A recent business sojourn to Key West, FL, gave your intrepid blogger (who still has yet to set up his own CafePress swag shop) an opportunity to revisit a story we first discussed in February of an acupuncturist being arrested on three felony charges for obtaining controlled substances by forgery. Commenter ebohlman noted at the time the address of the acupuncturist's practice:
Duck Avenue? Is that where all the quacks have their practices?
While I expressed some sympathy for the practitioner if she were addicted to narcotics, I also feared that she might have used some of the drugs to dope herbal products she stocked to give her patients the impression that the herbs "worked." While I have yet to conclusively establish a causal association, the follow-up evidence I've learned is certainly consistent with that hypothesis:
The charges against a Key West acupuncturist arrested last week include forging prescriptions to obtain drugs not only for herself, but for her patients, according to arrest records.
Oh dear.
A doctor who performs cosmetic procedures at Hoyt's Clinic of Alternative Medicine, 3420 Duck Ave., contacted Key West police on Feb. 6, accusing Hoyt of using information on the doctor's Florida medical license and federal Drug Enforcement Agency license to open accounts with two mail-order pharmacies in Hallandale Beach and Melville, N.Y., reports say.
Hoyt allegedly obtained Cyclobenzaprine, a muscle relaxer; Rozerem, Lorazepam and Phenobarbital, all sedatives; Nandrolone, an anabolic steroid; Sermorelin, growth hormones; Alpha Lipoic Acid, an antioxidant; Furosemide, a diuretic; and vitamins.
So instead of prescribing warming herbs to better balance one's Chi, it is entirely possible that a little bit of prescription sedative might have been used as a synergistic booster.
Even an acupuncture association has tried to distance themselves from this case:
Except for the vitamins and antioxidants, the drugs are not associated with typical acupuncture procedure, said Bill Reddy, vice president of the American Association of Acupuncture and Oriental Medicine.
"We're not prescribing pharmaceuticals," Reddy said. "It's also important to note, I can't even suggest someone stop taking their current medication to take herbal medication. If there's a patient that says he or she was prescribed a man-made pharmaceutical by an acupuncturist, that acupuncturist has gone beyond our scope of practice."
As you might suspect, no one was available to comment when I showed up at the acupuncture practice to sniff around a bit.
But beyond the fact that the individual called themselves a "physician," I did find it striking that the proprietor also has a bit of a spelling problem:
And when one goes to the clinic website, one finds yet another spelling error, perhaps prescient: the individual is a graduate of the University of Missouri-Colombia*.
*with apologies to my colleagues from the beautiful country of Colombia who must endure endless, mean-spirited ribbing about illicit drugs.
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Nice shirt dude!!!
but yeah, what a scam. to actually slip a little bit of proven drug with actual function into the patient and then claim it was the other nonsense all along? wot a country!
Given the number of skeptics who occasionally perform the stunt of crunching down a whole bottle of homeopathic sleeping pills, I hope the makers of homeopathic sleeping pills don't start slipping real drugs in effective dosages into their products.
Hi Abel,
This is slightly OT but I think you'd be interested. I've noticed that I'm now recieving spam emails offering anti-virals (and not the software kind).
I can't think of anything more irresponsible. A sample;
I understand that acupuncture and chinese herbal medicine has very little support in established medical fields. My question to you, as an expert, is this because there is a lack of evidence or just a lack of studies that suggest these types of treatments work? I know of many women who use acupuncture in conjunction with fertility treatments, often recommended by practising physicians. Quacks are not simply relegated to the margins, but are also found in established medical fields. I'm interested to know what you think.
doublethink? or outright fraud? maybe both.
GirlPostdoc, the three-letter answer to you question is SBM.
Now for a longer answer. Yes, infertiles use complementary and academic medicine. As do many other people who are motivated by despair. That doesn't mean it works, though. Rather, it's called clutching at straws. Acupuncture is definitely a placebo.
My husband and I were infertile (unexplained) for three years. During that time, I saw a quack nutritionist, a shiatsu therapist, a reiki therapist, and a medical herbalist. Only the herbalist may have had anything to do with my pregnancy (agnus castus tincture), but taken together, the last three therapists offered me the support and counselling I needed to struggle through this difficult time. Often, the active ingredient is not the therapy, but the time and space for reflection, rest, and relaxation. (I hope you don't conclude from this that infertile women should just relax to conceive. )
Perceval,
That three letter answer link didn't work. Thanks for sharing that personal story. I am interested to know what studies show that acupuncture is a placebo. Do you have any references?
GirlPostdoc, I believe perceval was trying to send you here:
http://www.sciencebasedmedicine.com/
GirlPostdoc, a general look at acupucture.
http://www.theness.com/neurologicablog/index.php?p=14
A post about acupuncture and in vitro fertilisation.
http://www.sciencebasedmedicine.org/?p=43
@Drug - Thanks for the replacement shirt - It really provides an air of authenticity and authority, wouldn't you agree?
@GirlPostdoc - The best place to start would be to look at Cochrane Systematic Reviews and the references therein each therapeutic area. I'm perfectly fine starting from the standpoint that even if we don't have a plausible mechanism, it might be worth looking at some of these ancient modalities. Unfortunately, the best controlled studies show that acupuncture has a very strong placebo effect that cannot be overcome by "true" acupuncture.
Individual papers are good to examine but I would first recommend strongly R Barker Bausell's book, "Snake Oil Science." Despite the tone of the name, Bausell went into this field objectively as a biostatistician drafted into two acupuncture trials at the Univ of Maryland Center for Integrative Medicine. He spends much of the book explaining just how difficult it is to concoct an appropriate control intervention for acupuncture studies - i.e., it is difficult to blind sticking needles into the skin. In doing so, he provides a much broader discussion of eliminating bias in *any* clinical trial and, again very objectively, explains how even the most educated among us can introduce bias into our work. For this reason, I recommend Bausell's book for anyone involved in any kind of clinical trial.
In this paper discussing their two negative outcome trials of acupuncture for pain following dental surgery, Bausell and Maryland Int Med Center director Brian Berman note that belief in acupuncture working was the greatest predictor of individual response to the intervention. There appears to be a strong psychological influence of ritual in the perceived efficacy of acupuncture.
@GirlPostdoc - On the other hand, you will find me highly enthusiastic about systematically investigating traditional Chinese medicine herbal concoctions. For me, this is simply natural products pharmacology: the herbs may contain chemical compounds capable of a dose-dependent physiological effect. There has been very promising preclinical work with a multiherb mixture called antitumor B by the lung oncology group of Ming You at Wash U in St Louis - I saw him present recently that one of the herbs in the mixture was specifically responsible for the anticancer effect although I have not yet seen that in press so far.
There has also been a very good group at UCSF investigating Chinese herbal products for anticancer and women's health indications. A company has spun out of that work called Bionovo and they are taking the admirable approach of trying to earn FDA approval for a complex plant extract. Their BZL101 extract is currently undergoing a Phase 2 clinical trial for breast cancer out of Ohio State University.
What all of my verbiage is meant to convey is that there is deceptive alternative medicine meant to exploit the placebo effect for profit and there are other areas of alternative medicine that can become real medicine with real therapeutic benefits.
(Disclaimer: While I know some of the principals at Bionovo, I have no financial interest or professional relationship with the company.)
Thanks Fitz for the links. And thanks Abel those are great places to start. I've always wondered how one could conduct a proper double blind study with acupuncture.
As for chinese herbal medicines, I feel like the same problem is present - the people who give out those remedies still trade in superstition and mythology, rather than real evidence.
You really need to do your homework... if this person was practicing in Key West Florida? She is not and never was licensed to practice Acupuncture in this state. Just go the Florida Board of Acupuncture website and do a practitioner look-up. So she is not an Acupuncturist.
At any rate she gives the great healing profession a bad name.
GirlPD,
The best OnLine source for quackery is www.quackwatch.org and there is a good article at www.skepdic.com
The SBM blog (linked above) has several good articles, there are probably more at http://scienceblogs.com/insolence/ and http://scienceblogs.com/insolence/ which may complement what you see at SBM.
The regularity with which adulteration of herbs with clinically significant amounts of active ingredients is uncertain. The FDA certainly recalls quite a few (often, "natural Viagra"). I have heard that AP Grollman (Stony Brook) is looking into the frequency of adulteration of homeopathic preps, and finds it common. Mostly, they have OTC products (e.g., caffeine or analgesics).
Whenever I see a dramatic result for and herbal or, most especially homeopathic, prep I bear that in mind. If the clinician is part of the fraud, it is very difficult to detect.
@Joe, funny you should mention the adulteration point as I have a post going up tomorrow morning that addresses that very point. (I also respect Dr Grollman tremendously.).
Great minds think alike.
Abel,
I mis-read your post as suggesting the prescription drugs were being added to the herbs, that is what got me thinking. I look forward to your thoughts.
@GirlPD, I mistakenly cited one blog twice (above), the second should have been http://scienceblogs.com/whitecoatunderground/
To Abel P.
"What all of my verbiage is meant to convey is that there is deceptive alternative medicine meant to exploit the placebo effect for profit and there are other areas of alternative medicine that can become real medicine with real therapeutic benefits."
Agreed.
Abel, your the pharma expert here - what references do you use to find out about interactions between pharmaceutical drugs and herbs. Is there a single good one that you like?