Medical Science

Everything is moving so fast. The media reports on new research, studies and discoveries daily. People are living longer, healthier lives due in part to medical advancements.

 

I expect that this endless parade of seemingly miracle cures drives people to look beyond medical science and put their faith in so many unproven remedies. Scientific-sounding sales pitches, ancient wisdom or endorsements by friends, relatives and celebrities lure them in. Then all it takes is a little placebo effect to convince them that they have made a great discovery, and they too spread the word. 

 

Americans throw away countless millions of dollars in pursuit of relief from their latest aches and pains. Here are a couple more examples from reliable sources.

 

The first is about acupuncture. Many people believe acupuncture is an effective and safe alternative to mainstream medicine. Safety is not really the issue here. In the category of complimentary and alternative medicine, most of the pills and procedures are safe because they don’t do anything. The question in this case is whether it works.

 

If acupuncture works, it seems reasonable to assume that acupuncture points really exist and that experts or experienced practitioners can find them. Otherwise it would be random needling, a technique that would fly in the face of a theory based on the existence of qi and its meridians accessible at particular acupuncture points.

 

Journal of Acupuncture and Meridian Studies after looking at 14 separate studies found “’considerable variation’ in localization of acupoints among qualified medical acupuncturists.” They admit that accurate point location is a significant factor in effective treatment, but the various methods of finding them yield highly inconsistent results. 

Furthermore, my original source points out that the depth of the needles to access the point is not specified; and if the points were real, “wouldn’t they vary in location [from person to person] just as other anatomical structures” like blood vessels do? So many unanswered questions throw considerable doubt on the practice.

 

The second example concerns chiropractors charging thousand of dollars, not covered by insurance, for spinal decompression on a special device to alleviate back pain. One such device is “a mechanical table attached to Space Age-looking controls that its manufacturer claims can stretch the disks of the vertebrae.” (Medieval torture chambers had a similar table but without the space age-looking controls.) 

 

A group called Fair Warning, “based on review of lawsuits, scientific studies, government documents, chiropractic websites and interviews with experts, found that the claims of success for spinal decompression stretch the truth,” and that the treatment “has never been proven [to be effective] in scientifically rigorous studies.”

 

While Internet advertising and participating chiropractors rave about success, insurance companies describe the machines as experimental and investigative. While the promoters boast of success rates of 86% to 90%, investigators found their studies “lacked scientific rigor” and that “no definite conclusions could be drawn.”

 

A professor from Oregon Health and Science University and an expert on the subject of lower back pain says, “Eight in 10 people with back pain get better on their own.” The marginal difference with this machine, even if true, hardly seems like a good investment, especially since it has also resulted in serious injury.

 

Both cases are scientifically very dubious. Unfortunately, science means nothing to Americans unless it supports their preconceived notions. Climate change is real, based on science; but nuclear power is dangerous, based on emotion.

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One Last Time: Alternative Medicine

There are certain subjects that have come up time and again over the last 9 years. The main benefit of a behavioral approach is that so many seemingly diverse behaviors can be grouped into categories or dimensions to make sense of the consequences that arise from the resulting choices. 

About five weeks ago, in August, I wrapped up the subject of unfounded fears over GMOs with a One Last Time entry. Today the subject is the very broad area of alternative medicine, which I have described as magic pills and miracle cures. Just typing “magic pill” in the search box at the top left corner of the screen will reveal about 20 entries on this subject from vitamins to caffeinated underwear. In these and several other cases I pointed out the fallacies in their advertising and directed attention to the legally required disclaimer: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease."

Recently, I found this informative site with an excellent summary.

First they list the various aliases used instead of alternative including: esoteric, complementary, holistic, integrative or natural medicine. It includes such a variety of treatments that “generally accepted definitions do not exist.” 

An incomplete list includes: acupuncture, anthroposophical medicine, applied kinesiology, aromatherapy, autologous blood therapy, Ayurvedic medicine, Bach flower remedies, bioresonance, chelation therapy, chiropractic, colonic irrigation, detox therapies, dietary supplements, energy healing, herbal medicine, homeopathy, iridology, Kampo medicine, macrobiotic, magnet therapy, mind-body therapies, music therapy, neural therapy, ozone therapy, reflexology, Reiki, shiatsu and Traditional Chinese Medicine. I have discussed many of these elsewhere, here and here, for example, but some I’ve never heard of. 

Since they have no scientific backing, how do they lure in customers? “The realm of EM (Esoteric Medicine) is riddled with fallacies which confuse patients and consumers and are used regularly to undermine critical thinking.” In other words, they trick people. The most prevalent and important of these fallacies from the site are summarized below.

The “appeal to popularity” or “appeal to authority” tries to substitute popularity or the opinion of respected people for scientific evidence. But “medicine is no popularity contest” and “even people of high standing make mistakes.”

The post hoc fallacy wrongly assumes “an event ‘X’ that is preceded by another event ‘Y’ must be caused by ‘Y’. If the rooster didn’t crow, the sun would not come up. If the child skipped vaccinations, he would not have autism. (No and no.) It is not true for individuals or for groups.

Many of these interventions rely on the placebo effect. Scientists are just beginning to understand the power of the mind to heal the body. This effect is present whether the medicine is real or not. Likewise, sometimes people just get better on their own. These alternative treatments take advantage of these facts to gather supporters and celebrity endorsements without bothering with scientific evidence.

Using an appeal to tradition, citing a long history is another fallacy, assuming that if it has passed the test of time, it must be effective and safe. This may be good reason to conduct research, and if the argument is valid, the results will be favorable. But long history is no substitute for evidence. Many treatments were applied in the past that would be unconscionable today. Contrary to some popular opinion, ancient Chinese is not a code for safe and effective.

The article gives a long explanation of why EM is unethical by medical standards. “Informed consent is rarely possible in the realm of EM.” Often there is not a professional diagnosis.

“Another fallacy holds that EM defies science or extends beyond the boundaries of science as it is currently understood. Therefore, proponents claim, it cannot be tested in the same way as one would test conventional treatments.” 

Finally, because it is natural, it is assumed to be harmless. “Nature is pictured as benign and natural remedies are therefore not just intrinsically superior but also safer.” This shows a limited viewpoint and a basic misunderstanding of nature. Hurricanes, tornados and blizzards are natural. No one would argue that tobacco is safe because it is natural. To be enamored with words like “natural” and “non-chemical” or the phrase “available without a prescription” is to succumb to deceptive advertising.

These tools are used to “mislead the public such that even the most extravagant absurdities of EM might appear more plausible. Collectively they help foster and perpetuate a culture of unreason that is essential for EM to thrive.”

Ads for a vast number of bogus alternative medical products and services have cropped up since the advent of the COVID-19, faster than the authorities can alert the public or warn the purveyors about their illegal activity. The best defense is: Don’t be a sucker!

The truth is there is no such thing as alternative medicine (no matter what name it goes by); there is only medicine that works and medicine that doesn’t work. All these tricks, alluring words and excuses do not change that fact. Lack of critical thinking in this area can lead to a waste of money, but worse, real harm to you or your family.

Don’t Be a Sucker

Last week I received an email where the subject line included the words “immune system.” There was something in the message about clicking on a link to unsubscribe. It was obviously either a promotion for a fake product or a phishing attempt. In any case, I sent it to the spam folder without opening it. 

Even if there were no link attached, it would have suffered the same fate. Anytime you see words like “boosting your immune system” or “promotes healing,” put your hand over your wallet and run away! It’s surprising how many people still don’t get it.

Marketing of these products has ramped up as the threat of the coronavirus pandemic hit the US. In fact according to this website, the airwaves and Internet are already overrun with bogus products and fake cures. “The Federal Trade Commission (FTC) and U.S. Food and Drug Administration (FDA) have sent warning letters to seven companies allegedly selling unapproved products that may violate federal law by making deceptive or scientifically unsupported claims about their ability to treat coronavirus (COVID-19).” 

These companies and others are pushing products, running the gamut from teas to essential oils to colloidal silver and other supplements, as being able to treat or prevent the disease. By law all such substances must state in their advertisements that they have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease. Most do, but some, like the ones in the article, get into trouble when they fail to comply. 

In any case, there are not yet any treatments for coronavirus nor is there a vaccine to prevent it. Even without the disclaimer, it should be clear that these are scams. Here, for example, is what Mayo Clinic says about colloidal silver. “Colloidal silver isn't considered safe or effective for any of the health claims manufacturers make.” It doesn’t work for coronavirus or any other condition and may be harmful.

It takes almost no effort for critical thinkers to find flaws with the products and supposed health services listed. The truth should be common knowledge by now. (See any of my many previous entries debunking the benefits of dietary supplements, starting here.) References in the above article to a “naturopathic doctor” or to renegade chiropractors falsely claiming some power against the virus should raise red flags. 

But instead panic buying of supplements, or what this site refers to as “immune products,” in the wake of the coronavirus scare is leading to supply shortages and higher prices.

The expression “There’s a sucker born every minute” is often attributed to P.T. Barnum, but there is no evidence that he ever said it. It may have been said by any number of other people and is commonly heard and understood in the 21^st century.

I have no respect for these companies pushing fake remedies. They all should be sent to the spam mailbox. The ones that fail to post the disclaimer deserve their problems with the government. The ones that post the disclaimer but still imply some medicinal power for their products are no better than modern day snake-oil salesmen looking for the next sucker. Those who still believe in what NPR calls the Vitamin C myth or rely on other supplements, essential oils, reiki or other alternative medicine for their health needs may as well be handing their money to a witchdoctor for all the good it will do them.

Wise up. Don’t be a sucker.

Added Note: It is helpful to remember we are all in this together, except apparently for the news media, doing all they can to highlight the negative aspects of the disease and the efforts to combat it to promote fear and anxiety.

Opposing Views on Alternative Medicine

The Association to Protect the Sick of Pseudoscientific Therapies (APETP in Spanish) was formed by victims of those therapies along with scientists, doctors, nurses, physiotherapists, computer scientists, lawyers, and many other credentialed health professionals to fight against the rise of unproven alternative medical practices in Europe. They recently published a manifesto to “raise awareness in the media about the problem of pseudo-therapies and the position of the scientific community against them.”

They feel strongly about the dangers and deception of these practices. “More than 150 pseudo-therapies have been identified as being in use throughout Europe. Thousands of citizens’ lives depend on this being prevented. In fact, according to a recent research, 25.9 % of Europeans have used pseudo-therapies last year. In other words, 192 million patients have been deceived.”

They do not list all 150 in the manifesto, but summarize a few. “Homeopathy is the best known pseudo-therapy, but it is not the only one nor the most dangerous one. Others, such as acupuncture, reiki, German New Medicine, iridology, biomagnetism, orthomolecular therapy and many more are gaining ground.” They claim that these are not only unproven, but they distract patients from seeking professional help when desperately needed. They are calling for legislation in countries around the world to combat their spread. 

In the US, practitioners of these therapies are not allowed to advertise or otherwise imply that their products can “diagnose, treat, cure or prevent any disease or any other medical condition,” but the government has not considered consumer protection legislation. In fact, the FDA and other agencies are easier on these products and practices than they are on prescription medicine in terms of testing requirements for safety and efficacy.

Meanwhile, from halfway around the world comes another example of what that group is fighting against. 

In response to the Coronavirus outbreak and WHO’s warnings, a branch of the Indian government, the Ministry of AYUSH, issued an advisory based on traditional medicine.

The first part of the release gives the typical good advice on how to behave in this environment: maintain personal hygiene; wash hands frequently; drink enough water; avoid touching your eyes, nose, and mouth; avoid close contact with sick people; stay home when sick; cover your face if you cough or sneeze; and use a mask in public places.

But next they recommend “ways and means of prevention of Coronavirus infection through Homoeopathy” and use of a variety of Unani medicines for “symptomatic management of Coronavirus infection.” (This would be illegal in the US but it is government-sponsored in India.)

Unani medicine, not common in the West, is “a form of alternative medicine, which is based on the belief that the human body contains four humors, and that imbalance of these four humors is the cause of disease,…created by the ancient Greek physician Hippocrates, which later spread to the Islamic empires...during the Middle Ages. While this belief has no scientific basis, contemporary adherents still try to propagate these beliefs as science.” [Source: Wikipedia]

 An editorial in the Times of India decried the government advisory: “When all the authorities including World Health Organization claim there is neither any vaccine nor any treatment for coronavirus, the government is promoting unproven therapies to lull people into a false sense of security that they can be safe if they consume such concoctions.” Dr. Misba Hul Bashier added on Twitter that “loads of patients developed acute liver and kidney failure due to alternative medicines.”

Of course, recommendation of useless or even dangerous steps driven by fear of the virus is not limited to the Indian government. A Canadian news story cites “quack remedies and vaccine conspiracies – a global deluge of misinformation” including a recommendation on Facebook to drink a household disinfectant and another source claiming that a saline solution, salty water, can cure it.

What can we do when misinformation abounds – petition the government for new regulations like the Europeans? Critical thinking would be a lot easier and less intrusive by trusting real evidence rather than endorsements and recommendations.

Flashback - The Homeopathy Scam

[It's Friday and time for another flashback. This time we go back to April 2015 when I ask, does homeopathy really work? Since then I have posted a few more times on the same subject. All of that research comes to the same conclusion. No, it doesn't. Here is the original.]

In a widely circulated article from the Guardian newspaper, the news from Australia is that it does not. The headline reads: “Homeopathy not effective for treating any condition, Australian report finds.” After a thorough and extensive review of over 200 research papers on the subject, the National Health and Medical Research Council (NHMRC) states: “there are no health conditions for which there is reliable evidence that homeopathy is effective.”

They go on to warn that people who use homeopathic medicine as an excuse to delay or avoid professional medical help may be putting their lives at risk.

What is homeopathy? The article describes it as the belief “that illness-causing substances can, in minute doses, treat people who are unwell,” and by diluting them in water or alcohol, “the resulting mixture retains a ‘memory’ of the original substance that triggers a healing response in the body.” That is the theory.

Wikipedia defines it as “a system of alternative medicine created in 1796 by Samuel Hahnemann based on his doctrine of like cures like, whereby a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people.” 

The fact that it is not effective is certainly not news as the first paragraph of Wikipedia entry immediately goes on to say: “Homeopathy is considered a pseudoscience. It is not effective for any condition, and no remedy has been proven to be more effective than placebo.” References associated with this conclusion date back to 2000 and earlier. It was known for a long time, but the fact that any government agency has come out so strongly against it is new.

The industry has a different take. The National Center for Homeopathy tells us: “Homeopathy is a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health.... It is extremely safe to use, even with very small children and pets, has none of the side effects of many traditional medications, is very affordable, is made from natural substances, and is FDA regulated.”

This British source sees it differently. After an extensive explanation of the theory behind it they describe it as being rooted in superstition, ritual and sympathetic magic; and cite a comprehensive study from 2005 showing that it is ineffective. For the theory to be true “we would have to toss out practically everything we have learned over the past two centuries about biology, pharmacology, mathematics, chemistry and physics.”

It seems many people disagree with the industry portrayal. Many studies have shown it as ineffective, but what about the claims of safety and regulation? The US Government’s National Center for Complementary and Alternative Health states: “We have a fair amount of research on homeopathic medicine for a variety of conditions, but less evidence on its safety, particularly for over-the-counter products.” The FDA “doesn’t evaluate these products for safety or effectiveness” and “some contain ingredients or contaminants in amounts that could cause side effects, drug interactions, or other safety concerns.” [Note: As of November 2019, no homeopathic products have been approved.]

If potential contaminants along with the ingredients are diluted beyond the point of detection, usually the worst outcome would result from people relying on homeopathy to the exclusion of professional medical help, especially if they avoid vaccinations.

So what’s the big deal? It’s just people again throwing away money on products that have been known for years to be ineffective. But when a company gets you to pay money for something that doesn’t work, how can that be legal? Doesn’t the government also have an agency to protect us from our own foolishness, like credit card scams, payday loans and fraudulent vacation schemes? Out of curiosity I asked, “Where does the government’s Consumer Protection Agency stand on all of this?”  

Their website lists under the heading “Current Scams That You Should Be Aware Of” the following categories:  Benefits and Grants, Business, Cars, Citizenship and Immigration, Computers and Internet, Family, Home, and Community, Health and Nutrition, International Relations, Jobs and Education, Money, and Travel and Recreation. A closer look at the Health and Nutrition link shows no mention of homeopathy (but there are a large number of other very interesting topics where Americans have been sold worthless or dangerous products). Until there are enough complaints on this topic, I guess we are on our own.

The government can’t (or won’t) protect us from sellers of every product or service that takes our money and give us only promises in return. Again critical thinking and just a little research can eliminate a lot of wasted time and money and possibly keep us safer.

More Food For Thought

Almost three years ago I wrote about the widely advertised supplement, Prevagen. The Federal Trade Commission (FTC) challenged the company’s claims about the product’s safety and effectiveness in improving memory. That FTC action followed a number of warning letters to the company from the FDA expressing similar concerns.

Supplements in general cause regulatory headaches for the FDA. “In 1994, the Dietary Supplement Health and Education Act (DSHEA) defined dietary supplements as a category of food, which put them under different regulations than drugs. They are considered safe until proven otherwise.” (I wonder how many lobbying dollars were spent on that law.) The government may stop a company from selling a supplement if they can prove it “poses a significant risk,” that is, usually “only after they cause harm” to customers. Even then they may face a fight.

Because they are not drugs, rigorously tested for safety and effectiveness, at the end of their advertising they are required by law to carry the disclaimer, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent disease." Many get around this by making weak promises such as the supplement reduces the risk of certain health problems or it promotes a healthy condition. 

As far as that one and others that claim to improve memory, the Alzheimer’s Association finds such products, not approved by the FDA to be particularly troubling. “One of the biggest problem areas for unsubstantiated claims are dietary supplements...that claim to be beneficial for Alzheimer’s or other dementia symptoms.” But the promotion of these products and introduction of new ones hasn’t slowed down. “In the past five years, the FDA has issued more than 40 warning letters to companies illegally marketing over 80 products claiming to prevent, treat or cure Alzheimer’s disease.” Furthermore, the FDA recently warned that cognitive enhancement supplements “may be ineffective, unsafe, and could prevent a person from seeking an appropriate diagnosis and treatment.”

Now the problems and dangers surrounding the sale of supplements to prevent memory loss or to improve memory has been raised again in the November issue of JAMA Internal Medicine. A research team tested for the presence of Piracetam, a supposed brain-enhancing substance that “is not approved as a drug and is prohibited as a dietary supplement ingredient in the United States.” They found inconsistent labeling with errors ranging from 85% to 188%. This substance has known adverse effects including: anxiety, insomnia, agitation, depression, drowsiness, and weight gain.

These marketing techniques are truly unconscionable. They make every attempt to prey on older Americans who are already scared at the prospect of contracting some form of dementia by the ads, news stories, shared experiences of friends and personal experience with elderly relatives. Some are concerned about the prospect of mentally fading away. Others worry about being a burden on their family. 

Feelings of anxiety every time a name or fact is not at one’s finger tips make it easy to fall into the trap of buying these unproven products with the hope that maybe it really works. Action of the placebo effect on friends and acquaintances whose minds have fooled them into believing in it compound the problem. But reading and understanding the fine print that follows the ads and knowing that now there's a possibility of some products being adulterated with unapproved drugs should act as sufficient deterrent to critical thinkers.

It Doesn’t Take Much

A number of weeks ago, one of my loyal readers sent me an email with this excerpt of an article on homeopathy saying I might find it interesting. 

“Something like 5 million adults and 1 million children use homeopathy, remedies that, in fact, contain no discernible amounts of the active ingredients…. Analysts project that the global market for homeopathic treatments will rise 12.5 percent by 2023, and already it’s a $1.2 billion industry. People are beginning to feel cheated: a nonprofit suing Walmart and CVS for hawking such snake oil conducted a survey that found 41 percent of people feel negatively about homeopathy when they learn about the pseudoscience behind it.”

I did find it interesting. I was familiar with the lawsuit mentioned and had referred to it earlier. But this time what struck me was the data from the survey. If 41% are willing to change their minds (and feel cheated) when presented with the fact that there is no science behind homeopathy, that means 59% were unmoved even in the face of good evidence. They were that strongly committed to their opinions. From a critical thinking standpoint, this is very disturbing. Why look for evidence just to ignore it?

My reader thought that those 59% were in trouble, but I responded that we are all in trouble. When more than a majority hold any particular opinion, it is so easy for that to become policy. Cowardly politicians, primarily interested in job security, will go along with any crazy idea.

This phenomenon is not limited to homeopathy or alternative medicine. When I looked through articles on the Post Truth Culture and ignored those that spin the erroneous notion that it began with the Trump presidency, I found this interesting opinion piece arguing that the source lies in the ideas of individual freedom and the trend toward personalizing every experience: especially things like clothing, entertainment and tattoos.

“If you take this culture of hyper-individualism to its extreme, one might come to believe that we have the right to believe whatever we want, to – even if those beliefs are immediately provably untrue… Freedom to believe in one's own, individual universe; freedom to pick and choose facts, and discard those that are disagreeable.”

So we continue to see headlines like this one from last month: “Kindergarten Vax Exemption Rates Up – Again.” The science doesn't matter when people can personalize reality.

Likewise in politics, some recent research shows that “party identification bests ideological identification. And most people will stick with their party long after they’ve abandoned their ideology.”

Critical thinkers would work out their ideological beliefs first and then support the party or candidate that best fits them. They would begin by deciding where they stand on issues before committing.

“The truth, it seems, is closer to the reverse: We choose our party for a variety of reasons – chief among them being the preferences of our family members, core groups, and community – and then we sign on to their platforms.” 

What’s even scarier than this total disregard for information and facts by vast numbers of people is that it takes only a few people, not close to a majority, or a few incidents to incite calls for new laws or even mob action.

In one example, in response to the death of an Indiana woman from strangulation by her pet boa constrictor, the Humane Society of the United States called for legislative action. The news item tells, “at least eighteen people have died from large constrictor snake related incidents in the United States since 1978 – 13 of those since 1990. If less than one death every two years calls for a new law, what of the 350 children who drown in swimming pools each year? 

Another is the legal battle between Oberlin College and a local bakery featured on CBS Sunday Morning. A shoplifting incident by an African American student led to protests and accusations of discrimination and white supremacy, resulting in a substantial loss of business for a local family-owned store. All it took was a few activists using social media to spread a slanted story.

There are so many other examples where a minor action, incident or comment gets people up in arms, demanding changes, revenge or satisfaction, often based not on the facts or intention, but on the firm beliefs of the group. No amount or logic, reason or science will persuade them to change their minds.

Can You Trust Your Pharmacy?

A recurring comment in the script of an episode of an old TV Western (Maverick, 1958) was the line, “If you can’t trust your banker, who can you trust?” The modern day equivalent of that could well be, “If you can’t trust your pharmacy?” This is nothing against the pharmacists, who studied hard to be licensed. There is no evidence of them not giving accurate advice. The displays in the store itself along with some other corporate and industry practices, on the other hand, can and do imply things that aren’t true. Two recent news items act as a good reminder.

The first is about an on-line survey of 1000 Americans published in August, sponsored by the Center for Inquiry (CFI) and conducted by Lake Research Partners. The survey centered on people’s general trust in their pharmacy at Wal-Mart and CVS, and more specifically their feelings regarding homeopathic medicines at those pharmacies.

They chose these pharmacies because both corporations face a lawsuit over their practice of selling homeopathic medicine side by side with science-based remedies. CFI believes it is deceptive to imply that they are as effective as regular OTC cough, cold and other remedies, when they have “no medical benefits beyond that of a placebo.”

There is, in fact, broad agreement on this point. “After a thorough and extensive review of over 200 research papers on the subject, the National Health and Medical Research Council (NHMRC) [of Australia concluded in 2015]:  “There are no health conditions for which there is reliable evidence that homeopathy is effective.” (For a thorough explanation of homeopathic medicines click the link.)

That survey of Wal-Mart and CVS customers asked them about how they make their purchasing decisions for cough, cold, and flu remedies at the two stores “and about their general knowledge of the basic principles of homeopathy, an 18th-century pseudoscience that has been utterly disproven.” The survey showed that exposure to this new information about the failures of homeopathy in so many independent studies led consumers to have to negative feelings about the products and the companies selling them. More than 4 in 10, “described their feelings about the purchase of a homeopathic remedy in deeply negative” terms.

Remember, one of the companies, CVS, still talks about how proud they are of the decision to discontinue tobacco products five years ago and believe it shows their concern about the health of their customers. Tobacco sales were profitable, but ultimately stood in the way of them being considered “a trusted health care provider.” According to their CEO, they strive to be in the same class of business values as TOMS shoes (which donates shoes to African countries providing unfair competition to African small businesses trying to survive by selling shoes – but that kind of unintended consequence is a topic for a different time). If they value their reputation for being a healthcare resource, one would think they would be as concerned about the accurate representation of their products.

But if you can’t trust your pharmacy about the product displays, what about the prices?

That leads to the second news item. A lawsuit filed in August by PharmacyChecker.com accuses “The National Association of Boards of Pharmacy (NABP), LegitScript, and three Pharma front groups [of] operating a coordinated campaign to suppress market competition, artificially inflate the price of prescription drugs, and spread misinformation to scare consumers away from international online pharmacies.” 

PharmacyChecker.com verifies the reliability of international online pharmacies and compares their drug prices to allow consumers to be confident about their on-line purchases and to inject competition into the prescription drug market. They allege in the lawsuit that those organizations have conspired with Google, Microsoft and others to lower their page on search results and in some cases to display a warning box when the page is opened.

Companies and industries do many things to protect their business and to make a profit. Consumers have to do many things to protect themselves. Mostly it involves research and critical thinking, especially when health and healthcare costs are concerned.

Ancient Chinese Folly

There is something fascinating about ideas that are ancient and Chinese. They are in the same category as all-natural, sustainable and organic. People take them on faith, feeling that research is unnecessary, while risking the loss of time and money; and sometimes putting themselves at risk.

Take acupuncture for example. I am always skeptical of treatments that boast a cure or relief from multiple conditions. Just one example is listed here. “Health benefits of acupuncture include relief from chronic pain, arthritis, anxiety, insomnia, depression, migraine, nausea, postoperative pain, and obesity.” 

This other website adds to the list: nausea, sciatica, sinus congestion, stress, tinnitus and tobacco addiction. But then they go on to describe several recent research results in not very glowing terms. In 2017 authors reported limited evidence that acupuncture is modestly effective for acute low back pain. A 2016 review of 22 previously published trials concluded that adding acupuncture to standard treatments for migraines “may reduce the frequency of episodes, however the size of the effect is small when compared to a sham acupuncture treatment.” A 2016 review of 12 trials found that it may help people with frequent tension headaches. And another analysis “it appeared to provide only short-term(up to 13 weeks) relief” for people with chronic knee pain.”

One puzzling comment was that after the treatment “some people feel relaxed (or even sleepy), while others feel energetic.” One treatment with opposite outcomes may indicate a strong placebo effect.

Not many sources list the side effects of acupuncture. Since it’s ancient and Chinese many will automatically assume that it is only beneficial. But the treatment “can cause serious adverse effects, such as infections, nerve and blood vessel injury, complications from needle breakage or remnant needle pieces, punctured organs, central nervous system or spinal cord injury, hemorrhage, and other organ and tissue injuries resulting in death. Punctured pleural membranes around the lungs can lead to collapsed lungs.”

A study from China in 2015 claiming acupuncture is effective for treating the symptoms of angina was published only a few weeks ago. It received a harsh critique based on the time delay, lack of studies replicating the result, failure to use a double-blind design, the subjective nature of the results and that all authors were affiliated with schools of acupuncture or Traditional Chinese Medicine.

A report from 2013 states that “after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant.” Since then as we see above, evidence of effectiveness continues to be weak.

I always wonder why so many people, who mock those that don’t agree with them on climate change as being as unscientific as flat-Earthers, unquestioningly put their faith in these treatments and cures, some even crazier and more dangerous than acupuncture.

The BBC reports on a case from the Journal of Obstetrics and Gynaecology Canada of a 62-year-old woman who, on the advise of her traditional Chinese doctor, sustained severe burns when she tried vaginal steaming in an attempt to avoid surgery for a prolapsed vagina. “Vaginal steaming, which involves sitting over a hot water and herb mix, has seen a growth in popularity” and is “now available at some salons and spas.”

The practice began to gain popularity in 2010 and has been endorsed by Gwyneth Paltrow as a detox and cleansing treatment – those two words alone should scare off clear thinking Americans. Last year Chrissy Teigen, who tweeted under a picture of herself trying it, “no I don’t think this works but it can’t hurt right?” No, wrong! Ask a doctor rather than a model or movie star and you will get the opposite answer on all claims.

Once again, lapses in critical thinking are so obvious. There is no such thing as alternative medicine. There is only medicine that works and medicine that doesn’t. In the war between science and fairy tales, the fairy tales are winning.

Cancer is Nothing to Toy With

Last week some troubling news came by way of a Harris Poll conducted for the American Society of Clinical Oncology. Based on a sample of 4,038 adults and an additional 849 cancer patients, they found that 39% strongly or somewhat agreed with the statement, "Cancer can be cured solely through alternative therapies, without standard cancer treatment(s)" despite clear evidence that those patients “have much higher mortality rates.” Another  statement, "Alternative therapies are a good supplement to standard cancer treatments(s)," reached a level of 75% overall agreement. 

Some experts commented that the high level of agreement likely was due to strong promotional efforts by the alternative and complementary medicine industry combined with a weak public understanding of science. The opposite of alternative medicine is called evidence-based medicine. In the latter case there is evidence from well-conducted experiments to back up the efficacy of treatment; in the former there are only stories, endorsements, myths, legends, ancient wisdom and uncorroborated, so-called clinical trials. To paraphrase one doctor, “There is no alternative medicine; there is only medicine that works.” (Late addition, 11/20/2018: Spain plans to ban alternative medicine in health centres.)

Walking down the vitamin and supplement aisle of any pharmacy or grocery store exposes the shopper to a wonderland of miracle cures and preventive pills and potions. The only problem is that many studies have shown them to have little or no value (unless prescribed by a doctor for a specific need). And news about supplements found to contain little or none of what’s printed on the label, and sometimes containing dangerous substitutes comes out periodically. A law passed decades ago with a boost from the nutritional supplement lobby ties the hands of the FDA until after problems are reported. 

The industry survives on heavy promotion, a vast amount of shelf space and the placebo effect. But cancer is serious business and should be treated as such.

Here is a case in point involving Robert Young, author of the bestselling pH Miracle books. Sixteen months after going to jail for practicing medicine without a license he has been ordered to pay over $100 million in a civil trial brought by one of his cancer patients. Her suit alleged negligence and fraud after he advised her “to forego chemotherapy and traditional treatment, and instead go with treatment in line with his alkaline theories.” She now has stage four cancer and her oncologist gives her three to four years to live.

The 39% who say they would do this on a survey may be overstated. When it’s life and death people will make more considered decisions than when checking a box on a Harris Poll. But it does happen and every instance is unfortunate and avoidable.

I have advised many times in the past that words like miracle in "health" ads are clear warning signs of something fishy. After Young was found guilty of two counts of practicing medicine without a license, to avoid further jail time he “had to make a public admission [in court] declaring that he is not a microbiologist, hematologist, medical or naturopathic doctor or trained scientist." He may have been sincere about his belief in his miracle cure, but he had no evidence to back it up – as it turns out, and to the distress of his patient, he had just the opposite.

I like people to be able to do what they want with their time and money. If they want to throw it away on dubious pills, oils or ancient remedies, let them be. But when it comes to serious illnesses like cancer, please apply some critical thinking, and stick with real medicine from trained doctors. The odds are so much better.

Fake News Goes Non-political

Not too long ago, when you heard the expression “fake news” the assumption was that the speaker was talking about politics. That seems not to be the case any more.

This thought struck me as I came across a story on the fastcompany.com website with the headline: “Facebook deletes alternative health pages as the war on fake news escalates.”

The move began in the spring of this year, but few noticed except the advertisers who were suddenly being blocked. It appears that Facebook views several of the promoters offering alternative or holistic medicine as purveyors of pseudoscience, declaring them possibly as big a danger to the public as election tampering. “This includes rather large accounts focused on health, natural remedies, and organic living, such as Just Natural Medicine (1 million followers), Natural Cures Not Medicine (2.3 million followers), and People’s Awakening (3.6 million followers). Small accounts with under 15,000 followers were also hit.” Another affected company was Conscious Life News with 1.1 million followers.

The article goes on to say that these and similar complementary and alternative health pages “have been known to spread misleading or false information about medicinal remedies that are not backed by traditional science, or debate issues like vaccination.”

The subject of vaccinations is of particular interest for two reasons. First, Russian bots have been targeting both pro- and anti-vaccination advocates with on-line posts in an attempt to stir up controversy and conflict. Second, the recent increase in outbreaks of measles, mumps, and pertussis among unvaccinated children has “increased mortality from vaccine preventable diseases.”

But this brings up a couple of interesting questions. Why is it Facebook’s job to police all the false information on their pages? And, shouldn’t people be able to figure out for themselves whether their choice of medicine is effective or not?

Neither has an easy answer. Facebook has passed the point where they can declare themselves a communications medium, not responsible for content. The phone companies aren’t held responsible for what you say to a friend, but they also don’t run advertising during your conversation or otherwise try to influence you. That leaves Facebook in an awkward position.

According to the numbers shown above, millions of people are looking for magic answers in the areas of health and wellness. Many don’t care what science says and don’t make good choices.

Over the past three weeks I have seen numerous reports such as these:

• A doctor placed on probation by the Medical Board of California for four years even though she “received testimonials from celebrity patients…and has promoted [her questionable therapy] on the Oprah Winfrey Network.” Unfortunately celebrity testimonials are not the same as scientific evidence. 
• Crowd funding for patients to receive dubious cancer treatments with much fanfare, although after treatment “many publicized success stories have a tragic ending,” a fact that  is not widely publicized.
• After Federal Trade Commission (FTC) action, an intravenous vitamin cocktail marketer agrees to stop making deceptive health claims.
• The Texas Medical board required a promoter of the multiple chemical sensitivity concept “to revise the form he used to obtain consent to treat patients with injections of environmental substances. The form was required to state that (a) his injections contain only the ‘electromagnetic imprint’ of the agents in question, (b) the therapy is not FDA-approved, and (c) the therapeutic value of the therapy is disputed.”

See several more examples from this RAS post in June 2016.

I have argued in the past against too much consumer protection. Let people make informed choices. But the information above shows that some promoters, even medical doctors, will get away with as much as they can to dupe patients into undergoing unproven treatments until a medical board or the FTC is forced to step in.

Critical thinking should at least make everyone wary enough to shun those who try to avoid legal problems by burying wording in the fine print, “Not approved by the FDA and not intended to diagnose, treat, cure or prevent any disease or any other medical condition.” But even with the help of Facebook, people looking for easy answers and who don't care about science will still be at the mercy of liars and charlatans.

Real Medicine

There is no such thing as alternative medicine.  There is only medicine that works and medicine that doesn’t. (Paraphrased from Dr. Harriet Hall’s excellent lecture series on YouTube.)

 I’m reminded of this wisdom when I hear news like this from NBC. “Complementary therapies may sound good, but they don't cure cancer.” Last Thursday researchers published the results of a study showing that “cancer patients who choose alternative medicine over standard, proven cancer treatments are more likely to die.”

The practice of using herbs or meditation is fairly common among cancer patients and may make them feel better and more at ease; but it does nothing to cure the cancer. People who rely solely on complementary medicines are more likely to opt out of proven treatments and twice as likely to die from the cancer.

The study also found that those who relied on alternative cures tended to be younger women with more education and more money. This is an exception to data showing that the poor generally have worse outcomes. It is only natural to look for a gentler, less intrusive solution, but better-informed people should know that doctors and the FDA “have warned for years that unproven treatments may lure patients away from legitimate therapy that can save their lives.”

That last sentence is interesting in light of another recent piece of medical news. “The Center for Inquiry has filed a lawsuit in the District of Columbia on behalf of the general public against drug retailer CVS for consumer fraud over its sale and marketing of useless homeopathic medicines.” Their objection is that CVS sells homeopathic products side by side with scientifically proven medicines, leading customers to believe that the products are as effective as standard remedies for pain, insomnia, and cold/flu symptoms.

The Center for Inquiry (CFI) characterizes homeopathy as “a total sham” and explains their reasoning. Of course, they are a skeptical group, and this opinion would be expected. However, the experts come down on their side. “The FTC declared in 2016 that the marketing of homeopathic products for specific diseases and symptoms is only acceptable if consumers are told: ‘(1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.’ And last year, the FDA announced a new...policy of regulatory action against homeopathic products.” (It's only the CAM lobby that deflects stronger action.)

 Isn’t this CVS that seems to endorse homeopathy as legitimate medicine the same CVS that made headlines a few years ago by refusing to sell tobacco products, because they cared so much about our health?

That’s right. And now they are trying to take credit for a 1% decrease in the number of packs of cigarettes sold in 13 key states where they do business. But critics of the CVS claim see it a little differently and don’t think CVS should get much credit for the improvement.

With such a small percentage of the market, most analysts don’t believe the CVS claim that smokers made the switch from cigarettes to “mostly ineffective nicotine patches and quit smoking. [It] only illustrates how little the company knows about the difficulty of quitting." With so many smokers trying to quit anyway, it’s hard to believe the CVS decision had much influence.

CVS counters that their studies show an impact on public health. Also, a spokeswoman adds that the company is trying to drive impulse buying away from the traditional junk food by “placing healthier foods – such as yogurt and fresh fruit – in key locations in the front of the store.” But they still place homeopathic products under signs that imply real curative power when CFI, the FTC and the FDA see a problem with that.

CVS and many others try to convince us that they are really interested in our health while they sell ineffective homeopathic products, dietary supplements and "alternative" medicines.  I wouldn’t trust them with my health decisions, but I’m a critical thinker.

More Junk Science

Almost everyone is interested in making money and possibly even becoming rich. One way to do this is to offer others a product or service that makes their lives easier.  We buy bread at the store or at a bakery because we save the time it would take to bake the bread and the people who work there are usually better at it. The same general concept applies to almost all grocery items, entertainment, furniture and household appliances, vehicles, and everything else we buy. By exchanging goods and services in this way, we are really exchanging talents, each doing something for others thereby allowing them to use their talent to our benefit.  We use money to keep track of most of these exchanges.

Economic understanding leads to the conclusion that we can all be better off, enjoying a higher standard of living. By this talent exchange, everyone playing his or her role, the economic “pie” gets bigger and everyone benefits.

Another way to get rich is to fool people into thinking that a product or service will make their lives better, selling them something of little or no value for a price that is justified only by the hype. This is widespread, but is particularly common in the areas of health and diet. It is also not new. Medicine men and snake oil salesmen date back centuries.

When we patronize these businesses, we are parting with money that could be used for a real benefit and getting nothing of value in return. How can the standard of living improve when people are spending on lies and false hope? Somebody is getting rich, but they are not doing it by making lives better. Their talent is persuasion, and they employ all the tricks.

I am reminded of this when I see articles represented by this series of headlines from a newsletter called Consumer Health Digest, which is published weekly to warn of medical frauds and to expose some of the wrongdoers.  Here is just a sample:

• “Former holistic nutritionist confesses" that what she had learned in school and practiced for many years was based on “limited education” and a “lack of respect and understanding for real science.”

• “QLaser marketers sentenced” to 12 years in prison for selling “medical devices with false and misleading labeling in order to defraud consumers,” in one case to the tune of at least $16,669,015.

• “Funeral homes failing to disclose pricing information” – some do not offer the information as required by the FTC intended to keep them from taking advantage of grieving families.

•  “Beautician sentenced for illegal buttocks enhancement injections” to 24 months in jail for “receiving and delivering an adulterated and misbranded medical device” while charging thousands of dollars per treatment.

• “Studies Show that Liberation Therapy for Multiple Sclerosis Doesn't Work.”

•  “Discredited, alarmist HPV vaccine study retracted” – A journal retracted an article incorrectly blaming the vaccine for side effects such headaches, fatigue, and poor concentration based on a few anecdotal reports.

This is just a sample from 3 weeks of newsletters, but should serve as a reminder of the importance of critical thinking in the area of healthy living and medicine.  There are people out there, just as there have always been, more than willing to take your money based on false promises and magical answers.  As technology moves forward we get more real cures and procedures that seem miraculous, but that opens the door for even more sophisticated charlatans ready to take advantage of the desperate, the lazy, the unscientific and those who put their faith in unproven methods.  We can’t and shouldn’t expect the FDA or the FTC or some consumer protection organization to have our backs in every case. Sometimes critical thinking is nothing more than looking out for yourself.

The More Things Change...

The old saying is true: the more things change, the more they remain the same.  But today we must be far more careful than ever when facing old-fashioned threats.

This thought came from a new book I picked up at the library.  It's called Quackery:  A brief history of the worst ways to cure everything.  It contains several short sections, each covering one of the weird and often painful or disgusting medical practices of the past.

On page 47 in the radium section, I was stunned by the familiarity of ideas.  “Despite the passage of the Pure Food and Drug Act in 1906, radium remained entirely unregulated because it was classified as a natural element.  (Many today still make the automatic assumption that a natural substance is always pure, useful and has no side effects.)  Because it was natural and unregulated guess what happened.  “Advertisements sprang up in newspapers touting the ability of this radioactive and sometimes deadly element as, for example, an aid to youth and beauty, health, and relief of aches and pains in joints and muscles.”

Radium is related to radon gas, and you can’t buy or sell a house without an inspection confirming safe levels, because it can cause lung cancer.  Radium in general is dangerous and anything but healthy, so this is an extreme example, but it did remind me of a couple of my comments posted at the beginning of this year about raw water, which can be dangerous, and hydrogenated water, which is expensive and backed by weak science.

 The following week I featured some of those miracle cures in newspapers that promise instant results and portray themselves as such a threat to Big Pharma that behind the scenes moves are supposedly afoot to banish them from the market.  (So you’d better act fast!)

And in December I wrote about the British National Health Service no longer paying for what they consider low value treatments including:  homeopathy and herbal medicines, fish oil, glucosamine and chondroitin combination products and lutein and antioxidant combination products.  The NHS reject these and some others as having low clinical effectiveness, with scant scientific backing while presenting significant safety concerns.

The next paragraph in the Quackery book tells how radium was so expensive that most of the so-called radioactive products “did not actually contain any radioactive ingredients at all.”  Instead of buying a dangerous product, they were buying a worthless product relying on placebo effect for its curative powers, a fact that doubtless saved lives but still emptied pocketbooks.  We see the same advertising schemes and mislabeling today.

These tactics of taking an unregulated substance and touting its supposed miraculous health benefits have been going on for years.  But the promotions today are even more insidious.  They go to the very edge of their legal boundaries, using scientific sounding words, enthusiastic endorsements and often trying to pass as news articles while burying required disclaimers at the end in small print.  The speed and breadth of communications in the modern world, as I explained last time, distributes misinformation quickly.  Particularly in the case of health issues, dangers are compounded by the fact that diseases and conditions may clear up on their own fooling users into attributing a cure to a worthless product.  That’s why listening to friends who swear by the effectiveness of this or that cure is so problematic.  Finally, as this Scientific American article on fake news points out, the more you hear an idea or opinion, the more familiar it becomes and the more you tend to believe it, even if you already know better.

Things stay the same, but in this modern age critical thinking, being skeptical and doing good research from reliable sources are much more urgently needed to protect your health and your wallet.