Best of the blogs, November – on Science-Based Medicine: Scott Gavura:
discussed a paper showing that “CAM use leads to delays in appropriate, effective arthritis therapy.”
David Gorski:
discussed "integrative oncology." “…integrative oncology, like integrative medicine, is a brand, not a specialty. It rebrands what should be considered perfectly fine science-based modalities, such as nutrition, lifestyle interventions, and the like, as somehow ’alternative’ or ‘integrative,’ and then ‘integrates’ quackery like acupuncture, reiki, functional medicine, and even homeopathy with them, to give the quackery the appearance of scientific legitimacy.
in a related post, he noted “the proliferation of the quackery of integrative oncology in places that should be rigorously science-based, namely NCI-designated comprehensive cancer centers.”
Harriet Hall:
provided updates to her posts on ASEA, Protandim, and dōTERRA. In no case did she find convincing evidence that they are effective. “No one knows whether they work or not, because they have not been properly tested. I am simply asking for a single standard of evidence, the kind of evidence required to achieve a scientific consensus that any treatment is effective and safe. If they want us to buy their products, they should test them against placebo controls in human studies looking for objective, meaningful improvements in health; and they should get those studies published in reputable peer reviewed journals.” Steven Novella also addressed the claims of ASEA: “After deep consideration, and re-review of the ASEA current website, I have come to the personal conclusion…that ASEA is selling quackery and nonsense with misleading claims designed to defraud both their customers and their sales agents…Harriet appropriately asked what was in ASEA anyway. It appears to be just salt and water, and ASEA makes the pseudoscientific claim that the salt water molecules have been arranged somehow into these redox signaling molecules.”
discussed the promotion of turpentine by Jennifer Daniels. “Not only is turpentine not the Fountain of Youth, it has not been proven effective for any health condition.”
Clay Jones:
wrote about “celebrity energy healer Charlie Goldsmith.” “Orac” also discussed him on Respectful Insolence. “Before you can ask questions like, ‘Why is this happening?’ we have to know that ‘this’ is actually happening, something that Goldsmith thus far has utterly failed to demonstrate.”
Steven Novella:
posted “Placebo Myths Debunked.” “Placebo treatments are often sold as magical mind-over-matter healing effects, but they are mostly just illusions and non-specific effects.” CAM proponents “are saying that placebo effects are real, and therefore being as effective as placebo means that their treatments ‘work’,” but “anything useful about placebo effects can be had with a positive therapeutic relationship, using science-based interventions, and following the ethical requirements of informed consent and patient autonomy.”
On Respectful Insolence, “Orac”:
dealt with the claim of antivaccine activists that they are really just interested in vaccine safety.
discussed antivaccine views of Nobel Prize winner Luc Montagnier.
in yet another antivaccine post, he analyzed a paper claiming to find a link between aluminum in vaccines and autism. A followup post (Dec. 6) provided more criticism of the paper’s author, Christopher Exley.
wrote “The FDA cracks down on quack stem cell clinics…or does it?” “The FDA is woefully underfunded and understaffed for what it is expected to do… The FDA can’t go after all of the quack stem cell clinics out there, even though it now has better regulatory guidelines to do so.”
discussed claims of gadolinium toxicity due to use of the element in a contrast agent used in MRIs. “Based on currently existing evidence I definitely think it’s way premature to propose a new condition, ‘gadolinium deposition disease’…The reason is that neither a distinct syndrome nor causation by gadolinium has been conclusively demonstrated yet—or even strongly suggested.”
posted “Yet another clickbait testimonial manipulates emotions to make cancer quackery appear effective.”
Edzard Ernst:
reported on a statement by the Royal College of Veterinary Surgeons concerning homeopathy: “Homeopathy exists without a recognised body of evidence for its use. Furthermore, it is not based on sound scientific principles….It is vital to protect the welfare of animals committed to the care of the veterinary profession and the public’s confidence in the profession that any treatments not underpinned by a recognised evidence base or sound scientific principles do not delay or replace those that do.”
criticized the UK Advertising Standards Authority list of allowed claims for chiropractors: “I am puzzled by this list; for most indications, there is no good evidence at all – unless, of course, we consider chiropractic to consist of ‘manual therapy… exercises, and health and lifestyle counselling’…But, in this case, the list is still very odd because it would then need to include practically all conditions that can affect humans.”
asked, “Is Boiron (the world’s biggest manufacturer of homeopathics) telling the truth?”
argued against chiropractors as prescribers of medicines.
discussed a paper by a lawyer explaining how a jury can rule that a homeopathic manufacturer did not “misrepresent the efficacy of its products.” The court erred by allowing “expert” testimony in favor of homeopathy, when it is scientifically unsupported. “Trial courts have robust power and clear responsibility to preclude litigants from introducing irrelevant and unreliable evidence in support of purportedly scientific claims…”
criticized a proposal for a clinical trial of homeopathic vaccines against malaria.
November – A review concluded that “Vitamin D supplementation reduced the rate of asthma exacerbations requiring treatment with systemic corticosteroids overall” (Jolliffe et al., Lancet Respir Med. 2017 Nov;5(11):881-890 Paper).
November – Braga and others wrote “What do Cochrane systematic reviews say about probiotics as preventive interventions?” (Sao Paulo Med J. 2017 Nov-Dec;135(6):578-586 Paper). They concluded: “Despite the marketing and the benefits associated with probiotics, there is little scientific evidence supporting the use of probiotics. None of the reviews provided any high-quality evidence for prevention of illnesses through use of probiotics. More trials are needed to gain better knowledge of probiotics and to confirm when their use is beneficial and cost-effective.”
November 1 – The FDA issued a warning to “companies marketing unproven products, derived from marijuana, that claim to treat or cure cancer” News release.
November 2 – A Story in Bloomberg News was entitled “Patient Deaths Show Darker Side of Modern Chinese Medicine.” A new trend in China is to make injectable drugs from traditional remedies, some containing numerous components in untested combinations.
November 7 – Marx and others reviewed carnitine supplementation for cancer-related fatigue (Nutrients. 2017 Nov 7;9(11). pii: E1224 Paper). They concluded: “Results from studies with lower risk of bias do not support the use of carnitine supplementation for cancer-related fatigue.”
November 14 – The FDA has issued a Warning letter to Mannatech concerning its dietary supplements. Among the violations were unapproved new drugs, adulterated supplements, and misbranded conventional food and supplements. It was also noted that the use of the term “glyconutrient” is misleading.
November 14 – A paper by Renzi-Hammond and others reported that supplementation with lutein plus zeaxanthin increased cognitive function in young adults (Nutrients. 2017 Nov 14;9(11). pii: E1246 Paper).
November 15 – A Story with video explains the flaws in fad concepts of “detox,” and how the body’s organs already carry out needed detoxification functions.
November 22 – Health Canada has ordered warning labels on products with green tea extract after a teenager suffered nearly fatal effects News story. While the products appear safe for most people, some people are susceptible to severe liver injury.
November 27 – Beth Mole wrote “Creeping quackery: 'Integrative' cancer care spreading in NIH-supported centers.”
November 29 – Dr. Chad Hayes attended and reported on an integrative medicine conference. “While I am confident that many alternative medicine practitioners (including some who are positively delusional) truly believe that they are helping their patients, there are some out there that knowingly take advantage of people who are sick, hurting, and hopeless. They market themselves using fear, diagnose diseases that their patients don’t have, demonize science-based treatments, and claim to possess secret knowledge of the only cure.”
November 30 – The FDA and the state of Maine have reached a settlement with Health Research Laboratories and Kramer Duhon concerning marketing of dietary supplements with false and unsupported claims Press release. The products are “BioTherapex, a dietary supplement that purportedly targets the liver to address a host of ailments, and NeuroPlus, a brain supplement.”
November 30 – Under new regulations in China, “traditional medicines may no longer be required to pass safety and efficacy trials in humans” (Cyranoski D. Nature. 2017 Nov 29;551(7682):552-553 Story). A related Editorial (Nature. 2017 Nov 29;551(7682):541)said that the changes would be “a backwards step.” “Just because standardized trials are difficult or expensive is not a reason to say they can’t be done — fast and cheap cannot be the goal of drug regulation. The world needs more such rigorous trials of herbal remedies, not a carte blanche for manufacturers to sell them to vulnerable patients.” “Orac” also commented on Respectful Insolence. “…while it is good that the Chinese government will now be screening products for pesticides and heavy metal products, it is most definitely worrisome, however, that China has decided, in essence, to give TCM a privileged position, such that it is no longer subject to anything resembling science to demonstrate its efficacy and safety.”
Best of the blogs, December – on Science-Based Medicine: Jann Bellamy:
reported that “The VA recently mandated inclusion of acupuncture, reiki, reflexology and other CAM in veterans medical benefits and will require that they be offered at VA medical facilities, ignoring the lack of evidence and federal rules on what medical benefits can be covered.” “… the VHA is including acupuncture in veterans’ medical benefits and directing all VHA facilities to provide it based on a conclusion it has ‘promising or potential benefit’ even though it’s been told not to make policy grounded in that conclusion and even though the RAND report clearly states the evidence is ‘non-conclusive.” “In addition to the ethical issues posed by integration of pseudoscience into medical care, funding for veteran medical care is a zero-sum game. Congress allocates a finite amount of money to the VA, so monies absorbed by, say, therapeutic touch, do not get spent on, for example, cognitive behavioral therapy for PTSD.”
described how “naturopathic 'doctors' gained state licensure and practice expansion, but also suffered major defeats, in 2017.”
Scott Gavura:
wrote “Top ten signs your detox may be a scam.” “There’s no published evidence to suggest that detox treatments, kits or rituals have any effect on our body’s ability to eliminate waste products effectively. ‘Detox’ focuses attention on irrelevant issues, giving the impression that you can undo lifestyle decisions with quick fixes.”
Harriet Hall:
wrote “I Was Wrong about Protandim.” On May 9 she wrote that there was no evidence that the product, a mixture of five herbal supplements, increased antioxidants as claimed, but appeared to be safe to use. Now, after being informed of serious flaws in the study supposedly showing safety, she says: “we can’t really know that it is safe, and there is certainly reason to be concerned about possible adverse effects.”
wrote “A Misguided Study to Test the Reliability of Traditional Chinese Medicine Pulse Diagnosis.” “Chinese pulse diagnosis and tongue diagnosis are based on imaginary concepts, not on reality. If they want to bring them into the real world of science, perhaps the place to start would be to pick just one of the spots on the wrist or tongue that are said to represent a given organ and test whether that claim is true.”
Clay Jones:
discussed Salmonella infections linked to rattlesnake pills. “Rattlesnake ingested in any form is not a cure for cancer or any other ailment. And it isn’t risk free. The link between rattlesnake-based products and Salmonella is well-established, and it is even more dangerous when the person consuming them has a weakened immune system.”
Steven Novella:
analyzed why some claim that acupuncture “works for a long list of medical indications” when a close look at reviews shows otherwise. “…part of the problem comes from proponents interpreting weak preliminary and flawed evidence as if it is definitive, when it is not even adequate (especially given the low scientific plausibility of acupuncture). However, the problems go deeper than that. The evidence base itself, including the systematic reviews, are rigged in favor of acupuncture…Even with all these factors… systematic reviews do not show that acupuncture works for anything.”
On Respectful Insolence, “Orac”:
discussed the growth of integrative medicine at National Cancer Institute-sponsored cancer centers.
criticized Gwyneth Paltrow and Goop for “featuring an HIV/AIDS denialist and antivaccine quack at its upcoming Goop Summit.” A followup post was entitled “Dr. Kelly Brogan's e-book ‘Vaccines and Brain Health’: A cornucopia of antivaccine misinformation and pseudoscience.”
wrote about the spread of naturopathic oncology from large cities and academic medical centers to smaller community centers.
posted “Florida: A paradise for dubious stem cell clinics.”
explained why, despite his claims, Robert F. Kennedy, Jr. is antivaccine.
Edzard Ernst:
provided a critique of Schuessler Salts, “a derivative of homeopathy that is hugely popular in Germany and is slowly spreading also to other countries.”
found a review of acupuncture by Australian acupuncturists to be full of “deceit and wishful thinking.”
summarized findings from a review of treatment options for musculoskeletal pain. “These findings confirm what we have pointed out many times before on this blog. There is very little that alternative therapies have to offer for musculoskeletal pain. Whenever it is possible, I would recommend exercise therapy initiated by a physiotherapist; it is inexpensive, safe, and at least as effective as acupuncture or chiropractic or osteopathy.
found no convincing evidence for the claimed health benefits of apple cider vinegar.
wrote “Alternative treatments for the common cold: good business, bad evidence.”
found no evidence for the claimed benefits of placentophagy (eating the placenta after childbirth).
discussed electrohomeopathy, “a version of homeopathy few people know about.” “If one would assume that electrohomeopathy is nothing more than a bizarre and long-forgotten chapter in the colourful history of homeopathy, one would be mistaken; it is still used and promoted by enthusiasts who continue to make bold claims.”
refuted the claim of alternative medicine proponents that “one strength of their approach is disease prevention…and that conventional medicine neglects prevention almost completely.” “1. So far, I have seen no good evidence that any alternative therapy might be effective in preventing any disease. 2. Practically everything we know today about disease prevention originates from conventional medicine and science.3. There are thousands of papers that address prevention and, as far as I can see, they all originate from the realm of conventional medicine.”
December – Autier and others reviewed “Effect of vitamin D supplementation on non-skeletal disorders” (Lancet Diabetes Endocrinol. 2017 Dec;5(12):986-1004 Abstract). They wrote, “we found no new evidence that supplementation could have an effect on most non-skeletal conditions, including cardiovascular disease, adiposity, glucose metabolism, mood disorders, muscular function, tuberculosis, and colorectal adenomas, or on maternal and perinatal conditions…The main new finding highlighted by this systematic review is that vitamin D supplementation might help to prevent common upper respiratory tract infections and asthma exacerbations. There remains little evidence to suggest that vitamin D supplementation has an effect on most conditions, including chronic inflammation, despite use of increased doses of vitamin D, strengthening the hypothesis that low vitamin D status is a consequence of ill health, rather than its cause. We further hypothesise that vitamin D supplementation could exert immunomodulatory effects that strengthen resistance to acute infections, which would reduce the risk of death in debilitated individuals.”
December – A review by Yong and others was supportive of a benefit of vitamin D in chronic pain (Clin Rheumatol. 2017 Dec;36(12):2825-2833 Abstract).
December – Yan and Khalil reviewed “Vitamin supplements in type 2 diabetes mellitus management” (Diabetes Metab Syndr. 2017 Dec;11 Suppl 2:S589-S595 Abstract). They concluded “No clear evidence supporting the beneficial role of any specific vitamin in the treatment of T2DM was found. Thus, it is recommended that until further studies are conducted to clarify the role of such vitamins in T2DM management, they should not be routinely recommended in clinical practice.”
December – Vincent wrote “New Evidence against Chromium as an Essential Trace Element” (J Nutr. 2017 Dec;147(12):2212-2219 Abstract).
December – Sirtori and others reviewed “Nutraceutical approaches to metabolic syndrome” (Ann Med. 2017 Dec;49(8):678-697 Abstract). They noted that “specific nutraceuticals have proven to be of benefit, in particular, red-yeast rice, berberine, curcumin as well as vitamin D.”
December – A review of “Herbal medicines for treating acute otitis media (Son MJ, Kim YE, Song YI, Kim YH. Complement Ther Med. 2017 Dec;35:133-139 Paper) concluded that “the evidence regarding the effectiveness and efficacy of herbal medicine for acute otitis media is inconclusive due to the poor quality of trials included.”
December – Stein published “Massage Acupuncture, Moxibustion, and Other Forms of Complementary and Alternative Medicine in Inflammatory Bowel Disease” (Gastroenterol Clin North Am. 2017 Dec;46(4):875-880 First page preview). He concluded, “Based on the current level of evidence, it remains difficult to make recommendations for or against massage, acupuncture, or moxibustion therapy in IBD patients…although there have been several clinical trials showing favorable effects of acupuncture and moxibustion, they have, in general been of low quality and of considerable heterogeneity to warrant incorporation into routine clinical practice.”
December – A review of integrative medicine for pain management was written by Lin, Wan, and Jamison (Anesth Analg. 2017 Dec;125(6):2081-2093 Abstract). They concluded: “Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and manipulation. Strong evidence for acupuncture as a complementary treatment for chronic pain that has been shown to decrease the usage of opioids was found.”
December – Ranard and others (Eur J Nutr. 2017 Dec;56(Suppl 3):37-42 Paper) wrote: “Based on a review of the literature supporting these criteria, lutein is ready to be considered for intake recommendations. Establishing dietary guidance for lutein would encourage the consumption of lutein-containing foods and raise public awareness about its potential health benefits.”
December 1 – Yilmaz and others published a review on supplements for diabetes (J Pharm Pract. 2017 Dec;30(6):631-638 Abstract). They wrote, “Despite many studies being available, the majority lack uniformity across multiple dimensions, including varying participant characteristics, inconsistent formulations of supplement and dose, and differing study durations. This, coupled with variation in quality and purity of commercially available products, prevents universal recommendation for use in diabetes management.” Some support was seen for the use of fenugreek and cinnamon.
December 2 – A Cochrane review of acupuncture for neuropathic pain (Ju et al., Cochrane Database Syst Rev. 2017 Dec 2;12:CD012057 Abstract) concluded “Due to the limited data available, there is insufficient evidence to support or refute the use of acupuncture for neuropathic pain in general, or for any specific neuropathic pain condition when compared with sham acupuncture or other active therapies.”
December 4 – Wobser and Pellegrini published a Review of black cohosh, which is used for menopausal symptoms. “Studies have not found that black cohosh is more effective than a placebo in relieving vasomotor symptoms.”
December 14 – A News story (Marchant J. Nature. 2017 Dec 14;552(7684):157-158) discussed reports of a study reporting benefits from acupuncture for pain in women being treated for breast cancer. “But sceptics have criticized the research. Regardless of how rigorous the trial was in other respects, the acupuncturists knew whether they were delivering real or sham treatment, says Edzard Ernst.. This could have influenced how the recipients responded, he says. ‘I fear that this is yet another trial suggesting that acupuncture is a “theatrical placebo”.’”
December 18 – The FDA proposed new enforcement priorities for the regulation of homeopathic drugs (News release). “…this proposed new approach would update the FDA’s existing policy to better address situations where homeopathic treatments are being marketed for serious diseases and/or conditions but where the products have not been shown to offer clinical benefits. It also covers situations where products labeled as homeopathic contain potentially harmful ingredients or do not meet current good manufacturing practices.” Steven Novella, writing on Science-Based Medicine, called the new proposals “A move in the right direction, but they do not go nearly far enough.” “Orac,” on Respectful Insolence, agreed. Edzard Ernst also commented.
December 22 – “The Center for Inquiry has filed a complaint against CVS Health with the D.C. Department of Consumer and Regulatory Affairs in order to keep CVS from marketing homeopathic products as though they are scientifically proven treatments, or displaying them alongside real, evidence-based medicine. CFI warned CVS that it is endangering the health of its customers by erasing the line between genuine and pseudoscientific treatments, and in so doing may be in violation of the law in the District of Columbia.” Press release
December 28 – Britt Hermes, in Naturopathic Diaries, wrote of the death of a baby born in a birthing center directed by a naturopath. “Despite signs that the baby was perhaps in distress,” the naturopath “recommended that a homeopathic remedy be given every fifteen minutes, until the situation improved” and followed with additional homeopathic remedies over the next several hours. She “was absolved of any liability for the baby’s death. The naturopathic board ruled that she had acted like any licensed naturopath in her position could be expected to act.”
Additions to Earlier Months
September, 2016 – Ioannidis published “The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses” (Milbank Q. 2016 Sep;94(3):485-514 Paper. The paper noted that “Currently, there is massive production of unnecessary, misleading, and conflicted systematic reviews and meta‐analyses. Instead of promoting evidence‐based medicine and health care, these instruments often serve mostly as easily produced publishable units or marketing tools.” Although not focused on alternative medicine, the following comment seems relevant to the field: “Finally, even when systematic reviews and meta‐analyses are well done and have none of the problems mentioned above, most may still not be informative. A very common conclusion, in particular for meta‐analyses of randomized trials, is that the evidence is weak or insufficient; thus, the review is not informative on what the best interventions are in terms of patient care or health policy.”
February 15 and May 24, 2017 – Two reviews dealt with probiotics. Dermyshi and others concluded that “the use of probiotics was beneficial for the prevention of severe NEC [necrotizing enterocolitis], late-onset sepsis, and all-cause mortality in VLBW [very low birth weight] infants” (Neonatology. 2017;112(1):9-23 Paper). Wang et al. (J Pediatr Endocrinol Metab. 2017 May 24;30(6):611-622 Paper) wrote that “Probiotics may have beneficial effects on the reduction of glucose, insulin and HbA1c for diabetes, especially for T2DM mellitus patients.”
August 23, 2017 – Campbell and Campbell wrote “‘The 'Plant Paradox' by Steven Gundry MD– A Commentary.” Gundry’s book makes “the surprising claim that lectins are the source of most, perhaps all human disease... It’s particularly alarming because these findings lie in opposition to well established observations about diet and health... What a shame that this type of unscientific nonsense creates so much unnecessary confusion, with deadly consequences.”
September and October, 2017 – Two reviews concerned vitamin D supplementation for knee osteoarthritis. Hussain et al. (Rheumatol Int. 2017 Sep;37(9):1489-1498 Abstract) concluded “The study found evidence from RCTs [randomized controlled trials] to be insufficient to support the use of vitamin D supplementation for patients with knee osteoarthritis.” Gao, Chen, and Deng (Int J Surg. 2017 Oct;46:14-20 Abstract) concluded “Vitamin D supplementation was effective in improving the WOMAC pain and function in patients with knee OA. However, it had no beneficial effect on the prevention of tibial cartilage loss. Therefore, there is currently a lack of evidence to support the use of vitamin D supplementation in preventing the progression of knee OA.”