Best of the blogs, May – on Science-Based Medicine, Mark Crislip discussed flaws in a New York Times article supportive of chiropractic for back pain. He published “An Evaluation of a Naturopathic Education FAQ.” Naturopathic education “appears appealing until you look below the surface and find average students receiving little quality education or training in the real medicine and extensive training in pseudoscience.” Scott Gavura refuted the claims of Anthony Williams, who calls himself a "Medical Medium" receiving advice from the spirit world, and who focuses on alleged thyroid problems. David Gorski discussed outbreaks of measles in Somali communities in Michigan and Minnesota as a result of propaganda from antivaccine activists (the Minnesota outbreaks were also discussed in a Respectful Insolence column and a Washington Post story). He refuted the claim that “medicine has a bias against acupuncture, holding it to a higher standard of evidence than conventional medical interventions.” He criticized an FDA proposal “ that doctors learn about chiropractic care and acupuncture as therapies that might help patients avoid opioids.” He deplores how BMJ has joined some other medical journals in publishing “quackery in the form of ‘integrative medicine’” with little skepticism, focusing on reviews related to chronic pain and headache. Edzard Ernst also discussed the pain and headache reviews. Harriet Hall reviewed cases of deaths or permanent impairment of children due to medical neglect. She provided an update on Protandim, a mixture of herbal supplements marketed to treat and prevent numerous diseases. The FDA sent a warning letter related to these violations. There is still no good evidence that the product is useful. Another post defended the Wikipedia article on acupuncture as properly skeptical. She found reasons to be skeptical of a new study finding chondroitin sulfate to be as effective in treating arthritis as celecoxib. “The new study must be considered along with previous research. Some of the previous studies used the same or even a higher dose of the same CS formulation and found no improvement of pain. The positive studies were funded by CS manufacturers, raising the issue of possible bias. The mechanism of action is questionable.” On the other hand, Edzard Ernst wrote, “In my view, CS can be considered an evidence-based option in the management of OA.” Steven Novella criticized the New York Times for a “credulous” article on the book The Other Side of Impossible. “Their business of selling fake and dubious treatments is dependent on first selling a narrative in which reality is turned upside down. Brody and the NYT have just sold that narrative to their readers, and quacks everywhere are thankful.” “Orac” had similar comments in a Respectful Insolence post.
On Respectful Insolence, “Orac” reviewed updated clinical guidelines for breast cancer from the Society for Integrative Oncology. “Basically, these guidelines were even more unnecessary and pointless than the first set of guidelines published in 2014. It’s not as though clinical studies have advanced knowledge enough to justify a new set of guidelines, and these guidelines suffer from the same issue that integrative medicine itself suffers from…” He provided an update on the activities of alternative cancer doctor Stanislaw Burzynski. He presented critiques of two “horrendously bad” antivaccination studies May 8 May 9. Another post dealt with an attempt to justify acupuncture despite its origin in “prescientific vitalism.”
Edzard Ernst noted that the “cracking sound during spinal manipulation” is “much to do about noting…it has no therapeutic value.” He critiqued a study supposedly indicating the benefit of acupressure for knee osteoarthritis; since the results were no better than sham acupressure, “the only correct conclusion is that acupressure is a placebo.” Another critique dealt with a review of homeopathy for allergic rhinitis. He found the suggestion that it might be beneficial “more than a little over-optimistic.” He published an open letter from a Canadian therapist disputing the Clinical Practice Guidelines from the American College of Physicians with respect to acupuncture for back pain. He refuted the claim that only a small portion of “what conventional clinicians do is based on sound evidence.” A new review concludes that trials of spinal manipulation (as performed by chiropractors) do not adequately report adverse effects (giving a misleading impression of safety), in agreement with a 2012 review by Ernst. He took on a site advertising apricot seeds (a source of amygdalin or laetrile) for cancer; “The only thing that matters and the only message relevant for vulnerable patients is this: RESEARCH HAS NOT SHOWN THAT THIS STUFF WORKS FOR CANCER.” Another post analyzed a proposed new definition of the chiropractic subluxation. “Subluxation is not so much a ‘self-perpetuating motor control problem’ as a self-perpetuating money-maker for chiropractors, it seems to me…we have repeatedly been told that chiropractors have all but given up the concept of ‘subluxation’. This is clearly not the case.” He discussed an article that defended a National Health and Medical Research Council (Australia) report that was highly critical of homeopathy.
May – Khan, Samson, and Grover reviewed antioxidant supplements for gastrointestinal diseases (Med Princ Pract. 2017;26(3):201-217 Paper). They concluded that “For Crohn's disease, the supplements for which clear benefits occurred in at least 2 studies were allopurinol, Boswellia serrata (frankincense or shallaki), Artemesia species (wormwood), Tripterygium wilfordii (léi gōng téng), and omega-3 fatty acids. Similar beneficial supplements for ulcerative colitis were allopurinol, Matricaria chamomilla (chamomile), Curcuma longa (curcumin in turmeric), and omega-3 fatty acids. There was also a clear benefit for ulcerative colitis in 2 studies where a multiherbal Chinese medicine preparation and an Ayurvedic medicine preparation were used. For irritable bowel syndrome, there was only a marginal benefit of some of the antioxidant supplements.”
May – Greenlee and others published “Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment” (CA Cancer J Clin. 2017 May 6;67(3):194-232 Abstract). The authors supported the use of a number of integrative therapies, but their inclusion of the pseudoscience of reflexology casts doubt on their scientific rigor. However, they note that “No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment‐related side effects.”
May – Hunter and Hegele published “Functional foods and dietary supplements for the management of dyslipidaemia” (Nat Rev Endocrinol. 2017 May;13(5):278-288 Abstract). They concluded that “Those with good evidence for a biochemical effect on plasma lipid levels include soy protein, green tea, plant sterols, probiotic yogurt, marine-derived omega-3 fatty acids and red yeast rice. Other products such as seaweed, berberine, hawthorn and garlic might confer some limited benefit in certain patient groups…Natural health products marketed at individuals with dyslipidaemia, such as policosanol, guggulsterone and resveratrol, have minimal definitive evidence of a biochemical benefit.”
May – A meta-analysis by MacPherson and others (Pain. 2017 May;158(5):784-793 Paper) concluded that benefits of acupuncture for chronic pain were sustained over one year.
May – D’Onofrio et al. reviewed nutraceuticals for treatment of headaches (Neurol Sci. 2017 May;38(Suppl 1):117-120 Abstract). They noted that “While the evidences for magnesium, riboflavin and butterbur are fairly good, other nutraceutical substances reported inconsistent results…there was insufficient evidence to suggest that feverfew was more effective than placebo.”
May 1 – Kryscio and others published “Association of Antioxidant Supplement Use and Dementia in the Prevention of Alzheimer's Disease by Vitamin E and Selenium Trial (PREADViSE)” (JAMA Neurol. 2017 May 1;74(5):567-573 Paper). In the study, which followed more than 7000 men for over five years, “Neither supplement prevented dementia.”
May 4 – The Federal Trade Commission (FTC) took action against marketers of herbal products for opiate withdrawal Press release. The commission charged that “the withdrawal treatment claims for their ‘Withdrawal Ease’ and ‘Recovery Ease’ products were false or unsupported by scientific evidence.”
May 8 – Truth in Advertising published an Article on “Goop, Gwyneth Paltrow’s Wellness Empire.” The article notes Goop’s “questionable health claims” and marketing of products for conditions not recognized by the medical community.
May 16 – Millstine, Chen, and Bauer reviewed “Complementary and integrative medicine in the management of headache” (BMJ. 2017 May 16;357:j1805 Abstract). The authors proposed that several types of alternative medicine were useful for treatment of headache. However, they noted that the quality of the evidence “is generally low and occasionally moderate.”
May 23 – Maldarelli wrote “Do probiotics actually do anything? The tiny bugs are marketed as a quick fix, but the body of evidence is miniscule.” “A combination of misleading marketing and media hype keep us clambering for probiotics in spite of their ineffectiveness.”
May 26 – Boser investigated Neurocore, a “brain training” company that employs neurofeedback. Boser concluded, “By wrapping weak science in sleek packaging, by promising something that it cannot fully deliver, Neurocore offers false hope to people who need honest help.”
Best of the blogs, June – on Science-Based Medicine, Jann Bellamy continued to describe legislative initiatives by naturopaths: “Naturopaths want the same scope of practice as MDs and DOs, allowing them to make important medico-legal judgments that put life, liberty and property at risk.” Scott Gavura gave an updated version of his post on "adrenal fatigue," a “fake disease.” David Gorski discussed the closing of two integrative medicine centers, but feared that this was only a temporary slowing of the infiltration of unscientific methods into medicine. He also argued against claims that mind-body practices can “reprogram” our DNA. Harriet Hall provided a critique of a study offered in support of On Guard, a mixture of essential oils marketed by DōTERRA. The product supposedly is useful for treating the flu, but Dr. Hall found the study to be “worthless except as a suggestion for further research.” Another article was entitled "Consumer Reports Misses the Boat on Back Pain". “They seem not to understand the difference between anecdotes and data, between a popularity contest and a controlled scientific study. These articles may do harm by encouraging readers to try treatments that don’t work and by suggesting that it is reasonable to prioritize testimonial evidence over scientific studies.” Samuel Homola wrote on "Chiropractic Subluxation Theory": “Legally licensed, unbridled subluxation-based chiropractors who offer unproven treatment for a broad scope of health problems endanger public health, stigmatize appropriate use of spinal manipulation, and deter development of chiropractic as a legitimate back-care specialty.” Clay Jones discussed several topics in his post on "Quackery for Kids".
On Respectful Insolence, “Orac” discussed the case of a cancer patient who chose alternative methods: the “cancer is progressing, and the quackery didn’t stop it.” He provided a critique of a study on the use of acupuncture for pain in the emergency department: “So, basically what we have here is a pragmatic non-inferiority study that is only single blinded that purports to find no difference between acupuncture and pharmacotherapy for several different kinds of pain with different etiologies…The lack of full double-blinding easily explains the positive result of the trial as very likely due to placebo effects…” His June 21 post was entitled “Deaths and complications due to treating the fake disease known as 'chronic Lyme disease'” (not to be confused with real Lyme disease). The post discusses a report by Marzec and others (MMWR Morb Mortal Wkly Rep. 2017 Jun 16;66(23):607-609 Paper). On June 23, he took on another ridiculous product marketed by Gwyneth Paltrow’s Goop: "Body Vibes", stickers that allegedly “rebalance the energy frequency in our bodies.” His June 26 post was entitled “You can’t have naturopathy without antivax”: “The high prevalence of antivaccine views and very low support for vaccination show that. Antivaccine views are baked into naturopathic education and philosophy.”
Edzard Ernst asked the question, “Are alternative practitioners fear-mongers?” Another post was entitled “How to protect yourself from bogus claims about so-called alternative medicine.” Questions to ask include: Is the claim plausible? What is the evidence for the claim? Who is behind the claim? Where was the claim published? Is there money involved? He criticized a “Recklessly stupid TCM-promotion by the ‘Daily Mail,’” which claimed that “Traditional Chinese medicines could help prevent heart disease and the progression of pre-diabetes, according to research.” Ernst stated that the article is “misleading to the point of being outright dangerous… Chinese research is everything but reliable; there are practically no Chinese TCM-trials that report negative results. Furthermore, the safety of Chinese herbal preparations is as good as unknown and they are often contaminated with toxic substances as well as adulterated with synthetic drugs…the trial evidence is often of such poor quality that it would be a dangerous mistake to trust these findings.” Another critique dealt with the claim that homeopathy can be explained by nano-particles. “If the ‘nano-theory’ were true (which I doubt very much), it totally fails to provide an explanation as to how homeopathy works. This explanation would still need to be identified for each of the thousands of different remedies in separate investigations.: (See also our article: Nanoparticles). He addressed claims that Cannabis can cure cancer. “So, the evidence suggests that Cannabis might be helpful in the supportive and palliative treatment of cancer by reducing some of the symptoms from which cancer patients may suffer. But there is no good evidence to show that it can change the natural history of any type of cancer.” He discussed two studies on the use of garlic to treat infections. “The two recent studies above are, I think, a good start. They are far from perfect but their findings are nevertheless mildly encouraging.”
June – A review by Sathe and others (Pediatrics. 2017 Jun;139(6). pii: e20170346 Abstract) concluded that “There is little evidence to support the use of nutritional supplements or dietary therapies for children with ASD [autism spectrum disorder].”
June – Dossett, Cohen, and Cohen reviewed “Integrative Medicine for Gastrointestinal Disease” (Prim Care. 2017 Jun;44(2):265-280 First page preview). They concluded that “Promising results have been achieved with mind-body therapies, acupuncture, diet, and some dietary supplements, including probiotics and specific herbs in distinct gastrointestinal conditions.”
June – Bakhiya and others discussed possible health risks from two compounds used in sports nutrition: synephrine (extracted from Citrus aurantium) and hydroxycitrate (HCA), found in Garcinia cambogia (Mol Nutr Food Res. 2017 Jun;61(6) Abstract).
June 13 – Kreider and others authored the “International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine” (J Int Soc Sports Nutr. 2017 Jun 13;14:18 Paper). They concluded that “creatine can not only improve exercise performance, but can play a role in preventing and/or reducing the severity of injury, enhancing rehabilitation from injuries, and helping athletes tolerate heavy training loads. Additionally, researchers have identified a number of potentially beneficial clinical uses of creatine supplementation.”
June 13 – “Safety of Acupuncture: Overview of Systematic Reviews” was published by Chan and others (Sci Rep. 2017 Jun 13;7(1):3369 Paper). They found that “Minor and serious AEs [adverse events] can occur during the use of acupuncture and related modalities, contrary to the common impression that acupuncture is harmless. Serious AEs are rare, but need significant attention as mortality can be associated with them.”
June 18 – Former naturopath Britt Hermes described a program created for her former practice in “The anatomy of a detox scam.” “The entire concept of detoxification in alternative medicine is bogus…The harm for patients is not just wasted money and time. Naturopaths bring their patients emotional damage by endlessly treating health problems with detoxes and other gimmicks.”
June 26 – A Webinar presentation by William London was entitled “Talking Public Health: ‘Health Freedom’ Movement Versus Consumer Protection.” Topics include: “1) Efforts by the ‘health freedom movement that undermine progress in consumer health protection and sound public health initiatives; 2) Basic history of consumer protection legislation; and 3) How ‘quackery’ is a pervasive societal and population health scandal that is often neglected by public health professionals.”
June 28 – Two papers in JAMA dealt with acupuncture. In the first, which actually was of electroacupuncture, not genuine acupuncture, favorable results were obtained for treating stress urinary incontinence (Liu et al. JAMA. 2017 Jun 27;317(24):2493-2501 Paper). The second found that acupuncture did not increase fertility in women with polycystic ovary syndrome (Wu et al. JAMA. 2017 Jun 27;317(24):2502-2514 Paper). An editorial by Briggs and Shurtleff (JAMA. 2017 Jun 27;317(24):2489-2490 First page preview) discussed the studies. “Generally, the clinically meaningful benefit of acupuncture is limited to subjective outcomes, particularly conditions associated with pain…” This is consistent with placebo effects providing at least some of the benefit.
Additions to Earlier Months
August 2016 – Reilly published “The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad” (J Pediatr. 2016 Aug;175:206-10 Paper). Excerpts: “For individuals who do not have CD [celiac disease], wheat allergy, or NCGS [nonceliac gluten sensitivity], the latter which has been described in adults but for which there is little evidence in children, there are no data supporting the presumed health benefits of a GFD [gluten-free diet]. 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…” “There is no evidence that processed gluten-free foods are healthier than their gluten-containing counterparts…”
January 2017 – Aronson wrote “Defining 'nutraceuticals': neither nutritious nor pharmaceutical” (Br J Clin Pharmacol. 2017 Jan;83(1):8-19 Paper). Excerpts: “There is no internationally recognized definition of a nutraceutical, and various confusing and contradictory definitions have appeared. All of the proposed meanings are covered more precisely by other terms.” The U.S. definition of dietary supplement “is based on unwarranted assumptions of efficacy…the final catch‐all clause quoted above opens the door to inappropriate description of any other substance as a dietary supplement: if you label it as a dietary supplement, it is one!”
January 17, 2017 – A review by Schwingshackl and others (Adv Nutr. 2017 Jan 17;8(1):27-39 Paper) concluded that “we found insufficient evidence to support the use of dietary supplements in the primary prevention of cause-specific death, incidence of CVD [cardiovascular disease], and incidence of cancer.”
January 17, 2017 – “In a blog for non-medical readers, Lynda Ware, Senior Fellow in General Practice with Cochrane UK, gives a round up of twelve Cochrane systematic reviews on remedies for the common cold.” Excerpts: “Taking regular Vitamin C did not reduce the incidence of colds in the general population, although there was a modest reduction in the duration and severity of symptoms… Trials looking at taking high dose Vitamin C at the onset of cold symptoms showed no consistent effect on the duration and severity of symptoms and more research is needed to clarify these findings.” “A Cochrane review (2014) showed that some Echinacea products may be more effective than placebo in treating colds but the overall evidence for clinically relevant effects was weak. There was some evidence of a small preventative effect.” “A single trial with 146 participants showed that taking garlic every day for three months might prevent occurrences of the common cold but the evidence was of low quality and more research is needed to validate this finding. (Cochrane review 2014.)” Edzard Ernst commented on the article.
February 15, 2017 – An analysis of 31 melatonin supplements found that the melatonin content varied considerably, with some containing nearly six times the label value (J Clin Sleep Med. 2017 Feb 15;13(2):275-281 Paper). Moreover, 26% contained serotonin, which is a more serious concern in case of overdose.