries." “As far as I know, there is no good evidence for the claim that any of these 20 foods will clear arteriosclerotic arteries. There is some evidence for fish oil and some for green tea to reduce the risk of cardiovascular disease. But surely, this is quite a different matter than reversing atherosclerotic plaques.” He criticized a comparative study of three types of acupuncture for tinnitus: “Neither of the three treatments tested in this study have been previously proven to work. Therefore, it is quite simply nonsensical to compare them. Comparative studies are indicated only with therapies that have a solid evidence-base…POORLY DESIGNED CLINICAL TRIALS ARE UNETHICAL AND NEVER LEND THEMSELVES TO MEANINGFUL CONCLUSIONS.” He critiqued a review on aromatherapy for depression: “Given that half of the trials were of poor quality… many totally failed to control for placebo-effects, I think that calling aromatherapy an effective therapeutic option for the relief of depressive symptoms is simply not warranted. In fact, it is highly misleading and, given the fact that depression is a life-threatening condition, it seems unethical and dangerous.” He addressed a study, and accompanying press coverage, concerning yoga for depression: “The observed effects might have nothing at all to do with the specific intervention tested. The trial was poorly designed…The trial lacked a proper control group. It was published in a journal that has no credibility…The press-release is irresponsibly exaggerated. The authors have little incentive to truly test their therapy and seem to use research as a means of promoting their business.” He commented on a review of alternative therapies for premature ejaculation. The review “demonstrates that alternative therapies are being touted and occasionally tested for even the most unlikely conditions, the quality of the studies is generally too poor to justify the research (particularly in an area as intrusive as PE), clinical trials often seem to be used not for finding answers but for promotion, in alternative medicine, trialists regularly violate research ethics by failing to report adverse effects.” He critiqued a method called bioresonance, which allegedly cures addictions. “Bioresonance is, as far as I can see, complete baloney.” He discussed a review that gave a positive evaluation of therapeutic touch: “This review is badly designed and poorly reported. Crucially, its conclusions are not credible.”
March – A review by Chiu, Hsieh, and Tsai concluded that “Acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain” (Eur J Cancer Care (Engl). 2017 Mar;26(2) Abstract).
March – Acupuncture was also the subject of a review by Dimitrova, Murchison, and Oken (J Altern Complement Med. 2017 Mar;23(3):164-179 Abstract), in this case for peripheral neuropathy. The authors concluded, “Acupuncture is beneficial in some peripheral neuropathies, but more rigorously designed studies using sham-acupuncture control are needed to characterize its effect and optimal use better.”
March – Rojas-Fernandez and Tyber reviewed nutritional supplements for preventing progression of age-related macular degeneration (Ann Pharmacother. 2017 Mar;51(3):264-270 Abstract). They wrote, “The weight of the evidence supports using genetic testing to guide selection of ocular vitamin use. This approach will avoid using supplements that could speed the progression of AMD in vulnerable patients, avoid using supplements that will have little to no effect in others, and result in appropriately using supplements in those that are likely to derive meaningful benefits.”
March 1 – A meta-analysis on the use of St. John’s wort for depression concluded, “For patients with mild-to-moderate depression, St John's wort has comparable efficacy and safety when compared to SSRIs [selective serotonin reuptake inhibitors]. Follow-up studies carried out over a longer duration should be planned to ascertain its benefit” (Ng et al. J Affect Disord. 2017 Mar 1;210:211-221 Abstract).
March 7 – An article by Ross, Blau and Sheridan in STAT was entitled “Medicine with a side of mysticism: Top hospitals promote unproven therapies.” “…Hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing.” Steven Novella, quoted extensively in the article, offered addition comments on Science-Based Medicine. Orac also discussed the article on Respectful Insolence, noting that “There’s a lot more quackery in academic medical centers than even Ross, Blau, and Sheridan realize.”
March 7 – Liperoti and others reviewed “Herbal Medications in Cardiovascular Medicine” (J Am Coll Cardiol. 2017 Mar 7;69(9):1188-1199 Abstract). They concluded, “Use of herbal medications for the treatment of cardiovascular disease is not supported by scientific evidence. Although most of the herbs demonstrate an effect on biological mechanisms associated with cardiovascular disease, available clinical studies are limited in sample size and do not show any impact on relevant clinical outcomes…In addition, potential relevant side effects, including increased risk of drug interactions, have been described, and the possibility of contamination or substitution with other medications is a concern.”
March 7 – Stephen Barrett has posted the article “iTOVi Scanning: Another Test to Avoid” on Device Watch. This is yet another device that uses electrical skin resistance to supposedly determine health problems. The claims are preposterous; Barrett concludes that the device has “no proven practical value.”
March 9 – Nelson and others published a review entitled “The Essential Medicinal Chemistry of Curcumin” (an active ingredient in turmeric) (J Med Chem. 2017 Mar 9;60(5):1620-1637 Paper). The authors point out that the chemical characteristics of curcumin make it likely to give misleading results in laboratory tests, but unlikely to be a good candidate for developing a useful drug. “The likely false activity of curcumin in vitro and in vivo has resulted in >120 clinical trials of curcuminoids against several diseases. No double-blinded, placebo controlled clinical trial of curcumin has been successful.” Novella discussed the article in NeuroLogica. (See also items below related to a death from administration of intravenous turmeric.)
March 13 – Stephen Barrett published “A Skeptical Look at Chris Wark and His “Healing Journey” on Quackwatch. Wark sells a “coaching program” with advice for treating and preventing cancer. According to Barrett, “He promotes a wide variety of unproven methods and exaggerates the risks of standard treatment. His advice against taking chemotherapy will put some cancer patients at unnecessary risk.”
March 16 – A Cochrane Collaboration review of vitamin C for prevention of heart disease (Al-Khudairy et al., Cochrane Database Syst Rev. 2017 Mar 16;3:CD011114 Abstract) concluded that “Currently, there is no evidence to suggest that vitamin C supplementation reduces the risk of CVD in healthy participants and those at increased risk of CVD, but current evidence is limited to one trial of middle-aged and older male physicians from the USA.”
March 27 – In an article in Forbes, Hermes discussed the death of a woman from intravenous turmeric administered by a naturopath. The “death should not be seen as an isolated incident at the hands of a rogue practitioner. Naturopathic doctors across California advertise intravenous therapies with dangerous substances, including hydrogen peroxide, ultraviolet light and ozone gas. And their descriptions of these substances delivered directly into the blood raise serious concerns about their medical training and ability to serve as state-licensed doctors.” “Orac” also discussed the case on Respectful Insolence. (See below for further discussions of the matter.)
Best of the blogs, April – on Science-Based Medicine, Jann Bellamy gave her latest update of “Legislative Alchemy,” the efforts of naturopaths to expand their scope of practice in at least 16 states. She also described how the FDA issued a warning letter concerning thermography for breast cancer detection. Amy Campbell found no evidence that quenepa, an alleged “miracle superfood,” has health benefits. Moreover, “The one and only paper on the possible health benefits of quenepa warns that ‘the fruit pulp may have toxicological effects when consumed excessively or during periods of growth or high iron requirements’.” Mark Crislip discussed his experiences dealing with patients that had also been seeing naturopaths. He also provided a critique of a meta-analysis (published in JAMA) of spinal manipulation (which is usually done by chiropractors) for low back pain. He found numerous flaws in the studies on which the analysis was based. Edzard Ernst also discussed the meta-analysis. Harriet Hall examined Vital Stem, “a dietary supplement mixture that supposedly reverses the changes of normal aging by increasing the body’s production of stem cells. We can’t know if it works, because it hasn’t been tested.”
On Respectful Insolence, “Orac” discussed the case of Belle Gibson, who claimed to have treated her own cancer and then “used her story to build a ‘wellness’ empire”; her claims about her cancer appear not to be true. He reported that cancer doctor Stanislaw Burzynski “is back in business attracting families of dying children with false hope and inducing them to pay hundreds of thousands of dollars for his ANP treatment, which has never been shown to be effective for brain cancers or any cancer and is known not to be safe…Basically, the regulatory and legal system, which is supposed to protect patients from predators like Burzynski, has failed at every level.” Several posts dealt with the death of a patient of a naturopath from intravenous curcumin (a component of turmeric). According to the April 11 post, the case demonstrates “Why licensed naturopaths are no safer than any other naturopath.” The April 12 post described the response by naturopaths to the incident: “Naturopaths circle the wagons and the chair of the Naturopathic Medical Committee of California looks for dirt on conventional medicine.” The April 25 post explained “Why state licensure doesn’t protect patients from naturopathic quackery.” Steven Novella also discussed the case on Science-Based Medicine, emphasizing the lack of evidence for curcumin (see March 9 item above). “This episode exposes what is clear from any review of naturopathic practice – they base their treatments on a pathetically low standard of evidence…They do not police their own profession to maintain a standard of care. Naturopaths are what you get when you abandon science-based medicine, an eclectic hodge-podge of nonsense, worthless, and sometimes harmful treatments.”
Edzard Ernst discussed a review on the risks of spinal manipulation (usually performed by chiropractors); he notes that the risks “are likely to be real and serious.” He found no evidence that jackfruit can kill cancer, and wondered “How many fell for the scam? How many gave up their conventional cancer treatments and used jackfruit instead?” He discussed the flaws in two meta-analyses of acupuncture for alcohol dependence; “the efficacy of acupuncture remains unproven. And this means that we should not employ or promote it for routine care.” Another review that he found unconvincing concerned tui na (a massage technique from traditional Chinese medicine) for radiculopathy. The included studies “lack scientific rigour,” and all “originate from China where reliability seems to be a serious problem.” He described a study of acupuncture for nausea, and pointed out that the authors did not state the obvious conclusion: since true and sham acupuncture gave the same results, there were no significant effects of acupuncture beyond placebo. Three posts dealt with homeopathy. On April 11 he discussed a large retrospective cohort study showing that the homeopathic remedy Influenzinum did not prevent the flu. The April 14 post concerned a new meta-analysis that “confirms that the clinical effects of homeopathic remedies do not differ from placebos.” The April 18 post examined the supposed three best studies in support of non-individualized homeopathy; he found the evidence in favor to be “rubbish.” He noted that a study of acupuncture for asthma is yet another example of the “A+B versus B” study, guaranteed to produce a positive result because of the placebo effect. Another highly flawed study was one of shiatsu for headaches. With no placebo group, the results were “uninterpretable,” and the sample size was small to make any conclusions of safety.
April – Avery and others published “An examination of structure-function claims in dietary supplement advertising in the U.S.: 2003-2009” (Prev Med. 2017 Apr;97:86-92 Abstract). They found that many advertisements made claims that were “unsubstantiated in the medical literature.” Ads often included seals of approval that may mislead consumers into thinking the validity of the claims were endorsed by independent organizations, when in fact they were only verifying good manufacturing practices.
April – A review by Taylor and Taylor-Piliae (Complement Ther Med. 2017 Apr;31:100-108 Abstract) concluded that “Tai Chi is likely safe and may provide physical and psychosocial benefits in individuals with Multiple Sclerosis. Further research is needed using more rigorous study designs to assess the benefits of Tai Chi…”
April 1 – Zhao and others published “The Long-term Effect of Acupuncture for Migraine Prophylaxis” (JAMA Intern Med. 2017 Apr 1;177(4):508-515 Abstract). They concluded that “Among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list.” However, it should be noted that the study did not actually use acupuncture; it used electroacupuncture, which is a distinct form of stimulation. In an associated Commentary by Gelfand (JAMA Intern Med. 2017 Apr 1;177(4):516-517 First page preview), several weaknesses in the study were pointed out, notably the difficulty in blinding participants and acupuncturists.
April 1 – Deane and coworkers published “’Nutraceuticals’ in relation to human skeletal muscle and exercise” (Am J Physiol Endocrinol Metab. 2017 Apr 1;312(4):E282-E299 Abstract). They concluded that “Although it is extremely unlikely that a single nutraceutical will prove to be a ‘magic bullet,’ it is clear that certain nutraceuticals, under certain conditions, do indeed possess ergogenic potential. Of the nutrients discussed herein, strong evidence exists for leucine, HMB [hydroxyl β-methylbutyrate], and Cr [creatine] for muscle mass, leucine and HMB for protein metabolism, carnitine for fuel metabolism and leucine, and HMB, carnitine, Cr, nitrates, and β-alanine for athletic (strength or endurance) performance. Further empirical in vivo evidence is required to firmly establish the currently emerging roles of VitD [vitamin D], UA [ursolic acid], and PA [phosphatidic acid] for promoting muscle mass and n-3 PUFA [polyunsaturated fatty acids], UA, and PA for muscle protein metabolism.”
April 21 – Marketers of the NutriMost Ultimate Fat Loss System settled charges by the FTC that their claims “were deceptive and not supported by scientific evidence” Press release. “What the defendants allegedly failed to say, however, was that to achieve the weight loss advertised, users would have to follow a restrictive diet, including a very low-calorie diet of about 500 calories a day.”
April 25 – The FDA “posted warning letters addressed to 14 U.S.-based companies illegally selling more than 65 products that fraudulently claim to prevent, diagnose, treat or cure cancer. The products are marketed and sold without FDA approval, most commonly on websites and social media platforms” News release. Orac discussed the actions in his April 27 Respectful Insolence post. He notes that “apparently little has changed” in the 9 years since an even larger FDA crackdown.
Additions to Earlier Months
June, 2016 – Kucharz and others reviewed glucosamine for knee osteoarthritis (Curr Med Res Opin. 2016 Jun;32(6):997-1004 Paper). The authors note that favorable results have been obtained using a patented crystalline glucosamine sulfate formulation, whereas other formulations have not shown significant benefits.
August 24, 2016 – A review by Cadegiani and Kater (BMC Endocr Disord. 2016 Aug 24;16(1):48 Paper) concluded that “This systematic review proves that there is no substantiation that ‘adrenal fatigue’ is an actual medical condition. Therefore, adrenal fatigue is still a myth.”