Corrigendum. The Week in SBM for 01.29.2017

http://ift.tt/iClz9I

Selections from Society for Science-Based Medicine Points of Interest with comments.

Not every article and study that pops up my feeds in the world of pseudo-medicine is worthy of a complete blog post. But they need to be noticed and commented upon. Duty Calls.

What’s the Harm

FDA confirms elevated levels of belladonna in certain homeopathic teething products.

The U.S. Food and Drug Administration announced today that its laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label.

The other name for belladonna is deadly nightshade. I suspect that having “Deadly Nightshade” in large letter on the box would have been off-putting for consumers, but homeopathic products have never been known for their transparent labeling. These products were linked to at least 10 deaths. Thanks to the Congress, homeopathic nostrums and supplements have been under no manufacturing oversight and it is not until problems arise that the FDA can intervene. In other words someone has to be harmed or killed first.

Not an optimal oversight.

In India there have been 6 deaths from methyl alcohol and/or chloral hydrate poisoning with fake homeopathic nostrums. The report is not as clear as one would like, but it raises the question. If you are going to make counterfeit homeopathic products, why bother to even use real chemicals? Just slap a label on a bottle of water and avoid accidentally harming or killing people.

Homeopathy

J Pharmacopuncture. 2016 Dec;19(4):319-328. doi: 10.3831/KPI.2016.19.033. Embryonic Zebrafish Model – A Well-Established Method for Rapidly Assessing the Toxicity of Homeopathic Drugs: – Toxicity Evaluation of Homeopathic Drugs Using Zebrafish Embryo Model..

I have mentioned in the past that Harriet’s excellent concept of Tooth Fairy Science seems incomplete. Tooth Fairy science covers the what of pseudo-medicinal research, but not the how. What continues to amaze me is the use of advanced technology to ‘investigate’ pseudo-medicines. In the above study they evaluated three homeopathy nostrums at ‘potencies’ of 30CH and 200CH.

30CH and 200CH is also known as water. At the delusion, er, I mean dilution, there is nothing in the water but water.

And then, for no reality-based reason (they were looking for nanoparticles in water) they used

…ultraviolet-visible spectrometry (UV-Vis) characterization of the homeopathic drugs, their particle sizes were evaluated by using an Epoch Microplate Spectrophotometer (BioTek-SN-141215F) to monitor the visible absorption band. Data reported encompassed the wavelength range from 190 to 1100 nanometers (nm) [20]. For the nanoform characterization of the homeopathic drugs, the sizes and the morphologies of the homeopathic drugs were determined by using field emission gun – transmission electron microscopy (FEG-TEM) (Tecnai G2, F30 magnification 58 X 1 million X (300 kV)). Carbon-coated grids were immersed in the sample and left to dry prior to observation. The selected area electron diffraction (SAED) ring patterns were examined using high-resolution TEM (HR-TEM).

And then they evaluated the water, er I mean, the medications, for toxicities by trying to induce birth defects in zebra fish embryos. Poor fish, but they found no toxicity.

Our findings clearly demonstrate that no toxic effects were observed for these three homeopathic drugs at the potencies and exposure times used in this study. The embryonic zebrafish model is recommended as a well-established method for rapidly assessing the toxicity of homeopathic drugs.

What a surprise. Water is not toxic to fish. Who’d a thunk it.

This research was done in India where I would think they would have a better use of funds than for studies like this.

Acupuncture

Nothing like a review of reviews. The worse the methodologies, the more more likely a postive result and the clinical trials of acupuncture are usually fatally flawed. But fatal flaws doesn’t prevent organizations from suggesting acupunctures use in clinical guidelines. The British NHS has, rightly, abandoned acupuncture for back pain. But acupuncture is still recommended in many guidelines to a degree that is sobering.

Over at the National Guideline Clearinghouse they have 39 guidelines with 80 recommendations concerning acupuncture

49 recommendations were clearly for acupuncture, 25 recommendations were against acupuncture and 6 recommendations did not indicate any clear recommendations, 37 recommendations were for painful diseases/ disorders,

and these recommendations were

are not high in strength, and most of the evidence is moderate or low in quality.

I know from the guidelines in my own specialty of Infectious Diseases that some recommendations are not based on the best of data, but are at least grounded in reality. Interventions suggested in any guidelines should at least be based in the reasonable extrapolation of reality if no good clinical studies exist, not the fantasy that is acupuncture.

As we have seen with Lyme , the National Clearinghouse does not judge of the quality of the guidelines, nor should they. That is the responsibility of the organizations who produce the guidelines, and they are often lacking. But somehow I expect Ed McMahon to show up at my door with the next set of guidelines. Yes. I know.

In the Literature

Addict Behav. 2017 Jan 18;69:27-34. doi: 10.1016/j.addbeh.2017.01.022. Efficacy of mindfulness meditation for smoking cessation: A systematic review and meta-analysis..

They found that

Overall, mindfulness meditation did not have significant effects on abstinence or cigarettes per day, relative to comparator groups.

So mindfulness meditation offers nothing special, although I do not doubt that the practitioners of mindless mindfulness meditation found the process pleasant. If I were going though nicotine withdrawal I would like an opportunity to mellow out. And is always the case

Low-quality evidence, variability in study design among the small number of existing studies, and publication bias suggest that additional, high-quality adequately powered RCTs should be conducted.

No. Don’t think so. Many flawed negative studies are not a reason for further studies unless you really need a well done to prove you interaction does nothing. Not like anyone would pay attention.

Law and Legislative

In California the vaccine law was recently challenged by

a group of over twenty individual plaintiffs filed a complaint in a federal court in Los Angeles against a group of legislators, their wives, the governor and his wife

Yes, they went after the wives because, well

the biblical principle that the wife falls under the husband’s covering, and whatever the husband does in public comes back to haunt him in private.

Yep. The wives must pay for the sins of the husband by being sued. And they argue that vaccines are dangerous and part of a pharmaceutical conspiracy, under the Racketeer Influenced and Corrupt Organizations (RICO) Act. Neither are true.

Their suit was dismissed and in their appeal rather than address the legal flaws of their argument, they attacked the judge. I guess How to Win Friends and Influence People is not required reading.

It would appear that the vaccine law in California is safe.

For updates on the pseudo-medical Legislative shenanigans in your state, visit the Legislative Updates page at the Society for Science-Based Medicine website.

Precise Language

In medicine we almost have a complete language to describe diseases and treatments. And it is more useful than Klingon. You want to be precise when describing a patient. No one wants a surgeon to way they are going to remove your thingy. Precision of language reflects precision of thought and understanding.

The genius of alternative medicine is that it uses imprecise language as if it were precise. My favorite example has been acupuncture; there are as many acupunctures as they are acupuncturists but the pseudo-medical world, and often reality-based medicine, speaks, and acts, as if all these acupunctures were the same: Acupuncture. Damn near anything can be called acupuncture, just as damn near anything can be called CAM. For example:

J Altern Complement Med. 2017 Jan 23. doi: 10.1089/acm.2016.0288. Inpatients’ Preferences, Beliefs, and Stated Willingness to Pay for Complementary and Alternative Medicine Treatments.. And anything can be CAM, including

acupuncture, aromatherapy, art therapy, guide imagery, healthy food, humor therapy, massage therapy, music therapy, pet therapy, Reiki, and stress management.
.
Which of these inteventions were patients willing to pay for? Nothing CAM:

were most willing to pay for healthy food (71%), massage therapy (70%), and stress management (48%).

I can’t access the table to see how many would pay for the fraudulent interventions like reiki and acupuncture.

But of course they conclude that “CAM” should be implemented in hospitals, whatever “CAM” is.

Tax Dollars In Action. Or perhaps inaction

The Tewksbury (Massachusetts) Health Department and Town Nurse Sarah Kinghorn sponsored a lecture on Tong Ren, the goofiest form of acupuncture: you hit voodoo doll with meridians painted on it with a magnetic hammer. Really.

The acupuncture model becomes an energetic representation of the patient’s body,” a way to impart the benefits of acupuncture without using needles.

The same speaker will be back to discuss acid reflux and diabetes in his role as a nutritionist. I can’t wait.

Odd Language

The Massachusetts legislature now has their double O with licensure of naturopaths. I would hope, in spirit of openess, the each license number begins with an 00. In the spirit of 1984 and the era of alternative facts I give you the following quotes from a naturopath

This licensure ensures the safe practice of naturopathic medicine in the Bay State.

and

This law affords people of Massachusetts an option to include well-educated and trained NDs on their health care team for the ND expertise in both preventive care and natural integrative medicine.

Sigh.

See http://ift.tt/2dFcSeL for the truth the Massachusetts legislature ignored.

Corrigendum. The Week in SBM for 01.29.2017 Mark Crislip

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s