Best of the blogs, November – on Science-Based Medicine, Michael Booth discussed "Positive Psychology and Health." “Propagation of exaggerated or unsubstantiated claims related to the role of positive psychological factors in health inadvertently creates more problems than helpful solutions.” Abby Campbell wrote concerning phenibut, a licensed drug in Russia (but not in the US, where it is classified as a dietary supplement). It is marketed for a variety of supposed psychological benefits. However, “There is no legitimate evidence to support the fact that it works for any of the stated purposes, but there are worrying reports of significant toxicity.” David Gorski provided a critique of German alternative cancer clinics. He again took on "functional medicine": “Basically, FM borrows from the worst tendencies of conventional medicine through its indiscriminate use of dubious lab tests, all in the name of ‘individualization’.” Harriet Hall described an animal study of the analgesic properties of a component the herbal remedy Corydalis as “the right way to study herbal medicines.” She reviewed Edzard Ernst’s new book, Homeopathy: The Undiluted Facts. She critiqued BrainPlus IQ, “a dietary supplement that falls into the category of nootropics, substances that enhance cognition and memory.” However, “There is little evidence that any of the ingredients boost cognitive abilities, and there is no evidence that this particular combination of ingredients does anything. It has not been tested.” Clay Jones critiqued a study supposedly showing the value of homeopathic syrup for treatment of pediatric colds. “…this study was a complete and utter failure. There were no differences in any of the 4 core symptoms compared to placebo.”
On Respectful Insolence, “Orac” devoted two posts to Deepak Chopra. On Nov. 3 he criticized medical groups for inviting Chopra to be a keynote speaker. Chopra responded, and on Nov. 7 Orac provided a rebuttal. He criticized the proposal to carry out more pragmatic trials
of complementary and alternative methods. “The reason they’re inappropriate for CAM, though, is because pragmatic trials of CAM put the cart before the horse. Pragmatic trials are useful and can provide data that can be very helpful in determining which treatments work in the ‘real world.’ However, they are only useful to test interventions that have already proven themselves to be efficacious and safe in RCTs [randomized controlled trials].” He continued his attack on "Quackademic medicine," this time the Integrative Medicine program at Memorial Sloan-Kettering Cancer Center. “Basing treatment on pseudoscience and prescientific belief systems might be ‘taking care of the whole patient,’ but it isn’t taking care of the whole patient correctly…you don’t have to embrace pseudoscience and quackery to take care of the whole patient.” He criticized a study of the effect of meditation on gene expression. “Basically, this is a study that purports to find differences in gene expression that might or might not be clinically relevant, with the emphasis being on ‘probably not.’…In other words, this is a fancy, expensive study that didn’t find much of interest but is being sold as evidence that Chopra’s brand of meditation modulates the immune system.”
Edzard Ernst criticized the promotion of medicinal mushrooms for management of diabetes. “On the basis of all this evidence, it seems fair to conclude that mushrooms have little or no effect on diabetes…I find such promotion irresponsible, unethical and outright dangerous.”
November – A study supposedly supporting the use of acupuncture for pain in the emergency room was published. Orac found serious flaws, such as the lack of blinding and likely non-comparable groups.
November – Costello and others reviewed cinnamon supplements for use in type 2 diabetes (J Acad Nutr Diet. 2016 Nov;116(11):1794-1802 Abstract). They concluded that “cinnamon supplements added to standard hypoglycemic medications and other lifestyle therapies had modest effects on FPG [fasting plasma glucose] and HbA1c [hemoglobin A1c]. Until larger and more rigorous studies are available, registered dietitian nutritionists and other health care professionals should recommend that patients continue to follow existing recommendations of authoritative bodies for diet, lifestyle changes, and hypoglycemic drugs.”
November – Deldicque and Fancaux published “Potential harmful effects of dietary supplements in sports medicine (Curr Opin Clin Nutr Metab Care. 2016 Nov;19(6):439-445. Abstract). They found that “New data show that 90% of sports supplements contain trace of estrogenic endocrine disruptors, with 25% of them having a higher estrogenic activity than acceptable. About 50% of the supplements are contaminated by melamine, a source of nonprotein nitrogen... Although most supplements may be considered as safe when taking at the recommended doses, athletes should be aware of the potential risks linked to the consumption of supplements.” Edzard Ernst commented on the review.
November 6 – An investigation by Truth in Advertising found that “Despite declarations by the Direct Selling Association (DSA) that it is committed to business ethics, a TINA.org investigation has found that 97 percent of DSA member companies selling nutritional supplements have distributors marketing their products with illegal health claims….Simply by Googling the name of one of the MLM companies and ‘cancer,’ or ‘arthritis,’ or ‘eczema,’ or ‘diabetes,’ or any other disease of one’s choosing, a plethora of websites and social media posts making false and deceptive claims pop up. From autism, Alzheimer’s and HIV/AIDS, to eczema, Ebola and epilepsy, there is an MLM supplement that is being marketed to cure, treat, mitigate, or prevent almost any disease or disorder one can think of.”
November 8 – A study by Juthani-Mehta and others (JAMA. 2016;316(18):1879-1887 Paper) found that cranberry capsules did not prevent urinary tract infections in older women. An Editorial by Nicolle (pp. 1873-1874) discussed the findings: taken together with previous studies showing no benefit, the evidence “is convincing that cranberry products should not be recommended as a medical intervention for the prevention of UTI…It is time to move on from cranberries.” Gavura also discussed the findings on Science-Based Medicine.
November 14 – Stephen Barrett has reprinted, with updates, "A Historian's View of Quackery in 1974."
November 15 – The Federal Trade Commission has issued an Enforcement Policy Statement concerning the marketing of over-the-counter homeopathic drugs Press Release. According to the new policy, “Efficacy and safety claims for homeopathic drugs are held to the same standards as similar claims for non-homeopathic drugs…For the vast majority of OTC homeopathic drugs, the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product's efficacy. Accordingly, marketing claims that such homeopathic products have a therapeutic effect lack a reasonable basis and are likely misleading…the promotion of an OTC homeopathic product for an indication that is not substantiated by competent and reliable scientific evidence may not be deceptive if that promotion effectively communicates to consumers that: (1) there is no scientific evidence that the product works and (2) the product's claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.” Novella on Science-Based Medicine and Orac on Respectful Insolence discussed the ruling.
November 22 – Branson criticized the way in which journalists covered news about dietary supplements: “Inconclusive research is characterized as conclusive, the larger evidence context is ignored, and important marketing influences may get overlooked.”
November 23 – Stephen Barrett updated his “Adverse Court Rulings Related to Clinical Ecology.” “There is now a clear consensus of judicial opinion that the diagnosis and concepts of multiple chemical sensitivity (MCS) have no scientific basis and that expert testimony based on such concepts should not be permitted.”
November 28 – Pomeroy, on RealClear Science, published “The Worst Websites for Science in 2016.” Related to alternative medicine were: #5, The Food Babe (Vani Hari). “Hari's recipe is simple: pick a foreign-sounding food ingredient, label it a ‘toxin’, then demonize it relentlessly. #3, Age of Autism. “Either ignorantly or willfully, they misconstrue science and mislead their readers into believing that vaccines are dangerous.” #2, Mercola. “Visitors to Mercola's site frequently read health information not supported by scientific evidence, like that homeopathy is effective and that supplements can improve general health. Dr. Mercola capitalizes on this disinformation by selling the questionable products that his website directly or indirectly promotes.” #1, Natural News, “which has possibly done more to popularize conspiracy-oriented and pseudoscientific beliefs than any other news outlet this century.”
Best of the blogs, December – on Science-Based Medicine, Jann Bellamy wrote “State Medical Boards should not recognize board certification in 'Integrative Medicine'.” “State medical boards should be deeply concerned about recognizing a board certification in an ill-defined ‘specialty’ run by unidentified parties with no published standards.” Mark Crislip provided a review of Reiki and Therapeutic Touch. David Gorski critiqued a “credulous” article in National Geographic that “peddles the false narrative that placebo effects have real ‘healing’ powers against diseases like Parkinson’s disease.” (He also took on placebos on Respectful Insolence, refuting the idea placebos without deception can be useful.) He criticized naturopathic oncology: it, “like all of naturopathy, is a fake medical specialty and will remain so until it embraces science and evidence.” He also criticized the new Trial to Assess Chelation Therapy (TACT2) and its coverage by STAT News. “…The federal government has greenlighted a new trial that not only uses the same flawed composite endpoint but is even worse in that it is a pragmatic trial, uses many of the same quack clinics to accrue patients, and will cost even more, $37 million.” Clay Jones critiqued a show of The Doctors concerning newborn chiropractic. “There is no real debate over the safety and efficacy of newborn chiropractic. Their claims, some of which may have a thin patina of legitimacy, are easily revealed to be total nonsense with minimal skeptical investigation.” Katherine Pett provided a review of Benecol, a plant-stanol margarine promoted for reducing cholesterol. The product appears clearly to be beneficial; however, there are some drawbacks, including cost and the need to eat sufficient amounts twice a day.
On Respectful Insolence, “Orac” analyzed the arguments made by homeopaths in response to the FTC ruling on homeopathic drugs (see Nov. 15 item above). Edzard Ernst also provided an analysis.
Edzard Ernst dealt with homeopathy in several other posts. He criticized a study of a “homeopathic treatment in preventing excessive weight gain during pregnancy in overweight or obese women who were suspected of having a common mental disorder.” Though the results were negative, the authors highlighted a supposed positive effect on newborns which was “almost certainly nothing but a chance finding.” A study on the common cold had numerous flaws and was characterized as “scientific misconduct.” He found no good evidence that homeopathy works in animals. He analyzed an open letter from “leading integrative medicine” specialists suggesting that homeopathy would be useful in treating infectious diseases.
In other topics, a guest post by Frank Van der Kooy discussed the concept of “energy” in traditional Chinese medicine. Ernst took on another aspect of TCM, paida or slapping therapy. He found a meta-analysis of aloe vera for diabetes to be “of unacceptably poor quality,” and potentially dangerous if patients attempted to control their glucose levels with aloe. He discussed many treatments proposed for "detox"; “they are not based on anything remotely resembling good evidence.”
December – Salehi and others published a meta-analysis of acupuncture for treating hot flashes in breast cancer patients (Support Care Cancer. 2016 Dec;24(12):4895-4899 Abstract). They concluded that “The meta-analysis used had contradictory results and yielded no convincing evidence to suggest that acupuncture was an effective treatment of hot flash in patients with breast cancer.”
December – Neuhouser and others reported on breast cancer patients using complementary and alternative medicine (Breast Cancer Res Treat. 2016 Dec;160(3):539-546 Abstract). They found that use of CAM was not associated with mortality. Edzard Ernst commented on the study.
December – A meta-analysis by Bach and others (J Korean Med Sci. 2016 Dec;31(12):1879-1886 Paper) concluded “We found that there was insufficient clinical evidence to support the use of ginseng supplements on reducing fatigue and enhancing physical performance because only few RCTs [randomized controlled trials] with a small sample size have been published so far.”
December – Kwok and others reviewed mind-body exercises for Parkinson’s disease (Complement Ther Med. 2016 Dec;29:121-131 Abstract). They concluded that “mind-body exercises demonstrated immediate moderate to large beneficial effects on motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD. However, the effects of mind-body exercises on psychosocial well-being had not been amply investigated, especially for yoga intervention.”
December – A case of liver failure associated with Garcinia cambogia was reported (Lunsford et al., World J Gastroenterol. 2016 Dec 7;22(45):10071-10076 Paper). Garcinia, whose active ingredient is hydroxycitric acid (HCA), is used in many weight loss products.
December 8 – Riley wrote an Article entitled “Why vitamin pills don’t work, and may be bad for you,” focusing on antioxidants. “…these supplements are rarely going to be the answer for a longer life when a healthy diet is also an option. ‘Administration of antioxidants is justified only when it is evident that there is a real deficiency of a specific antioxidant,’ says [Cleva] Villanueva. ‘The best option is to get antioxidants from food because it contains a mixture of antioxidants that work together.’”
December 13 - Abasi (JAMA 2016; 316(22)2343-2344 Abstract) discussed an article by Nahin et al. (Mayo Clin. Proc. 91(9):1292-1306 (2016) Paper) on complementary approaches for pain management (see our September news item). Edzard Ernst in turn provided a critique of both articles: “A summary of this nature that fails to take into account the numerous limitations of the primary data is, I think, as good as worthless… the NCCIH [National Center for Complementary and Integrative Health] has so long indulged in such poor science that even its top people have forgotten what good science looks like.”
December 16 – A survey of Canadian naturopathy, homeopathy, chiropractic and acupuncture clinic websites found high levels of advertising of allergy and asthma treatments (Murdoch B, Carr S, Caulfield T. BMJ Open. 2016 Dec 16;6(12):e014028 Paper). The found that “Of the interventions advertised, few are scientifically supported; the majority lack evidence of efficacy, and some are potentially harmful.”
December 20 – Because of concern of a possible increase in cardiovascular disease from calcium supplements (with or without vitamin D), the National Osteoporosis Foundation and American Society for Preventive Cardiology convened an expert panel to address the subject. The resulting review (Chung et al., Ann Intern Med. 2016 Dec 20;165(12):856-866 Paper) concluded that “Calcium intake within tolerable upper intake levels (2000 to 2500 mg/d) is not associated with CVD risk in generally healthy adults.” The societies published clinical guidelines expressing the conclusion that these levels are safe (Kopecky et al., Ann Intern Med. 2016 Dec 20;165(12):867-868 Paper). An editorial by Margolis and Manson (Ann Intern Med. 2016 Dec 20;165(12):884-885) discussed the findings. “Although the preponderance of evidence does not support cardiovascular adverse effects, dietary sources of calcium are preferable to supplements for other reasons…Based on the totality of evidence for both calcium and vitamin D, more is not better.”
December 24 – Gong and others reported a meta-analysis on the effect of fenugreek on hyperglycemia and hyperlipidemia in diabetes and prediabetes (J Ethnopharmacol. 2016 Dec 24;194:260-268 Abstract). They concluded that “fenugreek is safe and effective on reducing elevated FBG, 2hBG, HbA1c and TC in subjects with T2DM or prediabetes. Taking into account the low qualities of the included studies, more studies with better methodological designs are warranted to confirm the efficacy and safety.”
December 29 – A study by Bisgaard and others (N Engl J Med. 2016 Dec 29;375(26):2530-9 Paper) concluded that “Supplementation with n−3 LCPUFA [long-chain polyunsaturated fatty acids, found in fish oil] in the third trimester of pregnancy reduced the absolute risk of persistent wheeze or asthma and infections of the lower respiratory tract in offspring by approximately 7 percentage points, or one third.” The findings were discussed in an editorial by Ramsden (N Engl J Med 2016; 375:2596-2598) and also by Edzard Ernst.
December 30 – Pang and others reviewed acupuncture for functional dyspepsia (Evid Based Complement Alternat Med. 2016;2016:3862916 Paper). They concluded that “acupuncture therapy achieves statistically significant effect for FD in comparison with sham acupuncture and is superior to medication (prokinetic agents) in improving the symptoms and quality of life of FD patients. Nonetheless, despite stringent methodological analyses, the conclusion of our review still needs to be strengthened by additional RCTs of higher quality.”
Additions to Earlier Months
April, 2016 – Fogarty, Smith, and Hay reviewed complementary and alternative medicine for eating disorders (Eat Behav. 2016 Apr;21:179-88 Abstract). They concluded that “A potential role was found for massage and bright light therapy for depression in those with Bulimia Nervosa and a potential role for acupuncture and relaxation therapy, in the treatment of State Anxiety, for those with an eating disorder. The role of these complementary therapies in treating eating disorders should only be provided as an adjunctive treatment only.”
June – Blattner and others wrote “Update: Do probiotics prevent or treat pediatric atopic dermatitis?” (Pediatr Allergy Immunol. 2016 Jun;27(4):425-8). They concluded, “probiotic supplementation may provide a significant reduction in the development of pediatric AD.” However, “Unfortunately, the evidence that supporting probiotics for treatment of AD is less convincing than the data for prevention.”
August – Interlandi published “The Acupuncture Myth” (Sci Am. 2016 Aug;315(2):24-5 On-line version: “Research Casts Doubt on the Value of Acupuncture”). She concluded, “It may well be that the reams of research scientists have done on acupuncture have lit the path toward improved understanding of—and eventually better treatments for—intractable pain. But it may also be time to take whatever bread crumbs have been laid out by that work and move on.”
August 1 – A review by Janssens and others concluded that “a mixture of green tea catechins and caffeine has a beneficial effect on body-weight management, especially by sustained energy expenditure, fat oxidation, and preservation of fat free body-mass, after energy restriction induced body-weight loss, when taking the limitations into account” (Physiol Behav. 2016 Aug 1;162:83-7 Abstract).
September – A review by Wu and others (Pain Physician. 2016 Sep-Oct;19(7):415-27 Abstract with link to free full text (pdf file)) concluded that “these results suggest that vitamin D supplementation could have a role in the management of chronic pain.”
September 6 – Belluz published “Amazon is a giant purveyor of medical quackery” Story. She wrote, “Amazon’s websites are hawking a universe of dangerous, pseudoscience health products — from electronic ‘zappers’ that promise to cure HIV to bleach enemas for autism.” Cancer “cures,” metabolism boosting products, and oxytocin products are also discussed.
October – The benefits of coenzyme Q10 for heart failure were reviewed by Jankowski et al. (Pharmacol Rep. 2016 Oct;68(5):1015-9 Abstract). They concluded that “Supplementation with various pharmaceutical formulations of CoQ10 improves impaired cardiac function and clinical course of heart failure. Current data from clinical trials indicate that CoQ10 can significantly reduce morbidity and mortality of heart failure patients in addition to guideline recommended pharmacotherapy.”