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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Another Health Scam

With the coronavirus leading every news broadcast, the networks have begun also to highlight the prevalence of false claims, fake cures and scams. To make the point that this is not new, CBS Sunday Morning (4/26) addressed the history of fake medicines and cure-alls, but was disappointingly vague on some of the current scams, ones people fall for every day, probably from fear of offending both promoters and viewers. They did, however, include a few comments from Dr. Stephen Barrett who pulls no punches in his criticism of modern scams.

In one of his latest investigations into junk medical science, Dr. Barrett addressed a process known as bioresonance hair testing. Practitioners use a device "based on the pseudoscience of radionics to analyze hair samples mailed in by customers" to "detect nutritional deficiencies; overexposure to heavy metals; and food and environmental intolerances” to serve as a “roadmap to better health.” He calls the practice preposterous, in that “hair analysis is not reliable for evaluating the nutritional status of individuals” as well as giving several other reasons why it doesn’t work.

An earlier article on the same subject he warned its use by “chiropractors, nutrition consultants, physicians who do chelation therapy, and other misguided practitioners who claim that hair analyses can help them diagnose a wide variety of health problems and can be used as the basis for prescribing supplements.” 

Since bioresonance is based on radionics, it gets even more “preposterous.” These theories supposedly rely on quantum entanglement, a central principle of quantum physics where information can be transmitted instantaneously at a distance apparently violating the speed of light. Quantum physics is arcane and incomprehensible to non-scientists, yet many questionable products use it to explain action at a distance to add a scientific-sounding aura to their sales pitch. But it's all bogus.

Then it gets more unrealistic. According to this site, “Radionics can be used for humans, animals and agriculture by means of radionic instruments which amplify and 'balance' the subtle energy field of the subject” by using “a photograph, hair snippet or other biological sample.” It works best with a good quality digital photograph because “the image stores the information of the subject and a digital file cannot be contaminated like a biological sample can,” and the light “creates a crystallization of the energy matrix of the subject.” 

Another site says, it’s “a method of healing and diagnosing at a distance using the unique extra-sensory faculties of the operator supported and amplified by a physical instrument, device, geometric pattern, energy or substance.” Since “every person's energy patterns, frequencies, signatures, vibrations or rhythms are as unique to them as their fingerprints,” they can easily detect and help correct any type of “illness, injury, infection, stress, pollution, malnutrition, or poor hygiene.”

In summary, “patients” send a full digital picture or some strands of hair. "Doctors,” using their powers of ESP, run it through their energy detection machine, make a diagnosis based on an individual energy matrix, vibrations and rhythms and recommend supplements to cure what ails them, all using the magic of quantum physics. Remember, the same technique applies to their pets or their houseplants – with a separate charge for each.

But that’s not all! In some cases, their house may be causing the problem due to the presence of “geopathic stress,” which messes with the occupants’ health. That, too, can be cured at a distance by sending a photograph and using the above technique.

This seems so outlandish that I can’t help wondering who would be taken in by it. Then I see the statement that radionics can be a “supplement to other complementary and Subtle Energy therapies especially Homeopathy, Acupuncture, Reiki,” and it all becomes clear.

CBS might mock citizens of the nineteenth century for buying Stanley’s snake oil concoctions or for making a millionaire of Albert Abrams (1864-1924), developer of devices that were the precursors of today’s radionics, but they needn’t look far to find twenty-first-century parallels.

Arthur C. Clark wrote, “Any sufficiently advanced technology is indistinguishable from magic,” but come on, people! These scams are packaged as advanced technology and sold to people who want to believe in magic.

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.

Medicare for All – Part 2

With all the campaign promises about Medicare for all, I took the opportunity about two months ago to explain how Medicare actually works. Politicians give the impression that it’s a totally free health insurance program. Just walk into the doctor’s office or emergency room, tell them your number, get fixed up and leave with no expectation of receiving a bill. 

Real Medicare today is not like that at all. Why would they spend time on TV and in mailings advertising supplemental insurance that “helps pay some of the health care costs that Original Medicare doesn't cover, like: Copayments, Coinsurance, Deductibles”? Those extra costs can only be avoided by paying money up front as a premium for the additional insurance.

From recent news, though, it’s clear that this misimpression is not the only problem. Medicare fraud is another big issue. Sometimes this is a critical thinking issue where patients are lured in as unwitting participants. Sometimes it goes deeper.

Late last month, thirty-five individuals associated with dozens of telemedicine companies and laboratories were charged with fraudulently billing Medicare more than $2.1 billion for expensive cancer genetic tests. Nine of the defendants are medical doctors. “In addition, the Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI), announced…adverse administrative action against cancer genetic testing companies and medical professionals who submitted more than $1.7 billion in claims to the Medicare program.”

One of the defendants in this case, who cost taxpayers more than $1 billion in illegal Medicare reimbursements, “has been under near-constant federal scrutiny for the past five years and was supposed to have been deported more than a decade ago.” That was billions lost to fraud as a result of only one investigation, due in part to government inaction.

Meanwhile, the U.S. Department of Health and Human Services Office Inspector General has issued an alert to the public about other genetic testing schemes. Medicare eligible patients are offered a free genetic screening for undetected conditions, but the real motive is to get their Medicare information “for identity theft or fraudulent billing purposes.” The screenings are unnecessary and are usually denied by Medicare. When they are, the individual could be responsible for the entire cost of these useless tests, sometimes thousands of dollars. 

They get nothing but the promise of some new information about their health with the selling point that, as Medicare recipients, it may be free to them. This promise of something for nothing – free testing or free devices all paid for by Medicare – is used so often it’s beginning to sound stale, but it must be working.

Advice from the Inspector General is to not volunteer any information to these genetic testers, don’t stop at their booths at health conferences, ignore their ads, and return unopened any testing kits received in the mail.

Medicare fraud is a huge problem. The AARP reported in March of last year “roughly 10 cents of every dollar budgeted for the giant health insurance program is stolen or misdirected before it helps any enrollee. Looked at another way, about $1,000 is lost per Medicare member through theft or waste each year.” That estimate is based on government reports, but a leading expert from Harvard University believes the real number could be much higher, 20% or more.

AARP used the figure of $60 billion in fraud for the 2018 calculations cited above. Other sources show exactly the same estimate for 2015 and 2011. The number hasn’t changed in eight years. Apparently as fast as they can lock people up or put them out of business, more fraudsters spring up to take their place.

Would the general public as a whole be less likely to become victims of Medicare-for-All fraud schemes? That’s doubtful, and it leads to so much waste. 

The Latest Big Thing – CBD Oil

I began to wonder about CBD oil when I saw on the local television news a very non-critical report about a new store in town. It was like a press release from the store that the reporters used as an excuse to fill airtime with a very positive interview of the owner, but without questioning any of the exaggerated claims about the its curative powers. I knew that it had been until recently illegal, making good scientific research very difficult and sparce, and that researchers generally look at only one effect at a time when testing any treatment. How could this substance arise out of the blue with so many promises?

This webpage, for example, lists seven benefits including: relieving pain, reducing depression and anxiety, alleviating cancer related symptoms, reducing acne, having neuroprotective properties and benefiting heart health. Of course the last three are conditioned with “may," “might” and “could.” It warns: “Although CBD is generally considered safe, it can cause adverse reactions like diarrhea and fatigue in some people. It may also interfere with certain medications.”

Based on such reviews, it appears to fall into the familiar too-good-to-be-true category. So I was not surprised to find the headline: “FDA warns company marketing unapproved cannabidiol products with unsubstantiated claims to treat cancer, Alzheimer’s disease, opioid withdrawal, pain and pet anxiety.” And if you are going to advertise in the realm of too good to be true anyway, why not throw in that it counteracts the growth of [and/or] spread of cancer, kills breast cancer cells, treats Parkinson’s disease, reduces the severity of opioid-related withdrawal, addresses symptoms of chronic pain, anxiety and ADHD, and helps with PTSD, schizophrenia, fibromyalgia and eating disorders. The FDA objects to all these claims (and more) as “unsupported and unapproved.”

 WebMD calls it “all the rage” but warns that “experts say the evidence is scant for most of these touted benefits." Like many other over-the-counter products and supplements, it is “being produced without any regulation, resulting in products that vary widely in quality.” Dosages vary from one product to another, possibly from one production run to another and from one brand to another. “Only one purported use for cannabidiol, to treat epilepsy, has significant scientific evidence supporting it.”

Last April the USA Today piled on, asking: “Is this hemp plant derivative snake oil or a legit remedy?” In addition to all the powers listed above, they add that it’s also hyped as a cure for inflammation, stress, unsatisfying sex and PMS.  But it's sold at local pharmacies (including the one that stopped selling cigarettes because they care so much about our health) in the form of creams, lotions, oils, tinctures, pills, powder or liquid. But this story also comments that the marketers' therapeutic claims are "rarely supported by medical evidence that CBD is significantly better than a placebo.”

Again from USA Today in a different story: “The head of the National Institute on Drug Abuse said there’s no evidence that marijuana [or CBD] weans people from opioid addiction – and promoting such treatment might deny people a chance at recovery.”

The Mayo Clinic sums it up: “While CBD is being studied as a treatment for a wide range of conditions, …research supporting the drug's benefits is still limited." It can cause more serious side effects than those mentioned above and “can interact with other medications” such as blood thinners.

And remember that part about it being unregulated? “Another cause for concern is the unreliability of the purity and dosage of CBD in products. A recent study of 84 CBD products bought online showed that more than a quarter of the products contained less CBD than labeled. In addition, THC [the psychoactive ingredient found in marijuana] was found in 18 products.” But don’t sweat those pesky details – it’s all-natural and I heard on Facebook…!

Save Your Vitamin Money

At least once a month we see reference to one or another survey or report about people being unable to afford retirement. They haven’t saved enough money, but may not be able to keep working either. But now just when it’s needed, along comes a reliable tip on how to save a little more: Don’t waste your money on vitamins. 

This is not the first time I have written about the waste and potential dangers of dietary supplements. The last entry on the subject of supplements in general was about two years ago where I quoted from the New York Times saying that annual spending in America averages about $100 per person. I focused on vitamin and mineral supplements as recently as last September. I was hoping after many attempts to have wrapped it up, but it’s good advice, so I will give it another shot based on some fresh headlines.

About two weeks ago researchers from West Virginia University School of Medicine published a study in the journal Annals of Internal Medicine showing “that although reduced salt intake and certain supplements may lower the risk of cardiovascular diseases, most nutritional supplements do not improve the risk for heart disease or death.”

An article reviewing that study quotes the lead researcher: “The reason we conducted this study was that millions of people in the United States and across the world consume supplements or follow certain dietary patterns, but there was no good-quality evidence to suggest that these interventions have any effect on cardiovascular protection." 

The study itself was not a clinical trial but a review of 277 other studies with a total of nearly one million subjects. It looked at the effectiveness of many popular nutritional supplements and 8 diets. “Findings show that of the 16 dietary supplements, only two showed beneficial effects on heart health, namely omega-3 long-chain fatty acids and folic acid….[whereas] selenium, vitamin B6, vitamin E, vitamin C, iron, and vitamin A, among others, show no significant effect on heart health.” 

Other important findings were that some supplements by themselves, not just the tainted ones that appear in the news from time to time, are potentially harmful. Another surprising finding was that “most diets, like modified fat intake, the Mediterranean diet, and reduced saturated fat intake, had no effect on the heart at all.”

Some other sources reporting on the same study had more watered down headlines. This one says, “For Heart Health, Some Popular Supplements Aren't as Helpful as We Thought.” But the sub-headline is more direct: “Consumers should ‘stop wasting their money on these products.’ ”

Another one is even more careful in its wording: “Nutritional supplements and diets not always protective, research suggests.” But they did provide a link to another study from 14 months ago that also came to the conclusion that “most commonly consumed vitamin and mineral supplements provide no consistent health benefit.”

The final conclusion as always is “only eating a healthy balanced diet is the key to overall health.” That shouldn’t come as a surprise to anyone who has been paying any attention to and looking into health news over the years. Once again, it’s looking for the easy, magical answers that cause us to waste time and money on pills and fad diets. Avoiding that mindset is, though, an easy way to come up with some extra money for that problematic retirement savings plan. 

Critical Thinking: When to be Skeptical (Part 2)

Last time I wrote about a case where ill-advised skepticism leads to dangerous decisions, what the World Health Organization calls “vaccination hesitancy,” one of the ten threats to global health. About 1.5 million deaths per year could be avoided if global coverage of vaccinations improved.

In the case of vaccines, that skepticism is based on faulty evidence and discredited research promoted by unreliable sources. But in many other cases, with access to reliable sources, it makes sense to be a little skeptical of all the threats and warnings we encounter on a daily basis. After all, no one has enough time to be scared of everything the media warns us about.

Sometimes it’s a health issue where the underlying data is insignificant, e.g., when a certain habit is shown to increase the chance of getting a condition by 50%, when the original chance of getting it was miniscule. Sometimes organizations raising money and the media selling advertising space don’t present the full story. For example, data from the early 2000s on missing children shows that 99.8% of those children return home. “Only about 100 children (a fraction of 1% [of all missing children]) are kidnapped each year in the stereotypical stranger abductions you hear about in the news.” More die in swimming pool accidents, yet “stranger danger” gets much more attention than pool safety. It is very likely that the data have not changed since that original study.

Things are not always as they seem. Here is one example I intend to keep an eye on. At sciencemag.org a feature titled “Dubious Diagnosis” asks, “The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?”

The piece points out that the term prediabetes originated only about ten years ago as a “public relations catchphrase” to raise awareness at a time when the American Diabetes Association (ADA) “needed a pitch to persuade complacent doctors and the public to take seriously a slight elevation in blood glucose, which might signal a heightened risk of type 2 diabetes.” Indeed it has a catchier sound than impaired fasting glucose or impaired glucose tolerance. And notice the expression might signal in the explanation. Further along, the article tells, “the CDC's own data show progression from prediabetes to diabetes at less than 2% per year, or less than 10% in 5 years. (Other studies show even slower rates.)”

This increased public awareness probably benefited the ADA, but other health-oriented organizations such as the World Health Organization (WHO) along with some diabetes specialists argue “medical and epidemiological data give weak support, at most, for increasingly dire prediabetes admonitions.” One diabetes researcher goes so far as to characterize the effort as scaremongering directed at approximately 48 million Americans.

The result is that billions of dollars have been spent on “research, education, and health improvement programs – generally focused on weight loss and exercise – that have generated lackluster results, according to critics.” So far no drugs are effective, but some of those research dollars include “drug companies…testing dozens of drugs aimed at prediabetes in hopes of tapping a potential worldwide market of hundreds of millions of people.”

And the rising costs are already compounded by additional doctor visits, off label prescriptions, and the sale of continuous glucose monitor devices – all very likely unnecessary.

Meanwhile, the ADA continues to ratchet down the standards for various blood sugar measurements with the potential of adding another 72 million new patients to the prediabetes rolls in the United States and many more worldwide.

The article includes several interesting timelines showing changes in those standards and other key events. It then discusses at length the scientific and financial conflicts. So despite some very confident statements favoring prediabetes screening and treatment, the jury is still out. “Many public health organizations believe a mainly clinical approach to diabetes prevention [endorsed by the ADA and CDC] is ineffective.”

There seems to be plenty of reason to remain skeptical about this issue. (It does not affect me, but I find it very interesting from a critical thinking point of view.)

More Reason to Ban Drug Ads

The last time I wrote a “Don’t Ask Your Doctor” piece was almost three years ago. It was a follow up to the original in November 2012. 

It seems clear that the many drug ads on TV and in magazines with the punch line “Ask your doctor if [fill-in-the-blank drug] is right for you” are merely an attempt by pharmaceutical companies to bypass doctors to increase sales by appealing directly to Americans with a demonstrated weakness in the area of discipline. The companies try to use the patients to put additional pressure on their doctors to prescribe expensive medications. It often interferes with the doctors’ ability to make a proper decision for fear of getting into an unnecessary battle with or ultimately losing a patient.

A common example of this patient pressure that I have run across in the past is the number of people who have gotten antibiotics from their doctors to fight a cold. Antibiotics are not effective for a cold, because it is a viral infection, not bacterial. Doctors know this. It is a waste of money for the patient and a danger to the rest of us as it promotes the evolution of stronger, more drug-resistant viruses.

I am not alone in my objection to these ads. The Washington Times points out that “only doctors have the training about, and knowledge of, such drugs, as well as insight into their patients’ medical backgrounds that may or may not be appropriate for such medications” and that the ads “contribute more confusion than useful information.” The US and New Zealand are the only countries in the world to allow this practice.

The American Medical Association has been calling for a ban on those ads for many years. Their position “reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices.”

And those marketing costs are high! From 1997, when it was first allowed, to 2016 “spending on medical marketing of drugs, disease awareness, health services, and laboratory testing nearly doubled, going from $17.7 billion to $29.9 billion.” The direct-to-consumer portion increased the most, both in amount and proportion of spending from $2.1 billion (11.9% of total spending) in 1997 to $9.6 billion (32.0%),” while the amount spent in journals directed at the doctors decreased.  That spending adds to the cost.

This is doubly important today when we have such strong evidence of how easily patients, and in this case parents, are influenced by misinformation and make such foolish decisions, pressuring their doctors about vaccinations. 

Here is a subject where the science is clear, while warnings and side effects are not buried in the fine print. It’s simple; measles can kill. Vaccinations work.

In 2015, California passed a law eliminating personal belief exemptions for vaccinations that kids must receive before they can attend public school. They can only get a medical exemption from a doctor. Fearful parents are pressuring doctors, causing this medical exemption category to increase by 250% over the first two years of implementation. Some doctors are even cashing in on this unwarranted fear by charging $300 to $500 to write recurring exemptions. The understanding about measles prevention is clear, but there has been an outbreak on the West Coast (and in Europe). These falsified exemptions and parental beliefs endanger not only the kids with fearful parents, but those who cannot be vaccinated due to valid medical exemptions.

This single example casts doubt on the FDA’s original argument for TV ads, that giving consumers more information would lead to better outcomes. It has more likely led to more unnecessary prescriptions and higher drug costs.

Is It False Advertising?

A couple of years ago plaintiffs brought a class action suit against Boiron Inc., the maker Oscillococcinum, a homeopathic cold and flu remedy claiming that it didn't work. What was unusual in this case is that it went to a jury trial. Most of the time, in fact twice in the past in other lawsuits against Boiron, these types of cases are settled before they go to trial. Apparently this time the company decided it was time to take a stand and risk the decision of a jury. Surprisingly, the company won in court. The jury simply felt that the plaintiff hadn’t presented sufficient evidence that the product did not work as advertised, that is, they had not shown that it did not relieve flu symptoms.

 The reason this is coming to light now is that the plaintiff appealed to the 9^th Circuit, but the court sided with the company. The court found that “the jury appeared to have believed Boiron’s expert, clinical studies, and anecdotal evidence more than it believed the plaintiff’s expert." According to the court, there was no legal reason to overturn the verdict.

 But what exactly is going on here? Is there a scientific reason to doubt the claims of the company?

More can be learned from the website Rxlist.com. “Homeopathic products are extreme dilutions of some active ingredient. They are often so diluted that they don't contain any active medicine.” Due to legislation passed in the 1930s this type of product can be sold in the U.S. but, like dietary supplements, are not held to the same safety and effectiveness standards as approved drugs.

Oscillococcinum claims to relieve flu symptoms, but not cure the flu. It’s effectiveness is based primarily on self-reporting. The website finds “no reliable evidence that taking Oscillococcinum can prevent the flu and evidence of any beneficial effect at all is questionable “due to flaws in the study design.”

It is made by highly diluting in water a compound extracted from the heart and liver of the Muscovy duck. Its dilution rate is coded in homeopathic terms as 200C. This means there is one part duck in a solution containing 1-followed-by-400-zeros parts water. That is an insanely huge number. There isn't even a name for this number. It is more than the estimated number of molecules in the entire universe! It is physically impossible for any part of any active ingredient to survive that level of dilution. But homeopaths explain this away by saying that the water retains the essence of the ingredient (even though there is none left). The remaining water is then combined with inactive ingredients of lactose and sucrose.

“Most experts believe that it will have no beneficial effect and also no negative side effects.” How could it not be safe when it’s primarily sugar water, unless the sugar was somehow contaminated? The company relies on the placebo effect to influence customers and then uses endorsements and personal accounts in their advertising and in this court case.

In my opinion this is nothing but snake oil and that people are basically throwing money away. However, I agree with the jury and the court that they did not advertise falsely. People who are willing to pay about a dollar per dose and take three doses per day really believe in its power to reduce flu symptoms. That belief alone is often enough to make them think they feel better and to report a reduction of symptoms. (Note: Some people take it to prevent the flu, a benefit the manufacturer doesn’t even claim.)

 We each get to decide how to wisely spend our dollars. (Annual sales of Oscillococcinumin in the U.S. were $20 million in 2013, and they probably only had to use one duck!) Information on homeopathic medicines is so easy to find, but the ability to overcome most people’s longstanding beliefs is so difficult to sway.  And suppose those people who still have the flu, but strongly believe they feel better, decide to come to work or school and spread it around. What then?

Being Misled About Multivitamins

I have been writing about a couple of related subjects lately. Last Monday’s theme was that no amount of consumer protection will keep the charlatans of the health industry from coming up with enticing schemes based on junk science. Americans must use critical thinking to avoid the traps that lead to certain financial loses and possible physical harm. The second is that much of what makes the news as “a new study” or “latest research” is merely a rehash of previous discoveries, traditional understanding or common sense.

Here is another example from last week characterized as a new study, attacking what to many is a “sacred cow,” which is why it has been ignored for so many years.

Canadian researchers found: “Popular vitamin and mineral supplements didn't provide any measurable health benefits to prevent cardiovascular disease, stroke or early death.” They also “found no helpful or harmful outcomes for people who took multivitamins, vitamin D, calcium and vitamin C.” But this was not based on comparing medical records for a large number of people. Instead findings came from a review and analysis of existing information, many other studies mostly around from 2012 through the fall of 2017 – in other words, old news with information confirmed many times over.

A quick search of the Internet yields many of these previous studies. A CBS News story from December 2013 carries the headline: “Multivitamin researchers say ‘case is closed’ after studies find no health benefits.” The advice back then was to save your money because “supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.” Studies backing up this announcement were not trivial. One tracked 24 studies and two trials involving more than 350,000 individuals. A second followed 5,950 older male doctors over a 12-year period under controlled conditions. Another of 1,700 heart patients showed “no difference in rates of another heart attack, chest pain, the need for hospitalization, cardiac catheterization, or rates of stroke and early death between vitamin-takers and placebo-takers.”

Clearly, this is not new. Many professionals have recognized the ineffectiveness of multivitamins for a long time. Five years ago the U.S. Preventive Services Task Force (USPSTF) decided not to recommend the regular use of any multivitamins or of any herbal supplements and recommended against taking additional beta-carotene or vitamin E.

But what about the earlier comment that they found no helpful or harmful outcomes? This comes from the USA Today last summer.  “Taking too much vitamin B6 and B12 could dramatically increase lung cancer in men, according to a new study.” That study consisted of more than 77,000 patients followed for more than 10 years. 

The majority opinion is that these supplements have no benefits, and adverse side effects are possible. So, as this headline reads, why do “Americans Spend Billions on Vitamins and Herbs That Don’t Work”? The numbers vary from one source to another, but the amount spent on vitamins and herbal supplements, which can be far more dangerous, ranges from $30 billion to $37 billion per year, and that number is expected to grow with an aging population and increased health concerns.

Sales typically make up “5 percent of all grocery sales in the United States” with profit margins nearly ten times higher. But despite the high cost and years of research 50% of Americans take at least one multivitamin and about 20%, take other supplements as well. Have they not been paying attention?

The explanation is simple. The power of the industry and the accompanying superstitions that drive people to the magic of supplements and so-called health foods is frightening. As an example, one of the references I cited above proclaiming the dangers and impurities in supplements has an accompanying link to one of those you-may-also-be-interested articles entitled: “11 Vitamins and Supplements That Boost Energy.” After warning of the dangers in the first article, the second sings the praises of a bunch of airy-fairy herbs and chemicals. Everyone should know better, but there is no escaping the hype.

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.

In Search of Longer Life

We love to believe that certain products will help us live longer and healthier lives.  The problem is we are often wrong, but continue to spend lots of money on these supposed preventions and cures.

In light of this, the latest research should come as no surprise.  “Calcium and vitamin D supplements may not help prevent bone loss and fractures, according to a new study released Tuesday in the Journal of the American Medical Association.”  This article goes on to say that in 2016 Americans spent close to $2 billion on these supplements hoping to enjoy the benefit of stronger bones.  In conclusion the researchers remind us that the best way to get nutrients is not through supplements, but through food rich in vitamin D and calcium.  And stronger bones are also promoted by regular exercise.

The part about skipping the supplements and getting vitamins and minerals through healthy eating is standard in much of this scientific health advice, but often ignored.  Taking a pill or two is much easier, and the idea of exercise to promote health just seems like too much work.  The result is $2 billion wasted.

Calling it a waste may seem harsh, but here is a direct quote from WebMD from about 3 weeks ago:  “Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age.”  They are unnecessary and there is little evidence that they work.  But try to tell that to anyone committed to a daily regimen of supplements of any kind and they will resist, saying it works for them or it makes them feel better.

The problem is even greater for those buying homeopathic remedies.  Here is an excerpt from a Food and Drug Administration (FDA) press release from last month with the subtitle “FDA continues to find that some homeopathic drugs are manufactured with active ingredients that can create health risks while delivering no proven medical benefits.”

The press release continues:  “Until relatively recently, homeopathy was a small market for specialized products. Over the last decade, the homeopathic drug market has grown exponentially, resulting in a nearly $3 billion industry that exposes more patients to potential risks associated with the proliferation of unproven, untested products and unsubstantiated health claims.”  The Federal Trade Commission is also cracking down due to the unsubstantiated claims that these substances cure anything.

I don’t think it is a coincidence that the popularity has grown over that last decade when social media began to spread so many false reports about health, miracle cures, and vast conspiracies by the medical profession and insurance companies to keep the truth from the public.  Again I am not being harsh in exposing this information.  Consumer Health Digest puts it even more bluntly:  “Although homeopathic products have no proven effectiveness and their theoretical basis is senseless, a complete ban is not politically feasible.”  Isn’t it a shame that popularity trumps science in this and so many other cases?

These ideas get embedded so deeply in the social consciousness that no amount of persuasion will change habits.  Take for another brief example this from the New York Times a little over a year ago:  “Misconception: Drinking buckets of cranberry juice can cure, and even prevent bladder, infections.”  Yet how many will continue to swear by cranberry juice for those mythical benefits?

There is no fighting it.  Weakness in discipline leads us to rejoice at the thought of an easy answer and weakness in critical thinking leads to the victory of emotion and popular opinion over science.  What’s the problem here?  After all, it’s only $5 billion wasted, and the cranberry juice will at least keep us hydrated.