Space City Skeptics

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Posts Tagged ‘Alternative Medicine

Heavy Metal

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The October 27, 2009  edition of  Wall Street Journal ran a story called “Metals: Panacea or Placebo?” by science reporter Melinda Beck that put a skeptical eye on claims of medical and health benefits to the use of metals (copper, silver, gold, titanium, and magnetic items) as adornments and “dietary ‘supplements.” The same week, a blog post by Steven Novella at Science-Based Medicine discussed the recently published “Therapeutic effects of magnetic and copper bracelets in osteoarthritis: A randomised placebo-controlled crossover trial” from Complementary Therapies in Medicine (abstract), which documented a controlled test on the efficacy of magnetic or copper bracelets to help arthritis and other ailments. Unsurprisingly, any benefits from the different bracelets were no better than placebo. Readers are referred to his excellent write-up for a discussion of the study and links to other peer-reviewed work. In it, the National Center for Complementary and Alternative Medicine, a dollar-sucking entity foisted on the taxpayers by Congress, admits that it has found no evidence for beneficial effects on fibromyalgia, migraines, or other painful conditions, from the use of metal bracelets. The idea of people volunteering to put large amounts of metal and metal solutions into their bodies intrigued me, so I reviewed the current state of Metal Medicine.

A couple years ago, Paul Karason became briefly famous as the “blue man” whose skin turned blue due to argyria — a condition where silver collects in the skin and organs and reacts with light, much as the silver emulsion on film. He dosed himself with silver solutions that he created in his home, a procedure easy for anyone who has taken a basic high school chemistry class. “I did it all on my own,” he said. “Originally, I just saw an ad for a colloidal silver generator in a magazine and the picture stuck in my head like a song might stick in your head. I had a friend who had severe petroleum poisoning, and I heard colloidal silver was helpful for that, and that’s how I started.” In the same interview, he admitted that his original health problem, dermatitis, was not cured by ingesting silver, although he continued to drink silver solutions daily. Proponents of colloidal silver claim that ingesting silver can cure or treat colds, flu, cancer, diabetes, herpes, shingles, and HIV/AIDS, among other ailments. Silver solutions, such as silver nitrate, have been used as anti-microbial disinfectants for many years, and frequently used as eyedrops for newborns to prevent conjunctivitis (although most former uses have been supplanted by newer, less toxic treatments). The FDA has repeatedly stated that ingesting silver is not beneficial, is not even safe, and can cause kidney damage.

Of course, one man’s woo is another man’s scam. A company called Purest Colloids charges that Karason was not using the correct silver (he’s ingesting silver in an ionic solution instead of pure silver in a colloid form), and that the stories about his condition are a hoax on the American people. From their web site:

The Blue Man charade demonstrates once again that the mass media cannot be trusted to report anything that even resembles a truthful “news” story. All “news” today is propagated with an agenda just like the phony economic statistics put out the U.S. government.

In other words, a conspiracy to make people afraid to take silver supplements. Oh, yeah.

Silver is not the oldest “magic metal.” Magnets have been tried as treatments for thousands of years. Randi has written extensively about the Q-ray and magnetic bracelets, and those scams continue to be perpetrated on the public with the usual blather about aligning one’s auras, improving the blood flow by acting on the iron in hemoglobin, and other wishful thinking. Dozens of websites sell these items, and while I do not wish to drive traffic to their sites, it’s interesting to poke around to see the prices, claims, and testimonials. “I thought I could save money,” says one alleged testimonial, “by buying another magnetic bracelet from another company advertising them at half the price with 5000 gauss. Well, let me tell you, I was scammed! When that ‘other’ bracelet came in, I checked the magnetic strength by seeing how strongly it attaches to a piece of metal compared to your bracelet…Thanks for a great product!” To view the going prices for lumps of metal, see for example Ace Magnetics or AACopper, which warns you again those cheap Chinese copper bracelets that don’t leave a green ring on your wrist. By doing a search of various magnet proponents, you’ll find you can now buy magnetic mattress pads, cushions, hair brushes — and even styling gel! I suspect if you spend $30 for magnetic hair spray, you are going to see some effects. (These items are ubiquitous on the internet, and a new company pops up every time one is shut down. For instance, in 2002, Quackwatch reported that the California Attorney General sued European Health Concepts for selling magnetic mattress pads and cushions. They’ve been out of business since then, but Googling ‘magnetic mattress pad’ turned up a dozen sites, selling pads running upwards of $800.)

Magnets are cheap to manufacture, but for a classy scam you need something more exotic. Gold has an ancient history as a nearly-magical elixir to provide immortality. For many years, gold salts were used to treat lupus and rheumatoid arthritis, although the toxicity of the metal caused mouth sores, kidney damage, and occasionally, problems with the bone marrow’s ability to make new blood cells (a side effect that killed one of my engineering professors). One supplier, Optimox, carries colloidal gold in tablet form. Although their site states “For use as a source of colloidal metallic gold without medical or health claims,” the subsequent copy clearly implies that colloidal gold can detoxify the liver, act as a anti-oxidant, control joint pain and swelling, and promote resistance to infection. (Since my 50 hours of college chemistry is nearly 30 years old, I won’t embarrass myself with a critique of all their claims about redox reactions, but invite knowledgeable readers to comment.) Another alarming claim, among many, is that taking 30 mg of gold per day for one month increases IQ scores by 20%. In rough terms, that means a month’s worth of tablets could take a person of average IQ into the top 5-10% of the population.

A more recent trend in metal therapies is titanium, which started in Japan. Generally, companies market titanium bracelets or pendants, claiming that the material enhances the flow of energy and creates a positive charge that cancels out pain’s negative charge — i.e., neutralizing the pain. To my knowledge, this particular benefit of titanium has not made it into the anesthesiologist’s tool bag. Some sites sell titanium items to relieve stress or back pain, and feature testimonials from professional athletes. One company, Rob Diamond, explains how the bracelet causes ions in the blood to push against vessel walls, causing heat, which improves circulation and carries away toxins. One of the biggest hawkers of titanium products is Phiten, founded by a chiropractor in Japan. This company has taken the snake oil to a new level, infusing titanium particles into lotions, clothing, shoes, and bedding. Testimonials from Olympic athletes and baseball players spread the word, enforcing the placebo effects of the items. They also market a product called “G Water” which they claim will suppress fatigue of the brain when you spray it on the head.

As the author of the WSJ article remarked “Perhaps if consumers became smarter, they would be more skeptical of such claims.”

Written by Geek Goddess

March 4, 2010 at 9:50 am

Alternative Medicine Gimmick of the Week #1: Pen Power!…..

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Pen Power!!!

Pen Power!!!

 

According to the website for this product, a pen which represents a spine bent by chiropractic subluxations,

“the “Subluxated Pen” is a trusted and proven way to promote your practice. Your personalized information is imprinted on the bent part of the pen. The bend in the pen attracts attention in a unique, fun and powerful way. Using the Bent Pen is the inexpensive and professional method for building your patient community.”

 The manufacturers of this promotional product tout the results of a 2008 study performed by ASI (Advertising Specialty Institute) which appear to show that Bent Pens are “the most effective and least expensive form of advertising.” I noticed some shady business when comparing the provided information on the website and the actual report from ASI. Most importantly, the report only mentions writing instruments. It does not specifically look into the effectiveness of Bent Pens themselves. That may not be a distinction that matters, but it could be that people don’t like novelty writing instruments with caps, instead preferring conventional click-top pens. It is unfair to make claims about a specific product based on the data. Despite this fact, the graph used by H.W. Industries on the Bent Pen website, which compares the cost per impression of Bent Pens (using the data based on writing instruments in general) with such advertising entities as magazine ads, prime time television spots and billboards, is made to look as if it came directly from the study. It did not. There is a section which lists the cost per impression of various types of advertising, however. In it, one can easily see that writing instruments, while cheap compared to national magazine ads for example, are no better than caps or bags in this regard.  

In addition to the misleading graph, there is a section on the website which is cut and paste verbatim from the ASI study summary of conclusions. Well, almost verbatim. It curiously left out the part which revealed that of all the studied promotional products, wearable bags delivered the most impressions. The same wearable bags which had an equal cost per impression to writing instruments. Writing instruments provided only the fourth highest number of impressions per month. I guess Bent Bags are too difficult for even chiropractic technology to produce though. Of course a better form of advertising might be actually treating a legitimate medical problem.

To be entirely fair, H.W. Industries is not a chiropractic practice building company. They just seem to sell gimmicky crap, and they are apparantly no less concerned about twisting data to improve their profits than chiropractors are. But I probably shouldn’t be making fun of this at all considering I hand out fetus shaped keychain flashlights.

Written by skepticpedi

May 18, 2009 at 7:15 pm

Skeptical Pearls #2: Beware the Testimonial…..

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Faster than a speeding case report. More powerful than a double-blind, placebo-controlled study. Able to leap peer review in a single bound. Look! Up on the internet! It’s a story. It’s an anecdote. It’s a testimonial!

Every implausible and unproven quack therapy, from acupuncture to quantum healing, comes bearing testimonials of its effectiveness. These stories are typically brief, to the point, extremely powerful and, across the board, absolutely worthless. To anyone with a decent skeptical filter in place, the reliance on testimonials is an obvious sign of a complete lack of credible support for one’s claims. Yet to far too many people there is no introductory phrase more meaningful than “In my experience”. And no amount of published contradictory data or number of explanations from critically minded experts can match the effect from just one of the seemingly neverending supply of these uncontrolled, unblinded, and often tall, tales.

Sadly, even outright harm and suffering, or the complete lack of achieving the claimed benefit, are often unable to shake the faith of one who has stepped over the line that seperates credulity from a more critical approach to one’s health. It is far too easy to rationalize away these failures, placing the blame on themselves or the medical community, when the stranger whose gout was cured by taking goat urine supplements is trusted more than the family doctor. Perhaps the believer doesn’t realize that the near totality of the testimonials seen on television or on the internet are fabricated. Maybe they don’t realize that a significant number of them, as is often the case with fraudulent cancer cures, even when provided by real people are found to be the former words of the now deceased, victims of their disease process, their lack of critical thinking skills, and the bastards profiting off of them. It is more likely, however, that the undue influence of testimonials is hard-wired in the human brain, a remnant of something which at one point bestowed a survival advantage on our primitive ancestors.

There is a reason why quacks rely on testimonials. And that is because they don’t have science in their corner. Sure they will jump on poorly designed studies, usually coming out of the National Center for Complementary and Alternative Medicine and published in biased pseudojournals, and tout them as proof of their legitimacy. But they will just as quickly denigrate methodological naturalism and the methods of so-called “western science” when better studies come along revealing their pet delusion to be a charade. The testimonial circumvents this problem, rendering science irrelevant. This is a recipe for disaster, or at the very least a lighter wallet.

Proven treatments don’t need stories. In my line of work I often am faced with parents who refuse recommended practices such as vaccines and the administration of intramuscular vitamin K for newborns. When I am discussing the care of a child with parents, and presenting them with treatment options or evidence-based prophylaxis regimens, I don’t tell them about the time I used a particular treatment and how it cured the patient, or how I had this one kid who suffered a poor outcome because they didn’t get something I recommended. There are too many uncontrolled variables in most clinical situations to trust such anecdotes.  I have to rely on good data, which should not consist of anecdotes regardless of how many I might collect over my career. I would be no better than the quacks I often rant about were I to attempt to manipulate parents with emotional testimonials.

Written by skepticpedi

May 12, 2009 at 11:54 pm

My Family Members Aren’t Immune

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A few days ago, my aunt sent me the name of a ‘nutritional supplement’ that her cousin had sold her sometime back.  When she first told me about it, I pointed out that it sounded fishy.  I did some research on the product, and found that it a product sold through a multi-level marketing company called “FirstFitness“.  The website is more dedicated towards promoting new distributorships than its products, and like most MLMs, stresses how the participants can quit their stressful, high income jobs and work from home a few hours a week, and eventually win a Mercedes, dream vacations, and the like.  Of course, you have to sign up 10 people, who each need to sign up 10 people…

She was persuaded to buy something called Lipomax 10, advertised as a homeopathic remedy to ‘support optimal liver function’  and ‘help relieve the symptoms of bloating, fatigue, water retention, allergies, sluggish bowels and a sluggish metabolism.’  That’s some powerful stuff!

The ingredients include ground dandelion seed, ground Celandine stem, milk thistle powder, and a ‘proprietary blend’ which is 99% turmeric extract, turmeric being a spice that gives mustard its characteristic yellow color and is a component of many curry powder blends.

For milk thistle, I did find that some research has been done, through the National Institute of Health, but through the National Center for Complementary and Alternative Medicines.  If you’ve kept up with the news, you’ll remember that the sponsors of this center have been disappointed that the research has turned up no efficacy in anything they’ve studied to date.  As far as milk thistle:

  • There have been some studies of milk thistle on liver disease in humans, but these have been small. Some promising data have been reported, but study results at this time are mixed.
  • Although some studies conducted outside the United States support claims of oral milk thistle to improve liver function, there have been flaws in study design and reporting. To date, there is no conclusive evidence to prove its claimed uses.
  • Recent NCCAM-funded research includes a phase II study to better understand the use of milk thistle for chronic hepatitis C. Additional research, cofunded by NCCAM and the National Institute of Diabetes and Digestive and Kidney Diseases, includes studies of milk thistle for chronic hepatitis C and nonalcoholic steatohepatitis (liver disease that occurs in people who drink little or no alcohol).
  • The National Cancer Institute and the National Institute of Nursing Research are also studying milk thistle, for cancer prevention and to treat complications in HIV patients.

In other words, nada.

My quick search of the dandelion and celandine showed even less promise – all the links were to natural or homeopathic sites, and talked about the wonders of these all-natural ingredients, and how they have been used ‘well known and used throughout Europe’ which apparently is meant to confer status.  The sites claim that these herb promote health, aid digestion, improve liver function (apparently most of us are going around with non-functioning livers), prevent colds, inhibit tumor growth, improve appetite, cure yeast infections, and decrease glucose levels.  Considering that my aunt is a diabetic, I’m not sure that taking dandelion capsules would be a good idea, if it really did change glucose levels in the blood willy-nilly.

I think my aunt was a bit embarrassed, and threw the stuff away.  I suggested that she take the company’s money-back guarantee to heart and get her $35 back.  She needn’t be embarrassed.  I don’t know the cousin who sold her the stuff very well, but I recall that she is a bit incredulous about a great many things (she out one time belonged to a religious group who thought they could raise people from the dead), and was likely merely trying to supplement her income.  The herbal, natural, and homeopathic supplements generate billions of dollars in sales each year, so there are a lot of well-intentioned, educated people who are uninformed about what is being sold, legally.  Oprah is a big source of unsubstantiated garbage.  For instance, she touts Acai berry, and sales increase dramatically.  Wikipedia states:

Recently, the açai “berry” has been touted and marketed as a highly beneficial dietary supplement. Companies sell açaí berry products in the form of tablets, juice, smoothies, instant drink powders, and whole fruit.

Marketers of these products make claims that açai provides increased energy levels, improved sexual performance, improved digestion, detoxification, high fiberantioxidant content, improved skin appearance, improved heart health, improved sleep, and reduction of cholesterol levels. More dubious claims include reversal of diabetes and other chronic illnesses, as well as expanding size of the penis and increasing men’s sexual virility and sexual attractiveness to women.[1][2] weight loss product.

As of March 2009, there are no controlled studies backing up any of these claims. According to ABC News correspondent Susan Donaldson, these products have not been evaluated (in the US) by the FDA, and their efficacy is questionable.[3] In late 2008, lawyers for The Oprah Winfrey Show began investigating alleged statements from supplement manufacturers who suggested that frequent Oprah guest Dr. Mehmet Oz had recommended their product or açai in general for weight loss. (Link)

The best we can do is to educate, gently, one person at a time. This morning, my mom sent me another one of those emails about how Swiffer cleaning solution kills pets, and added this note:  ” thought I’d send it on just in case. please don’t google it and correct it,  just delete.”  She meant, don’t send her a link fromSnopes about how this is not true.   I of course looked it up, and found that it not only wasn’t true and had numerous factual errors, the manufacturer of Swiffer, Proctor & Gamble, had issued press releases about the misinformation being circulated.  Someone sent that link to my mom, someone who had probably received it via email on a list with hundreds of other email addresses in the chain, and some people would stop buying a perfectly safe product, and pass the email along yet again.  I love my mom, and I’m not criticizing her, but she didn’t want to know the truth, and certainly didn’t want to respond back to the person who sent the email to her.  And that is why bad information persists against the evidence.


Written by Geek Goddess

April 25, 2009 at 8:31 am

Starbucks to Offer Retail-Based Health Care Clinic…..

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Seattle, WA-Starbucks, the largest coffeehouse company in the world, announced earlier today that it would begin opening retail-based health care clinics in select locations as early as July.

According to Starbucks CEO Howard Schultz, the decision to expand into medical care was inspired by the growing popularity of clinics in supermarkets and pharmacies. “Folks are hurting out there, and retail-based clinics are a more economical option in many circumstances,” Schultz explains. “Starbucks will offer convenience and reasonable prices for the treatment of common medical concerns just like we do for whole bean organic Mexican shade grown medium roast coffee.”

But Schultz adds that Starbucks won’t be unveiling just another version of the CVS MinuteClinic or Walgreens Take Care Clinic. “There is a growing mistrust of mainstream medical establishments, regardless of whether they are located in a doctor’s office, a hospital, or a Walmart. And this won’t be one of them.”

Schultz points to a 2008 survey of health care consumers from the Center for Responsible Application of Pseudoscience (CRAP), a Seattle based think tank coincidentally located in the basement of a Starbucks. Advanced statistical analysis of the survey of nearly eleventy thousand adults revealed that almost 80% of responders would prefer that their medical care be provided by practitioners open to drawing from the world of alternative medicine for more natural treatment options. In response to epidemiological data like this, and the mounting evidence in CRAP approved peer-reviewed journals supporting the safety and efficacy of alternative therapies, Starbucks will staff its clinics with acupuncturists, chiropractors, and energy healers instead of the typical nurse practitioner. These operations will be supervised by naturopathic physicians.

Written by skepticpedi

April 22, 2009 at 7:59 pm

Acupuncture for Chronic Itching?…..

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The following gem was included in an Australian Broadcasting Corporation report on the recent identification by University of Minnesota researchers of specific spinothalamic tract neurons implicated in the sensation of itching and shut down by the act of scratching. The researchers, whose study is published as a Brief Communication in the April issue of Nature Neuroscience, express hope that now that this pathway has been discovered, it may eventually pave the way for treatments, pharmaceutical or involving electrical stimulation, that replicate the phenomenon and render scratching obsolete. For folks with certain conditions associated with chronic itching, which can be debilitating for some, this would be a welcome advance.

“Professor Marcello Costa, a neuroscientist at Adelaide’s Flinders University, says a pain treatment like acupuncture could be developed for itching.

“The acupuncture is not damaging, it’s a little bit invasive but it works very well because it activates much better than just rubbing,” Professor Costa said.

“So we all discovered rubbing by ourselves, just like we discovered scratching; we have a scientific rubbing which is called acupuncture but we don’t have a scientific scratching. So I expect this paper will generate interest in developing such a scientific scratcher.””

In the article, it is implied that Costa was one of the scientists or doctors in Australia excited by the team’s findings, and he appears to have no connection with the research. In reading the full text of the paper, I can find no mention of acupuncture so it would seem that Costa came completely out of left field with this comment, which makes not a lick of sense. How does one develop a new acupuncture treatment? Does a new acupuncture point, where there exists yet another mysterious blockage of “energy” as it courses along its equally enigmatic meridian, need to be discovered? One that impacts this specific spinothalamic tract pathway?

Clearly Costa already knows that acupuncture “works very well” for itching because it “activates much better than rubbing”. But activates what? Regardless, I’m sure we will soon be reading about a landmark study proving that acupuncture cures itching. It will involve a small number of unblinded subjects with no control group naturally but that won’t matter to the people that already know it works.

Written by skepticpedi

April 10, 2009 at 10:07 pm

Chiropractic Practice Building Schemes…..

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Making it as a chiropractor is hard. Some do very well, but because of low demand and marketplace oversaturation many practices fail. In fact, chiropractors are more likely to default on student loans than any other health related profession. It is easy to see why so many turn to the practice building techniques taught in chiropractic school classrooms and seminars run by companies promising to bring more patients in.

Virtually everything you see on a chiropractic website or read about a chiropractor in a local publication, is part of a prepackaged practice building scheme. The wording is carefully chosed to have the biggest impact. Every flyer or handout found in a chiropractor’s waiting room is designed to indoctrinate you so that you not only come back, but you go out and spread the word. Here is a nearly ubiquitous example from a chiropractic website’s FAQ section:

“How long will you need chiropractic care?

You’ll need chiropractic care as long as you live in Hanover Park and encounter physical, chemical or emotional stress that you cannot adapt to or accommodate. Ready to get started? Call our office today.”
 
And another from a different chiropractic website’s “Story of Chiropractic” page: 
 
“Ultimately, the goal of the chiropractic treatment is to restore the body to its natural state of optimal health.  In order to accomplish this, I use a variety of treatment methods, including manual adjustments, massage, trigger point therapy, nutrition, exercise rehabilitation, massage, as well as counseling on lifestyle issues that impact your health.  Since the body has a remarkable ability to heal itself and to maintain its own health, the primary focus is simply to remove those things which interfere with the body’s normal healing ability.”  
 
Usually these practice building techniques come in the form of setting up information booths at local gyms or fairs, ads for free spinal exams, or pseudojournalistic press releases run in smaller local publications or on personal websites (1, 2, 3, 4). I’m sure you have seen these before, but you may not have realized something.

These seemingly personal stories always revolve around two things. The chiropractor always tells the story of how he or she, or a family member, was injured and could only find relief in the caring hands of a chiropractor, thus inspiring them to join the field. And they always involve the chiropractor making a confession about how they have been taking the credit for healing all those patients when really it was the chiropractic all along. Check out the links above and you’ll see, and trust me there are thousands more that are easily accessible online.

The reason why the general format is similar, and often exactly the same word for word, is because these chiropractors are using a standard template bought from practice building firms. The chiropractor simply puts in his or her name, practice location and hours, and some personal information such as a picture and a description of his or her beautiful family. I imagine that they choose from a list of personal tragedies that led them into the chiropractors office, and the testimonials typically placed in the ad are likely invented as well.

 Many of these ads disparage the medical profession, and I have come across a number which blame vaccines for SIDS and other health problems. I am constantly amazed at the audacity of placing these cookie cutter ads when the internet provides such an easy way to compare them to others and see through the charade. But I don’t think that anyone using such techniques ultimately care. It probably doesn’t take many suckers to fall for this tactic, and to sign a longterm maintenance contract, to turn a profit.

Written by skepticpedi

March 30, 2009 at 7:03 am

Acupuncture for Pets…..

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Making the rounds last week was another example of the poor quality medical and science reporting that has come to saturate the mainstream media. The article in question, on the benefits of acupuncture for animals, is fairly typical. The situation appears to be rapidly worsening as more dedicated science reporters are being replaced with generalists, although as a skeptic I must recognize that a certain degree of selection bias may be coming into play. I do tend to go out and look for this sort of fluff pseudojournalism. But as I continue to read report after credulous and poorly researched report on topics like vaccine safety, alternative medicine, and even ghost or UFO sightings my expectations continue to steadily decline. If not for blogs like Science-Based Medicine and Neurologica, I feel I would have very few places to turn. I do like to tell myself, in an attempt to feel just a little better about the current state of affairs, that the blame falls primarily on inexperienced journalists, but even seasoned reporters with significant exposure to scientific topics are dropping the ball, as was the case in E.J. Mundell’s March 3rd HealthDay News report.

According to his bio, Mundell, the Senior Assigning Editor for HealthDay News, has 10 years of experience writing (among other things*) on health related topics for a variety of outlets such as Reuters Health and The Scientist. At one point he was even the managing editor for the consumer health news division for Reuters. Yet despite this experience, he penned a sloppy piece of pseudojournalism entitled Animals Respond to Acupuncture’s Healing Touch.

In the article, it is clear that Mundell did not seek out the scientific or skeptical viewpoint on acupuncture or its use in animals. But instead of the more common error made by journalists who, because of some seemingly pathologic need to provide a sense of balance,  write as if there were two legitimate sides to a scientifically one-sided issue, Mundell has written what reads more like a press release from The International Veterinary Acupuncture Society. A vet who teaches one of their certifying courses is quoted in the piece along with a pro-acupuncture private vet and a “skeptical” pet owner who is amazed by her animal companion’s miraculous turnaround. There isn’t even the typical misquoted straw man one-liner from a skeptic included so that a believer might easily shoot it down. The two vets in the piece are allowed to spread blatant misinformation unchallenged. Why would Mundell write such thoroughly false information as if it were gospel truth and pass along such worthless anecdotes and testimonials?

There is so much wrong with this story that it is difficult to know where to begin. I think I’ll start, as so many reports on alternative medicine miracles do, with the standard anecdote about how a suprising therapy changed a patients life. In the article, Mundell cleverly describes the medical problems of a patient named Nelly in a way that is meant to fool readers into thinking she is human. Status post spine surgery, weak, lethargic and with poor appetite, Nelly’s friend takes her to a specialist for a seemingly last resort attempt at recovery. After just a few sessions, Nelly the dog is restored to her vibrant former self, all thanks to acupuncture. That’s right, animal acupuncture.

“Almost immediately after the first treatment, Nelly’s energy went from zero to 100,” recalled that friend, Annie Washburn, who works as a community organizer in New York City. Nelly became more mobile, ate more and resumed regular bowel movements. “She bounced back in a way that seemed miraculous,” Washburn said.

This anecdotal experience is unreliable and unable to effectively establish that Nelly truly experienced any improvement secondary to the acupuncture. In the many months that have passed since those initial treatments, Washburn’s memory could easily have been altered over time by multiple retellings of the anecdote. Also, humans tend to exaggerate positive outcomes over time. In reality, the actual events could have been very different than what we are being told without Washburn actually lying. All memories, even those that have evolved over time or were implanted by another person, feel real to us. And the more dramatic a so-called flashbulb memory is to us, the less likely it is going to be accurate weeks, months, and years down the road. This is why we are such poor medical historians and a big part of why properly designed studies are necessary to answer questions regarding efficacy of treatments.

What is more plausible is that the dog improved slowly over time and would have recovered eventually regardless of what therapy was being provided. Many proponents of inert therapies make a fuss over animals as patients because of their supposed inability to be effected by placebo. This notion is entirely false, however, as the placebo effect does have an impact on animals as well as on the owner’s perception of their pet’s recovery. The primary error is in thinking of the placebo as a single entity, that being some kind of mind-over-matter effect stemming from the expectation of the patient. If that were the case, then I would agree that animals are not susceptible to placebo. But that is a straw man manifestation of it. Instead of simply being mind-over-matter, the placebo effect consists of a number of different components, some of which are pure artifact, which can lead to the appearance of a true improvement. Among these components are the tendency for symptoms to regress to the mean, which is probably the largest component of any placebo effect, investment justification, a novel therapy or more complicated therapy effect, or the desire to please an authority figure to name just a few. None of these have anything to do with an actual physiologic effect from the intervention and they only require the pet owner’s biased and subjective personal experience.

It is easy to imagine how a dog lover might interpret their pet’s behavior differently secondary to a placebo effect. It usually takes Rosco a whole week to get over his flare ups but with acupuncture it only takes 7 days. In addition to pet owners and the potential for biased evaluations, it is equally easy to see how an animal might act differently because of how their owner interacts with them. Rosco might actually act more energetic and appear to be feeling better simply because his owner is paying more attention to him in anticipation of a postive therapeutic result. Perhaps other changes, like an improved diet or a new and more interesting location, may lead to positive changes in behavior that do not stem from any new therapy. It is foolish to think that the placebo effect can’t be applied to animals, particularly our doting animal friends.

The article is overflowing with misinformation and contains the expected pseudohistorical mention of how acupuncture is an “ancient healing technique.” Perhaps I employ too narrow a definition of the word, but I would not consider a therapy that has in reality only been practiced for at most  a few hundred years as ancient. It is a commonly accepted myth that acupuncture as we know it has existed for thousands of years. I’ve even read one source which claimed that acupuncture dated back to the dawn of man. I have to wonder where our primitive primate ancestors would have acquired not only the steel used to fashion such thin needles but also the paper upon which to bill insurance companies for their use. According to Mundell,

“Experts point out that animals have been treated with acupuncture therapy from the very beginning. In fact, Chinese records that go back thousands of years describe the use of healing needles on horses and other livestock.”

This is simply false. Needle like instruments considerably larger than what are used today were used to drain pockets of infection in animals but there is no historical record from that time period of the placing of thin needles in special areas of the body in order to remove obstructions to a mystical healing energy force. This concept, as mentioned above, is probably only a few hundred years old and did not even become popular in China until the 1960′s when it was forced on the public by their government. And it has become steadily less popular as  scientific medicine has come to play a larger role in Chinese society.

Mundell further reveals his ignorance of the subject, or perhaps his purposeful covering up of the rather silly underlying mechanism claimed by acupuncture believers, in the following explanation.

“The points, referred to as loci, represent important locations for nerves and blood vessels that, when manipulated, somehow aid healing, experts say.”

Acupuncture, as it is promoted by the near totality of practitioners and patients, involves the shoving of thin needles into specific points on the body in order to relieve the obstruction of a vital, yet undetectable by any modern scientific techniques, energy force. There is no legitimate evidence, anatomic or otherwise, that these loci have any special relationship to nerves or blood vessels. They are, in fact, completely arbitrary. There isn’t even agreement over the number or location of these loci, or over which should be focused on. Some proponents claim that only the ear requires needling while others only care about the bottom of the feet.

One of the experts in the article reveals that “veterinary acupuncture has proven effective in healing or easing the symptoms of arthritis, acute injuries, hip dysplasia, respiratory disorders, immune system ailments and a host of other problems” This is also entirely false. There have been, over the years, a number of small and poorly designed studies, typically unblinded and uncontrolled, that have shown a weakly positive effect. But, as is the case with inert therapies, as larger and better designed studies are performed, particularly studies that are appropriately blinded and have a placebo control group, it becomes increasingly evident that there is no effect. This is certainly the case with acupuncture.

Animal acupuncture is only one very small step above pet psychics on the list of the most absurd jobs in the pseudosciences or the paranormal.

* E. J. Mundell was the production secretary for 1990′s Prom Night III: The Last Kiss

Written by skepticpedi

March 10, 2009 at 10:28 am

Skeptical Pearls #1: If It’s Too Good To Be True…..

with 15 comments

One of the more common approaches that attending physicians take when teaching medical students and residents is the use of clinical pearls. Rather than cold, hard facts, such as the most common form of congenital adrenal hyperplasia being 21-hydroxylase deficiency, these pearls of clinical wisdom are more akin to generally accepted rules of thumb. My personal favorite example is the admonition to avoid poking the skunk. Poking the skunk occurs when labs are ordered which aren’t necessary in the care of the patient. Checking a basic metabolic profile when all you really need is the serum sodium is risky. In fact, it seems that the less vital a particular lab value is to management decisions, the more likely it is going to come back as falsely abnormal, which often leads to further unnecessary tests. I don’t like to stick needles in babies, although you might not think that if you spent a day with me at work, so this particular clinical pearl comes up pretty often on my rounds.

I also make a point, on an almost daily basis, to incorporate pearls of critical thinking into my teaching of medical professionals in training. Naturally, these tend to focus on my particular area of interest, the myriad and often contradictory therapies falling under the umbrella term alternative medicine. As I’ve said many times before, I prefer terms like unscientific medicine, or quackery to be quite honest, over alternative medicine, integrative medicine, or complementary medicine. These are manipulative marketing terms used to lull the general public into acceptance with a false air of legitimacy, and the academic community into the application of a double standard to the evaluation of safety and efficacy of these therapies. There is only one legitimate means of determining whether a treatment works, and that is with science.

One example of a very helpful critical thinking pearl that should be applied to the claims of a large number of so-called alternative approaches to health, is that there is often an inverse relationship between the number of symptoms or conditions supposedly treated by a therapy and the number that is actually treated. This is better expressed with the adage that if something is claimed to cure everything, it almost certainly cures nothing.  The number of alternative medical modalities that fall into this category are numerous and experiencing seemingly exponential growth, however the most important example because of its acceptance by the general public as a legitimate and science-based practice is that of chiropractic.

Though nobody, even chiropractors themselves, have been able to define themselves in a way that allows a consistent and practical understanding of just what it is that they do, there are some safe generalizations which can be made. For instance, they tend to be spine-centered rather than the oft advertised “holistic”, and a significant percentage of them categorize themselves as “straight”. This distinction shares a dichotomous relationship with self-described “mixers”, which as the name implies are prone to incorporating a wide variety of decidedly non-spine centered therapies into their practice such as acupuncture, applied kinesiology, or nutritional supplementation, as well as some science-based modalities like standard physical therapy.  Mixers outnumber straights by a large margin, and though they do make use of other therapies, they still primarily focus on the correction of a non-existant entity known as the subluxation.

Subluxations in the chiropractic sense, as opposed to the legitimate medical diagnosis, are as polymorphous as one would expect of something invented out of whole cloth* by a former magnet healer and spiritualist over a hundred years ago. Since 1895, the term has evolved into many different forms with all stages still believed in by varying numbers of chiropractors today. The manifestation which likely is accepted by the largest number of currently practicing chiropractors involves a proposed “complex of functional and/or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health”. This definition is so slippery as to be rendered utterly meaningless, and is a prime example of the inability of chiropractors to be able to establish a standard definition of who they are and what they do. This fact actually benefits chiropractors however, as it allows for a near limitless scope of practice and the ability to bill many insurance companies for the treatment of a phantom condition.

Regardless of whether a chiropractor is a straight or a mixer, they are likely to claim that they have special insight into your particular complaint regardless of what it is. With rare exception, chiropractors assert their ability to treat not just common musculoskeletal complaints, a category of conditions falsely considered by many to be their area of particular expertise, but the entirety of known medical maladies. Many will even treat one or more of a growing number of fictitious conditions such as adrenal fatigue or Wilson’s Thyroid Syndrome. This is often done overtly with outright claims of personal success in curing conditions ranging from asthma to zoster, with some even touting their ability to treat serious life-threatening illnesses like cancer and HIV.

Straight chiropractors take a different approach, boldly claiming only to treat subluxations, which then allows for the innate healing power of the human body to heal any disease state under the sun via an unimpeded spinal conduit. A critical evaluation of the medical literature reveals a far different reality however. After a little over a century of existence, there is essentially no good evidence that chiropractic care is effective in the treatment of any medical condition, or any made up one either. The one sliver of an exception is the treatment of acute lower back pain, which does appear to resolve under the care of a chiropractor. What they may not want you to know is that it has not been shown to work any better than more standard treatments such as physical therapy and the use of ibuprofen.

*The top link on google when inserting the phrase “invented out of whole cloth” takes one to an article on the history of chiropractic

Written by skepticpedi

February 27, 2009 at 9:16 pm

More Uneccesary Deaths from Vaccine-Preventable Illness…..

with 5 comments

I am young enough to not have experienced practically all of the vaccine preventable illnesses first hand as either a physician or a patient. But that doesn’t mean I don’t have a healthy respect for the amount of morbidity and mortality that they can cause. With one in particular, Haemophilus influenza type b (Hib), I at least know a large number of older pediatricians who have seen many cases. The vaccine against Hib was developed in the early 1980′s and nearly wiped this dreadful condition out here in America, but I have heard countless stories of residencies spent seeing young children with fatal or debilitating meningitis presenting with brains full of pus and children being suffocated by rapidly progressing epiglottitis, and the thought of this illness returning sends shivers down my spine.

At one time, Hib affected 20,ooo children each year. Since the vaccine, many states see one or two cases yearly and often none. Hib bacteria is still prevelant, but high vaccine rates and herd immunity have kept our young children safe. Unfortunately, the return of this disease may be happening, and if it does it will be because of the anti-vaccine nonsense that has so overtaken this country over the past two years. I received an emergency news alert from the CDC today revealing that Minnesota reported 5 cases of Hib in 2008, the largest number in children under 5 since 1991.

The alert provided some details of the cases:

“Three patients had received no vaccinations due to parent or guardian deferral or refusal of vaccinations. One of the unimmunized patients, a 7-month-old infant, died of Hib disease. Two of the remaining children received age-appropriate immunizations. One child, a 5-month-old, had received two Hib immunizations. The other child was 15 months old and was fully vaccinated for age but, subsequent to Hib infection, was diagnosed with an immune deficiency (hypogammaglobulinemia).”

Three of the children were not vaccinated, one had a condition which hampers the ability for the vaccines to work, and one had been fully vaccinated. That is not suprising, as no vaccine is 100% effective, and it perfectly illustrates the importance of herd immunity. There is a persistent and pushy minority of people in this country, led by clueless celebrities and pseudojournalists, who are so blind to the reality of science that they are willing to sacrifice not just the safety of their own children by refusing vaccinations, but that of every child in this country. It isn’t just the unvaccinated that are at risk. There are also the children too young to be immunized against Hib and other diseases, or with real medical contraindications as opposed to manufactured ones in addition to those in which the vaccine doesn’t confer protection.

This may end up as being only a statistical fluke, but increasing rates of vaccine-preventable illness are an inevitable result of increasing numbers of parents refusing to protect their children. We have already seen major spikes in measles infections, another potentially deadly diseases. The situation is a few years ahead in England, where there have also been outbreaks of measles as well as mumps. Hib is considerably more dangerous and if there are large outbreaks more children will certainly die.

If you know anyone who is considering refusing vaccinations for their child, please direct them to the CDC’s online information. Or, convince them to read Paul Offit’s recent book Autism’s False Profits. You may save a life.

Written by skepticpedi

January 23, 2009 at 6:24 pm

Posted in Medicine, Vaccines

Tagged with ,

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