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https://patents.google.com/patent/US8388512B2/en

So overall the idea is to remove all theoretical and historical rationale (nutty as they may be) thus repudiating anything that legitimzes acupuncture but to keep on needling?

Sounds like a great idea to me. Next we can expect the homeopaths to embrace Avogadro's Number, admit there is nothing but distilled water in the medicines but say it works better than tap water?

I for one wholly endorse an imbalance between matter and antimatter.

They packed a lot of fail into that article.

For instance, if they could translate the descriptions of the various pulse types into something I might see on an EKG, I'd be willing to listen. But the description of Ge Mai is so full of mixed metaphor that I don't know how you could predict what that looks like on an EKG. Bowstring and drum at the same time? Hard and light at the same time?

Then there's that bit about Chinese "words" (their scare quotes) having multiple meanings. Which is true; e.g., the character zhong can mean either "China" or "center", depending on context. But that happens with English words, too. "Row" can be something you do with oars in a boat, or it can be a fight of some kind.

So Priebe et al. have set themselves an impossible task, but are too incompetent to recognize that the task is impossible.

Is it true that frequent acupuncture therapy, in a clinical setting, may reduce the incidence of dust in your living space?

If this is true, the theatrical placebo may become a useful dust buster. :-)

. . . Comparative effectiveness [of acupuncture] research in clinical applications should demonstrate cost savings and improved outcomes when comparing techniques or procedures. . . .

So the basic plan is:

1. Rigorous clinical studies
Comparative effectiveness studies
2. ?
3. Profit

Apologies to underpants gnomes everywhere.

I think there is a typo in Clay Jones blog post over at SBM:

Bethesda, MD- Researchers at the National Center for Complementary and Integrative Health (NCCIH) have announced the discovery of a revolutionary form of “needleless” acupuncture that may soon replace the use of surgical-grade, .25 millimeter thick stainless steel needles that have been in use for millennia.

Shouldn't the NCCIH have not added le to the word needleless. Needless acupuncture reads so much better,

Rich, do you mean the Clay Jones' highly satirical blog post at SBM? At the end of the article: " Tagged in: acupuncture, Humor, Satire"

Rich, do you mean Clay Jones satirical blog post at SBM? At the bottom are these words: "Tagged in: acupuncture, Humor, Satire"

Ooops.... got caught in moderation. Well, remember to look at the words at the bottom of Dr. Jones' blog post. It is not a typo.

"surgical-grade, .25 millimeter thick stainless steel needles that have been in use for millennia."

Stainless steel has been in existence for millennia? And surgical-grade, no less? Not to mention .25mm thick. I learn so many things on RI...

Orac,

My next comments will be coming from either Chiang Mai or Puhket, over the next several weeks.

Rich@6: Both forms of acupuncture are equally needless, so I don't see what's so revolutionary about the former. I'd also ask how exactly the new technique differs from "electro-acupuncture", but I'm not sure I want to know.

Not to mention that the kind of acupuncture that uses 0.25mm surgical grade needles goes all the way back to the ancient times of the mid 20th century. Meaning it's even newer than reiki, which at least goes back to the early 20th century.

My guess is that some idiot PR flack (pardon the redundancy) wrote that press release.

Eric @9: Hate to burst Rich's bubble but It's Clay having a good laugh (and playing upon the Emperor's New Clothes).

Although I can totally see someone advertising acupuncture needles that disintegrate upon being looked at. "Skip that pesky sterilization step and use new inviso-needles!"

The scientification (scientific sanctification??) of acupuncture by means of pragmatic studies?

Delusion redux.

The local paper recently devoted the front page of the Lifestyle section to what can only be described as a love letter to some nutbag who advertises heavily. Acupuncture is her game, and she desperately wants to be integrated into the "holistic" practices on call at our regional hospital.

The stupidest of the stupid was her claim that "the NIH recommends acupuncture for a wide variety of ailments," by which she means the propaganda arm going by the name of NCCIH.

But these people do know their audience.

... positive and negative charge or matter and anti-matter.

Sure. Adopt those terms. That will impress people - except the people who happen to know those terms already have actual accepted meanings will likely be impressed on the negative/anti side. Hooey is hooey, even if you prefer to call it alternative facts.

Speaking of inane, have you heard the one about a TCM remedy for bleeding in childbirth? It's a fish bladder that sells for more than cocaine, and it's threatening the world's most endangered species of porpoise, along with the existence of the fish from which the bladders are taken from.

@Robert L Bell

The 1997 NIH Consensus Statement on acupuncture was one of the more unfortunate episodes in the annals of the NIH.

Checking the references in Priebe et al. makes for a gruesome experience. Lousy quality studies of scant relevance to the case being made.

For example reference 10 is supposed to show scientific confirmation of traditional acupuncture points.

What we find is an RCT in which 41 healthy females were randomised to one of two acupressure groups (one group used points on the lower arm, the other group points on the leg) and a control group who received no acupressure. Subsequent physiological measurements on the trapezius muscles were similar for the arm acupressure and control groups but were significantly different for measurements of effects of leg-points acupressure. Reference is made to an earlier study by the authors which turns out to be a small study claiming to show acupuncture works for neck pain, but which could be perfectly well explained by placebo effects.

All of which amounts to nothing more than a waste of time.

It is always like this. Crap piled on crap all the way down.

@19
It was acupressure for neck pain, not acupuncture.

Speaking of inane, have you heard the one about a TCM remedy for bleeding in childbirth?

Why can't TCM remedies involve species like squirrels, or grackles, or coyotes?

@Shay Simmons #21: I know; it's all a bit fishy. I mean, why couldn't they use ergot?

@Leigh Jackson

Thank you! Properly forewarned, I will be properly forearmed in my next skirmish with the alt med people - who, sad to say, are a huge complex of businesses in my neck of the woods.

@Lighthorse: I was curious if one could go out on a limb to "justify" fish bladder (okay, only if pre-industrial or marooned somewhere) on the basis of a slight similarity to balloon tamponade for PPH. But, noooo. They had to go and eat a perfectly good, in a pinch balloon.

Plus, I second Shay's suggestion. I think I'd choose mosquitoes, though. Likely there'd be enough Anopheles aegypti and Aedes aegypti extant to supply TCM demand and balance the ethical quandaries surrounding deliberate extinction, and still enough other spp. left over for the birds and bats, if we were to guess wrong.

But the main criterion for choosing ingredients in TCM -- just as in other pre-modern, non-functioning traditions -- is scarcity. Expense and unobtainability. Like bezoars in Traditional European Medicine. I can see several reasons for this:

1. If a curative ingredient were readily available, cures would also be readily available, in contradiction to the abysmal life expectancy in Traditional China. QED.

2. The clients for TCM were wealthy powerful people, who do not want a treatment that is also accessible for commoners.

3. "Oh, the patient died anyway? I guess that ground-up stone cut from the head of a toad from Tartary must have been a fake. It is so hard to tell the real stones cut from the heads of toads from Tartary."

"Why can’t TCM remedies involve species like squirrels, or grackles, or coyotes?"

Or gullible H. sapiens (a few TCM cures do involve preserved human parts).

But the main criterion for choosing ingredients in TCM — just as in other pre-modern, non-functioning traditions — is scarcity. Expense and unobtainability.

There is a fine line to be walked here. The practitioner cannot prescribe unobtainium, because he has to be able to provide it when his powerful patient--especially if said patient is the emperor--demands it. Sure it can be expensive, but it must be available, at least to somebody who wants it badly enough.

Speaking of emperors, I have heard that one of the reasons that Qin Shihuangde's tomb has not yet been excavated is that in his day mercury was thought to provide immortality, so one of the things they have to be prepared to deal with is serious mercury contamination. Yet another case where the "wisdom" of the ancients turns out not to be so wise. Of course the emperor was hedging his bets--this was the guy who ordered the creation of the terra cotta army to defend his body in the afterworld.

ang et al.[34] has attempted to resolve the mysterious balance of yin and yang with the biophysical, i.e., positive and negative charge or matter and anti-matter.

Bwahahahahahaha.

Did those guys think about that before they wrote it?

@Eric Lund #28: Mercury and then some. Writings from the time have it that the Emperor's remains are entombed in the middle of a lake of mercury. Like the later practice of alchemists in Europe, from the fumes of their experiments, the quest for immortality through the manipulation of mercury by Chinese alchemists must have brought a number to madness, death, or both. Yet, to this day, practitioners of ayurvedic medicine in India insist that mercury can be rendered beneficial by means of "purification", whereas they recognize unpurified mercury to be harmful. In years gone by, I found mercury, gold, lead, and other "purified" metals listed on boxes of ayurvedic herbal--mineral formulations sold domestically and abroad. An educational campaign among Indian pharmacists to root out such practices is ongoing in India., but formulations with "purifiied" (often abbreviated on labels as "purif.") metals continue to show up in the marketplace.

Very interesting read. It's always a good thing to be open to all angles on an issue.

Old wine poured into a newer skin: The Society for Integrative Oncology updates its clinical guidelines for breast cancer

oracknows — Tue, 02 May 2017 01:58:19 +0000

Old wine poured into a newer skin: The Society for Integrative Oncology updates its clinical guidelines for breast cancer

"Integrative medicine" is a term for a form of medicine in which pseudoscience and quackery are "integrated" with real medicine. Unfortunately, as Mark Crislip puts it, when you mix cow pie with apple pie, it doesn't make the cow pie better; it makes the apple pie worse. Unfortunately these days, there's a lot of cow pie being mixed with apple pie. Worse, it's gotten to the point where integrative medicine is subspecializing. For instance, there is now a specialty known as "integrative oncology," which particularly burns me. Indeed, supportive care oncology has been very susceptible to the woo embraced by integrative oncology, to the point where naturopaths are involved, and when naturopaths are involved quackery such as homeopathy is involved.

Two years ago, the Society for Integrative Oncology, the main society promoting the integration of pseudoscience into science-based oncology, published a monograph in the Journal of the National Cancer Institute (JNCI) with guidelines for what it referred to as the evidence-based supportive care of breast cancer patients. I referred to it at the time as "old wine in a new skin." Well, leave it to the SIO not to be able to leave bad enough alone, as it's come up with what I like to refer to as SIO Clinical Guidelines 2: Electric Boogaloo. It comes in the form of an article by Heather Greenlee et al published in CA: A Cancer Journal for Clinicians and entitled Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

Its author list includes MDs, some of them respected, like Debu Tripathy, but it also contains quacks like an acupuncturist named Misha Cohen. It also contains three naturopaths, starting with the first author, Heather Greenlee. Dugald Seely is on the author list again, as well. We've met Seely before on multiple occasions. Indeed, he's quite the flush little naturopathic quack, complete with millions of dollars donated by an anonymous donor to fund "integrative oncology" research at the Ottawa Integrative Cancer Center (OICC). Then there's Suzanna Zick, who's even worse than a naturopath. She's a naturopath at my alma mater, the University of Michigan Medical School. It always depresses me to contemplate that U. of M. actually has a naturopath working for it, but, then, it also has an anthroposophic medicine program. So I guess it's not a stretch any more for there to be naturopaths there.

Let's get back to the clinical guidelines and systematic review, such as they are. To show just how debased medicine has become in accepting woo as "evidence-based," you can even answer questions about the article and earn CME for learning. One thing I can't figure out is why this group felt the need to update the guidelines a mere two years later, and this explanation doesn't help:

In November 2014, the Society for Integrative Oncology (SIO) published clinical practice guidelines to inform both clinicians and patients on the use of integrative therapies during breast cancer treatment and to treat breast cancer treatment-related symptoms.[9] The SIO adapted methods established by the US Preventive Services Task Force[10] to develop graded recommendations on the use of specific integrative therapies for defined clinical indications based on the strength of available evidence concerning associated benefits and harms. The 2014 clinical practice guidelines were derived from a systematic review of randomized clinical trials published between 1990 and 2013 and organized by specific clinical conditions (eg, anxiety/stress, fatigue). This review provides an updated set of clinical practice guidelines based on a current, systematic literature review of randomized controlled trials (RCTs) published through December 2015 along with detailed definitions of integrative therapies and clinical outcomes of interest, a detailed summary of the literature upon which the clinical practice guidelines are based, and suggestions for how appropriate therapies may be integrated into clinical practice.

So my first reaction was: Really? You needed to publish again just to add two years' worth of new trials to the guidelines? Do the new trials add much to the recommendations from the previous iteration of these guidelines? Do they change the recommendations in any substantive way? What do Greenlee et al mean by "recommendations," anyway. It's not what you would normally think:

Of note, it is important to define the use of the term recommendation in these clinical practice guidelines. In many settings, a clinical guideline recommendation suggests that it should be used as the standard of care and is favorable or equal compared with all other options based on best clinical evidence for benefit/risk ratio. Here, in the setting of integrative oncology, we use the term recommendation to conclude that the therapy should be considered as a viable but not singular option for the management of a specific symptom or side effect. Few studies have conducted a head-to-head comparison of a given integrative therapy against a conventional treatment, and most integrative therapies are used in conjunction with standard therapy and have been studied in this manner. Moreover, combination-based approaches and the interactions of the numerous permutations of integrative and conventional treatments have not been formally investigated, such that recommendations must account for this limitation of our knowledge. Despite these limitations to evaluating the use of integrative therapies in the oncology setting, there is a body of well conducted trials of specific therapies for specific conditions that provides sufficient evidence to warrant recommendations on the therapies as viable options for treating specific conditions.

Ah, "integrative medicine," where even "recommendation" doesn't mean what it does in real medicine. In clinical guidelines in real medicine, "recommendation" means just that: a recommendation to use the treatment in question, graded, of course, according to the strength of the evidence. Yet here in the world of integrative medicine, "recommendation" means something...squishier. One can't help but make the analogy that integrative medicine's evidence standard is squishier than that of real medicine. Oh, and the answer to that question of whether the new studies add much of anything to the 2014 clinical guidelines is, as I suspected, no, at least as far as I can tell. As was the case with the previous review, interventions are graded thusly:

Grades were based on strength of evidence, determined by the number of trials, quality of trials, magnitude of effect, statistical significance, sample size, consistency of results across studies, and whether the outcomes were primary or secondary. The highest grades (A and B) indicate that a specific therapy is recommended for a particular clinical indication. Grade A indicates there is high certainty that the net benefit is substantial, while grade B indicates there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Grade C indicates that the evidence is equivocal or that there is at least moderate certainty that the net benefit is small. The lowest grades (D, H, and I) indicate no demonstrated effect, suggest harm, or indicate that the current evidence is inconclusive, respectively.

Interestingly, this review does add something in that it defines each intervention more explicitly than the previous guidelines. Not surprisingly, the definition of acupuncture parrots the same sort of revisionist history that acupuncture advocates frequently repeat when justifying the practice. It is, in essence, an appeal to antiquity that paints acupuncture thusly:

Acupuncture involves the stimulation of specific points, (ie, acupoints) by penetrating the skin with thin, solid, metallic needles.[154, 155] A variation of acupuncture includes electroacupuncture, in which a small electric current is passed along acupuncture needles to provide a stronger stimulus than acupuncture alone, with distinct effects suggested by functional magnetic resonance imaging.[156, 157] Acupuncture has been practiced in Asia for thousands of years as a component of traditional medicine systems (eg, traditional forms of Chinese, Japanese, and Korean medicine) and is thought to stimulate the flow of a form of energy called qi (chee) throughout the body. Traditional Chinese acupuncture, which is commonly used in North America, requires needle manipulation to produce a de qi sensation (a soreness, fullness, heaviness, or local area distension[157, 158]), along with a period of rest with the needles in place.[159] It is posited that this removes energetic blockages, thus reestablishing homeostasis. The mechanisms for acupuncture's effects are not well understood but are thought to function in part through modulation of specific neuronal/cortical pathways.[160]

It's always a sad day when a respectable medical publication publishes papers that invoke vitalism in the form of the flow of "life energy" and suggests that this flow can be manipulated. Then there's the revisionist history. Think about it. The claim is that acupuncture has been practiced "thousands of years," most commonly for at least a couple of thousands of years. Yet two thousand years ago the technology to produce thin needles of the sort used by acupuncturists didn't exist. In fact, it's unclear when acupuncture in something resembling its current form evolved, but it appeared to have evolved from bloodletting. Harriet Hall once related the story of Dugald Christie, a Scottish surgeon who served as a missionary doctor in northeastern China from 1883 to 1913, and his experiences observing traditional Chinese medicine (TCM), including acupuncture. Let's just say that acupuncture practiced 100 years ago was rather brutal. In fact, acupuncture began as nothing more than a Chinese version of bloodletting, very much like "Western" bloodletting and has been called "astrology with needles." In reality, acupuncture and TCM achieved their current form under Chairman Mao Zedong, who promoted their use when he couldn't supply enough doctors for his people and exported to the world, something China is still doing. It's a history that's been retconned, and Greenlee et al repeat that retconned revisionist history. No wonder there are so many forms of acupuncture.

Basically, there's not much new in these guidelines. Relatively uncontroversial modalities like meditation, music therapy, stress management, and yoga are given the highest recommendations. However, acupuncture and its bastard offspring electroacupuncture (which really has no basis in TCM, given that there was no electricity hundreds or thousands of years ago to hook needles up to) consistently get B or C recommendations for several indications, despite acupuncture being nothing more than a theatrical placebo that hasn't convincingly been shown to work for any clinical indication. That includes acupressure.

As is the case with most systematic reviews of integrative medicine, there are some head scratchers. For instance there's this level C recommendation, meanding that they can be considered

Acupuncture,[49-51, 91, 92] healing touch,[93, 94] and stress management[36-38, 95, 96] can be considered for improving mood disturbance and depressive symptoms.

And:

Acupuncture,[119-124] healing touch,[93] hypnosis,[125, 126] and music therapy[31, 34] can be considered for the management of pain.

Healing touch is the rankest quackery. It's energy medicine that postulates that practitioners can manipulate human life energy fields. It's such a silly form of quackery that even a 12-year-old girl could disprove it.

Basically, these guidelines were even more unnecessary and pointless than the first set of guidelines published in 2014. It's not as though clinical studies have advanced knowledge enough to justify a new set of guidelines, and these guidelines suffer from the same issue that integrative medicine itself suffers from, mixing cow pie with apple pie as though they were equivalent. I called the previous guidelines old wine in a new skin. Greenlee et al have just poured that old wine out of the new skin into a newer skin, seemingly expecting it to make the vinegary wine better.

oracknows Mon, 05/01/2017 - 21:58

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Technology

Ugh. So now we have not only alternative facts, we have alternative recommendations.

Of COURSE the SIO had to adjust the meaning of the word recommendation. If they actually used the same rigor the USPSTF used in grading treatment modalities based on the medical evidence, every one of their woo therapies would get a D for "Discourage this service" or at best an "I" for Indeterminate.

Orac, I'm starting to feel your frustration for quackademic medicine in a personal way. I took my final in Women's Health on Sunday. There was a question asking me what "natural remedy" I would recommend for a woman dealing with menopause symptoms.

Sadly, "none of the above" was not a choice. Black Cohash was the answer, which I knew (so I got it "right") but I would never RECOMMEND anyone actually take it. It annoyed the crap out of me that I'd be asked a question like that. Knowing about "herbal" supplements is one thing since so many people take them, but to actually be expected as an FNP to recommend it? Oh HELL NO.

I shudder to think that a question like this will be on my certification exam.

It is written,

...there is a body of well conducted trials of specific therapies for specific conditions that provides sufficient evidence to warrant recommendations on the therapies as viable options for treating specific conditions.

MJD says,

A specific example?

Systems and methods for music therapy (Brandes in Patent number 8,388,512 - March 5, 2013)

The inventor explained that disorders are related to stress, which also contributes to coronary heart disease, depression, and some cases of cancer.

@ Panacea,

Q. What type of music can lower stress and affect cancer.

A. Hip hop
B. Rock
C. Punk
D. Integrative music therapy

At least they don't recommend (or 'recommend') any supplements?

And all but one of the things suggested in the report are pretty basic "stuff to make you feel better" (music therapy, stress reduction, yoga, massage), which are barely CAM.

Who wants to bet that the acupuncture/acupressure for nausea/vomiting is a combination of distraction and not wanting to move for fear of moving the needles?

The mechanisms for acupuncture’s effects are not well understood but are thought to function in part through modulation of specific neuronal/cortical pathways.[160]

The mechanisms for prayer’s effects are not well understood but are thought to function in part through modulation of the Luminiferous Aether.

The mechanisms for Leprechaun Magic’s effects are not well understood but are thought to function in part through modulation of the Morphogenetic Synchronicity Field.

The mechanisms for the Evil Eye’s effects are not well understood but are thought to function in part through modulation of Phlogiston.

MJD: Answer, none of the above. When will you figure out the difference between a patent and scientific evidence?

MJD - this patent reads like a 21st century version of 19th century snake oil patent medicine - their silly ass pretentious music system can ease everything from mental problems to cancer. Logically, how likely is that? Not possible.

But they patented anyways. Thought they were on to something but they only fooled themselves - and wasted a lot of money. Oh well, it's their money to waste. To quote Trump "Sad"

Sun Ra beat out Vera Brandes by over 40 years.

Panacea - I would bet that the lady I met as a medical student who was awaiting a liver transplant due to taking black cohosh shares your disgust. So do I, for that matter.

Thought they were on to something but they only fooled themselves

They fooled the patent examiner, too.

MJD's question was definitely a loaded question. Hip hop, rock, and punk are genres that are intended to get the heart rate up, which is generally the opposite of what you want to achieve by relaxing. There are other genres that might be more effective at relaxing the listener: folk, classical, etc. And for most people this option will be cheaper than some patented but unproven integrative music system. I can't speak for everybody, but presumably most people (myself included) primarily if not exclusively buy music they enjoy.

Same with the question on Panacea's final exam. I agree it's reasonable to expect an MD these days to know enough about herbal supplements to have some idea why her patients might be taking them, but it is beyond the pale to expect an MD to recommend a supplement.

So...my sister has breast cancer. Her life revolves around vomiting, trips to the doctor, trips to the ER :( and as much sleep and as many cheese sandwiches as possible. I have no idea what's up with the sandwiches. It's all she wants to eat right now.

I can see listening to music but meditating just seems stupid. Should she get out of bed to meditate? Should it be part of her post-vomit cleanup routine? And yoga? That's just surreal. The upper right side of her body is a mess. She has to limit her arm motion. She's highly asymmetric. How about we start with a trip to an actual physical therapist?

Or an FNP ;)

Speaking of music therapy. When I was a student in my BSN program, I took a course in Nursing Research. Our final project as a class (we were a small class) was to design, conduct, and analyze data from a research project.

We decided to have some fun with it, and looked at music therapy: would music played during an exam result in better exam scores?

We had students from another class take a mock nursing exam under various conditions: rap, rock n roll, country, and classical music, with a control of no music at all.

To our surprise we got mildly statistical significance with rap music, but no significance with any other kind of music.

@Panacea :) for FNP

It seems like these "integrative" people have taken normal supportive care, given it funny names and called it CAM.
Well, how about we turn it around, and give these things different names and call them mainstream medicine?

Meditation = CBT (I know, not exactly, but some of it is similar)
Yoga = breathing exercises, physical therapy
Music therapy = music
Stress reduction = stress reduction (this isn't defined so it could be anything from a nice colored blanket to someone coming over to do the laundry/grocery shopping/walk the dog)

All that leaves is acupuncture and acupressure (which we could describe as when you clench your fist or squeeze your arm or leg to distract yourself).

Thought they were on to something but they only fooled themselves

They fooled the patent examiner, too.

Don't fool yourself :^Þ. Unlike prior times, a patent examiner nowadays only examines the adequacy of the paperwork, whether the paperwork claims a perpetual-motion scheme, and whether the subject has already been granted a patent. Other considerations, especially whether the claimed invention works, are not on the table.

In q quick reading of this huge "guideline," I did not find a single instance where it recommended against using any of the things it described.

Alternative medicine for premature ejaculation? Surprise, surprise! It doesn't work.

oracknows — Wed, 01 Feb 2017 06:00:35 +0000

Alternative medicine for premature ejaculation? Surprise, surprise! It doesn't work.

I must admit that the last couple of weeks have been rather grim here on the old blog. Betweemn Donald Trump's White House spewing , an unfortunate patient embracing quackery, pseudoscience at the VA, and more. So it is that I feel as though it might not be a bad idea to step back for a day, to look into an acupuncture "study" that's been making the rounds in the media. Oddly enough, I remember it showing up a week ago and meant to discuss it then. So I'm glad that I saw a new news story on it in —where else?—The Daily Mail in the form of an article entitled Forget Viagra - acupuncture could stave off erectile dysfunction, experts claim.

As soon as I read the article, I laughed. It was so sloppily done that the title didn't even match what the study was about, saying "Acupuncture could help men with premature ejaculation, a new report claims.." So what was the paper about, erectile dysfunction or premature ejaculation? It turns out that it's about premature ejaculation. Darn. There go the boner jokes. Oh, well, there is this:

Acupuncture could help men with premature ejaculation, a new report claims.
The improvements were small, and the studies were of varying quality.
However, researchers in the UK concluded various alternative treatments - including acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine and a Korean topical cream - have significant desirable effects.

Experts claim the finding could bring welcome relief for men who have not got Viagra out of embarrassment, or are marred by a months-long wait to see a doctor.

'It's important to evaluate the evidence for other therapies,' said lead author Katy Cooper of the University of Sheffield.

'To our knowledge, this is the first systematic review to assess complementary and alternative medicine for premature ejaculation.

So wait a minute. Is this study about acupuncture and premature ejaculation or is it about more? I was puzzled. So I did what I always do in cases like this. I went to the source, which, I point out, took a bit of effort to find, thanks to the Mail's failure to link to the actual study. Find it I did (eventually), though, in the form of an article by Cooper et al entitled Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review. So wait. This is about all CAM for management of premature ejaculation. There go the jokes about sticking needles into men's nether regions and/or early liftoff. Or not. Or, I could just go for the joke about my never, ever having a problem or needing treatment for something like this.

In any case, it's important to understand what premature ejaculation is. According to this article, premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences. I wasn't familiar with the treatment of PE; so it was of interest for me to read the authors' summary in the introduction:

Management of PE can involve a range of interventions. These include systemic drug treatments such as selective serotonin reup- take inhibitors (SSRIs), tricyclic antidepressants, phosphodiesterase type 5 inhibitors, and analgesics and topical anesthetic creams and sprays that are applied directly to the penis shortly before inter- course.9,10 Behavioral therapies also can be useful.6,9,11,12 These can include psychosexual or relationship counseling for men and/or couples to address psychological and interpersonal issues that could be contributing to PE. Behavioral therapies also can include physical techniques to help men develop sexual skills to delay ejaculation and improve sexual self-confidence, such as the “stop- start” technique, “squeeze” technique, and sensate focus.6,9,11,12 There are sparse data on whether and for how long effectiveness is maintained after cessation of treatment (drug or behavioral) and whether repeat treatments are effective.

Well, OK, then. That's a bit more than I wanted to know.

Now, I can understand why men might try quackery if they have problems in the sack. It doesn't take much searching online to find the veritably panoply of remedies, herbal and otherwise, for PE and erectile dysfunction. That doesn't even take into account the various products sold as aphrodisiacs. So it makes sense to see what the authors defined as "CAM":

CAM has been defined by the Cochrane Collaboration as “a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying the- ories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.”15 In addition, many CAM therapies are based on a traditional model of health and well-being, and many (although not all) are designed to treat the whole patient as opposed to a specific condition, whereas some (although not all) involve the use of traditional or natural therapies. Therefore, CAM is defined in this study as therapies for PE that have typically not been provided within conventional Western health care systems and that appear on the list of CAM therapies collated by the Cochrane Collaboration.

In other words, CAM is anything outside of science-based medicine. Yeah, that will do it. They looked for randomized clinical trials, with a study being eligible for inclusion if they compared CAM therapies for management of PE against placebo, waitlist, no treatment, or another therapy or assessed combination treatment with CAM. They also had to include standard measures of PE outcomes, including:

Premature Ejaculation Profile (PEP)
Index of Premature Ejaculation (IPE)
Premature Ejaculation Diagnostic Tool (PEDT)
Arabic Index of Premature Ejaculation (AIPE)
Chinese Index of Premature Ejaculation–5 (CIPE-5)
International Index of Erectile Function (IIEF)

Live and learn. I had no idea there were so many measurement of PE. For instance, one of them mentioned is intravaginal ejaculation latency time (IELT), which, I learned through Googling, frequently measured by couples using a stopwatch. (It seems to me that that would really ruin the mood.) Again, I learned more reading this paper than I probably actually wanted to.

Not surprisingly, the quality of the studies was pretty crappy, too:

The risk of bias within included studies is presented in Table 2. Five studies reported the method of randomization,26, 28, 29, 32, 35 whereas the other five did not report the method but did state that the study was randomized. Allocation concealment was unclear in all studies. Blinding of participants and personnel was reported as being undertaken in five studies.26, 29, 33, 34, 35 Blinding of outcome assessment was unclear in all studies except one,35 which reported that this was blinded. All studies except one35 were considered at low risk of bias for completeness of outcome data, with eight studies including at least 90% of randomized patients in the primary analysis and the two studies of SS cream including 85%34 and 68%,35 respectively. All studies scored a low risk for selective reporting except for one that did not report on IELT.27 Of the nine studies reporting on IELT, this was measured by stopwatch in five studies,26, 28, 29, 34, 35 by questionnaire in one study,32 and the method of IELT assessment was not reported in three studies.30, 31, 33 In summary, all 10 studies were classed as having an overall unclear risk of bias because of unclear reporting of allocation concealment (all 10 studies) and unclear blinding of participants and personnel (five studies).

On to the results. Overall, 2,455 citations were identified through the search strategy chosen, which lead to 14 of them meeting all their criteria. Two of these were studies of Chinese medicine that were excluded because they did not report on IELT or any validated or widely used PE outcome measurement. Two more studies assessing a combination of yoga and pelvic floor exercises were excluded because one was not randomized and the other did not report on IELT or any validated or widely used PE outcome measurement. That left only ten RCTs. Two studies examined acupuncture, five looked at Chinese herbal medicine, one studied Ayurvedic herbal medicine and two of Korean topical 'severance secret' cream.

Despite all the news stories I saw about this systematic review emphasizing acupuncture, of the two acupuncture studies examined, one was from Turkey and one from China, each comparing acupuncture with either sham or various drugs used to treat PE. The results were, at best, quite equivocal. Indeed, the best the authors could say was this:

One study compared acupuncture against sham acupuncture (N analyzed = 60) and In summary, the available data indicate that acupuncture might be slightly more effective than placebo (sham) in treating PE, although this is based on only one study of unclear quality.

Yes, the "positive" result found is based on one crappy study. In other words, there's no good evidence that acupuncture helps PE. This is not surprising, given that there is no physiological reason to think that there would be Basically, what was presented was a grab bag of studies:

The included studies evaluated the effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine, and topical SS cream in improving IELT and other outcomes. Overall risk of bias was unclear in all studies because of unclear allocation concealment and/or blinding. Studies were clinically heterogeneous and stopwatch-measured IELT was reported in only 5 of 10 studies. Acupuncture increased IELT over placebo (one study; MD = 0.55 minute, P = .001). Ayurvedic herbal medicine increased IELT over placebo (one study; MD = 0.80 minute, P = .001). Topical SS cream improved IELT over placebo in two crossover studies (MD = 8.60 minutes, P < .001), although inclusion criteria were broad (IELT < 3 minutes), and there were mild irritant effects in some patients. SSRIs were more effective on IELT than Chinese herbal medicine (three studies; MD = 1.01 minutes, P = .02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies; MD = 1.92 minutes, P < .00001) or Chinese medicine alone (two studies; MD = 2.52 minutes, P < .00001). Adverse effects were not consistently assessed but where reported were generally mild. There were sparse data on the potential for drug interactions.

In other words, the results were mixed and pretty unconvincing. Even the Daily Mail article concedes it, stating quite plainly that "The main limitation of the study is the underlying weakness of the studies evaluated" and that "the studies are so different, it's tough to draw conclusions about the different options." In the article, the authors dance around this issue quite impressively:

Pragmatically, because there are so many CAM therapies available, it seems unlikely that they will all undergo further evaluation in large-scale studies. Therefore, it might be reasonable to summarize that the CAM therapies reviewed here have some (although limited) evidence for effectiveness in treating PE, and that they might provide another option for patients who favor a mind-body approach or who wish to avoid long-term pharmacologic treatment. It would need to be borne in mind that the effectiveness evidence is not conclusive, and care would need to be taken to monitor for adverse effects and to consider the potential for herb-drug interactions.

No it isn't reasonable to say that the CAM therapies reviewed "might provide another option for patients," and the evidence for effectiveness is far less than "not conclusive." In fact there's nothing much in this review article to suggest that alternative medicine helps PE.

oracknows Wed, 02/01/2017 - 01:00

Tags

acupuncture

alternative medicine

premature ejaculation

systematic review

http://i2.asntown.net/5/275x250_jpg.jpg

Two thoughts:
A. I have to imagine any way of measuring effectiveness would either be unreliable, if treatment actually worked, or voyeuristic.

B. Thank you for a lighter post these weeks. Much needed.

Not just by me. I only regret that I should have made some jokes about where the needles needed to be stuck. :-)

Acupuncture gave men about half a minute longer than they had previously, a study showed --claims a picture caption from the Daily Mail article (technically 0.55 minutes from the actual review paper).

Not worth the effort, time or money for a launch delay of only 30 seconds. I'd call this a premature evaluation of CAM on premature ejaculation.

Also, it's only one study. The other was negative. They got the number by taking the average of 0.55 minutes and 0 minutes.

Well, when I am about to ejaculate I just think about Rich Scopie in a bikini...

This usually buys me a few minutes!

There is a warm front cumming in! I can't wait until it warms-up!

The incidence of PE is estimated to be as high as 30%; a figure that once came as a surprise to me. As a man, it's not a problem that I have ever heard another man bring up. However, female friends assure me that it's far more common than men let on, even among younger men.

Years ago, I was asked to search herbal treatments for PE. One of the most dubious and disgusting was a Chinese preparation containing opium. It was dark brown gooey salve that left a stain on well, everything it touched. It also wasn't very effective, or at least the quality of studies on it was extremely poor.

Alpha blockers, commonly prescribed for lower urinary tract symptoms in men, have a common patient-reported side effect of retrograde ejaculation. Now, there's a problem I wouldn't wish on any man. Perhaps not surprisingly, some interest has been shown in low doses of silodosin as a potential treatment for PE. In a recent clinical trial, it appeared to work better and was more tolerable than the SSRI, dapoxetine.

I can hear the jokes already: Is your mercury retrograde, or are you just happy to see me?

In the detailed picture Orac provides for this premature ejaculation posting, why are the needles meticulously placed in a straight line?

I'm no expert but it's possible the medical professionals may be sending mixed signals to the brain using the straight-line acupuncture method.

So, is this another "fugglesworth" troll?

FFS Get lost Fendlesworth. Go buy a doll or something.

Well, it's better than people sucking up doctor's time for a non-problem.

New self help book: Men How to Self-Administer Acupuncture for Your PE.

Painful

I have to imagine any way of measuring effectiveness would either be unreliable, if treatment actually worked, or voyeuristic.

One could always use a structured piece of music. Carmina Burana, say.

PGP @11: I wouldn't say it's a non-problem, but I would say that it's a quality of life problem that could mess with a guy's head.

Frankly I'm amazed that all these researchers got enough participants. I would have thought this was one of those conditions most men would be unwilling to admit to.

(Unless the researchers promised a cure, which would be super unethical and would totally mess with the data.)

Wasn't there an episode of CSI where a guy was using topical cocaine to fix his PE?

What I find fascinating is that the reporter is incapable of ascertaining the difference between PE and ED.
That's about as bad as a reporter writing about CAM and describing "A cam is a rotating or sliding piece in a mechanical linkage used especially in transforming rotary motion into linear motion or vice versa" to explain it.

As one example that I'm familiar with, an individual may take metoprolol, a B1 blocker, to control hypertension and experience ED, but not ever experience PE. A person suffering from metoprolol induced ED could be successfully treated with viagra or similar PDE5 inhibitors and still not experience PE.
A person suffering from PE, if treated with a PDE5 inhibitor would still experience PE, but potentially suffer from priapism, necessitating emergency treatment.

While it may not be reasonable for a reporter to understand all of that, it is reasonable enough to expect a reporter to at least look up PE and ED and know the difference between popping way too early and not being capable of sustaining an erection.
Of course, considering the publication, perhaps it's enough to be able to expect comprehensible sentences and correct spelling, rather than competency.

@Narad:

Ravel's Bolero would work better to build up to the climax.

The Doors, "Light My Fire'

i know it's PE not ED, but I'm still going to say this gives a new meaning to the phrase 'needle dick'.

Too bad it was just a review Orac found, and not the original studies, as I assume Orac did not discover which acupoints supposedly control ejacuation. Could they be in the hands, especially if they're small?

Did the studies control for the kink level in the subjects? That could account for the difference between the sham and actual group, if the actuals were more uptight the shams were getting too stimulated from a little safe, sane and consensual pain. I hope the researchers were not so unethical as to not supply subjects with a safe word.

i know it’s PE not ED, but I’m still going to say this gives a new meaning to the phrase ‘needle dick’.

Oh, that's a treatment for priaprism.

I am going to the Pub and be the dart target tonight so be ready when I get home honey.

It must be said... New meaning to the phrase "Needle Dick" or "Pin Prick" So many puns, so little time.

Should have refreshed before posting.. I guess that means I had a premature verbal ejaculation. Maybe some pins in me will fix that.. ;-)

Sorry sadmar.

What I find fascinating is that the reporter is incapable of ascertaining the difference between PE and ED.

I imagine the journamalist knows the difference, but if you work for the Daily Fail you write to the insecurities of the readership, not to the facts of the story.

I was just surprised to see that there is a TCM contemporary Chinese scam purporting to delay ejaculation rather than promising boners. Can't help wondering which parts of which endangered species are involved.

Can’t help wondering which parts of which endangered species are involved.

Cialisaurus Rex bones.
Pity though, I'd not minded if they used eye of newt Gingrich...

Can’t help wondering which parts of which endangered species are involved.

Imma pretty sure that it is narwhal anus.

@Wizrd1 #18

I've actually seen a urologist do that to a fellow in the ER. Side effect of Seroquel.

Oy! :o

One of the hardest lessons to learn in any field of medicine is, "the patient's illness is not *my* illness" and "it ain't *my* member/body part" when administering a painful treatment.

Of course, the corollary is, it really, really sucks when it *is* your own illness...

Geez, a fitbit for a penis. Maybe not so hard to measure PE after all.

Geez, a fitbit for a penis.
Just what the Internet-of-Things needs... Bluetooth-enabled devices to let every hacker in the known universe know precisely what you are watching when engorgement occurs.

According to this article, premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences.

Mhh.

Really? You mean, there is something wrong with me?

What do I do?

measured by couples using a stopwatch. (It seems to me that that would really ruin the mood.)

That would depend on your feelings towards Morley Safer. I think that having Mike Wallace suddenly start asking questions would certainly have some impact.

For readers outside the US, there's a weekly news show called 60 Minutes which begins and ends with a ticking stopwatch. The reporters mentioned above were long time contributors to this show.

This may not work but Sally Jenkins at WaPo swears Tom Brady's longevity as a QB is due to Alex Guerrero's alternative-Eastern-something holistic approach.

The insufferable tone is a sight to behold!

https://www.washingtonpost.com/sports/redskins/tom-brady-uses-the-game-…

First China, next the world: The Chinese government gives a big boost to traditional Chinese medicine, just like Chairman Mao did

oracknows — Mon, 23 Jan 2017 02:37:18 +0000

First China, next the world: The Chinese government gives a big boost to traditional Chinese medicine, just like Chairman Mao did

Of all the forms of unproven and disproven alternative medicine being enthusiastically "integrated" into science-based medicine by proponents of "integrative medicine" (formerly—and sometimes still—known as "complementary and alternative medicine," or CAM), so-called "traditional Chinese medicine" (TCM) is clearly among the most popular and seemingly the most accepted. After all, acupuncture, the most famous modality in the TCM armamentarium, is offered in dozens of academic medical centers and hundreds of medical centers in the US, but it goes beyond that. It doesn't matter that the totality of science and evidence, when critically examined, strongly supports the conclusion that acupuncture is nothing more than, as Steve Novella and David Colquhoun put it, a "theatrical placebo," with no detectable difference in effect compared to sham or "placebo" acupuncture. As I like to point out periodically, just twirling toothpicks on the skin produces equivalent perceived relief of back pain to acupuncture, overhyped and publicly discussing the use of "cupping" quackery to enhance their performance, thereby glamorizing it. Oh, sure, occasionally a drug derived from an herb used in TCM will be found to be useful for something, leading to TCM proponents to argue that this finding vindicates TCM, when in fact it's far more a triumph of pharmacognosy (natural products pharmacology) than a vindication of TCM. None of this stops academic medical centers from embracing TCM, as, for example, the Cleveland Clinic did when it set up a TCM clinic and hired an herbalist, which appears to have served as a prelude to its hiring Dr. Mark Hyman and embracing functional medicine, an effort that, unfortunately, has been wildly successful. Thanks to the specialty dubbed "integrative medicine" by its proponents (and more appropriately called "integrating quackery with medicine" by skeptics), you can find articles in the scientific literature discussing qi (life energy) and its flow through acupuncture meridians or diseases as deficiencies or imbalances in hot/cold or dry/wet as though there were actual scientific validity to them.

What many people don't realize, even skeptics, is that the "integration" of TCM into scientific medicine is not new. It was the realization of Chairman Mao Zedong's dream. Apparently it still is. I was reminded of this earlier this month by an article in Bloomberg entitled "Traditional Medicine Won't Cure China's Ills." It's based on a story published by Chinese media, "China adopts law on traditional medicine." Basically, China adopted a law to provide TCM a larger role in the Chinese health care system, in essence legislating the "integration" of TCM with science-based medicine.

A brief history of the "integration" of traditional Chinese medicine into "Western" medicine

I've written in detail before about how Chairman Mao and his medical authorities in Communist China more or less invented what we know today as TCM and how this history has in essence been retconned into the narrative we hear today about how TCM represents "ancient knowledge" and how acupuncture is thousands of years old. (Never mind that the technology to make such thin needles didn't exist two thousand years ago, and that, as recently as a century ago, acupuncture was a brutal and primitive, using nothing like the thin, shiny needles acupuncturists use today.) If you want the detailed account, check this post out. For purposes of this post I'll provide the CliffsNotes version, beginning with this quote by Chairman Mao:

Our nation’s health work teams are large. They have to concern themselves with over 500 million people [including the] young, old, and ill. … At present, doctors of Western medicine are few, and thus the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine. (Translations from Kim Taylor’s Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution.)

And, more pertinently:

Mao was under no illusion that Chinese medicine—a key component of naturopathic education—actually worked. In The Private Life of Chairman Mao, Li Zhisui, one of Mao’s personal physicians, recounts a conversation they had on the subject. Trained as an M.D. in Western medicine, Li admitted to being baffled by ancient Chinese medical books, especially their theories relating to the five elements. It turns out his employer also found them implausible.

“Even though I believe we should promote Chinese medicine,” Mao told him, “I personally do not believe in it. I don’t take Chinese medicine.”

Yes, the exportation of TCM to the world was quite deliberate, as part of a strategy to popularize it among the Chinese. There was a problem, however. There was no such thing as “traditional Chinese medicine” per se. Rather, there were traditional Chinese medicines. For many centuries, healing practices in China had been highly variable. Attempts at institutionalizing medical education were mostly unsuccessful and “most practitioners drew at will on a mixture of demonology, astrology, yin-yang five phases theory, classic texts, folk wisdom, and personal experience.” Mao realized that TCM would be unappealing to foreigners, as even many Chinese, particularly those with an education, understood that TCM was mostly quackery. For instance, in 1923, Lu Xun realized that “Chinese doctors are no more than a type of swindler, either intentional or unintentional, and I sympathize with deceived sick people and their families.” Such sentiments were common among the upper classes and the educated. Indeed, as we have seen, Mao himself didn’t use TCM practitioners. He wanted scientific “Western” medicine. The same was true of educated Chinese. It still is. TCM is far less popular among educated middle class and affluent Chinese than conventional medicine.

Mao's strategy to deal with the criticisms of TCM of being prescientific and chock full of vitalistic and superstitious nonsense was quite clever. It consisted of two strategies, both designed to mythologize TCM as being a scientifically sound and harmonious “whole medical system” and to provide “evidence” that it worked. In other words, his health officials did their best to "scientize" it. Textbooks were written that portrayed TCM not as a wide variety of disparate folk medicine traditions, but rather as a harmonious theoretical and practical whole, with the contradictions and self-contradictions in the "classic" texts papered over and pounded into a self-consistent system. Terms such as “holism” (zhengtiguan) and “preventative care” (yufangxing) were used to provide the new system with appealing foundational principles, principles that are now standard fare in arguments about the benefits of alternative medicine. This version of TCM was taught in newly founded academies and exported to the West.

The second part of the strategy was to provide spectacular anecdotes that appeared to demonstrate that TCM worked. The most famous of these was the case of James Reston, a New York Times editor who underwent an emergency appendectomy while visiting China in 1971. This story, it turned out, was very much overblown. In fact, the surgeons there used a fairly standard anesthesia technique, described by our SBM colleague Kimball Atwood as sounding like a “standard regional technique, most likely an epidural,” and acupuncture was used to treat cramping on second evening after the surgery, which, not surprisingly, resolved, as most postoperative ileus does. Over time, more reports of "acupuncture anesthesia" trickled out of China to a credulous, enthusiastic Western press. Let's just say that, examined critically, these stories are not convincing, and some examples have been cataloged by Kimball Atwood in his “Acupuncture Anesthesia”: A Proclamation from Chairman Mao series (see Part I, Part II, Part III, Part IV, and Part V for the details).

Mao's vision was nothing less than the "integration" of TCM into "Western medicine," as discussed by Atwood through the listing of five party slogans about TCM:

1945-50 ‘The Co-operation of Chinese and Western Medicines’
1950-8 ‘The Unification of Chinese and Western Medicines’
1950-53 ‘Chinese Medicine studies Western Medicine’
1954-8 ‘Western Medicine studies Chinese Medicine’
1958- ‘The Integration of Chinese and Western Medicines’

Mao’s idea was nothing less than the complete unification of TCM and “Western” medicine, as quoted by Kimball Atwood further from The Private Life of Chairman Mao:

Mao laughed. ‘The theory of yin and yang and the five elements really is very difficult,’ he said. ‘The theory is used by doctors of Chinese medicine to explain the physiological and pathological conditions of the human body. What I believe is that Chinese and Western medicine should be integrated. Well-trained doctors of Western medicine should learn Chinese medicine; senior doctors of Chinese medicine should learn anatomy, physiology, bacteriology, pathology, and so on. They should learn how to use modern science to explain the principles of Chinese medicine. They should translate some classical Chinese medicine books into modern language, with proper annotations and explanations. Then a new medical science, based on the integration of Chinese and Western medicine, can emerge. That would be a great contribution to the world.’

Clearly, we at SBM disagree.

2016: China mandates the integration of Chinese and "Western medicine"

Fast forward to the end of 2016:

China's top legislature on Sunday adopted a law on traditional Chinese medicine (TCM) to give TCM a bigger role in the medical system.

The Law on Traditional Chinese Medicine was approved at the end of a seven-day session of the National People's Congress (NPC) Standing Committee which concluded on Sunday afternoon.

Huang Wei, deputy director of the NPC Standing Committee commission for legislative affairs, said the law, which will go into effect on July 1, 2017, is a significant step in the development of TCM. It is key to reform of medical and health sectors and the drive toward a "Healthy China."

According to the new law, county-level governments and above must set up TCM institutions in public-funded general hospitals and mother and child care centers. Private investment will be encouraged in these institutions.

All TCM practitioners must pass tests. Apprentices and previously unlicensed specialists with considerable medical experience may only begin practice when they have recommendations from at least two qualified practitioners and pass relevant tests.

With a history of more than 2,000 years, TCM is seen by many as a national treasure in China for its unique theories and practices, such as herbal medicine, acupuncture, massage and dietetics.

This is especially the case since Tu Youyou won the 2015 Nobel Prize for her work using artemisinin to treat malaria.

Argh! See what I mean? This is exactly what I was talking about when I pointed out how TCM apologists always point to various medicines that were derived from herbs used in TCM as validation of TCM even when they aren't. They also tend to forget all the hundreds of other TCM herbs that have never been shown to have medicinal properties. I'd also argue that TCM is no more a "national treasure" of China than humoral theory is to any nation in Europe. The two do, after all, share many characteristics, not the least of which is the belief that disease is due to an "imbalance" of various things. In humoral theory, it's imbalances in the four humors. In TCM, it's imbalances in the five elements. In both systems of medicine, vitalism is largely the basis of the concepts that undergird them.

In any case, what the Chinese authorities have done is the equivalent of, say, German authorities mandating homeopathy clinics because homeopathy was invented by a German and is therefore a "national treasure" for its "unique theories and practices" or if, say, Greece mandated the opening of clinics utilizing the four humors theory to treat disease because Hippocrates taught humoral theory, making it a "national treasure" for its "unique theories and practices." Of course, humoral theory is not so unique; it resembles TCM quite a bit in the basic concepts underlying it.

It turns out that TCM has continued to benefit from the policies that Mao instituted to favor it. As Adam Minter observes, TCM is a favored state industry, and the traditional medicines pharmaceutical industry raked in $114 billion in 2015 and represents nearly 29% of China's pharmaceutical industry. In China, TCM is big business. The TCM herbs and concoctions thus sold were dispensed by 452,000 practitioners working out of tens of thousands of clinics—many no more than single-room storefronts.

The law, while mandating the "integration" of TCM into conventional medicine in China (or at least its government support), does increase the regulation of those who practice TCM, but it does so in a way that elevates the status of TCM:

To this end, the new law said China puts TCM and Western medicine on equal footing in China, with better training for TCM professionals, with TCM and Western medicine learn from each other and complementing each other.

The state will support TCM research and development and protect TCM intellectual property.

Special protection will be given to TCM formulas that are considered state secrets, it said.

Use of technology and expansion of TCM in dealing with emergency public health incidents and diseases prevention and control should increase.

The state will protect medical resources including protection and breeding of rare or endangered wildlife, the law said.

The law went on to pledge enhanced supervision of raw TCM materials, banning the use of toxic pesticides.

Putting TCM (and all of CAM) on "equal footing" to science-based medicine is what CAM proponents have been striving for all along. It's a large part of the reason why "alternative medicine" was renamed "CAM" and then, more recently, renamed "integrative medicine." As I've described before, "alternative" implied that it isn't real medicine (which the vast majority of alternative medicine is not), and "complementary" implied that standard science-based medicine was the main medicine, and the "complementary" medicine (like TCM and other "alternative medicines") were merely the "icing on the cake," not as important as conventional medicine and, worst of all, not strictly necessary. Renaming the specialty "integrative medicine" and implying that this new specialty "integrates the best of both worlds" were intended to counter that perception and put the woo on equal footing with scientific medicine, just as Mao tried to do nearly 70 years ago and the current Chinese government is trying to do now.

One also can't help but notice that a lot of this new law goes towards protecting the business interests of the TCM industry in a manner that, if it were done for the pharmaceutical company, would provoke howls of outrage from CAM proponents—and rightly so. Worse, the part about "protecting and breeding" of rare or endangered wildlife implies to me that the government will promote the preservation and utilization of these animals for their various body parts that are, barbarically, used in TCM concoctions. For example, we've discussed before how cruelly bears are confined and operated on in order to harvest bear bile for various TCM treatments. We've also discussed how the market for animal parts for TCM remedies is endangering animals and could lead to extinctions as the TCM industry seeks tiger penis and rhinoceros horns to mix into their nostrums. It might well be a good thing if the Chinese government steps in to protect tigers and rhinos, but nothing in this law seems to say anything about ceasing the use of such animal components.

The one good thing about China's new law

The only potentially good thing about the law is the regulation of toxic ingredients. As Minter notes:

This lack of oversight extends to the thriving industry of traditional pharmaceuticals. Last year, a team of scientists found that nearly 90 percent of TCM remedies marketed in Australia contained undeclared ingredients, including antibiotics and decongestants, heavy metals such as lead and arsenic, and a range of plant and animal matter -- not least, the DNA of endangered snow leopards. The situation is almost certainly worse in China, which lacks Australia's (clearly inadequate) screening procedures. A 2013 Greenpeace study found pesticides in 51 of 65 popular herbal remedies marketed in TCM shops in China and Hong Kong. In one case, contamination levels were 500 times the European Union's accepted safety limit.

It's impossible to calculate the human toll of shady TCM practices, but there are hints. Several recent studies have found that herbal remedies are the leading cause of drug-induced liver failure in China, accounting for as much as 43 percent of all cases. The problem is equally severe in other countries where TCM is rapidly expanding: Herbal remedies may account for up to 40 percent of drug-induced liver injuries in South Korea and 55 percent in Singapore.

We've discussed this problem before multiple times on SBM (e.g., this discussion of contamination of TCM medicines with heavy metals). If China is going to permit and even encourage the TCM industry, at the very least it has a duty to make sure that the products its companies are selling are not dangerous. This is a duty that Chinese government has thus far failed miserably to live up to, a failure that has been documented on more occasions than I can recount. It is long past time that the Chinese government remedied that failure. I am not, however, optimistic that it will actually do so.

The real cost of traditional Chinese medicine in China and beyond

The law passed by the Chinese government last week is nothing new. China has been trying to "integrate" its prescientific system of national medicine that was cobbled together from various conflicting and internally inconsistent folk medicine traditions ever since Chairman Mao first hatched the idea after the end of World War II. Indeed, as a white paper published by the Chinese government a month ago (no doubt as a justification for the recently passed law), the promotion of TCM by the Chinese government did not end with the death of Chairman Mao in 1976. For example, here's what's been happening lately:

Since the CPC’s 18th National Congress in 2012, the Party and the government have granted greater importance to the development of TCM, and made a series of major policy decisions and adopted a number of plans in this regard. At the National Conference on Hygiene and Health held in August 2016, President Xi Jinping emphasized the importance of revitalizing and developing traditional Chinese medicine. The CPC’s 18th National Congress and the Fifth Plenary Session of the 18th CPC Central Committee both reiterated the necessity to pay equal attention to the development of traditional Chinese medicine and Western medicine and lend support to the development of TCM and ethnic minority medicine. In 2015, the executive meeting of the State Council approved the Law on Traditional Chinese Medicine (draft) and submitted it to the Standing Committee of the National People’s Congress for deliberation and approval, intending to provide a sounder policy environment and legal basis for TCM development. In 2016 the CPC Central Committee and the State Council issued the Outline of the Healthy China 2030 Plan, a guide to improving the health of the Chinese people in the coming 15 years. It sets out a series of tasks and measures to implement the program and develop TCM. The State Council issued the Outline of the Strategic Plan on the Development of Traditional Chinese Medicine (2016-2030), which made TCM development a national strategy, with systemic plans for TCM development in the new era. These decisions and plans have mapped out a grand blueprint that focuses on the full revitalization of TCM, accelerated reform of the medical and healthcare system, the building of a medical and healthcare system with Chinese characteristics, and the advancement of the healthy China plan, thus ushering in a new era of development for TCM.

Two of the goals are:

Equal attention to TCM and Western medicine. Equal status shall be accorded to TCM and Western medicine in terms of ideological understanding, legal status, academic development, and practical application. Efforts shall be made to improve system of administration related to TCM, increase financial input, formulate policies, laws and regulations suited to the unique features of TCM, promote coordinated development of TCM and Western medicine, and make sure that they both serve the maintenance and improvement of the people’s health.

Making TCM and Western medicine complementary to each other, and letting each play to its strengths. The state encourages exchanges between TCM and Western medicine, and creates opportunities for Western medical practitioners to learn from their TCM counterparts. Modern medicine courses are offered at TCM colleges and universities to strengthen the cultivation of doctors who have a good knowledge of both TCM and Western medicine. In addition to the general departments, TCM hospitals have been encouraged to open specialized departments for specific diseases. General hospitals and community-level medical care organizations have been encouraged to set up TCM departments, and TCM has been made available to patients in the basic medical care system and efforts have been made to make it play a more important role in basic medical care. A mechanism has been established for TCM to participate in medical relief of public emergencies and the prevention and control of serious infectious diseases.

Now there's a waste of money and effort, using TCM to participate in medical emergencies and the prevention and control of serious diseases. It sounds as though, like homeopaths without borders, there will soon be TCM practitioners without borders. Battlefield acupuncture, anyone? Oh, wait. That's not China. That's the US. One wonders if China is getting ideas from the countries to which it exported TCM to consider using acupuncture and TCM in the emergency department.

Aside from the destruction of endangered species, the poisoning of the unwary by adulterated and contaminated TCM herbs, and the degradation of the science of medicine where TCM is "integrated," there is the opportunity cost of investing in TCM. As Minter notes, TCM sucks up billions of dollars that could be better spent on China's regular health care system, which, he also notes, is "badly lagging." Chinese hospitals are overburdened and underfunded, and there is a shortage of pediatricians that even the government-run press is calling "urgent." Ironically, the reason for this shortage is very similar to the reason why primary care specialties are unattractive in the US. Chinese medical students don't want to become pediatricians because of long hours and low pay; more lucrative specialties such as ophthalmology or cardiology, are much more attractive. One student even says, "In China, we say 'Ophthalmology is gold, the surgical department is silver, and pediatrics is rubbish'. Some of my classmates have pointed out that pediatricians only earn half the average salary of other specialist doctors." Instead of investing hundreds of millions of dollars in TCM, China would do better to bolster its science-based medical system.

On the other hand, remember why Mao promoted TCM: To save money. He didn't have the resources to provide real medicine to all of his people. China in 2017 has the resources, but chooses not to invest them that way. Instead, as its white paper says, China's goal is this:

China will learn from the achievements of modern civilization, uphold the principle of making the ancient serve the contemporary, and strive to promote the modernization of TCM by making every effort to carry on the good traditions and practices of Chinese medicine, and promote the innovative development of TCM for health preservation, so that TCM will be incorporated into the modern outlook on health to serve the people. By 2020, every Chinese citizen will have access to basic TCM services, and by 2030 TCM services will cover all areas of medical care. Meanwhile, China will also actively introduce TCM to the rest of the world, and promote the integration of TCM and other traditional medicine with modern technology, so as to explore a new model of healthcare to improve the well-being of all people of the world, and make a full contribution to global progress and a brighter future for mankind.

This policy is virtually indistinguishable from the one Chairman Mao instituted in the 1950s. The main difference is that this time, it goes much further, in particular to protect the profits of the Chinese traditional pharmaceutical industry, which was not nearly as large or international in Mao's time.

Don't believe me? Listen to Huang Wei, deputy director of the NPC Standing Committee commission for legislative affairs, who puts it this way:

"The new law on traditional Chinese medicine will improve global TCM influence, and give a boost to China's soft power," Huang said.

Yes, the Chinese government is working to complete Chairman Mao's vision by the year 2030, in part to project China's "soft power." If supporters of SBM think it was tough to combat the propaganda promoting TCM before, now we have one of the most powerful nations in the world, one with the second largest economy in the world, stating that its goal is the integration of its favored national quackery with science-based medicine. Our task is about to get a whole lot more difficult.

If there is an afterlife, somewhere, Chairman Mao is smiling.

oracknows Sun, 01/22/2017 - 21:37

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the equivalent of, say, German authorities mandating homeopathy clinics because homeopathy was invented by a German and is therefore a “national treasure” for its “unique theories and practices” or if, say, Greece mandated the opening of clinics utilizing the four humors theory to treat disease because Hippocrates taught humoral theory, making it a “national treasure” for its “unique theories and practices.”

Or if Indian states funneled money to Ayurveda grifters in the cause of cultural supremacy, or rewarded every fraudster willing to make up some fake research results about the medicinal value of turmeric. It is good that that would never happen.

This is all about exports to the West. The other day I read that an estimated 60% of ingredients used in dietary supplements sold in the U.S. are now coming from China. It was already known that around 90% of the vitamin C sold in the U.S. is synthesized in China. Way back in the 70s, I knew a pharmacist who imported it by the drum. At $50 per 50-kg drum, he made a lot of hay by capping and bottling it up in a back room and retailing it in his store. A few bottles with 60 caps each paid for the entire drum. What a drum-load costs today is undoubtedly more than then, but the mark-up is huge.

Among suppliers and manufacturers of dietary supplements, though especially of herbal products, China is the cheapest and least reliable source for quality ingredients. Anyone claiming otherwise is lying to your face. When it comes to adulterated herbs, China has repeatedly been shown to be the biggest offender of all, with India coming in second.

Sounds like China is working on a method to counter the sudden population increase brought on by the death of the one child policy. (http://www.bbc.com/news/world-asia-china-38714949) If you can't keep people from having children, make the job of doctors who treat children undesirable, and replace it with something that is worse then nothing.

I find it amusing that TCM is still claiming a big win with the anti-malarial that got their Doctor a Nobel Prize in Medicine. They seem to be willingly ignoring that the drug she found based on TCM was a distant cousin of the plant actually used, and the method of preparation used in TCM killed all benefits. But ancient Chinese medicine was proven to work.

Perhaps it has something to do with the idea that Mao never did anything wrong and that those who write otherwise, shoulde be prosicuted.

I wonder how much of this is in response to the evidence recently found in a government probe that 80% or more of all biomedical data from China is fraudulent. Is this perhaps a compensatory reaction to that probe?

If China is sorely underdeveloped in the realm of biomedical ethics, it does explain the persistence of ideas that protein from ground up penises will give you a bit of a boost.

AP@3: Granted that the effects of the policy change haven't been fully felt yet, but according to your link, the fertility rate in China is 1.6, which is well below the replacement rate of 2.1. Urban and middle-class families, for whom children are as much if not more a liability than an asset, will still tend to have fewer children. In rural areas, where children can be more of a help starting around age 4, there probably will be more births. Remember also that there is a significant excess of males under 35 due to historical preference for male children.

But yes, the shortage in pediatricians (which will likely get worse, especially in rural areas) means a too large chance of keeping population levels in check the old-fashioned way: infant mortality. And TCM won't help that.

As Lighthorse said, art of this initiative seems clearly directed at increasing profitable exports – ramping up production in the "TCM pharmaceutical industry" and no doubt establishing or enhancing distribution and promotion of its products in North America and Europe. If they can make money at it, I doubt the Chinese care much about whether people in Kansas are wasting money on useless herbals. However, I doubt the Chinese are so sort-sighted as to limit their designs to that market alone, and not just 'legit' supplements like basic Vitamin C tabs, either. Funding designated for building the "TCM pharmaceutical industry" could turn out to be turned preparatory to dropping the 'TCM' from that quote, and wind up building the sort of research and production infrastructure that would allow the Chinese to challenge Novartis, Pfizer, and GSK in Europe and the US.

On the other hand, I'm dubious that the Chinese are into bilking their own people, or abandoning them to illness or even death at the hands of quacks. China is a still a growing industrial power, advancing on the world stage largely by being a source of labor that comes significantly cheaper than equally productive workers pretty much anywhere else in the world. They want to keep these people healthy enough to keep showing up and putting in good days at the factories. They have an economic interest in good public health.

I could be wrong, of course, but it seems to me that with "TCM herbs and concoctions dispensed by 452,000 practitioners working out of tens of thousands of clinics—many no more than single-room storefronts" with "pesticides found in 51 of 65 popular herbal remedies marketed in TCM shops" leading.to 43% of liver failure cases, China isn't "elevating the status of TCM" by putting "TCM and Western medicine on equal footing" – because TCM is on top of the ladder now. While they may declare the love for their 'Great National Treasure', my guess is that they're trying to squeeze out the "type of swindler, either intentional or unintentional" that deceives sick workers and their families, and actually elevate the status of 'real medicine' practices among the masses out in the sticks.

I'm not sure China 2017 has the resources to bring 'real medicine' to all of its 1.4 billion people. But even if it did, I'm not sure the ex-peasant population that has been sold the wonders of TCM for the last 70 years would suddenly embrace "Western Medicine", or that the Chinese leaders are willing to risk the legitimation crisis of trying. (What do you mean TCM's no good? Are you saying you've lying to us?). So, if you're the Chinese government, it's in your interest to clean up the dangerous parts of TCM, and 'Integrate' it with more simple, cheap, effective 'Western' practices that provide the most bang-for-the-buck in improving public health to keep those factories running. But it's not in your interest to call it a 'Westernization' program. Whatever you do (good, bad, or indifferent) you're going to call it an enrichment of your great unique National Treasure. Whatever fraction of that hundreds of millions of dollars being invested in TCM is going to domestic services rather than building the TCM export industry, it might all be pushing TCM closer to modern 'Western' practices. Safety regulations, increased training in modern clinical testing, increased use of modern technology "in dealing with emergency public health incidents". That may be far from establishing the standard of care we'd like to see, but it might be a Small Leap Forward...

But us? Yeah, we're just a market, and they'll happily sell us whatever we're willing to buy... And if it actually causes trouble, well the more better for them on several fronts.

@7 Eric Lund,
That is assuming that the birth-rate statistics are accurate, Since there was a large number of so called black-children, children not registered due to being born illegally (2nd, or 3rd child), in the cities, and even more in the country, I'd take that birth-rate information with a large grain of salt. They do have a sexual imbalance that will either kick the government in the ass, or provide them with a work-force with nothing in their lives but work. Eventually that will cause their population to crash, but how long will that take, and what form it will take is up for debate. I think India is going to have an even larger problem with population health-care in the near future. Combine a lack of funding for medical facilities, a brain drain to places with a higher standard of living for medical professionals, the caste system, and a plethora of quackery and you get a catastrophe in the making.

Slugdoc @6: I don't know, both the push for more TCM and the "80% is faked" came from the same (general) source. The fakery seems to impact the TCM sector as much as the pharmaceutical sector.
The article on it from Radio Free Asia indicated that at least some of the problem is just plain corner cutting and fakery in all industries, which is both sad and hard to cure.

It's pretty chilling, and sad, I think. When I was in China in the autumn, I saw plenty of people with cupping bruises apparent on the unclothed portions of their shoulders and backs in Shanghai (very upscale).

I thought I would quickly follow up on a previous post I wrote last week to point out something else that may be useful to science based medicine advocates about how people get roped into CAM, and particularly TCM from my experience:

Thanks to the specialty dubbed “integrative medicine” by its proponents (and more appropriately called “integrating quackery with medicine” by skeptics), you can find articles in the scientific literature discussing qi (life energy) and its flow through acupuncture meridians or diseases as deficiencies or imbalances in hot/cold or dry/wet as though there were actual scientific validity to them.

It's easy to brush Qi under the table as laughable prescientific vitalism, but one should keep it firmly in mind that this concept is actually one of the things that tends to attract people to alternative views. As it's used in TCM, it is totally vitalism: I grant that without the slightest reservation or hesitation. But, there is an empirical phenomenon here that you shouldn't overlook, which has a very strong amount of sway on people. I know that statement will sound immediately woo-y, but please allow me to elaborate.

Qi comes out of a culture that made a series of observations about biological phenomena but lacked any sort of framework of names to grant to those observations or to explain how those observations related to one another. There was no theory of cells, no notion of hormones and certainly no practical concept of nerves or any microscopic structures, but they did have observations about their bodies that they needed to some catch-all term to identify. In China, you have Taoist and Buddhist priests who, as a component of their codified worship, performed martial arts and athleticism. They used 'Qi' to describe sensations they found in their bodies under the various states encountered due to athletic stressing. At the surface level, Qi is what being athletic feels like, but they expand on that to describe pretty much all of what they feel in their bodies as some notion of Qi. Hunger pangs are Qi; pain is a manifestation of Qi; sexual orgasm is Qi and so on and so forth. Taoist monks do sexual meditation rituals where they restrict the orgasms they're allowed to have in order to store Qi. Easy to laugh at, but within a certain frame of reference, it's easy to understand why people would be moved by it.

My point about this is simple: we have names for all of these phenomena and underlying mechanisms to describe them in detail biologically. The problem is that these names can be incredibly dry and non-descriptive and the mechanisms are very complex. What the hell is "lactic acid build-up?" Sure, it's the pain from when you're recovering from exercise and are in a state where your body is not used to exertion. Without context, it's incredibly clinical. An old Chinese master would've called the same thing 'stagnant Qi'.

Under conditions of physical exertion, you can feel these sorts of body sensations. In the process of breathing meditation, you can feel heat building up in your hands or in your abdomen. A sensation which you localize to the top of your head can be incredibly convincing: "Wow, I guess that's part of Qi flow!" You can feel it flashing through your limbs as you move, if you stop to listen for it. It's a qualitative biological noise observation that anybody can feel, but in the West, people are told to look for these feelings in the context of Yoga and Martial Arts studios. The first time you stop and actually pay attention to it, you might get the feeling of points of heat in the palms of your hands or at the top of your head... a martial arts teacher telling you "yeah, that's Qi" can be a very formative and convincing experience. Why would you stop to doubt what this guy says about mental telepathy if he was correct about the feeling of Qi? It isn't something particularly special because any athlete can feel these things, but the context matters and it gives you a reason to believe that a martial arts teacher or Yoga teacher is giving you something special that you didn't otherwise have. For a lot of people, it isn't a far step to TCM, where this is treated like a real thing. It becomes woo because people misunderstand the extent of their control over these feelings and often misunderstand the scope of where the feeling stops... I've met people who believe they received a feeling from someone else and believe that they can transmit that feeling to someone; never mind that it was a nerve zing when they were struck too hard by a fist.

I think one thing that would help the skeptical movement in general and the medical sub-portion in particular would be to understand this context. Many people acting on the empirical observation of 'Qi' try to follow logically further and fall off the edge. When you have one thing to believe in, it is easy to go to the next thing, then the next thing after that. I'm not claiming that Qi is a real thing here, but that we have better names now for what it was used to describe when it wasn't broken. These days, because we are hit by scientific jargon from one side and eastern mysticism from the other, the term of Qi is very broken because it no longer just describes what it was intended to describe: it's 'The Force' now too, even though that's a very wrong way to look at it.

Has somebody actually sought to write a book on physical sensations and how they are culturally described? Maybe it would be useful for somebody with a scientific background to actually write a scientifically motivated treatise that ties Qi sensations to their actual biological origins that is accessible at a layman's level. I know things like 'pain' are subjective in the extreme and incredibly difficult to study, but having some accessible writing which shows people that science can explain Qi-like sensations, which is what people think they're talking about when they're talking about 'spiritualism,' would perhaps be a helpful way to rebut quackery and inoculating otherwise honest and good-natured people from being taken the wrong way down the primrose path.

Can't crank magnetism be exploited to swing people toward fact rather than fiction?

In other news: Tamara Lovett has been convicted of both charges, failure to provide the necessaries of life and criminal negligence causing death in the death of her seven year old son Ryan. Penicillin, given when it should have been, would have cured him. He got oil of oregano, dandelion tea and potato poultices instead.

The verdict in the Radita case, where Alex died at age 15 and a weight of 37 pounds because he got prayers instead of insulin, has been postponed til February 13.

AP: I think India is going to have an even larger problem with population health-care in the near future.

Forget health care, they're going to have a huge crisis in law and order before that ever happens. An excess of young men with nothing much to do, no war, and testosterone building up in their systems? Random murder sprees are going to become common.

Acupuncture: Getting the point

oracknows — Thu, 17 Nov 2016 06:00:56 +0000

Acupuncture: Getting the point

I’ve frequently written about what I like to refer to as “quackademic medicine,” defined as the infiltration of outright quackery into medical academia, particularly medical schools and academic medical centers. There’s no doubt that it’s a significant problem as hallowed institutions like Memorial Sloan-Kettering Cancer Center embrace nonsense, pseudoscience, and quackery in the name of “integrative medicine.” It goes far beyond MSKCC, however, with Dana-Farber and other elite institutions having apparently bought into the need to study prescientific vitalistic quackery.

One area that’s steeped in woo and has been for a long time is exercise and fitness. I was reminded of this when a reader sent me a link to an article in the November issue of EXPERIENCE L!FE Magazine by Selene Yeager entitled Acupuncture: Getting to the Point. I groaned at the cliched title, but was willing to give Yeager a pass because most headlines are chosen by the editor, not the author. What I was not willing to give her a pass on was the credulous take on acupuncture delivered. In fact, the credulous take was seen in two articles, because the first article was accompanied by an article about acupuncture research by Yeager, Making the acupuncture connection, which inadvertently shows how deep acupuncture has infiltrated medical academia.

The first article, as most such articles do, begins not with evidence but with an anecdote, this time about a man named John Pacharis, who crashed his off-road motorcycle, tearing his ACL, MCL, and PCL — three of the four major ligaments in his knee. Obviously, his knee was messed up bad (my medical terminology), and he needed surgery. He took too many opioids by his account and when he learned he needed another operation:

He began searching online for ideas about how to better manage his recovery and came across a support group where someone suggested acupuncture. “I was very skeptical but figured I might as well try it,” recalls Pacharis. “The first thing the acupuncturist did was put needles in my hands to calm me down and lower my heart rate. I felt an immediate, amazing flow of euphoria. It was like Dilaudid — but obviously so much better for me.”

Pacharis received weekly acupuncture treatments for two months, both to keep swelling under control and to manage pain with fewer drugs. He still gets treated on occasion, and says he’d do more if it were covered by his insurance.

“I don’t know how it works,” he says. “But it definitely works.”

Of course, as I’ve discussed before, there is no good scientific evidence that acupuncture has a detectable effect on chronic knee pain above and beyond placebo, a systematic review by the NCCIH notwithstanding. Basically, acupuncture is a theatrical placebo, all small risks and no real benefit. You’d never realize it from this article, though, which launches right into a discussion of emergency acupuncture, complete with the favored narrative of acupuncturists working side-by-side with real doctors:

“The current opioid epidemic has opened the door for safer, more natural ways to reduce pain,” says acupuncturist Adam Reinstein, LAc. He was hired in 2013 to work in the emergency room at Abbott Northwestern Hospital in Minneapolis as part of the hospital’s campaign to integrate Eastern techniques with a Western medical approach. He’s the first acupuncturist on an ER hospital staff in the United States.

During one shift, he might treat a car-accident victim and someone suffering complications from chemotherapy with the same basic approach. “We look at acupuncture as the first level of pain and anxiety relief,” he says. “Pain, anxiety, and nausea are the big three I treat most in this setting. In many cases, I can help patients start to feel better in the first two to five minutes.”

I can tell you that if I’m ever in a car wreck and land in an emergency room, if I see an acupuncturist offering to stick needles into me the reaction will not be a pleasant one. Of course, acupuncturists like to claim that there’s value to using it in the emergency room, but whenever I look at actual attempts to study its use there, I am inevitably underwhelmed by the results. Yeager notes that there has been a study of the results of emergency acupuncture at Abbot Northwestern Hospital that was very promising. So I looked it up, my intention being to do my usual deconstruction. Basically, it was an observational, retrospective study. No randomization. No blinding. No prospective enrollment of patients. In other words, for a subjective measure like pain it was pretty much a worthless study, and I saw little reason to delve more deeply.

This leads to the propaganda. Yeager first notes that the Kansas Chiefs hired the NFL’s first acupuncturist 23 years ago, that the US Air Force is using “battlefield acupuncture,” and that the VA in Boston is offering acupuncture. Of course, I’v discussed how ridiculous battlefield acupuncture is on many occasions, including the lack of evidence for its efficacy, and just how deeply pure quackery has infiltrated the military, as well as the VA. Unfortunately, Yeager buys completely into the myth of acupuncture:

Though pain relief is still the primary reason many Westerners seek acupuncture, more have discovered what people in China, where acupuncture is part of routine medical care, have long understood: Acupuncture can offer relief from a vast array of health problems, including digestive issues; stress, anxiety, and depression; respiratory disorders, such as asthma and allergies; hormone-related issues like infertility, PMS, and menopausal symptoms; and more. Read on to explore whether it might be right for you.

Of course, what Yeager seems not to realize is that more and more Chinese seek real medicine and reject traditional Chinese medicine (TCM). Indeed, what is considered “TCM” today is in actuality a retconning of several lines of Chinese folk medicine into a seemingly unified whole conducted under the rule of Chairman Mao Zedong. Acupuncture as we know it didn’t really exist until maybe 100 years ago, claims of its antiquity dating back thousands of years notwithstanding. The earliest Chinese texts don’t mention acupuncture, for one thing. For another thing, European surgeons who observed acupuncture and TCM as they were practiced in the hinterlands of China 100 years ago were horrified. Indeed, Mao himself preferred “Western medicine” and eschewed TCM. I’ll just quote one passage from the memoir of a Scottish surgeon named Dugald Christie, who served as a missionary doctor in northeastern China from 1883 to 1913:

Chinese doctors own that they know nothing at all of surgery. They cannot tie an artery, amputate a finger or perform the simplest operation. The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood vessels and important organs, and immediate death has sometimes resulted. A little child was carried to the dispensary presenting a pitiable spectacle. The doctor had told the parents that there was an excess of fire in its body, to let out which he must use cold needles, so he had pierced the abdomen deeply in several places. The poor little sufferer died shortly afterwards. For cholera the needling is in the arms. For some children’s diseases, especially convulsions, the needles are inserted under the nails. For eye diseases they are often driven into the back between the shoulders to a depth of several inches. Patients have come to us with large surfaces on their backs sloughing by reason of excessive treatment of this kind with instruments none too clean.

Acupuncture is believed to have developed from the Chinese version of bloodletting, very much like the “Western” version of bloodletting. This is the “ancient wisdom” of acupuncture, not the fantasy story told by acupuncturists and other believers to credulous journalists like Yeager, who basically accept what they’re told about qi and “life energy” and “energy flows,” in other words, the vitalistic, mystical, religious belief system underlying acupuncture, a belief system with no basis in science, and then write:

Those studies include a meta-analysis of randomized control trials with 18,000 total participants, financed by the NIH and published in JAMA Internal Medicine in 2012. This large study shows that acupuncture outperforms “sham” treatments (where needles are placed at random points or not far enough into the skin) in treating osteoarthritis, chronic headaches, and chronic back, neck, and shoulder pain.

No, no, no, no. That’s the Vickers meta-analysis, and it does not show that acupuncture works for pain. It just doesn’t. Yet every acupuncturist and believer trots this study out as definitive “proof” that acupuncture works for pain as they pontificate about their mystical magical medicine:

Chinese medicine views the body as an anatomical whole, with organs defined in terms of yin and yang. Like qi, yin and yang might sound esoteric, but Kaptchuk simply calls them “convenient labels used to describe how things function in relation to each other.”

Yin qualities are night-like: cool, dark, restful, and passive. By contrast, yang qualities are like the sun: hot, stimulating, vigorous, and active.

When we’re healthy, we maintain a balance of the two. When we have symptoms of illness, we usually have too much of one and not enough of the other. Hormonal cycles of all kinds readily reveal the interplay of yin and yang.

“There is a constant struggle to keep these two in balance, which is the root of all diagnosis and treatment in Traditional Chinese Medicine,” says Boggs. “For example, yin works to cool the body and maintain a constant temperature. So if yin becomes depleted or is insufficient, yang will increase, which increases body temperature.”

She explains how this works during menopause. “Our bodies are typically more yang during the day and yin at night. During menopause you have kidney yin deficiency, so your yang persists into the night and you have insomnia and hot flashes.”

Research bears this out. In one yearlong study of more than 200 women ages 45 to 60, acupuncture treatments reduced hot flashes and night sweats by as much as 36 percent, and improved sleep, memory, and anxiety.

No, research does not bear this out. There is a panoply of studies of acupuncture for menopause, be it natural menopause or menopause induced by the treatment of breast cancer. When carefully examined, they basically show that acupuncture does not work for menopausal hot flashes. And why should it? There is zero biological plausibility.

None of that stops Yeager from trying to convince us that acupuncture meridians are real. She even cites the work of Helene Langevin, who tried to map the anatomy of acupuncture meridians and acupuncture points on cadavers. I’ve discussed Langevin before. Her research has traditionally been—shall we say?—less than convincing.

The last section shows us the true intent of the article, which is to sell acupuncture as a treatment. Not a hint of skepticism having been shown thus far, Yeager dutifully tells the audience how they should only seek out acupuncturists certified by National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), concluding:

Finally, the question everyone asks is: “Does it hurt?” The needles are a very fine gauge, so acupuncture is different from getting a shot. You may feel a brief sting, especially if you’re a bit dehydrated or otherwise inflamed. Once inserted, the needles also may cause slight achy or itchy sensations, but this is rare.

The sensations are almost never as bad as people expect, says Tomás Flesher, LAc, of Three Treasures Natural Healing in Minneapolis, and the relief acupuncture provides usually overrides those concerns.

“For most people, it takes only one treatment to overcome whatever fear or anxiety they have,” he says. “Once they relax and start feeling the power of what acupuncture can do, any fear they did have completely goes away.”

The only real “power” of acupuncture is to separate the mark from his cash.

oracknows Thu, 11/17/2016 - 01:00

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https://www.cancer.gov/about-cancer/treatment/cam/patient/acupuncture-p…

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From my personal experience I can say that acupuncture is the best treatment for muscle knot pain bar none. If a muscle knot is hit by a needle it instantly releases. I have suffered muscle knots for many years and have tried many things, but nothing else works so good. Doctors I have been to about this problem have no solution at all.

I have a hard time understanding all of these attempts to justify acupuncture scientifically. They always start with citations of a clinical trial (or an anecdote) like they are really in the world of scientific evidence. They throw up some figures and numbers and mimic the style of real research. But then they go onto to explain qi:
Yin qualities are night-like: cool, dark, restful, and passive. By contrast, yang qualities are like the sun: hot, stimulating, vigorous, and active.
That has nothing to do with the clinical trial evidence. The clinical trial evidence shows nothing about qi or yin, nor even yang. Where is the evidence backing this up? Where is the model that predicts yin is cold and yang is hot?
And then they get worse and talk about how acupuncture could solve literally everything that is wrong with you. Then why hasn't it? People used aspirin for years and found it has benefits for heart disease. People used acupuncture for years and ...
It just doesn't seem like the original article was written to convince or persuade anyone that acupuncture is worthwhile but was designed to justify the alreadybheld belief that acupuncture is great.

I don't like too much the idea of disproving fairies by using clinical trials, but there is something that can be done, if someone is interested enough to make the effort.
Let's consider two groups of patients, each with a disease (A or B) with a different acupuncture treatment (a or b). Patients with disease A and patients with disease B will be treated by professional acupuncturists with treatment a and another group of A and B will be treated by the same acupuncturists with b. In each situation, the acupuncturist is told he is dealing with the disease corresponding to the treatment. At the end of the trial, one can see if the outcome is related to the matching of the treatments.

Orac writes,

"Basically, acupuncture is a theatrical placebo, all small risks and no real benefit"

MJD says,

It's all about the human element (i.e., touch/interaction).

If machines administered the needles, in the absence of the human element, acupuncture would quickly cease to exist.

Although, Disney Corporation is the only organization that could possibly make robotic acupuncture work. My guilty pleasure would be Mini-mouse.

My sister suffers from a condition for which there are no real treatments. She tried some of the drugs available and the side effects became intolerable. She was treated for an acupuncturist because she was desperate and she said it helped.

I know it's nonsense and I know she is wasting her money and putting herself at risk for no benefit. But I admit that as much as I hate these fakers bilking people out of their money, I can't deny her something she thinks helps her. I did point out the risks and costs involved, and hope she thinks about it.

But she is the reason I went in to research. People I care about who suffer from conditions for which medicine has no answers are particularly vulnerable. It's hard to stand by and watch.

*by* an acupuncturist, not *for* an acupuncturist. Makes it sound like another part of her condition that needed treatment.

They like to claim that acupuncture is 1000s of years old. I'd really like to see the miracle metal-working that produced the needles used in this. ( https://books.google.ca/books?id=j62mAwAAQBAJ&pg=PT508&lpg=PT508&dq=Nee… ) This indicates that the height of technology about 1000 years ago was a needle between 1.3mm and 7mm thick. The iron and copper needles were thinner then bone, but not by a whole lot. Not something I'd be willing to have jabbed into me.

Pandadeath@2: This precisely fits the definition of "cargo cult science" that Richard Feynman gave in his 1974 Caltech commencement address. Acupuncture isn't specifically mentioned in that speech, but reflexology (another pseudoscientific alt-med technique which has received some Respectful Insolence from our host) is.

You are right about the tell: qi is not a scientific term, so any attempt to define it scientifically will fail. Yin and yang may have some value in philosophy (IANA philosopher, so I don't know either way on that question), but again they are not scientific terms.

Since we're talking about anecdotal evidence, there's a plethora of it that acupuncture can cause pain and do serious harm. There's even more anecdotal evidence that it's a waste of time.

I recently wrote to the editors of The Berkeley Wellness Newsletter, a cridible publication (now digital) that I had subscribed to for 30 years or so, which had always presented good solid, evidence based information. I have always kept thier Wellness Encyclopedia on my kitchen shelf as a handy reference for looking up the nutritional details of almost any food. They’ve never been into woo. Then one day they proclaimed acupuncture as a viable thing to try and went on to give advice about getting someone who is licensed and such. When I wrote citing some of Orac’s work, the reply was the infamous Vickers Study. I fired back with Orac’s takedown of Vickers. I was expecting an apology, but instead was treated with, “you people are hopeless ideologues and as bad as those you criticize”. I didn’t even get to cancel my subscription--they cut me off (at least I never received another installment).

So, this is a bit like the recent election and, honestly, nothing can surprise me anymore if it involves the dumbed-down state of most of the population, especially those who truly ought to know better.

I’m tired of fighting. I fear we have lost and frankly, I’m glad I’m old. I’m abandoning the Beagle for a new inland location. I’ll be an illegal, but am hoping for leniency if that’s discovered. It seems more realistic than hoping for a rational response to blatant quackery/nationalism.

Yin and yang may have some value in philosophy (IANA philosopher, so I don’t know either way on that question), but again they are not scientific terms.

I am not a professional philosopher either, but I know a few, and my sense is "no." The whole concept beats John Gray in terms of gender essentialism, for one thing.

"I groaned at the cliched title"

Well, if you'd stop needling and sharply criticizing acupuncturists and puncturing their overblown claims, defensive articles like Yeager's wouldn't have to be published.

Dangerous Bacon has a point there.

I can see how being addressed by someone with a calming, charismatic manner - and I think people who do well in these roles have to have that - would be nice when you come into an ER stressed out of your wits. So I expect the presence of that person is not without value. But why add sticking needles in people if whatvyiure looking for is a calming influence?

"Yin qualities are night-like: cool, dark, restful, and passive."

Death is yin.

Anonymous Pseudonym #7

So, somewhat like a stilleto dagger, then?

re bloodletting

Although the standard acupuncture needles seemed painless ( I tried this woo because someone else paid for it)
the accompanying cupping treatment led to a form of bloodletting UNDER the skin which resulted in bruises that hurt and lasted for quite a while.
So much for free woo.

I didn’t even get to cancel my subscription–they cut me off (at least I never received another installment).

The same thing happened with my alumni magazine when I taped two nickels to the donation form and demanded to be listed as "The Colonel" as a donor.

So much for free woo.

It was worth exactly as much as you paid for it.

I was born in Abbott Hospital (before it became Abbott-Northwestern), and I'm shaking my head that Minneapolis of all places now boasts [irony] the first staff needler in a US ER. I can see how the ritual might help someone like John Pacharis get by with fewer painkillers – such folks go into it with a hope it will work, and the macguffin of the ritual allows their subconscious to do some mind tricks that alter their perceptions. I can't imagine that working in an ER, especially since patients roll in who wouldn't be predisposed to the mind game. I guess ERs deal with a range of things, from acute emergencies where patients are rushed in by ambulance, to minor injuries where patients drive themselves in and sit around for a long time before being seen. I wonder what range of patient issues they use it for, and how the apparent 'effect' varies among them. I don't have the energy to check the link for the study from Abbott.

Thinking back on the times I was ambulanced to to hospital, I was scared sh!tless...or maybe 'in panic' is a more accurate descriptor. My first thought on reflection was that getting acu-needled would have just made that worse. But then I had a second thought: I didn't mind getting big nasty IV needles shoved into my arm since I was already hurting, and I thought 'OK, they're doing something. Feeling the fluid go into my veins was hind of reassuring. So maybe sticking needles in people IS a calming experience. Maybe their reactions are near-reflex functions of the mid-brain, and the fore-brain cognitive processes that would lead to thinking 'this is bunk WTF?' just never get started. But there's simply no way I can imagine 'acupuncture' as the best way to achieve that sort of calming. I mean, couldn't whatever patient time Abbott is purchasing with Reinstein's salary be better spent on someone doing something that actually addresses the injury?
_____________

I'll joke (only a bit) in saying Orac could have ended the OP at the point where the acupuncture article was identified as appearing in EXPERIENCE L!FE Magazine. Not that I'm famiilar with that specific publication, but I've certainly seen the genre. Gushy, quasi-promotional pieces on 'health/wellness' magical thinking is their stock in trade, and make up maybe half (?) their editorial content. Thus, knowing the genre, I could have guessed pretty much everything Yeager wrote w/o actually reading it. And I could have auto-completed Orac's critique, too.

This being all so well-worn familiar, I find myself wishing the discussion went beyond the fact Yeager's piece is pseudo-science BS, and looked at the role these magazines play in the culture, economics and social relations of woo. I wonder if these rags might be the most important means by which woo is spread and supported in the US.

It just doesn’t seem like the article was written to convince anyone that acupuncture is worthwhile but to justify the already held belief that acupuncture is great.

I don't think so. For one thing, the two aren't mutually exclusive. You may think the level of hype would be say counter-productive to persuading the uninitiated, that it would set off 'sales pitch! con job!' warning sensors and activate skepticism. But message reception and processing is context dependent. If you pulled the article from the magazine, gave it to a randomly picked member of the magazines target demographic, and asked them to read it, they might well be put into caution by the approach. But the actual readers, even those who are encountering one of the CAM related pieces for the first, already have pump of acceptance primed in all sorts of ways. I'll spare the bandwidth of unpacking at length, and just note that everything in these magazines is presented in the same style – even the legit stuff is offered as magic and with magical promises, and these are all part and parcel of certain upper-middle-class 'lifestyle' aspirations represented by the attractive, 'fit', 'active' and happy people depicted on the covers.

Anyway, reading the OP sparked all sorts of question in my mind about 'the bigger picture' in which Yeager's article and EXPERIENCE L!FE Magazine are embedded. Who publishes it, how it makes money, how the different kinds of articles relate to one another, and to the ads surrounding them, who reads it, why, under what conditions (i.e. they may just gloss over the pieces without paying close enough attention to get more than the general positive vibe about the topic), what other media sources do they follow (Dr. Oz?), what are their desires, dreams, fears, what, if anything do they related to the stuff ballyhooed in the magazine? Etc. Etc.

To relate that back to RI, I'll just go back to Pandadeath's thesis: Does EXPERIENCE L!FE Magazine have any real effect on the adoption of pseudo-medicine by any significant number of people? If so, how big an effect, for what kind of people, and how exactly does that work? And, finally, what can any of that suggest about effectively countering that persuasion for anyone who might be susceptible to it?

I can tell you that if I’m ever in a car wreck and land in an emergency room, if I see an acupuncturist offering to stick needles into me the reaction will not be a pleasant one

That was my thought about battlefield acupuncture.

Or at the very least, those needles better have syringes full of morphine attached.

Yin Wibble and yang Wabble may have some value in philosophy.

sadmar@20: as a lifelong connoisseur of the cheap tabloids of the grocery-store checkout I've often wondered how much impact these "wellness: magazines have. I mean, "Women's World" has been telling me about the miraculous properties of apple cider vinegar since at least 1993.

In my experience the magazines that make me feel worst about my body (and offer the least-safe methods for addressing your horrible looks) are the magazines with "health" or "wellness" in the title. Running magazines intended for men and women are usually OK (though full of ads for that silly tape), but running magazines for women might as well be called "eating disorders and body dismorphia R Us!"

As for "natural health" magazines, I usually avoid them but this week was asked to do some research on nano-silver for my in-laws. They sent me an article that was so hilariously wrong I thought of Your Friday Dose of Woo. If you have any logical reasoning you wouldn't be caught, but if you read it credulously then there's a lot of happy shiny snake oil.

if you read it credulously then there’s a lot of happy shiny snake oil.

We shall ride eternal, shiny and chrome colloidal silvered!

Sorry, but I saw this page the other day and wanted others to share in my depression. It's U.S. National Cancer Institute rambling on about acupuncture.

Maybe the people of Kentucky can build an Acupuncture Museum next to their Creation Museum. Or, to save money, just add a diorama showing a a man performing acupuncture on a triceratops.

The triceratops is not very accurately drawn in this depiction.

I was told by my acupuncturist that what acupuncture does is creates small injuries to the body which increases blood flow-circulation to the area. Physical therapists now do an acupuncture technique and call it dry needling. And the needling produces opioid and other response in the brain on brain scans. At the end of the day dismissing it as quackery without further study is obtuse.

Quackademic medicine at Memorial Sloan-Kettering Cancer Center

oracknows — Tue, 15 Nov 2016 02:10:04 +0000

Quackademic medicine at Memorial Sloan-Kettering Cancer Center

The Society for Integrative Oncology (SIO) doesn’t like me much. I understand. I haven’t exactly been supportive of the group’s mission or activities. So it wasn’t surprising that SIO wrote letters trying to rebut a Perspectives article on “integrative oncology” that I published in Nature Reviews Cancer two years ago. What depressed me about that encounter was that one of the complaints the SIO had about my article was that it spent too much verbiage discussing homeopathy as one pseudoscientific treatment that “integrative” oncology “integrates” with science-based medicine and no one uses homeopathy. This led me to point out in my response that the SIO includes naturopaths as prominent members, including as co-authors of its guidelines for breast cancer supportive care. It also led me to point out that you can’t have naturopathy without homeopathy because naturopathy schools teach homeopathy, which makes up a prominent section of the NPLEX, the test naturopaths have to take to be licensed in states that license them. It further depressed me that apparently the doctors in the SIO who responded to my article didn’t realize that one of the naturopaths who was a co-author of the breast cancer guidelines was at the time actually running a clinical trial of homeopathy.

That incident, more than any other, convinced me that most “integrative medicine” MDs, even prominent ones and particularly ones who work with naturopaths, have no clue about the level of pseudoscience and quackery that they’ve embraced. No clue at all. They realize at some level that homeopathy is complete and utter quackery, with no basis in science, which is why they reacted so badly to my discussion of homeopathy. (Ironically, the homeopathy discussion in the first submission of the paper was much shorter, but I was forced to expand it because of comments from one of the peer reviewers.) However, they do not realize that all naturopaths are trained in homeopathy, most naturopaths use it, and that naturopaths used many treatments equally quacky. It’s not just naturopathy, either. Integrative medicine MDs have the same blind spot for traditional Chinese medicine (TCM), which they fail to recognize as a prescientific medical system based on religious and mystical beliefs that was in essence created by Chairman Mao through the “integration” of many Chinese folk medicine traditions because at the time Mao couldn’t bring science-based medicine to enough of his people.

I relate that story not because this post is about naturopathy or TCM, but rather to set the stage for a point that I want to make, illustrating it with the Chief of the Integrative Medicine Service at one of the most prestigious cancer centers in the world, Memorial Sloan-Kettering Cancer Center (MSKCC). On its website, there is an interview with Dr. Jun Mao, who is the Chief of the Integrative Medicine Service. It’s an interview chock full of the sorts of fallacies and what Kimball Atwood used to call the “weasel words of woo” that have facilitated the infiltration of pseudoscience and quackery into halls of medical academia as hallowed as those of MSKCC.

The first question was simple, basically about whether Dr. Mao always envisioned his career “bridging Eastern and Western medicine.” Of course, I hate the whole “Eastern medicine” construct. I view it as a racist term because it implies that those inscrutable Asians are all “holistic” and “natural,” in contrast to those “Western” (and white) doctors, who are all scientific and reductionist. Be that as it may, here’s Dr. Mao’s response:

I’m always interested in the system as a whole, while paying attention to the parts. If you look at a human being in that way, you can see cancer in the context of the entire body. As I pursued Western medicine training, it felt like some of that was missing —sometimes we focus so much on figuring out the exact parts of the body that we sort of forget the whole.

That led me to turn to Eastern medicine. Being the Chief of Integrative Medicine is my dream job. The goal is really to bring the best of conventional medicine together with therapeutics that originate from other cultures and traditions and apply scientific method to research them and eventually disseminate them into clinical practice. Ultimately, we want to allow cancer patients and their family members to have more tools available to them to deal with the physical, emotional, and spiritual impacts of cancer.

On the surface, this sounds reasonable, but you don’t have to dig too deeply or analyze too hard to see the problems with this view. First:

Seeing the body’s “system as a whole” ≠ TCM.

Think about it. TCM is based on the idea that disease is a result of imbalance in the five elements and various other permutations. For instance, some diseases are due to imbalances between damp and dry, heat and cold, and various other opposites. In its basic concept, TCM resembles ancient “Western” medicine; i.e., the humoral theory of medicine in which disease was thought to be a result of imbalances in the four humors. Also, it does no good to “see the whole system” if the lense through which you see that system is basically a kaleidoscope of pseudoscience that distorts everything you look at. That’s what TCM does as a prescientific medical system.

Dr. Mao goes on:

My research in acupuncture has shown that when used for these women, it can help reduce joint pain, decrease hot flashes and anxiety, and improve sleep. By combining Eastern and Western approaches, we allow them to have the best symptom control, hopefully adhere to their lifesaving drugs, and improve their longevity.

Another way to think about it may be that conventional drugs are more about targeting the disease and integrative medicine focuses more on healing the whole person.

This, I’m afraid, is utter and complete bullshit. There’s just no other accurate way to describe it. Unfortunately, it is the fallacy at the heart of so much rationalization of integrating quackery into medicine by advocates like Dr. Mao. Consider this aspect of TCM. TCM practitioners often use something they call “tongue diagnosis. What this involves is looking at the tongue and making diagnoses. So what’s the problem? After all, doctors look at the tongue all the time and can tell all sorts of things about the patient by doing so. Yes, that is true, but in TCM, tongue diagnosis functions a lot like reflexology, with different parts of the tongue thought to map to different organs and body parts. Also, TCM is based on prescientific vitalism, the idea that there is a “life energy” that flows through the body. After all, that’s what acupuncture is supposed to be affecting, the flow of this “life energy.” Let’s just put it this way. 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. My retort to this argument is that you don’t have to embrace pseudoscience and quackery to take care of the whole patient.

As for acupuncture, Dr. Mao is just plain wrong. It doesn’t help above placebo for pain, hot flashes, or anything else. It’s not as though I haven’t blogged about some of the very studies that Mao uses to support his belief in acupuncture.

Next up is my favorite: What’s the difference between alternative and integrative medicine? Dr. Mao’s happy to answer:

Unlike alternative medicine, integrative medicine focuses on using research to inform evidence-based practice of complementary therapies. Integrative medicine is also better integrated into patients’ treatment and survivorship care plans to help them adhere to conventional treatments while augmenting their symptom control and improving their quality of life through other means, such as yoga, acupuncture, or meditation.

As President of the Society for Integrative Oncology, I help lead our group to advocate for scientific research to understand both the safety and the efficacy of complementary therapies. There’s a continually emerging body of literature that suggests many of the therapeutics we use, such as massage, acupuncture, meditation, and yoga, have beneficial effects for psychological distress, insomnia, pain, and fatigue. And those are very common in cancer patients.

Alternative medicine often completely operates on empirical experience. In some contexts, there are people who take advantage of that and make unsubstantiated claims that some herbs or substance can cure cancer without scientific proof. And that’s really why integrative medicine tries to separate itself from alternative medicine.

Sigh. Yes, practitioners of “integrative medicine,” especially the ones at quackademic medical centers, take great umbrage if you mention alternative medicine and imply that what they do is in any way like it. They pull themselves up and say something along the lines of, “Oh, no, we don’t do that. We use only evidence-based treatments.” Then they go on about acupuncture, herbs that don’t work, and other aspects of TCM, mixing it with potentially real evidence-based modalities like exercise or massage. It is basically the central message of “integrative medicine,” and unfortunately it’s effective, a large reason why integrative medicine has infiltrated institutions like MSKCC.

It is rather interesting, however, to see what Dr. Mao says about skeptics:

I think skepticism is a healthy thing. Just like for a lot of conventional cancer treatment, there’s always skepticism, and that helps us to push the envelope more. Clinicians are always asking whether a therapy is working or whether it’s safe. I actually don’t think we should have a blind acceptance of everything.

In terms of people being concerned about a placebo effect, it’s a really great question. I am very intrigued and actually studying that.

Think about placebo effect as a mind-body effect: If you actively engage your mind in wanting a specific outcome, you achieve the outcome. I think the way we are answering whether acupuncture or other types of therapies are better than placebo is by trying to understand the mechanisms underlying the pain, depression, anxiety, and distress that people are experiencing, whether a lot of that is driven by the mind-body effect.

Ugh. This borders on what I like to refer to as the central dogma of alternative medicine, which is that thinking makes it so. It’s also combined with the fallback position that more and more advocates of “integrative medicine” have fallen back on as study after study have failed to find an effect due to their woo that is detectably different from placebo effects. That narrative is that, sure, something like acupuncture doesn’t do anything detectably better than placebo, but it’s the placebo effect that’s invoked that’s “healing.” Add a dash of Cartesian dualism to that, with the hole invocation of “mind-body” effects, as though the mind were somehow separate from the body when it is not, and you have a recipe to thoroughly depress me reading such words coming from a high ranking faculty member of an institution like MSKCC.

Sadly, SIO and the integrative medicine service at MSKCC are just two examples of all too many. All over the US—the world, even—once rigorously science-based institutions are embracing pseudoscience. Unfortunately, the reasons they give are the same all over the world and just as deluded.

oracknows Mon, 11/14/2016 - 21:10

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" If you actively engage your mind in wanting a specific outcome, you achieve the outcome."

And yet I keep not winning the lottery. :(

Think about placebo effect as a mind-body effect: If you actively engage your mind in wanting a specific outcome, you achieve the outcome.

And, as any double-blind study will show, it's something* which is obtained by giving no real treatment to the patient.

So, Dr Mao, riddle me this: why should I pay you to stick needles into me if I can obtain the same effect with a nice herbal tea and a positive attitude?

* assuming the placebo effect is "something", instead of just the wax and wane periods of a condition, or naturally-occurring healing (i.e. the one your body was going to do anyway).

"That incident, more than any other, convinced me that most “integrative medicine” MDs, even prominent ones and particularly ones who work with naturopaths, have no clue about the level of pseudoscience and quackery that they’ve embraced. No clue at all."

Yes David, no one has an utter clue but you, a cut-rate surgeon who blogs more than he treats patients. Have you ever heard the phrase "delusions of grandeur"? Its a common malady among PhDs. Unfortunately there is no cure, but there are treatments, but none that have been validated with an RCT :(

If they are willing to do trials on homeopathic remedies, I thought you would applaud that. Finally, you'll be vindicated when it turns out they don't work. Except you don't want that to occur. I wonder why...

You've probably all seen this one before. Posted for truth. Take it away Dara O'Briain.

"There’s a continually emerging body of literature that suggests many of the therapeutics we use, such as massage, acupuncture, meditation, and yoga..."

A large bowel movement from a severely constipated patient is also "continually emerging" and like Dr. Mao's integrative medicine stinks and deserves flushing. Also both are massive piles of fecal matter that usually need morcellation into more easily disposable waste as you so adroitly do with integrative medicine when it inspissates our medical institutions, Orac.

Sigh. It looks like Robyn Roberts is doing a report on "integrative" medicine, and that's the reason for the big publicity push from MSKCC. Its Twitter feed this morning is full of promotion of its integrative medicine services. Sigh.

One reason these institutions are getting into the game is that more money is becoming available from some private foundations to investigate CAM. Some of them are front groups funded by supplement manufacturers. In veterinary medicine, you are almost compelled to use crackpot non-medicine even if you don't believe in it, or you're not eligible for membership in some of the main groups. Supposedly that is being changed, but I know several honest vets who will privately tell you they resent having to endorse and promote these things. And of course there will always be those who are merely profiting from the credulous.

How the mighty have fallen. So sad.

I trained there for two years, and I cannot count the number of times I walked through that entrance pictured above.

I am also a patient there. Fortunately, everyone I have had contact with must have known not to try to push nonsense on me. This stuff was never mentioned. Or perhaps it is not as important as Dr. Mao thinks it is.

Dr. Mao: "As President of the Society for Integrative Oncology, I help lead our group to advocate for scientific research to understand both the safety and the efficacy of complementary therapies....If you actively engage your mind in wanting a specific outcome, you achieve the outcome.”

Well, there you go. All Dr. Mao's group has to do to get an alt med treatment validated by research is to want it badly enough.

Yes, practitioners of “integrative medicine,” especially the ones at quackademic medical centers, take great umbrage if you mention alternative medicine and imply that what they do is in any way like it.

This may qualify as extreme measures, but maybe you should send them to this essay by John Scalzi and tell them that the same analogy applies to them. The original essay compares Trump voters who claim not to be racist to people who, in order to subscribe to HBO, get a package that includes Cinemax and then claim not to be Cinemax subscribers. They knew, or should have known, that Cinemax was part of the package (the cable company does not conceal this detail) and that some of the subscription fee is paid to Cinemax. Likewise, Trump never concealed his racism, and Trump voters knew, or should have known, that they were supporting that racism. The same thing applies here: people who are into "integrative medicine", especially but not limited to naturopaths, make no secret that they practice homeopathy, so if you encourage the practice of "integrative medicine" in your medical center, you know or should know that you are actively promoting homeopathy, and they deserve just as much respect (i.e., none whatsoever) as a homeopath.

"If you actively engage your mind in wanting a specific outcome, you achieve the outcome.”

Damn! Why did no one tell me this before? I'm off now to actively engage my mind in wanting to be able to put weight on my right hip and stand up and sit down without yelping in pain. I'm sure that after I've actively engaged my mind, I'll be able to skip down the street singing, and farting rainbows!

In the photo of MSK that accompanies the article, is that guy on the right hailing a cab or chastising Laetrile supporters?

And the woman with what looks like really puffy lower extremities - might those actually be the legendary goodie bags MSK sends patients home with, stuffed with pharma drugs and GMO cookies?

Homeopathic remedies will now have to "prove" they work:
https://consumerist.com/2016/11/15/homeopathic-treatments-to-be-held-to…

DB,

That is just her weekly supply of supplements she just bought.

Let's take this statement "If you actively engage your mind in wanting a specific outcome, you achieve the outcome." and flip it around - if you don't achieve the outcome you want, it is because you did not actively engage your mind. Or to put it more bluntly - it's your fault that you have cancer and the treatment didn't work.

What the hell, Dr Mao. Do you have any idea how cruel you are?

Lester @3: I'm going to answer you directly, in case you don't understand why there are not more RCT of homeopathy.
Basically the answer is ethics. An ethical study requires many things, including prior plausibility (is there any data to suggest that the treatment will work?) and equipoise (is there data to support that this treatment is better or safer than the existing treatment?).

Homeopathy has no prior plausibility (it requires violations of the laws of physics), and therefore cannot achieve equipoise. Thus it would be unethical to study homeopathy.

Well, Mao didn't totally trash the PRC's medical system, he largely did, but later managed to repair it to a degree.
As one example, due to his insistence on reviewing ancient herbal treatments, we now have Artemisinin and its semi-synthetic derivatives to help treat malaria, which is becoming increasingly drug resistant.
Of course, had he not bothered with that cultural revolution purge, he'd have not had that much to repair.
Oh well, the broken clock is right twice a day.

As for ”If you actively engage your mind in wanting a specific outcome, you achieve the outcome.”, I'm still waiting, like #1, for that bloody winning lottery ticket to appear on my dining room table. Thus far, the laws of thermodynamics remain quite firmly in effect in my house. ;)

I also am an advocate for homeopathic IV infusions, to be used in capital punishment instances. ;)
That'd avoid the possibility of executing a wrongfully convicted prisoner and help put another nail in homeopathy's virtual coffin.

If you actively engage your mind in wanting a specific outcome, you achieve the outcome.

I wonder how this is supposed to work in cases of mental illness, where the illness affects your thinking; I suppose you just will yourself to "think positive" (my brother) and get over it.

Lester: "If they are willing to do trials on homeopathic remedies, I thought you would applaud that."

It is not ethical to lie to patients. Homeopathy is literally nothing, so claiming it works for anything is lying.

Now, you are quite welcome to do an animal study on homeopathy. Andre Saine claims homeopathy works better for rabies than the modern vaccine. So go and do that study with rodents. Have three groups: one that is vaccinated for rabies and two that are not. Infect all three with rabies and treat one group of unvaccinated rodents with homeopathy. Compare how all three do.

Come back after you publish your results in a PubMed indexed journal.

Seems to me they are doing sound studies on homeopathy to show irrefutably that it is junk. Use RCT and rigorous methodology to end this pointlessness, right? What other reason is there to spend money on this? But you cannot show confirmation bias at the outset: yes,we know this is garbage, but we just want to settle the question once and for all. This new indulgence of studying what's known to be useless is a response to a few decades of someone always whining about some fault or other with debunking studies. Do it right, show clear results, and move on to more important issues. Let the champions of woo cook up some reason why good studies showed their nonsense is nonsense.

"The goal is really to bring the best of conventional medicine together with therapeutics that originate from other cultures and traditions and apply scientific method to research them and eventually disseminate them into clinical practice."
"As President of the Society for Integrative Oncology, I help lead our group to advocate for scientific research to understand both the safety and the efficacy of complementary therapies."

And I thought the point of research was to find out IF a treatment worked, not to assume it does work. Sigh.

Sara: "Seems to me they are doing sound studies on homeopathy to show irrefutably that it is junk."

Who is "they"? If it is the naturopaths doing a clinical trial with homeopathy and breast cancer you will see that there are often very serious problems with the methods, etc. There have been some examples discussed on this blog.

I really want someone to do that rodent study of the efficacy of homeopathy to treat rabies. I have challenged many defenders of homeopathy about that kind of study starting when Andre Saine made his claim in a debate:

He even claims that homeopathy can cure rabies with 100% success. Rabies is almost 100% fatal, even with modern treatment, so this is quite an astounding claim. An audience member helpfully suggested that we can test this claim on animals that contract rabies, since they are just put to death in any case. I pointed out that if Dr. Saine’s claims are even remotely true it is amazing that such a simple study has not been done in the last two centuries, that we have been sitting on a cure for such a deadly disease all this time and yet homeopaths have never been able to silence critics with a controlled experiments.

....

I humbly suggested that we have not seen such a study – that would dramatically silence any skepticism about homeopathy – because homeopathy does not work, and Dr. Saine’s century and a half old anecdotes are perhaps not reliable. This prompted the audience member to ask me if such a study were done and cure rabies would I be converted to a believer in homeopathy. I responded in the affirmative, with the appropriate caveats about study design and transparency, but also turned the question around. If such a study is negative would the audience member then doubt the effectiveness of homeopathy.

No, actively wanting an outcome is not enough. Or do you think that Hillary Clinton, Bernie Sanders, Ted Cruz and everyone else who ran for president in the last two years didn't want to be elected? Does only one baseball team a year actively want to win the World Series, and only one jockey want his horse to win the Kentucky Derby?

Chris @22: The study you propose might well be declared unethical by any university IACUC, for the same reason that a human study would be ruled out: there is no evidence that it would work, and you would cause pain and suffering as well as death to the animals. (No matter what the animal rights activists say, people who do research on animals are bound by ethical considerations.)

""I really want someone to do that rodent study of the efficacy of homeopathy to treat rabies.

Ouch. Since those with rabies exibit hydrophobia, one would have to handle the little vectors to forcefully administer the treatment.

Addendum:

Rodents pretty much don't carry rabies:

Rodents (squirrels, chipmunks, rats, mice, hamsters, gerbils, and guinea pigs), rabbits, and hares rarely get rabies and have not been known to cause rabies among humans in the United States. Squirrels may suffer from the fatal roundworm brain parasite, which causes signs that look exactly like rabies. Opossums are amazingly resistant to rabies. Hissing, drooling, and swaying are part of the opossum's bluff routine. It is intended to scare away potential predators, yet it looks just like rabies and is the reason people can be convinced they’re seeing “rabid opossums” when they’re not.

http://www.humanesociety.org/animals/resources/facts/rabies.html

"It is not ethical to lie to patients. Homeopathy is literally nothing, so claiming it works for anything is lying."

Obviously there is no need to lie. Patients don't know whether they are getting placebo or the remedy, so your point is moot. Nice try though, really. I like the circular reasoning part of your argument where you make an assumption "Homeopathy is nothing" to justify not doing an RCT to find out if it is actually nothing. That would usually work on the dim-witted. Ditto the ethical gambit.

Wow. I thought Sloan Kettering would be the last people to embrace this stuff!

@ Chris
If, by any chance, you can perform the study you want, your manuscript will be evaluated by "experts". "Experts" in this field are homeopaths. They will criticize your lack of expertise in the field, the choice of your animal model, the way you did your dilutions, the time when you gave the treatment, and so on...
You are expecting too much from experiments and peer review, and not enough from knowledge, logic, and judgment. We don't have to do anything to prove that homeopathy is bllsht. Homeopathy interests me because it shows how much the knowledge industry is corrupted. MDs that are co-authors with homeopaths can be referees for journals. What do you think it means in terms of evaluation?

Corcos, the study would get more legs by someone who actually believes homeopathy actually works.

Also, it serves to just shut them up.

Lester: "Obviously there is no need to lie. Patients don’t know whether they are getting placebo or the remedy, so your point is moot."

That is the definition of lying.

@ Chris
They will never give up, like astrologists or believers. If they were able to change their mind in the face of evidence, homeopathy would be a science.

If you actively engage your mind in wanting a specific outcome, you achieve the outcome.>/blockquote>

My wife, Morgan Fairchild, tells me that all the time.

Corcos, the joy in the rabies challenge for homeopathy is that they actively avoid dealing with the question, and lurkers see the pure idiocy of the entire concept.

Mercy me. You're all taking Dr. Mao's "If you actively engage your mind in wanting a specific outcome, you achieve the outcome" out of context. He's not offering that as a pronouncement of metaphysics. He's describing placebo effects. What is placebo if not people engaging their mind in wanting to better, and thus achieving the 'outcome' of feeling better? And he's not just wooey-cheerful about the mind games that effect mood 'outcomes'. He identifies the 'mind-body effect' – the mind tricking itself about body conditions – as a source of the "depression, anxiety, and distress" experienced by cancer patients.

Orac privileges 'science' first and foremost, measures any IM thing against the ideals of high scientific rigor, and condemns it all as a result. Here anyway, I'm going to privilege patient well-being, and apply a more pragmatic standard. In that, I start with things as they are, and in the case of IM I see central problem as the conflation of physiological health and physiological effect in every way with psychological health and psychological effect. That's not just enabling for bad physiological medicine, but bad dealing with psychological health as well. Compared to IM pooh-bahs like Andrew Weil, Mark Hyman and (gag) John Weeks, it sounds to me like Dr. Mao is trying to move the IM needle in a positive direction. Is it perfect? No. But what change does not occur one step at a time.

At least Dr, Mao recognizes that cancer patients, especially those on chemo, face serious issues with "depression, anxiety, and distress", and is trying to do something about it.

As someone who has had enough "depression, anxiety, and distress" to make the phrase "quality of life" sound like a sick joke, my position is "if something gets you further from the bottom of the pit, far be it from me to be critical'. If somebody stuck a bunch of needles in my 'acupoints' I'm pretty sure I'd just get more "depression, anxiety, and distress". But it does seem there's evidence some folks get the opposite effect, and, well, good for them.

Actually, when I first read "If you actively engage your mind in wanting a specific outcome, you achieve the outcome," my first thought wasn't 'placebo' but 'that just sounds like CBT'. as it happens, CBT also just increases my depression anxiety and ditress, but, again I won't knock it sui generis since it does seem to help other people.

JP asked how Mao's approach "is supposed to work in cases of mental illness, where the illness affects your thinking; I suppose you just will yourself to “think positive” and get over it." And that's CBT in a nutshell. And yeah, JustaTech, if you're in CBT, and "you don’t achieve the outcome you want, it is because you did not actively engage your mind. Or to put it more bluntly – it’s your fault that the treatment didn’t work."

But here's the thing: Dr. Mao is just trying to explain some stuff to a couple 'journalists' from MSKCC's internal publications unit, not talking to patients. The patients have cancer. If Dr. Mao prescribes yoga for those who can do it and aren't turned off by it, and it lifts their spirits some and helps them cope, they will probably credit the yoga. If it doesn't, they'll chalk that up to the cancer and/or the chemo, don'cha think?

Finally, did it occur to any of you that MSKCC might be concerned with patients who have declined treatment there or left treatment there because fear of chemo or experience with the ravages of chemo has led them into the arms of cancer quacks? Well, it seems that Dr. Mao might be thinking about that, since he frames the value of "complementary therapies" to patients as "help them adhere to conventional treatments while augmenting their symptom control and improving their quality of life."

On that count, I'll ask of the conventional medicine standard-of-care: What does it offer to deal with "depression, anxiety, and distress"?

sadmar @35: "On that count, I’ll ask of the conventional medicine standard-of-care: What does it offer to deal with “depression, anxiety, and distress”?"
CBT, talk therapy, anti-depressants, group therapy, social workers, religious personnel, art therapy, music therapy, massage, occupational therapy, honesty.

You beat me to it.

Yes, sadmar clearly doesn't understand and in so doing falls exactly into the trap laid by advocates of "integrative medicine" and in the process once again mischaracterizing skeptics' views. We do not have objections to yoga, exercise, music, etc., for cancer patients. These used to be called supportive care or patient activities, the sorts of things long used to lift patient's spirits. And, as I've quoted Kimball Atwood about massage, it just feels good; so we don't have an objection.

What we do have a problem with is advocating using these modalities to treat specific conditions without evidence, which is a lot of what's going on in integrative medicine. Worse, as I've discussed before in my Nature Reviews Cancer perspective piece (which I really should send a copy of to sadmar, as it explains all this in nauseating detail), I find these modalities problematic because they medicalize exercise, diet, music, etc. Also, re: acupuncture. It is unethical to use a modality that has no real benefits and is, in fact, all risk and no benefits, even if the risks are very small.

"lift patient’s spirits"

The beauty of these therapies is you don't need to be a patient to feel better. Illness is not a prerequisite.

Applying systems biology to validate prescientific quackery is tooth fairy science

oracknows — Wed, 26 Oct 2016 04:45:42 +0000

Applying systems biology to validate prescientific quackery is tooth fairy science

Although I did not coin it, I frequently use the term “quackademic medicine” because, unfortunately, there’s a lot of quackademic medicine around. Although regular readers know what the term means, i always feel obligated to briefly explain what quackademic medicine is, for the benefit of any newbie who might happen upon this blog. Basically, it is a term used to describe an increasingly common and alarming phenomenon, the infiltration of rank quackery and pseudoscience into medical academia. You might think it impossible or unbelievable, but it’s anything but. Beginning around a quarter of a century ago, alternative medicine started finding its way into medical schools and academic medical centers, first in the form of “complementary and alternative medicine” (CAM) and then later renamed “integrative medicine.” The intent of renaming it “integrative medicine” was to portray the idea of “integrating” the “best of both worlds” (alternative medicine and conventional medicine) as though they were equals, but in reality all integrative medicine does is to integrate quackery with real medicine; that is, when it isn’t busy co-opting perfectly science-based modalities, such as exercise, nutrition, and lifestyle changes, as somehow being “alternative” and “integrated” into medicine.

One of the most pernicious effects of quackademic medicine is not just how it places the imprimatur of real medicine on sheer quackery like acupuncture, much of traditional Chinese medicine (TCM), reflexology, naturopathy, homeopathy, and the like. That’s bad enough. What’s just as bad, though, is how it distorts research, wastes money, and encourages research into treatments that are so implausible that it is unethical to subject man or beast to them in the name of science. I’ve listed many examples before, the first example coming to mind being the clinical trials of homeopathy for infectious childhood diarrhea in Third World countries, acupuncture for menopausal hot flashes, or acupuncture for in vitro fertilization. Then there are the many experiments subjecting rodents to various quackery, such as this one torturing rats in the name of pseudoscience by shocking them with electroacupuncture.

A while ago, I noted that the open access journal, PLoS One seemed to have a penchant for publishing horrible studies of quackery, such as one purporting to identify anatomic correlates of acupuncture meridians and functional MRI (fMRI) studies of laser acupuncture. Of course, it’s not just PLoS one, but a lot of journals, even journals within the Nature stable of journals, such as Scientific Reports. I’m referring to an article that its authors, Sun et al, entitled To Unveil the Molecular Mechanisms of Qi and Blood through Systems Biology-Based Investigation into Si-Jun-Zi-Tang and Si-Wu-Tang formulae. It might better have been entitled Disguising pharmacognosy research using crude plant extracts as evidence for qi and the five element theory of medicine.

Basically, this study uses various bioinformatics databases of compounds and their molecular targets in the cell, does a bunch of analyses that use the known effects of various ingredients in the TCM compounds to predict what molecular signaling pathways they affect. They used TCMID Cytoscape thusly:

Since the TCM formulae are normally composed of several medicinal herbs, and each herb normally has many ingredients, and each ingredient has a lot of targets, a formula is a complex biologic active network. Fortunately, along with the rapid development of life science and computer science, a variety of computational tools and bioinformatic database have been developed to facilitate the analysis of a large number of genes associated with complex ingredients of TCM formulae2, which provide opportunities to predict potential pharmacological actions of TCM formulae and clarify complex molecular mechanisms of formulae and theories of TCM. Based on primary biomolecular databases, e.g. Kyoto Encyclopedia of Genes and Genomes (KEGG, http://www.kegg.jp)3, HPRD4, PDB5, TTD6, OMIM7, Drug-Bank8, STITCH9 and ChEMBL10, a lot of TCM-related databases have been developed, such as TCMID11, HIT12, TCM Database@Taiwan13, TCMGeneDIT14, TCM-ID15, TCMSP16 and CHMIS-C17. These TCM-related databases complement each other to provide information on complex interactions of TCM-active ingredient-gene-disease2. Among these TCM-related databases, TCMID (http://www.megabionet.org/tcmid/) contains 3,791 diseases, 47,000 prescriptions, 8,159 herbs, 6,828 drugs, 25,210 compounds and 17,521 related targets, which facilitates the study of interactions between formula, ingredient, gene and disease to uncover the molecular biological mechanisms of TCM. Meanwhile, there are several network analysis tools for biological functionality of TCM-related network analysis, such as Cytoscape18,19. More than 150 specialized plugins integrated in Cytoscape can be used to import and map existing interaction data cataloged in public databases2, such as ClueGO20, BioGrid Plugin21 and MiMI22. ClueGO integrates Gene Ontology (GO) terms as well as KEGG/BioCarta pathways to create functionally organized GO/pathway term network and analyze one or compare two lists of genes and comprehensively visualizes functionally grouped terms.

I’ll translate. Basically, it is now possible to use biomolecular databaes, databases of molecular targets and their interactions with various molecules, and sophisticated bioinformatics tools like Cytoscape to import and map known interaction data from public databases and use network analyses to model and identify likely signaling pathways affected by the molecules. This list can be shaped and narrowed down by other databases cataloguing targets and signaling pathways known to be involved with specific diseases and conditions. All of this has become fairly standard in drug development, both in pharma and academia. It’s basically science.

But what are these sophisticated bioinformatics techniques being used for in this study. Here’s where it goes off the deep end. Now, I frequently refer to studies like this as “tooth fairy science.” It’s a term coined by Harriet Hall to describe science purporting to measure the properties of a phenomenon whose existence has not been established. Basically, you can study how much money the tooth fairy leaves each night, but you haven’t established the existence of the tooth fairy. Similarly, you can study the “effects” of homeopathy, but you haven’t established that homeopathy is anything more than water. Believe it or not, this isn’t tooth fairy science, as you will see. However, it is something almost as bad.

First, take a look at this figure to see how Sun et al set up their experiment (click to embiggen):

Yes, on the left, there is “Qi deficiency” on the left and “blood deficiency” on the right. Both are TCM diagnoses, not diagnoses that have anything to do with biology or medical reality, given that qi is a term to describe the “life energy.” I sometimes wonder if qi deficiency is caused by excessive use by the alien healing machine in Babylon 5 to heal others (that’s a joke only real Babylon 5 geeks will get). Be that as it may, on the one side, you have a diagnosis based on a prescientific concept of how the body works in an ancient Eastern medical system resembling ancient European humoral theory treated with an herbal remedy called Si-Jun-Zi-Tang (SJZT) based on that same prescientific understanding. On the other side you have a different diagnosis based on a prescientific concept of how the body works in an ancient Eastern medical system resembling ancient European humoral theory treated with another herbal remedy called Si-Wu-Tang (SWT) based on that same prescientific understanding. Each is then run through TCMID Cytoscape to find what is described as an herb-ingredient gene network. The two are compared using ClueGO KEGG analysis of predicted targets of SWT and SJZT. It’s not important that you understand what that is other than that it’s a computer analysis. You then get fancy network analysis charts like this, in which red nodes represent terms of SWT; green nodes represent terms (pathways) of SJZT; grey nodes represent common terms of the two formulae (again, click to embiggen):

A systems biology map of woo masquerading as pharmacognosy.

It’s not important that you know exactly what this chart means. All it shows is basically how the two herbs affect different signaling pathways. Basically, this is nothing but pharmacognosy (natural products pharmacology) using very “dirty” natural products (raw herbs with active compounds not isolated or otherwise purified). The authors then use this to try to convince you that the pharmacognosy investigations performed in this paper somehow validate the prescientific mystical beliefs of TCM, but only after first trying to convince you that TCM foresaw how modern medicine would work:

Combination therapy is the major feature of TCM, which is increasingly recognized by modern western medicine, such as cocktail therapy for HIV27 and the opinion shifting from targeting a single disease-causing molecule to the pursuit of combination therapies that comprise more than one active ingredient28. According to the symptoms of patients, different kinds of Chinese medicines are combined to form formulae to improve clinical efficacy1. such as SWT and SJZT have been used to rectify blood deficiency and Qi deficiency respectively for about 1,000 years.

This is, of course, utter nonsense. First, it invokes the false dichotomy of “Eastern” versus “Western” medicine. There is no such thing. There is scientific medicine, which knows no “East” or “West.” There is also quackery, which, unfortunately, also knows no “East” or “West.” (After all, homeopathy is “Western” medicine, having been invented, as it was, in Germany by Samuel Hahnemann over 200 years ago.) That’s just a pet peeve of mine, though. Scientific medicine has always used combination therapy, whether antibiotics to try to eliminate an infection before resistance evolves, the many, many multidrug combinations used in the chemotherapy of cancer, or even something as mundane as treating hypertension with more than one drug. There is nothing unusual or new about this. While it is true that scientific medicine did at one time tend to look for single genes that could be targeted, my perception is that the reason that changed was not so much a revelation that those ancient Chinese were right after all but rather as a result of the increasingly sophisticated technology that permits the study of gene networks and changes in the expression of every gene in the genome simultaneously instead of the levels of individual genes. TCM advocates would have you believe that TCM was there first, looking at individuals in a “holistic fashion,” but that’s just nonsense. TCM came by its beliefs because humans didn’t know any better and didn’t have the tools at the time to know better.

I used to call the co-opting of modern genomic techniques as “woo-omics,” to go along with genomics, metabolomics, and all the other “omics” in modern medical science, and TCM is not alone in this. This study is a perfect example of woo-omics or woo systems analysis. It’s perfectly fine as pharmacognosy, although most scientists in drug development would not be too thrilled with the use of crude extracts, but it is no evidence that the precepts of TCM have anything to do with reality. None of this stops the authors from arguing just that:

Blood deficiency normally manifests anaemia, vertigo, heart palpitations and menstrual discomfort. The SWT formula has effects on stimulating hematopoiesis in bone marrow, anti-coagulant, vasodilatation and sedative, so it can be used to treat anemia, bone formation dysmenorrhea and other estrogen-related diseases. Qi deficiency normally manifests lack of strength, body function decline and decreased disease resistance, and so on. The SZJT formula has effects on regulating granulocyte macrophage colony-stimulating factor secretion, enhancing phagocytosis of macrophages, recovering cAMP signal pathway and recovery of intestinal microflora. However, the mechanisms of the pharmacological action of SWT and SJZT have not yet been clarified.

And:

In conclusion, SWT with the functions of influencing amino acid and carbohydrate metabolism is significant different from SJZT with the actions of influencing neuroendocrine system by affecting excitatory synapses (serotonergic synapse) to regulate thyroid hormone, ovarian steroidogenesis, prolactin and oxytocin secrction and can regulate corrective hormones secretion and promoting vascular smooth muscle contraction. The common effects of SWT and SJZT are regulating the functional activities of the hypothalamic pituitary adrenal and gonadal axis by affect inhibitory synapses (GABAergic synapse) to stimulate estrogen and steroid hormones secretion and strengthening the ability of anti-infection. All the differences and common pathways also reflect the characteristics of blood deficiency and Qi deficiency, and the molecular mechanism of blood and Qi of TCM.

Molecular mechanism. You keep using that term. I do not think it means what you think it means.

Seriously, their argument boils down to being able to vaguely relate some of the molecular pathways apparently affected by SWT and SJZT to the TCM diagnoses of qi deficiency and blood deficiency and using that vague relation to claim that the precepts of TCM are valid and that this study has provided evidence in support of those precepts. This is a feature, not a bug, of studies like this, and this is not the first such study. Not by a long shot.

Hmmm. Maybe I was wrong. Maybe this is tooth fairy science, after all. Strike that. There's no "maybe" about it.

oracknows Wed, 10/26/2016 - 00:45

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http://umm.edu/health/medical/altmed/supplement/red-yeast-rice

Computer scientists would call this GIGO, as they put in a bunch of nonsense and used computational methods to map it to a different but equally nonsensical realm.

Chris@1: Just about every kind of woo is a form of GIGO: you assume that some "theory" of medicine is accurate, regardless of whether there is any evidence or even plausibility for it, and turn the crank to get nonsensical results.

As for the East-West false dichotomy, I suspect that is a literal translation of metaphoric Chinese. The Chinese didn't have a word for the kind of science-based medicine that those foreigners from countries bordering the Great Western Sea (i.e., the Atlantic Ocean) were practicing, so they used the character for "west" (xi) to describe it. Thus the indigenous folk medicine traditions would for contrast be labeled zhong ("Chinese")[1] medicine. Westerners translating from the Chinese would generally not know these nuances, so they would pick up the notion that science-based medicine was "Western" medicine.

[1]This character can also mean "center", which is why China (Zhongguo) is sometimes called the Middle Kingdom.

Yep, GIGO, Garbage In, Garbage Out.

Yes, I do indeed have an energy metabolism - chemical energy. Glucose and oxygen and all. All of the pins and needles in the world won't adjust any such flow, it might however make that which carries the glucose and oxygen leak out, assuming a large enough gauge was used (as I do have acupuncture needles (got them on a closeout and used them as microwave antenna probes in a basement experiment (which worked very, very well)), suffice it to say, they're a tiny gauge, useless for any valid purpose beyond intercepting microwaves).

As for unrefined herbals, I do know of some drug researchers who did enjoy just that, largely from remote areas and a few actually became marketable drugs or lead directly to a novel marketable drug.
Their challenge, finding what the active compound was, figure out what it was, figure out how it worked, then see if replication would work or perhaps, a modification of the compound would create a superior drug.
Most of the time, the results were... Disappointing.
But, we do have statins for a very good reason, studying the effects of some of the compounds released by some relatively common molds.
The difference between their activities and the woo outlined here, the woo is based upon disproved prescientific nonsense, the latter, upon biochemistry.

As for unrefined herbals, I do know of some drug researchers who did enjoy just that

Not sure if this is what you intended, but it gives me an image of researchers smoking ... something. Which can vary widely in potency: anything from Tampico ditch weed to BC Bud. (Not that I know the difference between them firsthand.)

""But, we do have statins

But because many red yeast rice supplements did have monacolin, the Food and Drug Administration (FDA) considered them to be drugs. Manufacturers were supposed to remove any red yeast rice products with monacolin from the market. As a result, many of the red yeast rice products you can buy may not contain monacolin. Unfortunately, there is no way to tell whether a product contains moacolin because it is not listed on the label.

Herbs that the FDA deem medicinal are taken away from the people -- Synthetic compounds are derived from them such that, for many, the former relief is put behind an insurmountable prescription and pay wall.

I am sure that there are plenty of dubious articles like this one in respectable journals, but we don't have the woo clue to identify them.

I followed Gilbert's link and found that the author appears to be

Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ.

Surprise, surprise. A woo practitioner pushes woo. Of course the FDA is not allowed to do what Gilbert (via this link) claims it did as long as red yeast rice is sold as a supplement.

Also of note: two of the alleged references cited on the page are conference presentations from 1999. On a web page with a last revision date of 2015. I can't speak for the medical field generally, but the leading journals in my field tend not to allow citations to unpublished sources--you can get away with a conference presentation in the last year or two because the corresponding paper may not have been published yet, but I'd raise eyebrows at a sixteen-year-old conference presentation, let alone two, on a reference list.

Also, I haven't seen the qualification "NMD" before. By chance, does it stand for "Not a Medical Doctor"?

'Also, I haven’t seen the qualification “NMD” before. By chance, does it stand for “Not a Medical Doctor”?'
Short answer - yes.
Long answer - Doctor of Naturopathic Medicine, so still yes.

The point of these studies is not to demonstrate that the initial TCM explanation of a formula's mechanism of action is correct; it is to demonstrate that it has conventional bioactivities that can explain benefits demonstrated in clinical trials and human experience. The precursors of Western drugs were considered to work by affecting "humors", which are no more real than qi. We do not declare that allopathy is therefore pre-Scientific and worthless across the board no matter how many clinical trials - and nowadays mechanisms of action - pile up. But your revanchism arises from an effectively religious belief, not a small-r rational one - what evidence would you accept that a formula invented by ancient Chinese physicians was effective? - and so there is nothing that can be said to change your mind. Fortunately, most potential readers can think for themselves.

Of course, we still run into the occasional bright individual who recalls the handful of classes of drugs in use today whose mechanism of action is either unclear or unknown.
The advantage of evidence based medicine is, eventually, the mechanism of action is found and fully documented. That isn't true with woo based medicine, which rely upon non-extant things like the immeasurable Qi, thereby keeping alive the "mystery" that science already solved.

We do not declare that allopathy....

TCM is "allopathic," Jane. Do consult the Rectification of Names.

I can't stand AZ naturoquacks

"what evidence would you accept that a formula invented by ancient Chinese physicians was effective?"*

How about reproducible evidence from quality clinical trials?

"But your revanchism arises from an effectively religious belief"

Yet another example of "your science is just religion har har har"

Do come up with something new, jane.

*this reminds me of the old TV ad where the dry cleaner claims his results are due to an "ancient Chinese secret", which of course turns out to be the American Wonder Product he is covertly using.

I found the layout of that diagram to be reminiscent of the Underpants Gnomes' business plan in "South Park".

what evidence would you accept that a formula invented by ancient Chinese physicians was effective?

The same standard that applies for any novel drug: evidence in the form of proper clinical trials that it is safe and effective. At that point it becomes science-based medicine rather than alternative medicine.

This has happened at least once. Last year's Nobel Prize winner in Medicine, building off TCM treatments for malaria, found an active ingredient, artemisinin, which was then shown to be safe and effective as a malaria treatment. But it was laborious work: of the hundreds of potential active ingredients, only one was found to be effective.

As Orac points out in the original post, pharmacognosy can be useful. But it is typically only the first step in identifying potential new drugs. After that comes the hard work of verifying that the drug actually works.

found an active ingredient, artemisinin, which was then shown to be safe and effective as a malaria treatment.

Great. Wormwood will now become schedule I in due time.

clinical trials of homeopathy for infectious childhood diarrhea in Third World countries,

Maybe I've spent too much time in Third World countries, but this makes me feel stabby.

Great. Wormwood will now become schedule I in due time.

Does this mean absinthe on prescription?

Well, they do say, absinthe makes the fart grow louder, erm, heart grow fonder. My bad. ;)

Jane @9:
The point of these studies is not to demonstrate that the initial TCM explanation of a formula’s mechanism of action is correct

Perhaps this explanation of the study's intention would be better directed to its authors, as they are the ones who are getting it wrong -- e.g. their conclusion that they have demonstrated the validity of TCM categories and curative mechanisms:

the characteristics of blood deficiency and Qi deficiency, and the molecular mechanism of blood and Qi of TCM.

# 18 HDB

Does this mean absinthe on prescription?

No, devil worship. See C.S Lewis and The Screwtape Letters .

However one can buy a goat to sacrifice without a prescription and usually more cheaply. Probably not covered by most insurance plans though.

@hdb,

Perhaps Demon Srewtape has found a new patient for his nephew to minister to.

Although the target might be too easy to be worth the effort.

However one can buy a goat to sacrifice without a prescription and usually more cheaply. Probably not covered by most insurance plans though.

Just don't let the ASPCA catch you.

Just don’t let the ASPCA catch you [sacrificing goats]

They can complain all they want to, but if it's a religious ritual, that's all they can do. The Supreme Court held in Church of the Lukumi Babalu Aye v. City of Hialeah that a city ordinance forbidding the "unnecessar[y]" killing of "an animal in a public or private ritual or ceremony not for the primary purpose of food consumption" was unconstitutional. So one can legally practice Santería if one so chooses.

Got the Babylon 5 reference. That machine lead to the death of my favorite character on the show, but did save my second favorite.

An obscure Babylon 5 reference! Marry me, Orac!*
I can just imagine you standing at the podium, declaring "Who am I? I am (Orac), M. D.... I am the right hand of medicine and the boot that is going to kick your sorry woo-peddling ass all the way back to the fringes, sweetheart! I am science incarnate, and the last academic presenter that you will ever see. God sent me."

*Don't take this proposal seriously, since I am already married, although you are kind of cute.

Derek, I have it on good authority (namely my own) that NMD stands for Not Much of a Doctor.
kiiri, I would have to say that Ivanova was tied for best character with Londo Mollari. Least favorite were Delenn, Lennier, and the Minbari in general. Totally insufferable, with all those damned rituals, prophecies, caste boundaries, and what not. Come to think of it, there was a culture with an overload of mystical (insert name of large Minbari draft animal)sh*t going on.

Has another celebrity embraced quackery?

oracknows — Tue, 20 Sep 2016 01:00:49 +0000

Has another celebrity embraced quackery?

I never in a million years thought I’d be writing a blog post involving Selena Gomez.

Gomez, as many, if not most, of you are probably aware is currently a young pop star and actress who got her start as a child actress. Oddly enough, she was on Barney & Friends with Demi Lovato. These days, Gomez specializes in the variety of overproduced, lightweight pop that I don’t really listen to, although, ever since I subscribed to Apple Music, I’ve been known to listen to songs by performers like Selena Gomez and Demi Lovato just to see if I could figure out why they’re so popular. So far, I haven’t been able to. Gomez clearly has a good voice, but it’s buried under sweetening, doubling, and other studio wizardry that, when overused as it seems to be in most pop music these days, irritates the crap out of an old fart like myself. But, hey, to each his own. Truly, I have become my parents, complaining that all pop music sounds the same. Of course, old fart that I am, I can’t help but mention that we have actual scientific evidence that, compared to 50 years ago, today’s pop music really does all sound alike because it’s even more formulaic. That’s not to say that there isn’t still great music out there. I discovered a lot of it over the last few years after having emerged from a period of being pretty much oblivious to any music more recent than the early 2000s. It’s just not on the pop charts.

Be that as it may, I only mentioned all this as kind of a background as to why I never thought I’d be writing about Selena Gomez. But then, the other day, my Google Alert for “alternative medicine” popped up a most unexpected story, Selena Gomez ‘Seeking Alternative Treatments For Lupus’: Organic Diet, Juicing & More. The first surprise to me was that Selena Gomez apparently has lupus. Being as oblivious as I am to the sort of pop music Gomez produces, I had had no idea that she even had lupus, but she was diagnosed a few years ago and has been .undergone treatment for lupus up to and including chemotherapy. I’ll get into that later. For now, here’s what the story I saw is reporting. I take it with a grain of salt because it’s not Gomez herself saying it but rather an unnamed source:

Selena Gomez, 24, has had it with pills, steroids, and bed rest. She’s planning to take her lupus, a disease in which the body’s immune system attacks healthy tissue, from a whole new angle: holistically. Selena told fans in early September 2016 that she’s struggling with lupus-related panic attacks and depression, but now she’s determined to turn her life around. She’s enlisted a new team of holistic doctors, naturopaths, and acupuncturists.

“Selena Gomez has not experienced a lot of relief from classic western medicine, and is seeking alternative treatments for her lupus diagnosis,” a source close to the singer told HollywoodLife.com EXCLUSIVELY. “She wants to begin ‘chelation therapy,’ which is a method of pulling toxins and metals out of the body. She’s switched to an all organic, grain-free diet, and thoroughly ‘detoxed’ her house. All her soaps, beauty products, and cleaning supplies are natural and organic.”

And that’s not all! “She’s also juicing 3 times a day. Her new team of doctors thinks drugs will only cover up the problem, but [these methods] will really help, if not cure [her lupus]!” Hopefully this works out for Selena! She revealed in 2015 that she had major problems with some of the traditional medicine that she tried. Selena told her fans that she had undergone chemotherapy to treat the illness. She was weak, nauseous, and her hair thinned as a result. Poor Selena!

OK, again, this is just an unnamed source interviewed by a Hollywood gossip website. Still, it doesn’t sound implausible. If it’s true, the only good thing I can say is that apparently Gomez herself is keeping it silent (unless, of course, she wanted that source to leak the information). Before I look at the quackery, let’s first take a look at lupus.

Contrary to Dr. House’s famous admonition, sometimes it is lupus. Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body’s immune system mistakenly attacks normal organs and healthy tissue. The mechanism involves an immune response against the patient’s own tissues by autoantibodies (antibodies to self), most commonly antinuclear antibodies (ANA). The attack of these antibodies against normal tissue does what immune activation does: It results in inflammation. Unfortunately, the manifestations of SLE are protean, and its severity can range from mild to severe. Common symptoms include joint pain and swelling, rashes, hair loss, chest pain, mouth ulcers, lymphadenopathy, fatigue, and many others. It’s also a disease whose symptoms can wax and wane markedly, with periods of remission, during which the sufferer is relatively symptom-free, interspersed with “flares,” when symptoms become much more troublesome and serious. It’s a lot more common in women than in men, and it is not infrequently diagnosed

If you want a disease that is perfect for quacks, it’s SLE. Its manifestations can be so varied and its course can wax and wane so markedly that it’s been called the “great imitator,” with a delay in diagnosis of years being more the rule rather than the exception:

Imagine yourself as a young woman who by all accounts appears healthy. One day you experience flu like symptoms, see your physician, and are sent home with the usual: sleep, hydrate, take two of these, and you get better. But do you? Some time passes and you become sick again, this time with a different gamut of symptoms including recurring infections, joint pains, headaches, fatigue, depression, rashes, etc. As a result, you find yourself in and out of this complicated domestic health care delivery system, seeing one physician/specialist after another and are left with little to no answers.

Fast forward a few years. You’re now in your mid-twenties and have found a personal physician who took the time to listen to your story of diverse symptoms. After reviewing your current symptoms, laboratory tests, and medical history, you finally have the answer to the question you’ve been asking yourself for years: Why am I always sick? You have systemic lupus.

To get an idea of how hard SLE can be to diagnose, take a look at the American College of Rhematology’s criteria for diagnosis. For purposes of diagnosis and inclusion in clinical trials, a patient has a diagnosis of lupus if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.

Malar rash (rash on cheeks)
Discoid rash (red, scaly patches on skin that cause scarring)
Serositis: Pleurisy (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart)
Oral ulcers (includes oral or nasopharyngeal ulcers)
Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion
Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups)
Blood—hematologic disorder—hemolytic anemia (low red blood cell count), leukopenia (white blood cell count<4000/µl), lymphopenia (<1500/µl), or low platelet count (<100000/µl) in the absence of offending drug
Antinuclear antibody test positive
Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody, and/or false positive serological test for syphilis
Neurologic disorder: Seizures or psychosis

You get the idea. When the criteria for diagnosing a disease are so broad, it’s a tough disease. So patients with SLE are frequently not diagnosed right away and misdiagnosed before the correct diagnosis is arrived at. Once diagnosed, the treatments can be difficult and not provide as much relief as patients would like. Basically, the treatment involves trying to prevent flares and decreasing their severity when they do occur. drugs used include nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials (which are also useful for lupus), steroids, immunosuppressives, and biologics (such as Belimumab (a type of agent referred to as a B-lymphocyte stimulator protein inhibitor).

The chemotherapy that Gomez received was almost certainly cyclophosphamide. It is a chemotherapy drug, one that is part of the standard of care multimodality treatment of breast cancer. The dose used in lupus is lower and the course of treatment is shorter, but the drug is the same. That Gomez received cyclophosphamide indicates that she must have had severe manifestations of the disease because the drug is so toxic that it is generally reserved for the most severe complications of SLE, such as severe kidney inflammation or other organ-threatening complications, such as brain inflammation. Basically, cyclophosphamide is an alkylating agent that targets rapidly dividing cells, and during severe inflammation immune cells are rapidly dividing. That’s the rationale.

So let’s circle back to alternative medicine for lupus. First of all, there is no known alternative medicine that affects the course of the disease. In fact, some herbal medicines are suspected to provoke or worsen flares. Reading between the lines, if this source is accurate, it doesn’t sound as though Gomez is using alternative medicine in addition to conventional medicine; i.e., as “complementary” medicine. Regular readers know that I’m no fan of so-called “complementary and alternative medicine” (CAM), now more commonly known as “integrative medicine” because integrating quackery with real medicine does not benefit patients and degrades the science of medicine by diluting it with pseudoscience.

Whenever I hear a story of someone getting together a “team of holistic doctors,” I get worried, because if the whole team is “holistic,” that generally means that there are no science-based doctors involved or, at best, there might be an “integrative medicine” practitioner who buys into the woo. Certainly the description of treatments being offered suggests this to be true, particularly given that the team is described as being composed of “holistic doctors, naturopaths, and acupuncturists.” I could have told you that there were naturopaths involved if you just told me the treatments Gomez is undergoing, nearly all of which consist of some form of bogus “detoxification,” such as the “grain-free” diet, the “detoxing” of her house, the juicing, and especially the plan to begin “chelation therapy.” As I’ve described before, naturopaths and other alternative medicine practitioners love to invoke The One True Cause of All Disease, and often that One True Cause is unnamed, undefined, but ubiquitous “toxins” that are making you sick. Unfortunately, chelation therapy is not only ineffective, but it is potentially dangerous. True, it’s probably safer than cyclophosphamide, but cyclophosphamide works. Chelation therapy doesn’t. So chelation therapy is all risk, no benefit. No doubt, if this story is true, Gomez is paying big bucks for these quack treatments.

Unfortunately, SLE is the sort of disease that quacks love because it is so difficult to diagnose and treat and because it has such variable manifestations and relapsing course. The drugs used to treat it have significant side effects and can even be toxic, which is unfortunately the case when drugs target an overactive immune system. Naturally, a young woman with a busy career that depends upon her ability to sing and dance would chafe at the limitations SLE imposes, the unpredictability of the disease, and treatments that are not as effective as we’d like them to be. Being only 25, facing the prospect of a life with this disease and lifetime treatment with these drugs must certainly be unappealing. So it’s understandable why Gomez might want to try something “nontoxic.” It’s understandable, but a mistake. Many are the SLE sufferers who discovered the hard way what a mistake going off their drugs was when their disease symptoms came roaring back.

What worries me about this story if it’s true is this. If Gomez experiences a prolonged period of remission while she’s using all this quackery, you can count on her publicist revealing it and there being laudatory stories about how “brave” she was to have chosen this course. This, in turn, might persuad others with SLE to follow a similar course. That’s the problem with celebrities choosing woo over medicine; they have influence. That’s why I’m hoping this story is nonsense but fearing that it isn’t.

oracknows Mon, 09/19/2016 - 21:00

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systemic lupus erythematosus

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https://www.researchgate.net/profile/Debu_Tripathy/publication/12740518…

"...irritates the rap out of an old fart like myself."
Misspelling or deliberate? ;)

Unfortunately, chelation therapy is not only ineffective, but it is potentially dangerous.

Chelation can be dangerous, but it is not ineffective. Chelation has been shown in dozens of studies to remove lead, mercury, and cadmium from the body.

It is ineffective against anything other than acute heavy metal poisoning, and lupus is not due to acute (or even chronic) heavy metal poisoning. Neither is autism, another common use for chelation. Ditto heart disease.

"In fact, some herbal medicines are suspected to provoke or worsen flares. " Too bad none of them were cited so skeptics like myself can decide if they do or not and exactly which ones are proven to be a problem for patients diagnosed with SLE.

I don't know the entertainer in question, but I have to applaud her for rejecting the poison, and the butchering, she would most likely have to endure if she went to a quack.

"Butchering"? She has lupus. No one's going to operate on her to treat lupus. Truly, you are a silly man. You didn't even bother to read the post, clearly.

Hopefully she has a good vodka practitioner in her holistic team. Otherwise it's not properly holistic, IMHO.

Comment #4

Since there is no list of herbal treatments being given to Gomez, the author could not cite anything she receives as being worse. Chelation is explicitly mentioned, so its lack of effectiveness was worth citing.

And #5, butchering? WTF

I think Zach sums up the, "best practice" debating skills around here.

How do you respond to, WTF?

@Quack, sorry Dr Gorski . . . No, on second thoughts, Quack is more accurate.
Seeing as though you're slow on the uptake, this was my point.
After ineffective, and the dangerous allopathic medicine to treat lupus, this will surely ensue.

http://www.webmd.com/lupus/guide/lupus-systemic-lupus-erythematosus-sur…

Wow, that's dumb even by your standards. The surgery described there is a kidney transplant to replace the function of kidneys destroyed by lupus nephritis.

No Dr Quack, I'm stating that the kidney transplant, will be needed as a result of years of toxic medication to treat the lupus.

The problem, of course, is that it isn't the "toxic medication" that causes renal failure. It's severe lupus attacking the kidneys.

@Orac

Don't bother Pete with facts. They are inconveniences to him and challenge his delusions. Best to simply ignore him as he wanders off on a litany of posts consisting almost exclusively of argument by assertion and insults.

Since she dated Bieber for years, I wouldn't expect her to know the difference between a doctor and a donkey.

Cyclophosphamide (Cytoxan®)

Originally developed as a chemotherapy drug (to treat cancer) and used as an immunosuppressant (to treat lupus).

SIDE EFFECTS: Side effects of cyclophosphamide include:

Hair loss
Nausea
Vomiting
Diarrhea
Mouth sores
Weight loss
Stomach pain
Rash
Mouth sores (stomatitis)
Skin pigmentation
Nail changes
Sterility
Jaundice
Cyclophosphamide causes kidney failure, and it also may affect the heart and lungs. Cyclophosphamide suppresses production of blood cells from the bone marrow, including white blood cells (leukopenia), red blood cells (anemia) and platelets (thrombocytopenia). Leukopenia reduces the ability of the body to fight infection, thrombocytopenia impairs the ability of blood to clot, and anemia reduces the ability of blood to carry oxygen. Cyclophosphamide suppresses the immune system which may result in serious and sometimes fatal infections. Severe allergic reactions also may occur. Cyclophosphamide may cause inflammation of the urinary bladder with bleeding (hemorrhagic cystitis). This can result in lower abdominal pain from the bladder, problems urinating due to blood clots, and anemia due to loss of blood.

Todd W. + Orac.

Disciple = Guru.

PREGNANCY AND BREASTFEEDING SAFETY:

Use of cyclophosphamide during pregnancy may affect the fetus. Fetuses exposed to cyclophosphamide may be born with missing fingers, toes and a poorly-developed heart. Cyclophosphamide should not be administered during pregnancy.
Cyclophosphamide is excreted in breast milk and could cause serious problems in the nursing infant.

Nothing to see here.
Move right along.

Methotrexate (Rheumatrex™)

Originally developed as a chemotherapy drug (to treat cancer) and used as an immunosuppressant (to treat lupus).
Known as the "gold standard" -- the best drug -- for the treatment of rheumatoid arthritis.

Rheumatrex may cause severe and sometimes fatal side effects. These may include bone marrow, blood, liver, lung, kidney, or skin problems.

Rheumatrex may cause birth defects or fetal death.

It's probably nothing folks, so carry on.
As you were.

We don't want you to stop taking your medication.

Is Gwyneth Paltrow Wrong About Everything? Great book by T. Caulfield on, among other things, the outsized influence of celebrity on society. Nothing like celebrity woo to give it undeserved attention.

Mr. Harris,

You know absolutely nothing about Methotrexate. Yes, MTX is used to treat autoimmune illnesses and it is used in a much lower dose for treating RA.

I know because I used it for several years to treat my RA. I had zero side effects......Next time you might want to actually talk to people who use MTX. The vast majority will tell you it is very effective for treating RA

Yeah, Mr. Harris is making enough of a nuisance of himself through his frequent posting that I might have to put the brakes on him. He'll still be allowed to comment, but his comments will not be approved right away and comments that consist of nothing more than insults will not be approved at all. How soon I approve his comments will depend on how well Mr. Harris behaves. If he's nice, I'll approve them right away. If not, well, it could be several hours before they see the light of day, particularly if he floods the blog.

I rarely ban any commenter, but Mr. Harris is cruising for one right now due to the volume and obnoxious idiocy of his comments.

Perhaps Peter Harris would like to grace us with his regime for treating or even curing Lupus since he's convinced he can do better. It would also be appropriate to provide evidence for his superior treatment.

If he were to produce such a comment, I would approve it rapidly. I'm not holding my breath waiting, though.

The slimeball David Wolfe has given his "expert" opinion on Ms. Gomez' chemo treatment: https://www.davidwolfe.com/dangerous-trend-selena-gomez-chemotherapy-tr…

But the comments are heartening.

I can't help but notice that these "natural", "holistic" practices never vary: organic diet, juicing, gluten-free, chelation... Which are all variations on the "detox" model. Because of the evil humors, or rather "toxins", of course.

For a discipline that likes to advertise itself as holistic and patient-centered, CAM is remarkably one-size-fits-all! You have cancer? Lupus? Autism? Heart disease? All are down to toxins, all get treated with the same mix of detox practices. That's not holistic, that's unicistic!

I'd like to hear Mr. Harris' cure all, too. What the DA doesn't get about autoimmune diseases- and the 200 or so types of cancer- is there are seven billion distinct, individual examples of our species. My wife battled Crohn's for decades until a drug was developed that was effective for HER. I would bet my last peso that his treatment regimen includes organic tomatoes, juicing and shoving coffee up his backside.

"I can’t help but notice that these “natural”, “holistic” practices never vary"

I'm selling X. Therefore you need X. It didn't work? You need more X.

Born and raised in Oklahoma, she moved to California for the protection of their medical marijuana laws after discovering that cannabis resolved her symptoms better than the legal immunosuppressants and steroids. “I decided to treat lupus with cannabis because I was on methotrexate,” Angie told us. “I ended up getting pulmonary fibrosis from the methotrexate.”...

“The key to treating lupus with cannabis is high levels of CBD orally ingested daily.

https://www.leafly.com/news/health/treating-lupus-with-cannabis/

CBD does not cause a 'high'.

How is the Endocannabinoid System (ECS) Disrupted in Lupus?

This is an area of medicine lacking in research. One day genetic studies will see if mutations in ECS genes are correlated with lupus. Because the immune system contains cannabinoid receptor type 2 (CB2), endocannabinoids directly influence the immune system.

https://unitedpatientsgroup.com/blog/2015/10/20/how-cannabis-helps-lupu…

Aww. No studies to show.

The Lupus Foundation of America supports further scientific research on the use of medical marijuana for treating and alleviating the symptoms of lupus. More research in this area will provide evidence regarding its safety and effectiveness.

lupus.org/answers/entry/what-is-the-foundations-recommendation-on-the-use-of-medical-marijuana

Organic seems to be the one commonality between almost all quackeries. Has anyone ever seen a quack advising people to avoid organic? Even those quacks who spout conspiracy theories about government are proponents of government regulated organic.

The only thing missing from prescription is wheatgrass and crystals to change to the vibrations around her.

I was called away from previous discussions so didn't find out if Mr. Harris ever cited his qualifications or CV.
I wonder if his naturopathy education was at the Jeremiah Jeffrey Hunter College of Naturopathy.

Personally, I'd change her diet to boost her immune system!

It is ineffective against anything other than acute heavy metal poisoning, and lupus is not due to acute (or even chronic) heavy metal poisoning. Neither is autism, another common use for chelation. Ditto heart disease.

It is impossible to determine how many Autistic children are suffering from heavy-metal poisoning. The two are not mutually exclusive.

It is impossible to determine how many Autistic children are suffering from heavy-metal poisoning. The two are not mutually exclusive.

Wait for it....

Well, Selena is no doubt doing the proper thing. Everything that Allopathic medicine has to offer for Lupus is pathetic. From Wikipedia:

The cause is not entirely clear.[1] It is believed to involve hormonal, environmental, and genetic factors.[2]...There is no cure for SLE.[1] Treatments may include NSAIDs, corticosteroids, immunosuppressants, hydroxychloroquine, and methotrexate.[1] ...

Uh huh. Just like cancer and CVD. The cause has been know for decades but the cure is so cheap and simple that it is being consistently ridiculed a suppressed.
Either that, or Allopathic medicine is full of incompetent cretins that cannot figure anything out.

Well, Selena is no doubt doing the proper thing. Everything that Allopathic medicine has to offer for Lupus is pathetic.

And what does "homeopathic medicine" have to offer? This is the alternative to "allopathic," peculiar capitalization or not.

Peebs @32: Do you understand what an auto-immune disorder is? It is when the body's immune system attacks itself.
So when you say you'd "boost her immune system!" what you're saying is "I would make her much, much sicker".

It's like pouring gasoline on a fire.

No.

The cause has been know for decades but the cure is so cheap and simple that it is being consistently ridiculed a suppressed.

So, Rebecca, what is the cause? I'd really like to know. I have a close friend with lupus. Any information would be appreciated.

Pete @18 seems to be surprised that medications can be contra-indicated during pregnancy.

I bet he'd prescribe tansy, lady's mantle and alcohol during pregnancy. They are all *natural*.

It is impossible to determine how many Autistic children are suffering from heavy-metal poisoning. The two are not mutually exclusive.

It is quite simple to determine whether a specific child is suffering from heavy metal poisoning. Take a blood sample and check the concentrations of heavy metals. If the amounts are more than de minimis, you confirm the diagnosis.

The reason such blood tests are not performed on most children, autistic or otherwise, is because most doctors will only order these tests in cases where they have specific reason to suspect heavy metal poisoning. Autism is not sufficient grounds to suspect such poisoning. Rather, there are specific neurological factors that would raise suspicion, or specific environmental factors such as a domestic water system with high lead levels (such as happened in Flint).

If the doctor confirms a diagnosis of heavy metal poisoning, then chelation is likely indicated. That's true whether the patient in question is autistic or not. If there is no evidence of heavy metal poisoning, then chelation won't help, again regardless of whether the child is autistic.

Eric, you're answering our incompetent persistent troll who is not remotely interested in facts.

It is quite simple to determine whether a specific child is suffering from heavy metal poisoning. Take a blood sample and check the concentrations of heavy metals.

Wrong. This is not so simple. It is well-known that blood levels are a poor indication of total body burden. Lead and mercury have a great affinity for tissues, and lead and aluminum have a great affinity for bone.

It is well recognized that once individuals are exposed to Cd, Pb, or Hg the metals can be detected in blood and urine but are quickly sequestered into tissue.45 It is therefore difficult to reveal the total burden of Cd, Hg, and Pb on the body.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027918/

Due to the dynamics of heavy metal pollutants, a single blood/urine sample does not reflect the total body burden...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027918/

I'm having a hard time imagining a more mistargeted citation than PMC 4027918.

Due to the dynamics of heavy metal pollutants, a single blood/urine sample does not reflect the total body burden…

Which is why diagnosis of metal toxicity does not rely upon a single blood/urine sample. I'm curious as to why you are evading the question about "natural" treatments for Lupus.

I have a hard time imagining how Narad couldn't be a paid shill of some sort.

Who signs your paycheck Narad?

Narad, you mean a study of adults with coronary artery disease that did not find any link with heavy metals isn't relevant to a conversation about lupus? Shocking.

Anyone with a brain can see that I was simply refuting Eric Lund's ignorant statement that:

It is quite simple to determine whether a specific child is suffering from heavy metal poisoning. Take a blood sample and check the concentrations of heavy metals.

Does anyone need more proof that the blood lead, mercury, cadmium, and aluminum levels do not accurately correlate with the total body burden?

Who signs your paycheck Narad?

Nobody. It's all wire transfers from an offshore account. Try to put some effort into this while it lasts.

Hey, where's "Mark DePaun" in this convo? Gone already?

I have a hard time imagining how Narad couldn’t be a paid shill of some sort.

Who signs your paycheck Narad?

Lazy, stupid and evasive...not a good combination.

Does anyone need more proof that the blood lead, mercury, cadmium, and aluminum levels do not accurately correlate with the total body burden?

True. there is intracellular, extracellular, and interstitial space that holds the bulk of heavy metals -- A blood test only checks intravascular space and is non-conclusive for heavy metal load.

I'm betting Rebecca is our morphin' troll.....

Modern medical treatments now allow lupus patients to live a normal lifespan. Sixty years ago people died within 5 years from it.

JustaTech @37

Peebs was taking the piss with respect to the way every second supplement or herb is purported to "boost the immune system" as if that is inherently a good thing.

JustaTech @37

Peebs was taking the piss with respect to the way every second supplement or herb is purported to “boost the immune system” as if that is inherently a good thing.

"Everything that Allopathic medicine has to offer for Lupus is pathetic."

We are experiencing a drought this year. Everything that science has to offer for this is pathetic. So I did a rain dance.

I have a hard time imagining how Narad couldn’t be a paid shill of some sort.

Fortunately I have a more fertile imagination.
The Argument from stupidity Lack of Imagination is not particularly convincing.

I guess the cure for SLE must be a spell from the Dark Arts, perfected by He-Who-Must-Not-Be-Named? Correct, Harris? Or, should I say .. Mr Wormtail??

@ Herr Doktor

What is your PhD in? Or are you a poseur?

I’m betting Rebecca is our morphin’ troll…..

And you would be correct.

Rebecca @60 -- "Herr Doktor Bimler" has been commenting here for years.

I don't know who he is, exactly, but I can attest that he's plenty smart, and often very funny.

My own PhD is in astronomy.

Narad, by the way, who was disparaged earlier, is another long-time commenter. He has spooky knowledge of scientific typsetting that indicates that he's spent quite a bit of time deep inside the academy.

You're apparently out of your league.

"You’re apparently out of your league." A few currants short of a cake?

@Doug
Coming from a guy that thinks thimerosal is a stable molecule.

@Doug
Aren't you the idiot that said:

The total content of solutes, suspended solids or mixed liquids in the majority of vaccines is under 1%

?
When this is obviously no the case. Take Merck’s ProQuad®, for example; which includes: 21 mg of sucrose, 11 mg of hydrolyzed gelatin, 2.4mg of sodium chloride, 1.8 mg of sorbitol, and a few more milligrams of salt and protein per 0.5mL.
Using a simple subtractive calculation would put this vaccine at around 91% water.

You are an arrogant twat of the third kind, who routinely authoritatively asserts things that are demonstrably false.

Stupidity so bad that I feel I have to comment rather than just peacefully lurk
Having just reviewed a PhD where sheep were fed lead (you can't do this to humans of course) I can tell you that a single blood sample can very clearly that someone has been exposed to lead at levels high enough to cause toxicity issues. Yes, the correlation between lead concentrations in the blood and the concentrations in tissues is only moderate, but that's not the question. The question is can you have lead toxicity without elevated blood values. The answer is absolutely not; the correlation with tissues isn't an issue it's a yes no question

Bunker has an almost-PhD in physics, and a PhD in psychology. I have a sort of almost PhD in literature, which we'll see about, but yeah, hdb is pretty frigging smart, a good sight smarter than me.

OK. Well give the Herr Doktor an honorary doctorate. 🎓

You are an arrogant twat of the third kind, who routinely authoritatively asserts things that are demonstrably false.

My irony meter just imploded into a singularity smelling faintly of worn socks. I wonder why that is...

What is your PhD in?
Contributions to multidimensional scaling methodology. If you have multiple dimensions you want scaled, come to me.

When I checked this forum in the morning, at one point I couldn't stop laughing.
Here we are, with Orac taking the high moral ground, with a disingenuous diatribe.
Talk about hypocrisy!
Everything he accuses me of, he himself has committed numerous times.
And everything and anything his disciples have said in the past, he's allowed to be posted, and he has even applauded the comments at times.

Here I am, using the exact same approach as others here, which is vigourously standing up for my beliefs, and hitting back at others where I think appropriate, and yet somehow, I'm labelled a troll, and accused of, "the volume and obnoxious idiocy of his comments."

This "science" Forum has a long history through the years, of inappropriate and foul language, from Orac, and from the commentators.
I was recently described as a c#@T, but somehow that was allowed.
I don't even use that word, and I very rarely use the F word.
And yet somehow, my "...comments that consist of nothing more than insults..."
The regular commentators here, have used foul language over the years, and yet nothing has been done until I came along.
Just one example; http://scienceblogs.com/insolence/2011/04/11/fun-with-a-naturopathic-ra…
And as I said, the C word is widely accepted here.
Again, another example; #79, #80. http://scienceblogs.com/insolence/2011/01/12/andrew-wakefield-in-it-for…
And; "You can take your ignorant raging idiocy and fuck yourself in your your senile, menopausal cunt." from;http://scienceblogs.com/insolence/2014/01/23/on-orac-isis-pseudonymity-…
Needless to say, that the word dickhead has been used liberally over the years on this forum.
http://scienceblogs.com/insolence/2012/07/10/an-inflated-view-of-ones-i…

"If he’s nice." Which is a reference to me of course, but the pole position hypocrite himself, Orac, uses smear, sarcasm and denigration, when he writes about people he disagrees with.
Example? The story I 1st commented on, Orac repeatedly refers to a website (Thinking Moms’ Revolution (TMR) as the "Drinking" Moms Revolution.
How funny. . . And how year 8 high school (Sophomore year to you Americans) the language is.
It's not very edifying, and yet, here he is criticising me!
And he accuses me of; "...obnoxious idiocy..."

"...through his frequent posting that I might have to put the brakes on him...particularly if he floods the blog."
Well, I get accused of not stating enough, in the way of evidence, when I make my claims, regarding the complete lack of safety and efficacy, in allopathic medicine.
And now I'm being accused of flooding the blog.
I made the accusation that, like all pharmaceutical drugs that treat modern-day diseases, in this case Lupus, of how dangerous they are, so I found as much evidence as I could on Cyclophosphamide (Cytoxan®), to back up my claim, and it seems that now; "Mr. Harris is cruising for one right now due to the volume..."

And yet again, in a masterful display of hypocrisy, it seems that Orac, can post any old nonsense, and pass it off as information.
It must have been a slow day back in 2006, when there was no medical news around, so the topic of the day was, "The Worst Band Names Ever."

http://scienceblogs.com/insolence/2006/12/02/worst-band-names-ever/

Yes, I may have been a little too forceful yesterday, when replying to elitesquirrel, and MI Dawn, but when I have everyone attacking me, from every direction, I will come out swinging.
I'm proud of my profession. I've successfully treated around 2700 clients, with safety and efficacy, and not costing the taxpayer 1 cent I might add.

This blog clearly resembles the classic characteristics of a cult.
You have a cult leader, Orac, you can say anything with impunity, no matter how ridiculous and insulting, and the disciples, gleefully and slavishly follow without question.

So hey Orac, if you want to nobble my free-speech, then as you Americans would say, knock yourself out.

Poor baby. Don't like it? Start your own blog. It is not "inhibiting" your free speech not to let you comment on a blog, as the First Amendment does not obligate me to provide you a platform. In fact, I could decide who gets to comment on any criteria I want, and I choose pretty liberal criteria. It's very rare for anyone to be banned, no matter what they say, and this "putting the brakes on" happens only occasionally. So stop whining and either contribute something substantive. Or don't. I do not care.

#69 I prefer magic mushrooms for multidimensional quandaries.

Nothing to see here.
Move right along.
(...)
It’s probably nothing folks, so carry on.
As you were.
We don’t want you to stop taking your medication.

Love how Mr Harris acts as if Orac didn't explicitly say that cyclophosphamide is toxic. The point isn't to deny there are adverse effects, some of them severe ; it is that we have nothing that has been proven better.

@Peter Harris, this comic refutes your free speech argument perfectly.

@Peter Harris
What do you do to treat cancer? I am curious.

Poor Peter. Everyone is picking on him. "Forceful" isn't quite the term I'd have used, Peter. "Infantile" maybe, or "Asinine" fits better.

Then you boast: I’m proud of my profession. I’ve successfully treated around 2700 clients, with safety and efficacy, and not costing the taxpayer 1 cent I might add.

Bully for you. So nice to know you make your clients pay cash instead of taking insurance. But then, at least here in the USA, most insurances do require that your treatments be 1) medically necessary and 2) as effective as the standard of care for that disease and cost the same.

What did your clients have and how did you treat them? I'll even give you an out: give us grouping like "40% had chronic sinusitis that I cured with XXX".

OK. Well give the Herr Doktor an honorary doctorate. ?

With "Rebecca" and "Paul," my Fucklesworth killfile entries have now topped 20. (Setting up the backup account in advance was far too obvious, Travis.)

I have a related illness - Vasculitis PAN - and I've gone through the cyclophosphamide regime, after a spell in intensive care for kidney failure - these diseases can get properly serious.

Hmmm. Maybe I should have asked for juicing woo in the ICU. After all, I really WAS having trouble with 'toxins'. That's what happens with kidney failure. Lots of toxins in your blood. You feel very horrible, and then you die. Maybe cupping?

Cyclophosphamide for autoimmune conditions is pretty lightweight, as far as chemo goes. Most people feel a bit off form for a couple of days and that's it. Maintenance therapy on something like Azathioprine is even easier. However, the steroids can make you put on weight..

Given that these diseases can lead to nasty complications, going down the woo path might be downright dangerous. I was able to ignore a whole raft of symptoms (*cough* denial *cough*) until getting very seriously ill indeed; being surrounded by a load of people who were against me going to hospital might well have killed me.

Heh.

Top four links are quoting three trolls (well, one of the three is Lilady quoting the troll) resorting to curse words when their claims are not taken seriously. Sound familiar?

But to Peter Harris. I'm sure our host is a reasonable guy and would allow you your full range of expression (references to incontinence and feces included) when you use it to post relevant links you've been asked for, or evidence you've been asked to support your (as of now) unfounded claims.

It is also relatively telling how dispersed the "damning" quotes are - there are after all total of ,tens of thousands of comments on this blog.

Lilady chastising the troll for his bad language, no less.

@Peter Harris,

I apologize for missing your cogent reply yesterday. Would you give me the thread name and comment # please.

I did dig back and found your link to an explanation of homeopathy. Unfortunately it didn't mention my specific question.

Number 65 was supposed to read Bimler, of course. That's what I get for commenting on a phone.

OK. Well give the Herr Doktor an honorary doctorate. ?

He has a real one numpty as opposed to being a window-washer like you.

Once again, Peter Harris does his country proud: "And as I said, the C word is widely accepted here." Just another example of Australian cultural supremacy, I suppose.
Moving beyond that,why do you still fail to answer any substantive questions?
As for cults, you blindly follow a belief system that is completely devoid of any evidence, logic, or even plausibility, and respond with anger and avoidance when challenged.. Sounds like a cult to me.

Once again, Peter Harris does his country proud: “And as I said, the C word is widely accepted here.” Just another example of Australian cultural supremacy, I suppose.

I'm pretty sure that "here" meant RI, although the word is a more general epithet in places other than the U.S.; I've certainly had it directed at me from an Australian Scot Netherlander friend with no particular force behind it.

If Peter Harris is so priggish, perhaps he should stick to holding hands and chanting Skies of blooo..., find your calm center... rather than wandering around online being an apparently completely self-unaware, raging asshole.

MA @ 55/56: Ah, I see. You can imagine how I can get confused around here.
And it seems like a good thing to remind the lurkers. I'm forever seeing things like that on FaceBook, and then the angry responses from friends with auto-immune diseases.

We're a cult? Who knew?

@Selena Wolf

You haven't yet signed over all your worldly possessions over to Orac? Where have you been?

We're a cult? Paid shills?

Oh come on!

Surely they have not yet discovered The Truth About Us?

It is so much more nefarious an imbroglio of internecine warring factions with geopolitical connotations.

Perhaps a simple - but fashionable- psychologist who has of late been assigned to more literary exploits could explain it in GREAT DEAL
but CRAP I'm tired now.

In other news...

Unfortunately, conspiracy theories reign supreme in woo-topia not just in Donald Trump's PFC ( if there is indeed a PFC under that frightening hair)

- Natural News is again engaging in candidate assassination speculation -( sound familiar? like unarmed security people?- courtesy of the Donald the other day)

- prn.fm announces a new website to be unveiled tomorrow BECAUSE the old one has been hacked TO PIECES by you-know-who
( most probably, us). The Daily Woo-cast has deteriorated into 15 minutes of woo and 45 of bizarre political speculation in the style of Alex Jones and Breitbart- or maybe worse if that is possible.

I suppose that loony right wing conspiracy mongering is not so difference from what Orac *et Compagnie* study.

I suspect worse from Jake and Dan .
I'll look.

May I join your cult? What do I get for joining?

(Tote bags are nice. Just saying . . . )

Trump is a Private First Class? You mean that bozo actually managed to get promoted once?

Back in MY day....

The analysis here should be less about Selena Gomez and more about Hollywood Life by Bonnie Fuller.

I have no clue, of course, what Ms. Gomez's actual healthcare decisions might be. But knowing how celebrity gossip items are written, my guess is that the lead - "Selena has had it with pills, steroids, and bed rest!" is wholly the interpretation/fabrication of author Susan McCoppin. If Gomez was just seeking to supplement conventional care with chelation, a restricted diet, juicing and what-not, there's no melodrama. The point of the 'story' is to exploit the sort of conflict that captures their readers imaginations. In this case, the payoff is a poll at the bottom of the copy: "HollywoodLifers, what do you think? Is the organic approach the way to go, or should Selena stick with white coats and stethoscopes?"

The word choices display an obvious bias as to who are the good and bad in this soap opera. The earlier reference to juicing is even preceded by a breathless infomercial-esque "And that’s not all!" (But wait, there's MORE!)

Hollywood Life's editorial staff may well be genuinely woo-ey, but if so, this is probably just 'natural selection' - in that they wouldn't be pushing this angle if it didn't appeal to the readership enough to drive traffic. That the audience for this variety of gossip (quite different from the snarky 'smart' gossip exemplified by the late Gawker) is into reading fluffy woo-paeans is hardly surprising. The whole celebrity fascination is rife with all manner of magical thinking...

However, it's also a realm of escapist fantasy, that at some level most of it's devotees understand doesn't map in any way onto their lives, any more than old-school magical fantasies about princes, princesses, warriors and wizards. If anything, fascination with celebrities is rooted in how utterly different and magical ('white' and 'black') their personas and experiences are from the dull, all-too-reality-bound quotidian existence of the fans.

So it's likely the vast majority of readers who follow the Gomez alt-med story won't be lining up for woo services any time soon. Which is not to say there's nothing to worry about here. But the story is symptom, not cause. If Selena's adventures in holistic healing will function as a vicarious 'liberation' narrative, the question is 'why and how do the fans feel trapped such that they need liberating?'. The 'tell' is the framing of 'the organic' (natural, comprehensible, inviting, useful THINGS) against 'white coats and stethoscopes' _ a metonymy for cold, uncaring, bloodless, intimidating PEOPLE, i.e. physicians.

What strikes me about this is that pop culture NEVER characterized doctors in this way in my youth. Kildare, Casey, Welby, McCoy, Hawkeye, Aucshlander, Doogie Howser, Dr. Quinn... until the mid-90s, pop-culture MDs were loci of wisdom and compassion. Whatever the medical strengths and weaknesses of contemporary heathcare in the US, the hyper-rationalized assembly-line medicine of watch-that-clock, in-and-out quick office visits, understaffed/overstuffed hospital wards and other patient-as-interchangeable-meat-machine procedures has led to too many people seeing conventional medical practitioners not as sources of comfort, knowledge and healing, but of uncertainty and fear.

[Actually, I think there's some projection in this, in that doctors are taking the heat for the insurance companies and the people in the business office who make you feel like you're filling out a mortgage application before they let you see the doctor, or even get admitted to the ER...]

Hollywood Life has gioosed-up some gossip about Selena Gomez to exploit these negative feelings about the medical establishment as clickbait to sell more advertising. But you can't create tabloid fantasy narratives to assuage anxieties that don't actually exist. That's the things about tabloid crazy: Taken literally it's not just nonsense, but as often as not full-out bonkers nonsense, yet it somehow acts figuratively to resonate with very real issues and life situations of its audience.

In short, then, the only way to stop the crazy may be to fix the underlying problem - which would mean reforming the delivery of conventional medicine to make it a more user-friendy experience.

OK, I'm confused about C-words and Australian cultural supremacy... Are we talking about 'l' or 'n'; going in cu_t, or are different people thinking of the two different words and talking past one another? All I can say is that the very strong Australian women I know use 'c.u.n.t' as a general pejorative descriptor for individuals of all genders, and equally often ironically as an endearment, and do not consider such uses a reproduction of misogyny. Which, however, often riles up folks from the U.S., where the connotations are different. and "What a bunch of cunts! I love you all!" just leaves them puzzled.

Narad, "I’m pretty sure that “here” meant RI, although the word is a more general epithet in places other than the U.S.; I’ve certainly had it directed at me from a ... friend with no particular force behind it."
The word is tossed around pretty freely by Australians, even used as a generic term for "person". It may appear harmless in that context, but it carries an unspoken connotation that is not a credit to its users.

@ Emjay:

We don't do totes. PLEASE.
Do I look as if I would use a tote?

HOWEVER as a bonus for signing we should probably offer recording equipment, tiny cameras or various spyware to assist us in our undercover work

Whilst we're on the subject of Oz and c-words...

I just learned ( AoA) that VAXXED! was pulled from an Ozian film fest that was to show the miserable pile of woo... er FILM

re c-word..
RuPaul uses it as an acronym

Do I look as if I would use a tote?

I once received a purse as a gift with a free Spiegel catalog. It was light blue with black piping and handles – for all the world, it looked like a miniature bowling-ball bag.

It performed yeoman duty in hauling pounds and pounds of pennies to the bank, though.

Narad, I actually have a black tote from Vogue which I used ONCE- totes! - to carry a wet swim suit in.

Truly, my travels usually involve a small carry on bag for clothes and a gigantic leather purse with multiple hidden compartments where I keep money, ID, tickets, camera, phone, pharmaceuticals, skin care, sunblock, makeup, earrings, a hat, a scarf ( no tie), secret stuff etc etc etc

DW: "Natural News is again engaging in candidate assassination speculation"

I like the prediction that even though Hillary Clinton is already dead, she'll be assassinated anyway.
Even if you acknowledge that most of the NN chatter is utterly loony, they could well be right about one thing.

"According to the latest insider buzz I'm hearing, a staged event of historic magnitude is set to take place in the next six days that will end the populist rise of Donald Trump and allow totalitarian globalists to seize control of America through political means."

Yeah, it's quite possible that Trump will drop his drawers or otherwise flame out during the upcoming debate, thus allowing the globalists, chemtrail-sprayers and vaccinationists to triumph with their zombie stooge, HRC.

I know I'm kind of late to this party, but I have a different take on it, which is based on my own experience.

I did know Selena Gomez had lupus, and it's become a part of her celebrity brand. I don't think she's too happy about it, and not just because she'd rather not have lupus. To give an example, the tabloids have been all over her weight fluctuations, and she's responded with interviews about how shallow Hollywood is about weight. But to anyone who knows what to look for her weight gain screams steroid bloat. In any case, she's explained it when she was unable to meet professional obligations, and otherwise not discussed it much.

Now we get to my own experience.

Selena Gomez is besieged with people who tell her to try quackery. She gets hundreds of message *every day* from fans who want her to do. People send her pictures of poop that she might see if she cleansed. Complete strangers ask her to come to their clinic for a free colonic, in exchange for sharing her private medical information. She gets suggestions for all sorts of incredibly weird stuff like fabric softener. (Personal experience here. Yes, it happened. Not on the clothes.) The point is, by now she's been listening to this junk for years.

Since lupus is a horrible disease, she probably felt miserable enough to try a few of these things out. And then her doctors recommended chemotherapy and steroids because she was getting worse. She took the medical treatments, and wasn't happy about the side effects, but she dealt with them and moved on.

At least this is my guess, based on her public presentation of the issue. She doesn't want people to know her business, and she's not about to gush about crap that's *already* been proved worthless.

@ Dangerous Bacon:

Oh great and prescient Dangerous One! You know the Truth.

Yeah, maybe.

Since I listen to SEVERAL political wonks**, I heard a few startling predictions:

- Snoozefest debate.
- as Trump gets closer in toss-up states, Republican bigwigs (big Whigs?) endorse HRC to save their party from certain destruction due to his malign influence
- women get really piss-d off and vote accordingly.
- fact checkers, a million strong at home, defy the Donald

** no names mentioned

re lupus and weight gain

One of my innumerable cousins was diagnosed with lupus at age 30 and gained a great deal of weight which impacted her life tremendously. She worked in medical technology/ administration and was very unhappy about her failure to conceive as well.

Fortunately, she was advised to seek out an expert in another city who UNdiagnosed her. She had NO lupus. She lost weight and had a baby at age 40.

@71 - Gorski.

I had another chuckle, when I read the quacks response; "Poor baby."
Obviously, he's trying to paint me as some type of sook, when its him that is throwing the toys out of his cot.
But hey, when it's clearly been demonstrated that you are a hypocritical fool, you desperately find some other spin to put on your reply, just to avoid the obvious.

But what can you expect from a pseudo-maven, and chief dribbler.

The threat I gave you, to ban me from your "ship of fools," wasn't a test of your willpower, because, quite frankly in the future, I won't have much time to come over to this forum and cracks some coconuts, because my sabbatical is almost over, and I won't be having much time writing on any blog.

But don't worry, I'll drop in from time to time, just to give you, and your Kool-Aid drinking disciples, a dose of reality, and a lesson in magnanimity.

@JeffM- 27
I knew of a doctor, who had chronic Crohn's disease.
He battled the disease for many years.
This doctor's father however, lived life with the basic principles of good nutrition, with organic produce, and other simple practices to keep the body healthy.
The son (the doctor) died a few years ago, aged 35.
The father, lives on into his 70s, and as we say in Victoria, he is as fit as a Mallee bull.

True story.

I guess you don't need me to state the bleeding obvious.

@Orac -13

September 20, 2016
"The problem, of course, is that it isn’t the “toxic medication” that causes renal failure. It’s severe lupus attacking the kidneys."

You still don't get it do you.
Maybe because as a doctor, willful ignorance, is stock-in-trade in your "profession."
You still don't understand why I referred to the treatment, as butchery, when that will be the ultimate conclusion to such a toxic pharmaceutical drug, in this case, a possible kidney transplant.
I will make it very clear again. Most pharmaceutical drugs, with their accompanied appalling side-effects, will result in surgery, as a direct consequence of taking pharmaceutical drugs.

In this case of lupus, the drug Cytoxan is a classic example.
But the sick part of all this is that, the drug is given to lupus patients, whose lupus is affecting their kidneys, and the drug will eventually destroy that organ, it's meant to save.

And they call Cytoxan the "gold standard" drug regimen for treating severe lupus.

You cannot make this shit up.
If these appalling situations arose in any other field of science, this would be laughed at, and ridiculed endlessly, and then completely banned.

But just imagine, the howls of indignation, if it was found that some natural and holistic remedy, destroyed the very organ it was meant to help.
I'm sure the allopathic's would be up in arms, and complaining loudly.
But because it is a pharmaceutical drug, sorry poisoning, then all is well, and don't you dare stymie the profits.

@ LouV-73

"Love how Mr Harris acts as if Orac didn’t explicitly say that cyclophosphamide is toxic. The point isn’t to deny there are adverse effects, some of them severe ; it is that we have nothing that has been proven better."

That would have to be the dumbest, and most ignorant comment I've read on this blog all week. . . But give it time, shortly, there'll be another dumb and ignorant comment to overshadow it.

@ gaist-68

"My irony meter just imploded into a singularity smelling faintly of worn socks. I wonder why that is…"

In between acting like Twat yourself over the weekend on other blogs, did you find time to answer my 2 simple questions?
I guess not, after repeatedly banging your fist on the under-side the computer desk, then maybe it's a little painful to hit the keyboard.

#104

knew of a doctor, who had chronic Crohn’s disease.
He battled the disease for many years.
This doctor’s father however, lived life with the basic principles of good nutrition, with organic produce, and other simple practices to keep the body healthy.
The son (the doctor) died a few years ago, aged 35.
The father, lives on into his 70s, and as we say in Victoria, he is as fit as a Mallee bull.

True story.

I guess you don’t need me to state the bleeding obvious.

I know what you think is the obvious lesson. However, without knowing why the son died, there really aren't any useful conclusions that can be drawn.

In between acting like Twat yourself over the weekend on other blogs, did you find time to answer my 2 simple questions?

No wonder you keep missing the answers already given when you keep losing the relevant thread as well.

"I guess you don’t need me to state the bleeding obvious."

That the son suffered from Crohn's disease due to genetic and/or environmental factors that did not affect his father?

Or that you are prone to jumping to conclusions based on inadequate/faulty evidence and then cover for your errors with abusive blather?

*I'm reminded of the late J.I. Rodale, who boasted that he was going to live to 100 due to his superior diet and lifestyle, then suffered a fatal heart attack during taping of the Dick Cavett show (he actually said "I've decided to live to be 100" and "I never felt better in my life" during his taped interview).
He didn't die of hubris, but it couldn't have helped.

That the son suffered from Crohn’s disease due to genetic and/or environmental factors that did not affect his father?

I am not a doctor but my reading indicates that Crohn's doesn't have a significant effect on lifespan, certainly not halfing it.

For all we know, the son got hit by a bus.

At least Gomez apparently hasn't fallen for UV blood therapy, advertised to treat lupus and a bevy of other conditions (numerous celebrities with "chronic Lyme disease" have gotten on the UV therapy bandwagon).

Good new article on this quackery in Forbes:

http://www.forbes.com/sites/brittmariehermes/2016/09/26/uvlrx-therapy-c…

Hey Orac, i woke up this morning to find that you did not post all of my comments.

So, not only are you a quack and hypocrite, but you can add coward to the list.

Oh, please. The only comments I didn't let through consisted primarily of insults and ad hominems. Try rephrasing them without the attacks, and I'll let them through like the ones I did.

" So stop whining and either contribute something substantive. Or don’t. I do not care."

Bullshit!

Again, more Bullshit from yourself.
Why don't you have the courage to post my comments, and let others decide.

Maybe if i use the words F&%#ing C$@t, i would get posted?

Poor baby. Don't like it here? I don't care. Piss off.

Quel Swiftian repartee!

"I don’t care."

Really, then post my comments.

"Piss off."

HA HA HA.
You cannot tolerate apposing views!

@Peter Harris

Just get a VPN and come back with different names. You can usually make a few statements without being insulted that way. This little coterie of modern medical apologists will usually give a newbie [sock] more consideration than what you are receiving at the moment.

Just get a VPN and come back with different names.

Oh, Chucklesworth, I'm from NANAE land. Where there's a will, there's a way. A really, really effective way.

You can usually make a few statements without being insulted that way. This little coterie of modern medical apologists will usually give a newbie [sock] more consideration than what you are receiving at the moment.

Yes, your M.O. was noted some time ago. You're also pretty much down to a single comment as far as recognition goes. Where you find some form of self-validation from this hobby is anybody's guess.

More to the point, though, Harris isn't bright enough for that.

Just get a VPN and come back with different names. You can usually make a few statements without being insulted that way. This little coterie of modern medical apologists will usually give a newbie [sock] more consideration than what you are receiving at the moment.

Have you considered the possibility that it is not the number of posts you or Peter Harris generates that invoked the response, but the content of said posts?

Have you considered the possibility that it is not the number of posts you or Peter Harris generates that invoked the response, but the content of said posts?

I think they're pretty much orthogonal. Travis Schwochert seems to have a completely different set of problems from Harris's.

// "The Demo-cat" // "Ted Striker", // "Robert Hayes", // "Lars \u00D8rnsted", // "Jeff Bollyn", // "Rafaela Gonzalez", // "Avocado Aficionado", // "monica", // "Tenfold Shrew", // "Stradlater", // "animal support", // "Animal Support", // "Under Protest", // "Annabel Lee", // "Concerned", // "Under the Bridge", // "Lord Windemere", "\u2602", "Rebecca Eckles", "Mark DePaun", "Zhang Wei", "Franciso",

Your the one with the Aardvark fetish.

Denice Walter
#96
"Do I look as if I would use a tote?"

My humblest apologies.

Spy gadgets are better that tote bags, anyway.

@ EmJay:

Apology accepted.

Yes, 'Orac's People' spend a lot of time spying so we'd better have the best gadgets. There's a shop nearby.
Woo hoo.

Unfortunately, my own efforts have been thwarted of late because some of the most accomplished woo-meisters I survey have switched over almost entirely to politics, chiefly of the anti-HRC variety.
- Mike Adams of Natural News
- Gary Null of prn.fm spends a short time on 'natural health' and most of his woo-hour maligning her ( also supposedly anti-Trump, more for Stein)
- Jake Crosby ( Autism Investigated) is a Trumpy fanboi as well.
- not true for AoA and TMR unfortunately.

We should be glad they spend less time misleading their audiences about health and vaccines.

Peter Harris, you seem to be under the impression that Orac is obligated or required to post your comments. He's not.

An analogy, if you will. If one of us walked into your office waiting room and started insulting you, shouting and using derogatory language, you would be 100% within your rights to demand that we leave.

Or even if we just said pointless things like "you have a bad taste in music." or "that painting is ugly" or "obviously wombats are better", you could still ask us to leave and enforce it.

All of us, lurkers, long-time commenters, antagonists, trolls and sockpuppets are here by Orac's whim and no other. If you can't play by the (very generous) rules, then he is allowed to ask you to leave.

@ Denice Walter
"There's a shop nearby"

There was one in my suburb, as well. Alas, it's long gone and has been replaced by a Krav Maga dojo.

The move from health woo-mongering to Trump-mongering is not an improvement. The net amount of idiocy spawned hasn't changed, just shifted.

@Peter Harris
"Why don’t you have the courage to post my comments, and let
others decide."

Because people already decided you're an asshole and they've shown you the door. Courage, my ass.

My last word (I hope): Michael Phelps, cupping, and "integrative medicine"

oracknows — Wed, 10 Aug 2016 01:01:54 +0000

My last word (I hope): Michael Phelps, cupping, and "integrative medicine"

As I mentioned yesterday, there are news events involving medicine (more specifically pseudoscience in medicine) that are so ubiquitous and irritating that they’re enough to bring me briefly out of my vacation to bang out a quick post. So it was when I wrote my post yesterday about Michael Phelps’ enthusiasm for cupping, a practice attributed to traditional Chinese medicine that is actually an ancient practice that seems to have been independently thought up in multiple cultures, such as the ancient Egyptians. Basically, cupping therapy is a near-universal practice dating back at least 3,500 years that was commonly practiced until at least the 1800s. Not surprisingly, the very ancientness of the practice is frequently used by advocates of cupping to argue for its efficacy, but I tend to like to turn that argument around and point out that a practice that’s it’s very telling that a practice that’s been around some 3,500 years has so little evidence for its efficacy. That’s plenty of time to prove a treatment works.

Be that as it may, it hadn’t been my intent to revisit cupping after yesterday, but then a reader pointed something out to me, namely how a part of the reason why cupping is now so accepted is because of the embrace of the prescientific medical system known as traditional Chinese medicine (TCM) by some of our most respected academic medical centers as part of “complementary and alternative medicine” (CAM) or, as it’s more commonly referred to, “integrative medicine.” Of course, it is obligatory (for me, at least) to point out whenever discussing integrative medicine that what integrative medicine involves is “integrating” pseudoscience, prescientific mystical beliefs, and quackery into real medicine. Traditional Chinese medicine is, after all, a prescientific belief system that is largely quackery in today’s world retconned by Chairman Mao to seem as though there’s something to it but that did, as many ancient medical systems have, find the occasional gem that actually works. The rest, particularly acupuncture, cupping, and tongue diagnosis, is based in prescientific vitalism.

Athletes, however, are notoriously superstitious. So it’s not too surprising that Michael Phelps and a lot of other American athletes would embrace cupping, particularly given that the US Olympic Swim Team trainer is clearly a believer. However, physicians, particularly physicians at our greatest academic medical centers, should know better. Unfortunately, they do not, which is a large part of the reason why integrative medicine is flourishing. Unfortunately, the Michael Phelps story revealed this to anyone paying attention. Here’s how. Basically, when on Sunday reporters noticed the large, ugly hickeys all over Michael Phelps’ shoulders and back, asked what the heck that was all about, and found out about cupping, they needed “experts” to interview for their stories. Integrative medicine programs all over the country provided those “experts,” who all gave answers that ranged from endorsement to what Kimball Atwood used to like to call the weasel words of woo.

For example, take a look at what Dr. Alex Moroz, director of the Integrative Sports Medicine program at NYU Langone Medical Center’s Rusk Rehabilitation, says in this story in VOGUE:

Dr. Alex Moroz, director of the Integrative Sports Medicine program at NYU Langone Medical Center’s Rusk Rehabilitation, uses cupping at home on himself and his family. He believes there’s wisdom in the ancient practice, as well as common sense. Cupping’s effect, he says, is “mechanical, much like a massage,” and though Moroz has not treated professional athletes personally, he says, “It makes sense that it would work for that group of muscular skeletal injuries and problems.”

One notes that massage doesn’t involve intentionally popping a bunch of capillaries in order to produce a bunch of huge hickeys that, when they get out of hand, can turn into full thickness necrosis of the skin. Yes, this complication is very uncommon, but when there is no objectively detectable benefit to cupping, that makes cupping all risk and no benefit.

Joining the crowd of academic “integrative medicine” specialists, there was a story this story from CBS Newsfeaturing Dr. Adam Perlman, director for Duke Integrative Medicine:

Perlman said he first spotted an Olympic athlete with telltale cupping marks while watching the women's gymnastic competition this past weekend with friends.

"I was pleasantly surprised to see cupping marks. It really speaks to this level of integration we're seeing with many things that are considered complementary medicine," said Perlman, who has tried cupping for back pain and said it gave him relief.

Did you hear that? Dr. Perlman was happy to see Olympic athletes with cupping marks on them because they were evidence of the popularity of “complementary medicine.” Meanwhile, Dr. Robert Glatter, an ER doc at New York's Lenox Hill Hospital, lays down a load of credulous BS:

"It causes blood vessels to dilate and increases blood flow," said Glatter, an emergency physician at New York's Lenox Hill Hospital, who is in Rio de Janeiro for the Olympics.

The aim of cupping is to relieve any blockages in the flow of energy and blood and lead to better recovery, Glatter explained.

“Blockages in the flow of energy”? It would appear that Dr. Glatter buys into the prescientific vitalistic thinking at the heart of TCM. One wonders what he would say if he were to be asked specifically what form of “energy” flow is “blocked” and describe a physiological mechanism that doesn’t involve handwaving and appeals to mysticism by which cupping “unblocks” it. One wonders if Dr. Glatter knows he’s spouting pure bullshit. Indeed, while admitting there’s no good evidence that cupping does what its proponents claim it does, Dr. Glatter joins Dr. Perlman in laying down more of the same:

But both Glatter and Perlman said the ancient therapy isn't scientifically proven to heal anything.

"There's no scientific evidence. There are multiple trials out there but no quality evidence. Producing giant welts on the body which basically make you feel better locally but injure local tissue doesn't have any systemic impact," said Glatter.

Of course, “integrative medicine” physicians like Dr. Perlman are anxious to claim legitimacy for cupping in light of so many Olympic athletes having shown their enthusiasm for the procedure. Perhaps they see potential new business coming their way. Wait. Scratch that. There’s no “maybe” about it:

If athletes or anyone else in the audience is seeing the alternative therapy and is interested in trying it, they should seek a qualified health expert, said Perlman.

"People should be looking for someone trained in traditional medicine and licensed and trained in Chinese medicine and who has graduated from an accredited school," he advised, noting that cupping is usually part of a more comprehensive medical approach, used in combination with other therapies.

It’s an approach also advocated by another director of “integrative medicine” in another story about Phelps and cupping in TIME Magazine:

There is a difference between how cupping is practiced in traditional Chinese medicine and how it is used in Western medicine, says Dr. Brent Bauer, director of the Mayo Clinic Complementary and Integrative Medicine Program. Bauer says a traditional Chinese medicine practitioner would likely offer cupping as part of a larger integrative health check, which might include recommendations around nutrition and other health things, and not just as a one-off therapy. “It’s kind of an American phenomena, I think, to consider cupping by itself,” he says.

In traditional Chinese medicine, the theory is that cupping can influence the flow of energy or “qi” through the body, says Bauer. If someone’s flow is blocked or stagnant, a practitioner might use cupping to impact the flow. Western practitioners may focus more on what the therapy might be doing to muscles or blood flow.

Yes, like Duke, the Mayo Clinic has gone all in for quackademic medicine. It has one of the bigger and more prominent “integrative medicine” programs. Be that as it may, it’s amazing how much alike Dr. Perlman and Dr. Bauer sound. It’s also depressing that, even more than Dr. Glatter, Dr. Bauer, who is faculty at one of the most respected academic medical centers in the country—nay, the world!—is spewing vitalistic nonsense as though it were legitimate medicine, with his credulous discussion of “qi.”

The list of once proud and science-based academic medical centers that offer cupping is depressingly long. For instance, the University of Maryland offers it. So does Beth Israel Deaconness. In fact, it’s a pretty good bet that any academic medical center that offers acupuncture and TCM probably offers cupping because cupping is an integral part of TCM. Perhaps the most disturbing and irresponsible media statements on cupping came from the Cleveland Clinic, which, as I’ve described before, has gone all-in with TCM and “functional medicine” quackery. Check out the Cleveland Clinic’s Twitter feed:

.@TeamUSA sports a different kind of @Olympics ring at #Rio2016. It's called #cupping. Listen as we explain.https://t.co/dL9CcR1NGh

— Cleveland Clinic (@ClevelandClinic) August 9, 2016

Note that this video features a TCM practitioner from the Cleveland Clinic touting the benefits of cupping. The complete video is right here on the Cleveland Clinic media page, which features Jamie Starkey, Lead Acupuncturist, Center for Integrative Medicine:

Yes, you saw it right here. A major academic medical center features on its media website a video showing one of its own employees, the “Lead Acupuncturist,” administering a quack therapy to a patient and touting its benefits for chronic pain and even asthma. (Yes, you heard that right, asthma.) There’s something wrong here, but unfortunately, the Cleveland Clinic apparently doesn’t see it. It gets worse, though.

More disturbing was this Tweet:

@da2102 (2 of 2) though other providers in traditional Chinese therapy will use cupping for asthma, GI issues and fatigue

— Cleveland Clinic (@ClevelandClinic) August 9, 2016

Yes, that’s the Cleveland Clinic’s official Twitter account. It’s sort of backing off Starkey’s claim that acupuncture is useful for asthma, while not really backing off. More importantly, in response to numerous requests from other Twitter users for actual scientific evidence supporting the use of cupping, the Cleveland Clinic can’t or won’t provide any. It’s almost as though the Cleveland Clinic knows that what it’s offering in its integrative medicine program is pure quackery but doesn’t care.

Sadly, the overall message coming from advocates of “integrative medicine” quackery is as disciplined and consistent as that of any political party and candidate. In this case, it is: When seeking pseudoscientific or prescientific treatments, be very sure that you only utilize a “qualified” and “licensed” practitioner (i.e., someone employed by Dr. Perlman’s program or other “legitimate” academic “integrative medicine” programs). Personally, I like to characterize this ploy as: Come for the cupping. Stay for the “comprehensive” quackery that “integrative medicine” integrates into real medicine.

That’s the message. Cupping is basically a gateway to the rest of the quackery integrative medicine “integrates” into real medicine.

oracknows Tue, 08/09/2016 - 21:01

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https://www.youtube.com/watch?v=Iw3a6pL6u4E

In other quack news http://www.abc.net.au/news/2016-08-10/mother-avoid-jail-over-breastfeed…

Yesterday, I was half tempted to mention that bloodletting still is a valid treatment for hemochromatosis, but honestly, I suspect some of the woo peddlers that have been hanging about would've run with it for their usual plethora of things other than iron overload.

As far as physicians offering woo based treatments, should one offer such to me, well, you'll see the fastest running physician in the world. Our conditions are serious and nonsensical mistreatments being offered will not be tolerated.

Asthma. Sure. I could combine cupping with some of those nifty homeopathic asthma cures found on the shelves of various drug stores! No more Big Pharma inhalers for me!

I received a letter in the mail yesterday from Memorial Sloan-Kettering inviting me to participate in a clinical trial of acupuncture for insomnia in cancer patients, as if causing pain by sticking needles in me would help me sleep better.

I have half a mind to send it back with a nasty note.

@Dr Finfer: I would, saying, "How would sticking useless needles into cancer patients help me sleep at night?" :)

The trick is in the language. These quacks talk about how cupping *MIGHT* relax muscles, *MAY* help blood flow. They are admitting that they just don't know, but phrasing it in a way that most people won't read into.

The Chinese divers (women’s synchronized) were covered in tape--all over their backs, some on shoulders. Others had it on their ankles. This was a 10 metre board and I realize they hit the water at 30-35 mph, so I can see the wrist braces, but what does atletic tape (at least it was flesh colored) do for the back? I read up here and at the other blog, and couldn’t find much to support it.

At least none of them had giant hickeys. Honestly, I can no longer look at Michael Phelps. His greatness is much diminished by his gullibility. I now expect to see cupping offered at mall kiosks along with those Chinese neck massages.

It causes blood vessels to dilate and increases blood flow

Prove it, quack. Prove that sucking a gob of flesh into a cup with a relatively thin rim which will result in high contact pressure around that rim does not in fact occlude vessels well above the size of capillaries and actually reduce blood flow. Provide a reasonable hypothesis for how static suction, which might conceivably encourage blood flow "out" of arteries does not prevent blood flow into veins. It can't simultaneously suck from one and blow to the other.

@7 A local news channel did a piece on the cupping, which, IMO, was just a free advertisement for a PT business that offers it. When I went to their website, lo and behold, I found Rock Tape. It's kinesiology tape, which is apparently an ancient Japanese secret. The company charges $10 a body part for taping. Perhaps that's what it was?

In addition to making athletes perform better, it also cures all kinds of things:
Achilles tendonitis
• Plantar fasciitis
• Jumpers knee (PFS)
• ACL/MCL issues
• Rotator cuff
• Groin and hamstring pulls
• Lower back issues
• Shin splints
• Tennis and golf elbow
• Pain associated with pregnancy
• Postural correction
I haven't been able to stand up straight in a couple of years. Maybe I need to get taped....after I have the cupping for my asthma.

#5 MI Dawn
Perhaps Memorial Sloan-Kettering know he's a sadist and would get a kick out of it? That warm feeling as you finish your warm milk and cookies just before going to bed?

The level of irrationality that seems to be overtaking the medical profession is not giving me warm feelings. It's making me more sympathetic to Wzrd1's approach.

When something like the Mayo Clinic is doing this, it gets scary.

Note to self: Check my doctor's clinic website before making any appointments.

When my eldest was doing sports (field hockey and softball), she had problems with her kneecap dislocating. I forget the actual diagnosis now; it's been 10+ years. The orthopedist gave her PT, exercises, and taught us to do some specific taping until her muscles were strong enough to keep the kneecap in place. It helped for that purpose, though it was tricky to do. I don't know if it helps for all the reasons listed above, or was a placebo for my daughter.

I have half a mind to send it back with a nasty note.

Do it. Tell them they shouldn't be wasting time, money, and manpower on clinical trials of treatments with no plausible mechanism whatsoever.

That goes for anything involving qi. In real medicine, terms have specific meanings, and while a layman like me may not always be familiar with a given term, I can ask any physician and be reasonably sure I'll get substantially the same answer as any other physician would give me. Qi, as far as I can tell, does not have a specific definition, so it can mean whatever the speaker wants it to mean. How can we scientifically study what qi allegedly does when the word means different things to different people?

Or e-mail the flyer to me and let me look up the clinical trial. Muhahahahaha!

Athletes, however, are notoriously superstitious. So it’s not too surprising that Michael Phelps and a lot of other American athletes would embrace cupping, particularly given that the US Olympic Swim Team trainer is clearly a believer.

The most plausible explanation is that it sucks all the brains out of their heads, thereby making them lighter and more buoyant.

It certainly sucks the money out their wallets effectively enough.

However, physicians, particularly physicians at our greatest academic medical centers, should know better. Unfortunately, they do not, which is a large part of the reason why integrative medicine is flourishing.

I rest my case. Funny how we never hear alties condemning that corruption in medicine.

I don’t know if [taping] helps for all the reasons listed above, or was a placebo for my daughter.

At least with taping there is a plausible mechanism. Like an emergency splint for a broken bone, it may help stabilize the joint by preventing it from bending too far in a certain direction, which is what a dislocation basically is. I have had occasion to tape certain fingers myself.

I'm not sure what taping might do for the back, though. If I thought someone's spine needed it, I wouldn't let her participate in any kind of athletic competition, for reasons that should be obvious.

Kinesio tape is Ancient Egyptian Medicin (AEM) and here's proofs: http://basementrejects.com/wp-content/uploads/2013/10/mummys-ghost-khar… . How can you argue against something that works so well that it makes the dead walk?

Playing high school football I remember after an ankle sprain getting my ankle taped for support. That was nothing like a single piece of this silly kinesio tape. It was much more like a cast, requiring a lot of tape (foam and sticky tape) to basically keep my ankle from inverting.

Duke Integrative Medicine...appropriate acronym.

It's disheartening to see the quackiness legitimized by real medical institutions. The Duke Center for Integrative Medicine (like any good center for legitimizing nonsense) even has a lawyer teaching a course called "Legal Issues in Integrative Medicine" which seems designed get around those pesky consumer protection laws.

Duke Integrative Medicine…appropriate acronym.

And it would be particularly appropriate to have the Duke University Marching Band perform at any and all of the center's celebrations.

As a recent participant, I believe that cupping caused increased pain- I found it difficult to wait the ten minutes or so until the practitioner returned to remove the bloody, miserable things.

Perhaps that's the point: the NEW pains ( caused by cupping) distracts you away from feeling the older pain which prompted you to seek out help.

Perhaps distraction is the secret of woo in general.

That should be: the NEW pain

Honestly, I can no longer look at Michael Phelps. His greatness is much diminished by his gullibility.

I know what you mean. What was even worse was his grotesque display upon winning the 200 Fly.

Believe it or not, good old Mikey is still selling cupping supplies ( Natural News/ Store) : a set of four costs 37.95 USD and the gift pack- which includes oil- is 85.95 USD.

I wonder the oil is for? ( I ask incredulously)

After many years of dedicated, in-depth research, I am now ready to publish my results. All the work I have done, all the analysis and measurement and hard graft, all can now be revealed.

Count yourself most fortunate, my friends, for here is the truth, the absolute truth which encapsulates all that any intelligent and conscientious person must know about qi.

Are you ready to hear it?
.
.
.
.
.
.
Steady yourselves.
.
.
.
.
.
.
Here we go...
.
.
.
.
.
THE TRUTH ABOUT QI

It's an incredibly useful word to know when playing Scrabble.

Doing a search now for other quotes from employees of academic integrative medicine programs, I was impressed to see that Barrie Cassileth of Sloan-Kettering was strongly critical of cupping (while still endorsing acupuncture) in a 2014 Wall Street Journal interview:

There's absolutely zero evidence that cupping has any kind of positive role in medicine," said Barrie Cassileth, the chief of integrative medicine service at Memorial Sloan Kettering Cancer Center in New York. She said the post-cupping bruises result simply from the suction on the skin, which may be more harmful to circulation than helpful.

"I cannot conceive of any benefit except a psychological benefit," said Cassileth, who has written books on alternative treatments and noted that, unlike cupping, holistic therapies such as acupuncture have been proved effective in medical tests.

Perhaps that’s the point: the NEW pains ...

I suspect that is exactly what happens. As I posted in the old thread, I could believe that cupping has the same effect as using a counterirritant, with added theatre that just isn't there when rubbing in some Bengay. It's the same sort of thing you get if you mash your fingers when your foot hurts.
Is it on the continuum to self-mutilation?

Look at the pretty acupuncturist demonstrate the 'cupping'. Look at the trauma of that lifted flesh:

Blood stagnation. Whatever, it looks brutal -- and now all the kids will be doing it; It could be a nepharious world government plot.

A new article at the CBC website: 'Very little evidence to support it': Why some scientists give cupping a poor score.
I haven't looked at the comments yet. CBC recently went to a no-psuedonym policy, so many of the more intelligent commenters have departed (while many that remain have obvious pseudonyms).

To me, if parents do this to kids, it should be considered child abuse.

"I wonder the oil is for?"

To allow the money in your wallet to slip more easily into his.

@28 doug
I've always commented non-anonymously at the CBC, but between losing my long commenting history due to not having my account linked to social media (had some really nice climate change denial rebuttal posts there that could be mined) and seeing the no-pseudonym policy fail (not that I ever thought it would work once they let their plans be known) my urge to read the comments/post comments has dropped off significantly.

Here ya go, Chris Hickie; Cupping for kids @1:45

https://www.youtube.com/watch?v=IH6CWyn63iQ

I bet the Peter Pump market gets a bump outta this!

# 28 doug
RE: CBC comments
I don't have time to read them all but Daimon Corston has a great one
Cupping is ridiculous! What he needs is a couple of lines of rhino horn, then wash it down with bird's nest soup.

It’s an incredibly useful word to know when playing Scrabble.

I concur on this point.

For those readers who are unfamiliar with Scrabble, I'll explain the reasons. First, it's a two-letter word, and those are handy to know for making high-scoring plays, as you get to count the letter twice--especially valuable with the Q, which (at least in the English language version of the game) is worth 10 points, the highest (along with Z) scoring tile in the game. It's also one of a handful of words that allow you to play the Q without a U, which is the rarest vowel in the game (there are only four U tiles, not counting blanks; for comparison there are 12 E's in the game). The others I can name offhand: qanat, qat, and qibla (all three are words of Arabic origin).

French and Spanish versions of Scrabble probably don't weight the Q as highly, as that letter is much more common in those two languages. I also don't know if they have adopted the Pinyin transliteration of qi--in older transliteration schemes it's usually spelled chi (the Q in Pinyin represents the "forward" CH sound). The French still call China's capital Péking, so it's unlikely they have adopted the Pinyin spelling.

The others I can name offhand: qanat, qat, and qibla

"Qabala" is good and admits a plural for a seven-tile play, per Hasbro.

^ "Initial" play, I suppose I should have said (I find the pace of the game tedious with the people I know), but "qabalah" is also good, as well as the plural.

I guess there's an obligatory mention of the Chevy Chase film Foul Play here, as well.

"much like a massage"...except uncomfortable, possibly painful, probably more expensive... Why not just get the massage, which feels awesome?

I love how everyone is talking about cupping as a "Chinese" thing when I know I saw a travel show where the host was subjected to wet cupping (the kind that draws blood) in a Finnish spa just a few years ago. (No Reservations)

Since it's basically just a hickey, I'm now imagining "I'm such a god cupper they used me at Rio" as a new terrible pick-up line.

I think the most telling point against the alleged value of "Traditional Chinese Medicine" is the millions of death from plague, cholera, yellow fever, malaria, influenza, typhoid, hepatitis, and every other transmissible what-have-you over the millennia, almost up to the present decade.
Why didn't they ever work out a cure for any of those when they had 3 or 5 thousands of years to work on them?

Jes, #37:
Not only does a massage feel awesome, but in cupping there's zero prospect of a "happy ending".

Olympians are overfond of cupping
and each evening they pair up for spooning,
...As quacks slither into their confidence
...with vague promises of a golden ambience
Athletes are twice primed for forking.

@ doug #26

Is it on the continuum to self-mutilation?

I am thinking so.
If an athlete, professional or not, is adhering to the "no pain, no gain" motto, a slightly painful ritual before the show may fit right in.

@ORD #40 I dunno, I'm sure one could find BDSM porn with cupping-like techniques in it (and the hentai joke's already been made). Rule 34 and all...

I have thought of one useful role for cupping. They are the visible marks of ....er...marks. It means grifters can focus their efforts when attempting to relieve excess cash from people with more money than sense. Saves the rest of us, and grifters, a lot of bother.

I know this isn't really related, but I have a picture of something I found yesterday that I think Orac would be interested in looking at and maybe writing a post about. I was out on a walk when I walked by a really stupid sign advertising some sort of reflexology foot massage quackery crap. I don't know how to send the picture, though. Orac, I think you should look at it and give it your usual insolence, but I have no idea how to show it to you! Um...help me help you?

If the US is being made fun of by Brits over their choice of woo, it has to be bad: https://www.theguardian.com/commentisfree/picture/2016/aug/09/ben-jenni…

@Science Mom, it's about time that the UK gives fair play.
I've forever been picking on them over, England, the land who gave the world civilization and blood pudding.
Even native Brits pause, then laugh. :)

“no pain, no gain”

This motto has an often overlooked corollary: No brain, no pain.

Jim Thompson has an appropriate cartoon:

https://thompsonsportsart.com/

@Dangerous Bacon, while my wife and I have been married for 34+ years and despite certain, general significant medical issues, we're still quite sexually active together and have successfully avoided various rut times via learning and experimenting.
We learned, around a decade and change ago about the suctioning cupping method being abused today as medicine.
We also learned how to utilize it for, erm, marital excitement, utilizing erogenous zones. Some, mutually discovered.
We'd have written a book, however, we're both dyslexic and our families would have and still would be scandalized by our vanillaness being so hedonistic. Hell, OPM might not actually recover from the discovery and they know everything else about us (as does China, via the OPM hack).
Although, usually, we stopped short of the hickey phase of injury, only toying about with the pleasure phase.

As for a former comment, there is indeed, not only BDSM films on the subject, but more mainstream films. Not a one of which are to our tastes.

So, yeah, I'm a dirty old man, my wife's a dirty old lady, with each other.
Those younger would just call it having fun as a couple.
Figuring out out, one dysfunction of the body through another. Once we find ridiculous, we'll seek absurd and abuse that into extinction. ;)

All, while she's laying in bed, due to two verterbral fractures, secondary to sever, premature osteoporosis, has an L5-S1 herniation, times 20+ years and ignored by previous providers, lacks a single cervical disc that isn't impinging upon the spinal cord and creating very concerning symptoms. Me? Osteoarthritis is nearly global, too many years doing combat things in the Army, L4-L5 disc has likely failed after catching her a couple of weeks ago after her gallbladder was removed and her c-section scar failed in the umbilical region, causing significant discomfort (read: pain, sufficient to limit her activities).
I'm currently using my deceased father's cane and honestly, I've not kept it around out of fondness for him, but because I've actually used it while caring for him in his final years, when he became immobile.

Alas, our cupping set was lost on a move. Still, it was trivial enough to purchase and alter a breast pumping set.
And a plethora of other things.

Know that herbal infusion needle used on beef? I use it on lamb. ;)
And chicken.
I'd need one of my smaller gauge needles to use it on rat. :P

Still, for healing, we go to the physician. Although, personally, for a short stop, should I have a hypertensive period in short term, I do have a tea that used to give me four hours of relief. Lately, not so much, but it still tastes good.
The latter is far more important to me. Medicinal effect is measured, taste is far more important in foodstuffs. Medicines are far more important, as prescribed.
All, while annoyed and awaiting a five time repeated request for an ophthalmological referral, to both laser a posterior lens capsule opaccification *and* measure, record and gauge lattice degeneration, first observed in 2009, when I had a trauma related cataract treated.
And a sixth time requested referral for a separated shoulder, which was injured in 2010.
For the record, this primary and we first met at the beginning of this year. He's still not well trained yet with us.

Some drives don't vanish with injury and disability. :)
They're merely adapted around.

As for this young and fit young man, younger than either of our children, no clue, beyond accepting woo and superstition.
As for us, I'm considering a cow milking machine, it'll clear out the basement sump and work additional duty for other usages.*

*That's a *really* dirty joke, as we both lack a basement and lack a need for such an absurdity.
But, we've reached some absurdities in negative directions, time to provide TMI.
Enjoy your nightmares. :)

And one more (this really needs to be blown up to a larger size, framed and in color for our clinician contributors to display):

https://www.facebook.com/photo.php?fbid=10154191853576558&set=gm.792762…

re doug ( 26):

Often cats, when experiencing discomfort, lick or bite themselves until they remove fur - & occasionally skin as well.

I had a large male tabby who ripped out about 30% of his hair when being treated with steroids for asthma. He actually didn't look bad.. sort of punk rock 1978-ish.
Cat with a Mohawk.

@Denice Walter, we still scratch our head over our Russian Blue, who, not long after we moved into our new home (we adopted him while in transit to our new home at a hotel), lost, to the point of appearing shaved, all of his lower abdomen fur, from just above the hips down.
Finer shaven than a shaving commercial, but grew back over time, at a similar rate to usual hair growth.
But, the line across his abdomen was surgically straight.

Hair pulling or exploring someplace with a metal straight edge?
As he's lost zero fur since, I have my suspicions.

we adopted him while in transit to our new home at a hotel

Your new home was a hotel, or you scobbed the cat from there? A displaced cat can loose fur like that. Cat napper!!

In June we heard from
http://shanghaiist.com/2016/06/23/cupping_fail.php
(and others):
"After undergoing cupping therapy for a month, a 63-year-old man from Sichuan is feeling the effects, namely seven gruesome marks on his back...."
(apparently victim was _very_ convinced about cupping benefits, ignoring his pain.
The best is the ending:
"You know what might help to relieve the pain from all those marks? A Fujian fire massage session:"

Just found an article from January 2015 which discusses the practice and it contains a fairly disturbing statement attributed to swimmer Kayla Hutsell:

"Hutsell has assured us that the bruises don’t hurt at all. Though they do make quite the fashion statement!"

The link is below. Interestingly despite the above, pictures of this swimmer with cupping marks seem to be very rare...

https://www.swimmingworldmagazine.com/news/cupping-therapy/

Are you sure, that cupping doesn't have a beneficial effect for muscle soreness for athletes?
I'm sure cupping is useless for internal ailments (gout and so on), but athletes use massage, external analgesics, ice packs, etc. on their skin. Perhaps irritating the skin with cupping makes muscle soreness less apparent to the athlete, improving performance. This is one case where dismissing things out of hand may be wrong, particularly when you have evidence of the best swimmers in the world winning races following cupping.

The term "cupping" is also used to refer to a procedure for assessing the quality of coffee. Too bad it has been appropriated for this purpose.

https://www.facebook.com/photo.php?fbid=1219032604806082&set=a.13829448…

@57
This is pretty thin evidence for the effectiveness of cupping.

... when you have evidence of the best swimmers in the world winning races following cupping.

By your own word these are the best swimmers in the world ... you might well expect them to win regardless of cupping.

Michael Phelps, who has drawn the most attention regarding cupping at the Olympics, has won 28 medals at multiple Olympics. If he won medals in the past before cupping, why would you assume he is now winning because of cupping?

Blockquote fail ... *sigh*

I’m sure cupping is useless for internal ailments (gout and so on)

I'm oddly fascinated by how you arrived at gout as the exemplar here.

Will not work for gout. The best way to stop gout is to simply eat less purines.

This is a disease of meat-eaters.

This is one case where dismissing things out of hand may be wrong, particularly when you have evidence of the best swimmers in the world winning races following cupping.

What you have seen is evidence that Phelps is a world-class swimmer (cos of the medals) and evidence that he has undergone cupping (cos of the bruises).

I'd like to point out that in 2004 and in 2014 he was arrested for driving under the influence. Few, if any, of his competetors have been caught driving drunk, and I note that he has beaten them and won an enviable amount of gold medals. Surely you can see the evidence that alcohol combined with irresponsible driving has been a key part of his success?

Wow, if I had only been caught driving drunk in my youth, I'd have become world emperor by now!
Oh well, just as well.

Wow, if I had only been caught driving drunk in my youth, I'd have become world emperor by now!
Oh well, just as well. Being an emperor looks to be way too much work.

@Pie #64

Don't be ridiculous, according to my Facebook feed it certainly wasn't the drunk driving charges that are the one and only reason for Phelps' success, we have documentation that he has smoked pot at least once, and it is the pot he smoked that was the performance enhancer!!!

@KayMarie #67, indeed!
Bill Clinton didn't inhale, all he made was POTUS and Monica, Phelps inhaled and got a body full of hickeys and a bunch of gold medals.
Although, I can think of more exerting ways to accomplish the former...
Alas, neither my wife or I are up to that kind of exertion any longer.

Getting older sucks, but nowhere near as much as not being able to get older. Otherwise, a lot of departed friends would've been back to tell me how great dead is and that I should really try it.
Instead, I've only had live people suggest that and honestly, I don't believe that they had my best interests at heart.

re the stone.... athletes and their drug of choice

I've always suspected that snowboarders who won gold medals despite their usage may in fact be accomplishing more than non-smokers. Same with Phelps - they DESPITE being stoned.

But you never know- perhaps they are just extremely nervous sorts and the drug calmed them down enough to achieve peak performance.

they win DESPITE

we have documentation that he has smoked pot at least once, and it is the pot he smoked that was the performance enhancer!!!

Yes, KayMarie #64. At the very least, it is a bronchiodilator -- good for runners and swimmers.

But THC, the main mind-altering chemical in marijuana, wasn't even included in the International Olympic Committee's banned-substances list at the time (it is now, but at a much higher level than the one he tested at). Rebagliati was allowed to keep his victory and medal. (He is now in the medical-marijuana business.)

http://www.businessinsider.com/how-marijuana-affects-working-out-2015-1

After winning the gold, he was found to have Tetrahydrocannabinol (THC) in his circulatory system following a blood test and he was automatically disqualified. This decision was eventually overturned, largely on the basis that marijuana was not on the list of banned substances, and Rebagliati was given back the medal.

https://en.wikipedia.org/wiki/Ross_Rebagliati

So, yes. The IOC now considers cannabis a 'performance enhancing' drug -- They bungled about for years on the issue and resisted the classification, presumably so as not to send mixed messages to the kids.

addendum:

Despite the prohibition, running on weed has become an increasingly popular trend among athletes, who use it either as a way to avoid fatigue, boredom or anxiety during long runs, or as a pain-reliever and anti-inflammatory medication during recovery periods.

https://www.theguardian.com/society/2016/may/02/marijuana-athlete-runni…

My god! I would be too paranoid to do sports on Marijuana.

I would be hugging the diving board; and crapping myself on the luge.

You know Bond was ripped during this chase; Just because you're paranoid doesn't mean they aren't out to get you!!

https://www.youtube.com/watch?feature=player_detailpage&v=RpBWIr4EWb8#t…

Sad fact: Stuntman Paolo Rigoni died during the filming of the bobsled chase.

http://www.imdb.com/name/nm0726808/

It is thought that the suction of the love bite – also known as a ‘hickey’ – caused a blood clot that travelled to Julio’s brain and caused him to have a stroke.

http://www.mirror.co.uk/news/world-news/love-bite-horror-teen-dies-8718…

My god! I would be too paranoid to do sports on Marijuana.

I'm just going to leave this here.

Thanks, Michael Phelps, for glamorizing cupping quackery!

oracknows — Tue, 09 Aug 2016 01:00:24 +0000

Thanks, Michael Phelps, for glamorizing cupping quackery!

So, in case you hadn’t noticed, I was taking a brief vacation, a long weekend if you will. As a result, I hadn’t planned on posting new completely original material until Wednesday or Thursday. (Monday’s post, some of you noticed, was a modified crosspost from my not-so-super-secret other blog.)

Then something happened.

You know you’re a committed blogger when your vacation can be interrupted by an overpowering urge to write about something in the news. Longtime regular readers (or even not-so-longtime regular readers) can probably guess right away what I’m talking about. Of course, I gave it away with the title of this post, but to drive the point home, let’s take a look at this photo:

Yes, it was all over the news Sunday night, with stories abounding over the purplish red circles on Michael Phelps’ shoulders and back as he helped the US swim team win Olympic Gold in the 4×100-meter relay. As Monday passed and I tried to stay away from skeptical news, I got more and more annoyed, as I saw credulous story after credulous story about the use of cupping by the U.S. Olympic team. It’s nothing new, either. Almost a year ago, Michael Phelps posted this to his Instagram account:

Thanks @arschmitty for my cupping today!!! #mpswim #mp ? @chasekalisz

A photo posted by Michael Phelps (@m_phelps00) on Sep 10, 2015 at 12:29pm PDT

He’s not alone, either. Eight months ago, American swimmer Natalie Coughlin posted this photo of herself undergoing the treatment:

Laughing because it hurts so bad. Gonna leave a mark! #AthleteLife

A photo posted by Natalie Coughlin (@nataliecoughlin) on Dec 9, 2015 at 11:02am PST

And even a longer time ago, nearly three years, to be precise:

Gee, I hope my #GoldenGoggles dress is open-backed.

A photo posted by Natalie Coughlin (@nataliecoughlin) on Nov 20, 2013 at 3:54pm PST

And Olympic gymnast Alex Naddour:

Heading to another training. One day closer to our goal!!! #TEAMUSA I hope everyone is ready for opening ceremonies tomorrow!!!

A photo posted by Alex Naddour (@alex_naddour) on Aug 4, 2016 at 9:44am PDT

Worse, given that NBC has the rights to cover the Olympics, NBC Sports has been delivering some truly irresponsible and credulous “journalism” about cupping:

Notice the tropes about this “ancient Chinese tradition” being merged with a “modern American one, winning.” It turns out that the head athletic trainer for the US Olympic Swim team, Keith Robinson, fully buys into this particular form of prescientific quackery:

“There is a psychological component where Michael has been doing this to feel good for a long time, about two years,” Mr. Robinson said. “Anything you can do to get the body to feel good — you have to use an educational assessment on it. You have to make sure that what you’re doing is causing a physiological intent to recover.

“I’m not just going to throw a stick of butter on him,” Robinson said, adding, “I’m going to make sure I have an educated approach to it.”

While there’s no question that many athletes, coaches and trainers believe in the treatment, there’s not much science to determine whether cupping offers a real physiological benefit or whether the athletes simply are enjoying a placebo effect.

If the goal is just to make the body “feel good,” then why bother with the nonsense that is cupping? A good massage would be The entire rationale behind cupping, as a hundred credulous stories tell us, is this:

In traditional Chinese medicine, the theory is that cupping can influence the flow of energy or “qi” through the body, says Bauer. If someone’s flow is blocked or stagnant, a practitioner might use cupping to impact the flow. Western practitioners may focus more on what the therapy might be doing to muscles or blood flow.

Is there any evidence for this? Certainly, as I’ve discussed in many posts about acupuncture, there’s no evidence that “qi” even exists, much less that acupuncture or cupping or anything else can influence its flow for healing effect. As for scientific evidence, there are studies. Heck, there are even systematic reviews. Typical reviews include this one, which suggests “a potential positive short-term effect of cupping therapy on reducing pain intensity compared with no treatment, heat therapy, usual care, or conventional drugs” and this PLoS review, which suggests “potential effect in the treatment of herpes zoster and other specific conditions” but concludes that “further rigorously designed trials on its use for other conditions are warranted.” However, even reviews in woo-friendly journals aren’t that enthusiastic; e.g. this one, which concludes that “there are few RCTs testing the effectiveness of cupping in the management of pain,” that “most of the existing trials are of poor quality,” and that “more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.” Personally, though, I tend to believe Edzard Ernst, when he did an overview of systematic reviews:

In essence, this means that the effectiveness of cupping is currently not well-documented for most conditions. This is in sharp contrast to the many claims made by the proponents of this therapeutic modality, including those practicing traditional Chinese medicine or complementary and alternative medicine.

All five systematic reviews relied on primary studies from China. Several groups have demonstrated that nearly 100% of all acupuncture studies from China generate positive results [9,10]. This finding raises considerable doubts about the reliability of these data. Table 1 also shows that the quality of the primary studies is often poor. Trials of poor quality tend to produce false positive results.

Exactly. Basically, reading the “evidence” for cupping tells me that there is no compelling evidence that cupping is effective for any condition. Certainly, there is no credible evidence that it helps athletic performance, be it in swimming or any other sport. Moreover, by the principles of science-based medicine, in which prior probability based on basic science is taken into account, the clinical evidence that weakly suggests a benefit can justifiably be called into serious question based on the extreme ridiculousness of the therapy and the lack of any sort of plausible rationale grounded in basic human physiology suggesting that it should work. In other words, the whole physiologic rationale for cupping is bullshit. As we know from other similar modalities, when that’s the case seemingly “positive” clinical trials become much less convincing.

Unfortunately, even though all of this is true, NBC Sports provided the template for a thousand local TV stations to do stories on cupping. For example, my local NBC affiliate sent one of its anchormen, Steve Garagiola, to a quack clinic to undergo cupping himself:

In this case, Lisa Vel of Renew Detroit Health is given carte blanche to lay down some howlers, like her appeal to antiquity in which she claims that “ancient Chinese medicine” like cupping has been practiced for 5,000 years. As I noted the last time I discussed cupping, even if it does date back 5,000 years, arguably so does bloodletting. If I were to argue that there must be something to bloodletting because it’s been practiced for thousands of years, you’d laugh at me—and rightly so. Yet, for some reason, when it comes to cupping (and, let’s face it, acupuncture and a lot of other traditional Chinese medicine quackery) this appeal to antiquity comes across as persuasive. I like to point out that 4,000 years ago in ancient Egypt, medicine and religion were one in the same, and the cause of a lot of disease was believed to be evil spirits. Indeed, what made Hippocrates’ views so revolutionary in ancient Greece is that he was among the first to argue that diseases had physical causes that could be addressed and were not caused by the gods or evil spirits.

Just out of curiosity, I checked out Renew Detroit Health’s website and immediately noticed a whole lot of quackery, primarily functional medicine, or, as I like to call it, making it up as you go along. Of course, as I’ve also mentioned many times, functional medicine embraces just about any form of pseudoscience and quackery you can imagine, complete with lab kits that cost $200 to $400 per kit. So it’s no surprise to me that Renew Detroit Health offers cupping. It’s also no surprise to me that my local NBC affiliate would so readily fall for this pseudoscience. After all, it did a when I first moved back to my hometown.

Sports celebrities are, of course, not a source of reliable health information. For one thing, athletes are notoriously superstitious. How many times have you seen stories of athletes who wear the same article of clothing endlessly as long as they are on a winning streak, no matter how disgusting it becomes? Or what about athletes who refuse to shower or shave as long as they are on a winning strak? You get the idea. Athletes have a distressing tendency to embrace pseudoscience, as long as they think it can give them an edge. For example, they believe that IV hydration helps them when it doesn’t; that kinesiology tape protects them from musculoskeletal injury when it doesn’t; and that acupuncture works when it doesn’t.

Yet, none of this stops advocates of cupping and other pseudoscience from promoting it as though it works, even though there is no evidence that it does. In fact, there is evidence that cupping can cause harm, up to and including full thickness skin necrosis that is, for all intents and purposes, no different than a full thickness burn. Just to jog your memory, I'll repost a photo I posted before of this very phenomenon:

Yes, this can happen, and, yes, those are basically indistinguishable from bad burns, even though the injury is not due to heat.

That’s what irritates me. Just because an Olympic champion like Michael Phelps believes that cupping works does not mean that it actually works. It doesn’t, and it can in some cases cause harm. It's basically all risk, no objectively demonstrable benefit.

Sorry, Mr. Phelps, but all those nasty hickeys from cupping are all for naught.

Unfortunately, that's not the message we're getting from the press. Oh, sure, there is the occasional nod to skepticism in some—but by no means close to all—stories in which it is mentioned, often almost in passing, that there is no evidence that cupping does any of the things its proponents claim that it does, that all it does is to produce what are, in essence, huge hickeys. However, even that little bit of skepticism, when it even manages to make its way into a story, is promptly overwhelmed by the glamor, attractiveness, and excitement of genuine Olympic athletes using this quackery. A better advertisement for cupping and traditional Chinese medicine is hard to imagine! Yet, that's what most of the news media are providing us, brief infomercials for quackery.

oracknows Mon, 08/08/2016 - 21:00

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