MAY-JUNE 2013 NEWS

May - A study by Koeth and others (Nature Medicine 19, 576-585 (2013) Abstract) explored the means by which carnitine leads to atherosclerosis News story. Although it is a normal chemical made by the body, carnitine is also found in red meat. In the intestine, dietary carnitine is converted by bacteria to other compounds that can increase atherosclerosis. Carnitine is also found in high levels in some dietary supplements, such as energy drinks. A New and Views story by Bäckhed (pp. 533-534) discusses the study.

May - A "Tools for Practice" summary by Kolber, Tennant, and Nickonchuk (Canadian Family Physician 59, 503) was entitled “Vitamins for Age-Related Macular Degeneration Demonstrate Minimal Differences.” The authors concluded that “Ocular vitamins only slow visual loss in AMD patients with intermediate and severe retinal findings...Progression to advanced AMD is rare in patients with minimal AMD, and ocular vitamins do not prevent AMD in those without AMD. Components of ocular vitamins are potentially harmful and should be used only in selected patients.”

May 1 - Two papers in Am. J. Clin. Nutr. explored effects of omega-3 fatty acids (such as found in fish oil). Xin, Wei, and Li analyzed previous clinical trials and concluded that fish oil supplements have a favorable effect on heart rate variability, and thus may help protect against dangerous heart arrhythmia (97, 926-935 (2013) Paper). Stonehouse and others performed a trial of docosahexaenoic acid (DHA) supplements and cognitive performance (97, 1134-1143 (2013) Paper). In healthy young adults having low dietary intake of omega-3 fatty acids, the supplements were found to improve some measures of memory and reaction time. However, an Editorial by Dangour and Allen (pp. 909-910) expressed reservations concerning the fact that the primary endpoint was apparently not specified prior to the study; with many outcomes being measured, some could appear to be significant just by chance.

May 7 - The U.S. Preventive Services Task Force has issued recommendations for vitamin D and calcium supplements to prevent fractures (Moyer, Ann. Intern. Med. 158, 691-696 (2013) Paper Summary for patients ). The recommendations varied depending on dose and type of individual. For men and premenopausal women, there was insufficient evidence to make a recommendation. For postmenopausal women, lower doses (400 IU or less of vitamin D3 and 1000 mg of calcium per day) provided no benefit. For higher doses, evidence is “insufficient to assess the balance of benefits and harms.” An Editorial by Nestle and Nesheim (pp. 701-702) discusses the recommendations.

May 15 - Results from the Age-Related Eye Disease Study 2 (AREDS2) were reported (JAMA 309, 2005-2015 (2013) Paper). Subjects were at risk for advanced age-related macular degeneration, and were taking the AREDS formulary of antioxidant vitamins and minerals. Addition of lutein plus zeaxanthin; DHA plus eicosapentaenoic acid (EHA); or the combination of these “did not further reduce risk of progression to advanced AMD.”

May 18 - The American Academy of Orthopaedic Surgeons issued an “Evidence-Based Guideline” for treatment of osteoarthritis of the knee. Among the recommendations were: “We cannot recommend using acupuncture,” based on lack of efficacy in five high- and five moderate-strength studies; and “We cannot recommend using glucosamine and chondroitin...there is essentially no evidence that minimum clinically important outcomes have been achieved compared to placebo, whether evaluated alone or in combination.”

May 31 - A Cochrane Collaboration Review of acupuncture for treating fibromyalgia indicated some benefits of acupuncture, especially electroacupuncture, but some effects were no greater than when sham acupuncture was used.

May 31 - Another Cochrane Review dealt with topical herbal therapies for osteoarthritis. Benefits were found for Arnica and comfrey but not for Capsicum.

June - Anesthesia and Analgesia published pro and con editorials concerning acupuncture. In the former, Wang and others (116, 1356-1359 (2013) Paper) concluded that “clinical trials support the efficacy of acupuncture in reducing PONV [postoperative nausea and vomiting] and postoperative pain; however, evidence supporting acupuncture as a treatment for chronic pain conditions is mixed.” The con editorial was entitled “Acupuncture is Theatrical Placebo” (Colquhoun and Novella, 116, 1360-1363 (2013) Paper). They wrote, “There is now unanimity that the benefits, if any, of acupuncture are too small to be helpful to patients...It would certainly be odd if a treatment that had been advocated for such a wide variety of conditions turned out to work only for PONV...The best-controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work.”

June - The National Institutes of Health has launched a “Dietary Supplement Ingredient Database,” which “provides estimated levels of ingredients in dietary supplement products sold in the U.S.” It “is intended primarily for research applications.”

June - A review entitled “Probiotics and Prebiotics in Preventing Food Allergy and Eczema” (Kuitunen, Curr. Opin. Allergy Clin. Immunol. 13, 280-286 (2013) Abstract) concluded that “Prevention of eczema with probiotics seem to work until age 2 years and extended effects until 4 years have been shown in high-risk for allergy cohorts. Effects are strain-specific, with L. rhamnosus showing the most consistent effects...”

June 1 - Colquhoun has published an Essay, “If a Medical Cure Looks Too Good to Be True, It Probably Is.” He notes that for a consumer to find out “what’s right and what’s exaggerated,” “an army of bloggers has arisen, who quickly dissect false and exaggerated claims.” Some examples of reliable sources are included.

June 8 - A Cochrane Review stated: “We found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms.”

June 13 - An Article by Palmer critiques some aspects of traditional Chinese medicine (TCM) as it is being practiced and researched within China. Some of his points: it is claimed that TCM treatments have few or no side effects, which is false; many of them actually contain conventional medicines; research studies are poor in quality and often do not control for placebo effects.

June 27 – Bellamy, in the Science-Based Medicine blog, has presented “Six Reasons CAM Practitioners Should Not Be Licensed.” These are (quoting from the article):

1. Practice acts grant CAM practitioners a broad scope of practice, including legalization of scientifically implausible and unproven (or disproven) diagnostic methods, diagnoses and treatments.

2. CAM practitioner education is inadequate preparation for the scope of practice permitted.

3. The fox is allowed to guard the henhouse (self-regulation).

4. Mandatory public and private insurance coverage

5. Licensing confers undeserved legitimacy causing public confusion.

6. Licensing decreases important health care consumer protections.