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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Flashback – Baby Powder

Almost exactly four years ago I wrote about the difference between how the legal system looks at the danger of baby powder vs. how science sees it. Of course, that makes no difference, as just this week I saw another class action lawsuit ad on TV. When it comes to taking money from big rich companies and giving it to poor victims (and their lawyers) juries don’t care about science. They just want to use someone else’s money to dry the tears.

But they still expect the same company to continue to make the Tylenol for their headaches while testing and producing a COVID-19 vaccine. It’s all part of some weird love/hate relationship.

From September 2016: "How Baby Powder Can Harm You?"

[Under the heading of Health, the Fox News headline read: “Research finds talc doesn't cause cancer; juries disagree.” The story tells that two juries awarded a total of $127 million dollars to two women claiming that the Johnson & Johnson baby powder gave them ovarian cancer. A second judge threw out two cases, saying there was no reliable evidence; but another 2000 women have already lined up to sue.

That’s the legal side. What does science say? “Most research finds no link or a weak one between ovarian cancer and using baby powder for feminine hygiene, a practice generations of American mothers have passed on to their daughters. Most major health groups have declared talc harmless.” The rest of the article gives more information about the research and the trials. Here is another conflict between science and the legal process, but that should come as no surprise in light of jury awards given years ago for silicon breast implants when the implants were later found to be safe.

It is very easy to understand how a jury could ignore science and award millions of dollars to a woman with ovarian cancer. They do it out of sympathy, and they do it because they can. To do otherwise seems cold and heartless.  It’s not their money and the company has plenty of money. What’s a few million dollars in the grand scheme of things when it can bring comfort?

What person would stand by and see a toddler fall and skin her knee and not immediately run over to pick her up, dust her off and give her some comfort? It is the human thing to do.

There are several similarities between the one who helps the fallen toddler and the juries who award large sums. It costs them nothing. It gives comfort to the afflicted, although it does nothing to cure the cancer or heal the skinned knee. And it makes the rescuers feel good about themselves.

There are, however a few key differences. When you comfort the toddler it truly costs you nothing, and other toddlers don’t look at the one who fell and line up to also fall down to get sympathy. (Some may independently discover that falling down is an easy way to get attention, and some of them probably grow up to be trial lawyers.)

Also, when a toddler gets sympathy, the costs of that sympathy are not spread to the rest of society.  When a jury finds for the plaintiff in this case, not only does the company (or insurance company) pay, but every other company in that industry is put on notice. They are at risk of losing a large judgment for one of their products that has been on the market for years with no ill effects. They don’t spend the money now, but must keep some in reserve to protect against such a contingency.

Likewise, all insurance companies, seeing that evidence means nothing to some juries, must save for similar outcomes. The companies making personal products slowly raise their prices to adjust for this, and the insurance companies raise their rates to cover the increased risk. This sympathetic redistribution, which is really what it is, ends up costing everyone in society. 

What’s worse is that this activity adds no value. It does not add to the GDP. It does nothing to increase the standard of living for anyone except the few women who win in court (and their lawyers – Remember personal injury lawyers are not paid for justice; they are only paid for winning.)

In the end what can Johnson & Johnson do (besides spend a lot more time and money appealing each decision)? What lesson could they learn? Should they get everyone who buys baby powder to sign a hold-harmless agreement? Why are they more at fault than the “generations of American mothers” referred to in the article? They made a product considered safe for years and suddenly they are on the hook for $127 million; and if the ratios hold true and half the next 2000 win similar amounts, it could be $127 billion! It’s “jackpot justice,” and the cost of all the winning “lottery tickets” is spread among the rest of us, including the people who served on those juries!

So how can baby powder harm you? It harms you in the same way other wasteful legal actions harm you. It takes money out of deep pockets to compensate “victims,” but the costs ultimately come back to each of us, with nothing to show for it but richer lawyers, and juries who, in some misguided way, temporarily feel satisfied that they did something to help.]

Understanding Experiments

When most people hear the word experiment, they picture a scientist in a lab coat with bubbling beakers and test tubes of mysterious liquids. This is not the real meaning. As a result of this misconception, news of the latest study is usually misleading.

An experiment is a rigorous process of testing an idea with the intention of either solving a problem or of improving a situation. Necessary first steps include defining the problem to be solved or determining how results will be measured. No one can claim improvement without measurements to compare (before and after). In the first case, the experiment is successful if the problem goes away. In the second, success is judged by the measurable amount of improvement.

When a well-designed experiment is successful, the implication is that the same solution can be applied widely to other situations: to solve the same problem elsewhere or to achieve the same amount of improvement. (Usually others replicate the experiment before findings are accepted.)

To achieve satisfactory results, any experiment must be well designed. Sloppy studies lead to problematic conclusions, ones that can’t be counted on to solve anything. Even the best experiments can yield bad information just based on the amount of diversity in the world and the fact that fluky things happen. 

Many experiments or studies the public is exposed to in the media relate to drugs or other remedies, and a strict procedure must be followed to ensure the conclusions are valid, otherwise the drugs or other remedies get on the market without proof that they are safe and effective.

In drug studies researchers try to choose a sufficiently large sample, because the larger the sample, the lower the chances of getting some oddball results just because you happened upon some atypical participants. A bigger sample tends to average out any unusual individual readings. 

The next step is to divide the sample into two parts that look as much alike as possible: same proportion by sex or race or education or income or background or location or any other feature that might affect the results. Sometimes this can only be done by random assignment to one group or the other. It's better if researchers have a good understanding of all the characteristics that might influence results and can make the two groups look as much alike as possible relative to those characteristics.

One group is treated – given the pill or the information or other treatment – the other, the control group, is given a fake pill (placebo) a sham treatment or left alone.

Afterward the groups are compared statistically to see if the change (hopefully an improvement) in the first group is significantly better than the change in the second. (Yes, there is often a change in the control group merely because the know they are participating in the experiment and believe the placebo is a real remedy.)

Ideally the people doing the testing are not aware of who is in which group (double-blind).

We know from the news that even these careful experiments can go wrong. Sometimes drugs are withdrawn from the market due to problems discovered only after they are released, released to a much larger sample size. That is why I have come down so hard and so often on vitamins and other dietary supplements where the law exempts them from the need for any research at all to prove safety and effectiveness. (They rely on endorsement, not proof, and use weasel words to imply effectiveness.)

Many times in the past I have also criticized experiments because they have been sloppy about their design. Sometimes they don’t define the problem until after the test is done and announce the findings with a press release. Sometimes the samples are too small due to budget constraints or laziness. Sometimes they rely on self-reporting so there is no real measurement. 

Finally businesses and educators like to say they are experimenting. In both cases it is rarely true. They don't set up two groups to compare. Then they measure by gut-feel.

Businesses are in too much of a hurry to do it right. They just try things, sometimes multiple things at the same time, so who knows which ones have a positive or negative or neutral influence on the final outcome.

In education they are still arguing about measurement. Teachers don’t want to be paid based on test scores, but haven't suggested a more acceptable criterion to measure their results. Yet school systems continue to try new methods and approaches without ever satisfying the first step – how to objectively measure real improvement.

Without understanding experiments, it’s too easy to be fooled by people who don’t know what they are doing and by people who do but are just trying to sell us a bill of goods. 

Appropriately Skeptical

From time to time I see an ad from a local doctor promoting stem cell therapy for pain. It includes one endorsement telling how the office was so easy to work with and how the pain went away. For some time now I have been skeptical about the validity of this promotion. I thought stem cell research was not yet in the mainstream of medical practice, and I know that endorsements are not reliable evidence. It seemed suspicious, so I decided to look into it.

The promotional material on line states in part: “Stem cell therapy uses your body’s most powerful and flexible cells to promote natural regeneration in damaged joints.” It claims to be effective for a list of conditions: surgical wounds, tendon damage, severe muscle strain, arthritis, damaged cartilage, torn meniscus and many other joint and soft tissue injuries and conditions.

“The stem cells … come from your own body … a small quantity of bone marrow from your large hip bone.” (Using the recipient’s own stem cells avoids the need for FDA approval.) The on-site lab processes the harvested cells. The doctor then can “precisely inject your stem cell mixture where you need it … where they morph into new cell types” and provide “long-lasting relief” for “many [but not all] patients.”

My first stop was WebMD with a sub-headline reading: “Unproven, Risky Treatments Mislead Patients to Seek Cutting-Edge Therapy.” International Society for Stem Cell Research (ISSCR) “advises patients to seek only stem cell treatments being tested in clinical trials approved by the FDA”… or some approved smaller studies.

There is a lot of information on the site but it is summarized like this: “Every treatment has some risks. So the question comes down to whether the benefits outweigh the risks. And those studies haven't been done yet.” 

This Healthline report from about 18 months ago says that stem cell therapies are being promoted for a wide variety of conditions, but “very few of these applications have any scientific backing, [however] stem cell therapy for knees has been the subject of quite a few promising studies.” It would be a big improvement over knee replacement, but promising studies hardly qualify a procedure for routine outpatient application. They list the cost of this treatment at “approximately $3,000 to $5,000 per knee, depending largely on geographical location.” 

The FDA gives much of the same information. “Stem cell products have the potential to treat many medical conditions and diseases. But for almost all of these products, it is not yet known whether the product has any benefit—or if the product is safe to use.”

Consumer Reports chimes in with a sub-headline: “A new industry is booming. But critics worry that the treatments are ineffective and dangerous.” Here is a very brief summary: “Stem cells are special cells with the potential to repair damaged tissue and organs.” But “not all of them are possessed of equal power.” According to the current scientific consensus, the therapeutic potential of stem cells taken from fully developed tissues, adult cells, is believed to be much more limited. (Does this include marrow from hipbones? I wonder.)

That Consumer Reports piece is a long article with many warnings about the confusion in the field and the inability of regulators to keep up with the proliferation of clinics, both legitimate and otherwise.

Another reason I am skeptical is that the same doctor offers many other questionable services including platelet-rich plasma (PRP), calling it “one of the most powerful natural healing methods available today.” Some conditions include dry eyes, hair loss and erectile dysfunction.

The Pain Science website opinion published earlier this year describes it this way: “injections bathe troubled cells in a concentrated mixture made from your own blood. Hopefully this stimulates healing where it is otherwise failing … but no one really knows for sure yet.” Regardless, it’s not hard to find someone willing to do it for you, but it’s not cheap. “Without any clear evidence of benefit beyond placebo, PRP is now being marketed aggressively as a cure-all for sports injuries.”

I did this research not because I would consider going to a pain specialist unless I was referred by my primary care doctor. I did it just to show how careful we need to be to avoid spending a lot of money on dubious treatments. 

I didn't name this doctor because I'm sure there are similar ads running all over the country. I am not demonizing any doctor who may truly believe in such treatments, but it is a warning to patients everywhere. 

It is nearly always better and safer to be appropriately skeptical.

Flashback – Why So Much Bad Advice

[This message was originally posted over six years ago, but since then the dynamic of bad information driving out the good has only gotten stronger with more fake news, advertising weasel words, political spinning, echo-chamber exchanges, media bias and health fads without any scientific basis.]

Why do bad ideas and bad advice seem to persist in a society with easy access to good science? One reason may be the tendency to cling to beliefs then look for evidence to support them, instead of accepting the conclusions of well-designed experiments. In his book The Righteous Mind Jonathan Haidt proposes that feelings and emotions come first, and that most reasoning works to justify rather than to test beliefs, that our “intuitions tend to drive our later reasoning.”  John Stuart Mill presented the same thought more than 150 years ago:  (paraphrasing) the more you argue, even while making clear, rational points, the deeper others dig in to protect long-held beliefs. Adding to the sad situation are the effects of scientists and doctors who would rather become famous as authors or TV stars by promoting popular beliefs than risk challenging them, as they should, with the truth.

One case that comes to mind is the persistent belief that artificial sweeteners are dangerous. Simple research is reassuring, but the belief is ingrained in our culture. The National Cancer Institute states clearly and unequivocally: “There is no clear evidence that the artificial sweeteners available commercially in the United States are associated with cancer risk in humans.” The Mayo Clinic’s view is that “there's no sound scientific evidence that any of the artificial sweeteners approved for use in the U.S. cause cancer or other serious health problems.” So who do Americans trust, these authoritative sources or a Facebook friend who watched some guy in a halloween costume on YouTube with scary stories?

Likewise folk remedies of all kinds continue to circulate. One longstanding belief is that magnetism has magical healing powers, leading people to buy bracelets, insoles and other magnetic devices. This is odd because over the past 15 years the FTC has ordered Magnetic Therapeutic Technologies, among others, to stop advertising magnets as a cure for numerous diseases or even as a pain reliever. No credible evidence exists of healing powers, and none can be claimed in their advertising. One recent well-designed test of such devices confirms this fact concluding: “Wearing a magnetic wrist strap or a copper bracelet did not appear to have any meaningful therapeutic effect, beyond that of a placebo, for alleviating symptoms and combating disease activity in rheumatoid arthritis.” Does that slow the sale of magnetic shoe insoles? – Not for people who don’t let the facts get in the way of a good story, a persuasive ad or a celebrity endorsement.

It’s your money to use as you please. You can save it for college and retirement, give it away to companies selling you magnetic health devices, or even flush it down the toilet. Two of those choices make the same amount of sense, but as Paul Simon sang, “A man hears what he wants to hear and disregards the rest."

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 – Electro-pseudoscience

[In recent news from England “a poster for the charity Electrosensitivity-UK asked, “How safe is 5G?” They oppose the roll out of 5G technology and warned, without any scientific evidence, that it causes a “range of health effects such as ‘reduced male fertility, depression, disturbed sleep and headaches, as well as cancer’”.

This fear mongering is reminiscent of my posting in December 2014 titled “Fear of Power Lines.” This kind of panic based on bad science will keep coming up as long as a gullible public will buy into it.]

If you are old enough, you remember the big scare in the late 1980s about power lines causing cancer. In fact, if you are not old enough to remember the news reports at the time, you have probably heard about this idea from someone who was. There was a great deal of concern, but after over 30 years of further research, it appears to have been a mistaken assumption.  Still the fear persists.

This fairly short (7:46) NY Times Retro Report is worth watching.

It begins with replays of news reports from all the major networks from 1987.  It was big news at the time, and this reminder is very informative showing in retrospect how the news business operates when breaking news has the potential to stir up a lot of fear based on a very limited study.  A voice-over talks about how power lines may cause cancer while showing the picture of a small bald child, apparently battling cancer (but not from power lines) – sneaky.  When seven children in one Denver school developed cancer and parents blamed it on nearby power lines, one reporter said that it could be a “tragedy of enormous proportions.”

The Times calls the episode “Power of Fear” with the message that once this type of fear is introduced into our society it never really goes away.  

The researcher who first suspected the problem now explains that further research has ruled out any problem. With the number and density of power lines, this should have developed into a major health problem, but it didn’t. “That suspicion [of a cancer risk] was simply wrong...The likely impact [of power lines] is zero.”  

Scientists in the 1990s conducted hundreds of experiments exposing rats, other animals and human cells to intense EMFs (magnetic fields around the power lines) over long periods of time with no change in the cells.  “In 20 years of looking, no one has found a way that power line fields can do anything at all to cells of animals; unless it can do something to cells, it cannot cause cancer.” The National Academy of Sciences confirmed this by reviewing 500 studies and releasing their findings in October 1996. Nothing since then has altered the conclusion of no danger.

The association was always “suggestive, but very faint” but correlation does not prove causation. Yet the idea, the fear, persists and is still spread by some public figures, some advertisers who use the scare tactics to sell real estate service and by word of mouth – now enhanced by the reach and power of social media.

Why do some Americans believe these sources and continue to fear the presence of power lines? Psychologists tell us that risks that are invisible, that might cause suffering before death or that might affect children have uncanny staying power, even in the face of firm evidence to the contrary. This highlights the need for critical thinking, to put aside emotional responses and listen to the facts. Don’t we have enough stuff to be afraid of without dredging up errors from the past?

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.

What’s All the Fuss about CBD?

As I was walking through the local mall, I had to steer around a large sign in front of the GNC store. It read: “CBD Products Available.” It did nothing to raise my opinion of GNC, which I consider to be the epitome of junk science, but I thought I should do some research to make sure my eye rolling was justified.

Cannabidiol (CBD) oil is an extract from industrial-grade hemp or the marijuana plant. It does not have the effect of getting the user “high” as the THC in marijuana does. It recently surged onto the market with a wide variety of health claims. What are the facts?

There is so much information, but it has to be sorted careful, as much of it is pure advertising, telling the stories of miracle cures. Many promises are unreliable to the point that in September the Federal Trade Commission (FTC) ordered three companies to stop making claims that they: relieve pain better than opioid painkillers and that they treat cancer, Alzheimer’s disease, multiple sclerosis (MS), fibromyalgia, cigarette addiction, colitis, autism, anorexia, bipolar disorder, PTSD, schizophrenia, anxiety, depression, Lou Gehrig’s Disease (ALS), stroke, Parkinson’s disease, epilepsy, traumatic brain injuries, diabetes, Crohn’s disease, psoriasis, and AIDS – while using the words miracle and magic to describe the effects. The following month both the FTC and FDA warned a Florida company marketing CBD products about making similar unsubstantiated claims. (These were only the ones that were caught.)

Stepping aside from the hype, Science News published a story earlier this year that is a little more down to earth. “A gaping chasm separates the surging CBD market and the scientific evidence backing it. While there are reasons to be excited about CBD, the science just isn’t there yet.” Trials are underway, but “much of the existing research was done with cells in the lab or in lab animals, with results that don’t necessarily translate to people.”

The next stop was a WebMD article, “CBD Oil: All the Rage, But Is It Safe & Effective?” They remind readers, “experts say the evidence is scant for most of these touted benefits” and it is being sold as a supplement, “produced without any regulation, resulting in products that vary widely in quality.” So far “only one purported use for cannabidiol, to treat epilepsy, has significant scientific evidence supporting it.”

CBS recognized the quality problem in this piece from about three months ago with the warning that “without wide federal oversight, there is no way of really knowing what's inside CBD [products].” They commissioned lab tests of samples from all over the country and found no harmful chemicals but significant differences between the amount of CBD on the label and actual contents making proper dosage a big problem. In addition, “cannabinoids do interact with prescription drugs. But because we lack reliable controlled trials, we don't have enough detail to understand all the interactions.”

The same viewpoint comes from Harvard Medical School. “Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting.” The JAMA network notes that in studies to date "evidence of effectiveness was scarce," and that a California testing company found 85% of samples inaccurately labelled.

This Slate article makes the point clearly. As more and more products, from foods and beverages to creams and lotions, have CBD added “CBD is in everything, but it hasn’t been proven to do much of anything." Despite this, it is forecast to become a $22 billion industry by 2024.

In summary, with no scientific evidence of health benefits outside of the treatment of epilepsy, CBD oil has become all the rage with companies adding it to all sorts of products and selling it as a miracle cure. Some companies have crossed the legal line with their claims, but those that are more careful can easily imply that it’s curative powers are enormous without coming right out and saying it. Instead they rely on endorsements from beneficiaries of the placebo effect, as do many of the other supplements on the market. (In other words, my eye rolling was justified.)

Flashback - Ignoring The Facts

[This one comes from January 2012 and is still one of my favorites. People, who are involved in a test that proves that a $30 item is not effective, continue to insist on buying one. Note, they didn't just hear on TV or read on the internet that the item is bogus - they were actually involved in testing it and shown the results. It didn't work as advertised, but they still wanted one regardless of what their eyes were telling them because of all the hype they had heard elsewhere! Being swayed by marketing promotions and celebrity endorsements is not wise behavior.]

While looking for a different article on the Placebo Effect, I found this interesting video. As you know, the Placebo Effect causes people to recover or show improvement even when they are given only a fake remedy, the familiar sugar pill. The power of the mind is amazing.

I recall an article a number of years ago stating that the improvement within the control groups in certain drug studies increased as the power of the real medicines increased. They were getting the sugar pill but believed they were getting the latest, stronger medicine, so they experienced even better results. It was all psychological. It is easy to understand how this reaction could play into the hands of "snake oil" salesmen. They sell you a useless cure and let your mind do the rest. Then they get a few believers who help them sell more. That's why I always say, "Endorsements are not evidence."

Here is the  CBS News video testing the claims of a particular performance wristband, one endorsed by famous athletes, and touted to improve athletic performance. When test subjects were given the advertised wristband, their performance on physical and balance tests did improve. But when they were given a one-dollar replacement band and told it also was special, performance on physical and balance tests improved comparably. The video also explains how the bracelet company sets up tests to ensure the perception of improved performance.

The scariest part is the ending where, despite the fact that the $30-wristband claims had been debunked, shown to be no more effective than the $1 bands or even not wearing a wristband at all, the participants still wanted one!

This is not critical thinking! This is the kind of decision-making that leads people to spend money on worthless items instead of using it wisely. Then they wonder why they get into debt and can't afford to retire. It's the kind of thinking that leads us to vote for candidates based on endorsements or personal appearance or charisma instead of the leadership and ideas we need. It's the kind of thinking that contributes to the decline of America!

Fluoridation Facts

I stole the above title from a newly released American Dental Association (ADA) pamphlet on the controversy about fluoridation of public drinking water. This is another area where people with little understanding of science have spread falsehoods leading to some resistance to a beneficial practice. A brief review of the executive summary makes it quite clear; fluoride prevents cavities.

Although I have never had doubts about the safety of adding fluoride to drinking water, twice a year I am faced with the question of whether to pay an extra $35 at the dentist for a fluoride treatment. I know there is evidence that these treatments, along with the fluoridation of drinking water and toothpaste, are beneficial for children’s teeth, but I wondered about the effectiveness for adults. 

The fact that my insurance company doesn’t pay for it raises some suspicion. Coverage decisions may be based on cost factors, but one cost factor they must consider is higher future dental bills. Normally they would prefer to pay for prevention than to pay more later.

I began my research on the effectiveness of fluoride treatment for adults at a site billing itself as “the top magazine for dental hygiene professionals.” One hygienist, whose boss wants her to push the treatment to increase business, asks directly whether every patient needs fluoride.

The answer goes to an ADA publication from 2007. (The advisor didn’t know of any more recent updates.) A patient whose risk is low “may not receive additional benefit from professional topical fluoride application.” Low risk is defined as "No incipient or cavitated primary or secondary carious lesions during the last three years and no factors that may increase caries risk." It goes on to say there are other factors to consider, but generally “blanket mandates of fluoride for everyone are not appropriate.”

Consumer Reports gives basically the same answer (with less dentist jargon). “Extra fluoride may be helpful if you’re at increased risk of developing cavities, indicated by frequent tooth decay in recent years, dry mouth caused by medications or disease, or gum recession that exposes the vulnerable tooth roots.” 

They go on to say that home treatments are not effective, and that those in the low risk category should do fine by brushing twice a day with fluoride toothpaste “especially if your water is fluoridated.”

The National Center for Biotechnology Information site reviews a compilation of research on the “effectiveness of fluoride in preventing caries in adults.” They believe that the authors' conclusions favoring the use of fluoride treatments for adults “appear to follow from the results presented, although the paucity of more recent studies and poor quality of the included studies limit their reliability and relevance to current populations.” This vague recommendation (also from 2007) is not very compelling.

A Healthline.com page from 2018 asks: “What Are the Benefits, Side Effects, and Recommendations for Fluoride Treatment?” Again the emphasis was on children and adolescents with some discussions of minor side effects of treatments and real dangers of fluoride supplements. A little new information was that it was “best to get fluoride both topically [gel or toothpaste] and systemically [ingested]” from drinking water.

With several references to the 2007 ADA advice, I went there next. In addition to brushing twice a day, flossing and regular dental examinations, a “key to good oral health is fluoride.” Maximum benefit “is achieved when fluoride is available both topically and systemically.” Treatments from a dentist are recommended for adults with high risk factors such as poor oral hygiene, active caries, eating disorders, drug or alcohol abuse, lack of regular professional dental care, high levels of bacteria in the mouth, exposed root surfaces” and a few others.

In my case it seems I have been correct in saving $35 per visit. I eat most of my meals at home, so I am able to brush three times a day. We use fluoridated tap water for cooking food and drinking. (Bottled water is non-existent in the house.) I have not had a cavity in at least ten years. (Knock on wood.) Nor do I have any of the other critical factors or habits.

It’s interesting what a little research – a factor in critical thinking – can do to help with everyday decisions. 

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.

Salt is Salt - Part 2

Almost seven years ago I wrote here about the sea salt scam. In that piece I quoted Mayo Clinic as saying, “Sea salt and table salt have the same basic nutritional value, despite the fact that sea salt is often marketed as a more natural and healthy alternative.” The American Heart Association (AHA) agreed.

But then a few weeks ago, I ran across an article with the headline: “How Pink Salt Took Over Millennial Kitchens.” Immediately it goes on to explain that, like sea salt, it’s not healthier than common table salt. It’s labeled as Himalayan, but does not come from the Himalayas. “Most of that comes from the enormous Khewra Salt Mine, situated between Islamabad and Lahore in Punjab, a bit south of the actual Himalayas in Pakistan.” 

Despite that, it has become another foodie fad, skyrocketing in popularity, featured at Trader Joes with it’s own grinder. The popularity stems not only from the color – it’s prettier than plain old white salt – but because it’s also rumored to be healthier. Take the warnings from the AHA and others about salt consumption, combine that with the fact that salt makes food taste good, mix that with the mistaken notion that this special salt is really healthy because of some mythological “trace minerals” and voila! - gullible people are willing to pay $2.70 a pound at Costco in bulk. For comparison, sea salt at Costco goes for 1.76 per pound and Morton Salt at a restaurant wholesale site is $0.38. Those must be some expensive trace minerals!

Contrary to what pink salt enthusiasts claim, real nutritionists agree that the amount of trace minerals in any salt “is too minuscule to make any difference, and we already get plenty of the same trace minerals from other foods.” Another site confirms that “The ‘84 minerals’ in himalayan salt is an unsupported claim.” It’s all marketing hype.

It’s so easy to go on line, though, to find glowing endorsements of pink salt pushing these imaginary health benefits. This one is a good example: “Many people believe that this pink salt is the purest salt that can be found on the planet.” Maybe so, but many people believe a lot of things that aren’t true.

In case you aren’t convinced by the purity and naturalness alone, it goes on to claim that pink salt stores “vibrational energy,” whatever that is. Supposedly it aids vascular health, supports respiratory functions, reduces the signs of aging, promotes healthy sleep patterns, increases libido, lowers blood pressure, and detoxifies the body of heavy metals – among other benefits. (Apparently, to get some of these benefits, we must add it to our bath water.)

First, the word detoxify should raise warning flags to anyone with any scientific understanding of how the human body functions. Second, the idea that any salt lowers blood pressure flies in the face of all medical understanding. Increased salt consumption increases the risk of high blood pressure. Finally, supports and promotes are words often used by snake oil salesmen regarding all sorts of magical supplements, potions and ointments to cure all sorts of ailments. Promoting and supporting cannot be measured, thus they are meaningless. It’s junk science at it’s finest.

But don’t let that stop Millennials searching for the magic potions allowing them to live forever. Set the grinder of pretty pink salt on the table to impress friends and mix it with the bathwater to increase libido and conquer aging. Then wonder why you are no healthier or younger looking and can’t afford to retire when you expect to. They fall for hype and fads in the same way their parents do. Gullibility must be hereditary.

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.

How Can Facts Compete With Fads?

A couple of years ago beet juice was all the rage. Promoters sold a powder to dissolve in water.  They called it a circulation super-food. They backed up their claim with a pile of testimonials but scant scientific evidence; except that beets are vegetables, and vegetables are healthy. Does that make any vegetable a super food?

Well, step aside beet juice. It’s time for celery to take a turn.

How do we know celery juice is the latest super food? – Testimonials, of course! Says one article, “Celery juice is everywhere. So much so, that the two New York Whole Foods locations I’ve gone to in the past two weeks have been out of celery” as people buy it in bulk to take it home and run it through the blender.

These are not ordinary testimonials. Apparently the fad start when the Medical Medium (MM not to be confused in any way with MD) told his thousands of on-line followers that celery juice was “one of the most powerful and healing juices we can drink.” Since then it has been “rising in popularity within the health and wellness world” with tens of thousands of personal endorsements on Instagram. Among them are celebrity/influencers including Gwyneth Paltrow, Kim Kardashian and Debra Messing.

When I looked up articles about celery juice, though, most that I found said that those claims are false. This one begins with a headline, “Celery Juice ‘Benefits’ Are Total B.S., According to Nutrition Science.” The claims of it reducing chronic inflammation are grossly exaggerated. It doesn’t necessarily help with weight loss, because juicing any vegetable “will yield a higher concentration of sugar.” Any mention of detox should automatically be a red flag for anyone with an ounce of nutritional common sense.

Another website mocks the whole idea of the detox claim saying, “this entire celery juice trend is the epitome of bullshit pseudoscience.” It’s all about being a member of the super cool crowd that crowed about kale until celery juice was declared the new kid in town. It’s more about a need to belong, than a desire to be healthier.

Another reason people are drawn to juice fads is the convenience. The answer to not having time for fruit and vegetables is to grab a bottle or tumbler of the liquid equivalent, but it’s not really equal. The process of juicing compromises some of the nutritional value because it loses the beneficial fiber you find in raw veggies.

And Americans don’t get enough fiber.

This BBC article argues, “people who eat more dietary fiber are actually feeding their gut microbiome,” and “fiber leads to greater satiety, less insulin secretion, and more short-chain fatty acids, which all amounts to one thing: less body weight.”

Studies show that “those who had the highest intake of fiber or total fiber actually had an almost 80 percent greater likelihood of living a long and healthy life over a 10-year follow-up, [and] were less likely to suffer from hypertension, diabetes, dementia, depression, and functional disability.” 

This fiber, that BBC calls a lifesaving food, is easily available. “You find it in fruit and vegetables, some breakfast cereals, breads and pasta that use whole-grains, pulses such as beans, lentils and chickpeas, as well as nuts and seeds.” That’s whole fruits and vegetables, not the ones that have been run through a blender.

Once again, that’s the truth about another so-called super food. But how does the truth compete with celebrities, influencers and self-declared wellness experts with thousands of Instagram followers but no formal training in nutrition or science? All these fad diets are based on testimonials and endorsements that appeal to the emotions without any scientific basis with the sole intent of selling to gullible people their books, products and other secrets of good health.