Posts Tagged ‘ altmed ’

TCM and You: Cupping


I have noticed that Chinese massage seems to be becoming popular, and seemingly with it Traditional Chinese Medicine (TCM1). At least browsing through two of the larger shopping centres in Hamilton (bring on the hick jokes) I saw massage centres offering these services. In particular cupping was advertised. But what exactly is cupping2?

As with many modalities in TCM Cupping appears to be based on pre-scientific notions of blood stagnation and energy blockages3. Applying cups with a slight vacuum to the skin is meant to draw out the “toxins” which then results in improved health, somehow.

The active part of cupping essentially boils down to a pressure difference. The pressure is lower on the inside of the cup and greater on the outside, this difference causes the skin to be forced up into the cup4. This process in turn causes blood to gather in the region and may cause minor damage to the area resulting in bruising.

Presumably the fact that the skin appears to be drawn up into the cup gives the impression that there is a general pulling action at work here and that toxins and other “bad stuff” are pulled out of the body in this fashion.

The trouble with this is that pressure difference is a fairly crude physical process and with regard to this biological system lacks what we in the science biz call “Specificity”5. What this means is that there is no way for the cup to restrict the “pulling action” to only harmful chemicals (the “toxins”, say) and allow everything else to be unaffected, i.e. it is not “specific” to toxins. Everything will be drawn up in the same way.

In which case you get a lovely bruise and feel like you’ve done something but that’s about it.

Ok, that’s fine for just thinking about it. What about evidence, we’re always going on about evidence here.

I attempted to find a Cochrane review on cupping but while one was listed for pain relief there did not seem to be a completed review for perusal. I did come across this review that found equivocal results for the effectiveness of cupping for pain.

The review comments on the putative mechanism of cupping:

“Assuming that cupping was beneficial for the management of pain conditions, its mechanisms of action may be of interest. The postulated modes of actions include the interruption of blood circulation and congestion as well as stopping the inflammatory extravasations (escaping of bodily fluids such as blood) from the tissues. Others have postulated that cupping could affect the autonomic nervous system and help to reduce pain . None of these theories are, however, currently established in a scientific sense.” [Emphasis added, citations removed]

The discussion of the reviews limitations is especially worth noting:

“Our review has a number of important limitations. Although strong efforts were made to retrieve all RCTs on the subject, we cannot be absolutely certain that we succeeded. Moreover, selective publishing and reporting are other major causes for bias, which have to be considered. It is conceivable that several negative RCTs remained unpublished and thus distorted the overall picture. Most of the included RCTs that reported positive results come from China, a country which has been shown to produce no negative results. Further limitations include the paucity and the often suboptimal methodological quality of the primary data. One should note, however, that design features such as placebo or blinding are difficult to incorporate in studies of cupping and that research funds are scarce. These are factors that influence both the quality and the quantity of research. In total, these factors limit the conclusiveness of this systematic review.

In conclusion, the results of our systematic review provide some suggestive evidence for the effectiveness of cupping in the management of pain conditions. However, the total number of RCTs included in the analysis and the methodological quality were too low to draw firm conclusions. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.”

In conclusion then, you may see a placebo effect from this treatment – though I suspect this is over rated as a therapeutic outcome6. You may also find yourself covered in bruises (though I hear they are painless – think of them as CAM hickies). So… Dubious premise with dubious benefit, same thing – different day.

Here are a couple of images for you to keep in mind…

Mmmmm, cupping goodness.

[UPDATE 30/5/12: Islam appears to support cupping, check out this completely unbiased arabic wikipedia article]

—————————————————————————————

Footnotes:

1. Can’t get away from TLAs

2. So many jokes spring to mind, I mean come on – “cupping”?

3. See this link for some scary science illiteracy around cupping. And here’s good old Wikipedia. And “blood stagnation” really? isn’t that gangrene or septicaemia or something?

4. Keeping in mind that a vacuum does not suck, high pressure pushes.  If I may geek out a bit here; hence one of my favourite exchanges from ST:TNG:

“You were right. Somebody blew out the hatch. They were all sucked out into space.“
“Correction, sir, that’s blown out.“
“Thank you, Data.“
“A common mistake, sir.“

- Riker and Data get precise about the physics of rapid decompression into the vacuum of space

5. Yeah, I know, it sounds made up.

6. See here, here and here.

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2012
04/04
CATEGORY
Alternative medicine
Medicine
Questionable Techniques
Sciblogs
skepticism
4 comments

Thai Yoga Massage: Herald, Wherefore Art Thou Sense?


So here I am, again latching onto the brilliance of others and writing my own counterpoint to the nonsense that is currently being run in the NZ Herald under the “Alternative Therapies” summer fluff.

Previously Alison kicked us off by looking at the use of medicinal leeches, as did  Siouxsie, and Michael took on Ayurvedic Medicine.

The latest round concerns something called Thai Yoga Massage or Nuad (Nuat) Boran. Essentially the practice consists of the massaged party adopting a series of yoga positions while the massager applies pressure to the body’s “Sen” lines. Those familiar with acupuncture’s “Meridians” can replace Miridian with Sen and get the general idea.

From an article describing the practice:

“The theoretical basis for traditional Thai healing is rooted in the belief  that all forms of life are sustained by a vital force (lom) that is carried  along invisible energy pathways (sen) running through our bodies.  This energy force is extracted from air, water, and food, and it is  believed that disease and dysfunction come about when energy  becomes blocked along these pathways. Accordingly, Thai massage’s  intent is to free this trapped energy, stimulate the natural flow of life  force, and maintain a general balance of wellness.”

Thus Nuad Boran is a system of energy medicine based on pre-scientific notions of “Vital Force” or “Life Energy”, blockages in which are the cause of disease (though exactly what disease seems to be harder to pin down). It is also claimed to be based partly on Ayurvedic medicine.

So what exactly does this “Alternative Therapy” treat? From the same article quoted above:

“The result of a full-body Thai session is often an exciting and powerful mind/body experience, bringing both the recipient and the practitioner to greater states of physical and mental well-being.”

But that’s kind of vague, what else?

Like many alternative treatments and especially the ones covered by the Herald this week the actual claims for Thai Massage seem to centre around improved blood flow. At least that’s the impression I got from looking at the listed clinical research on this page.

But apparently in the medical literature Thai Massage is mainly focused on pain relief, though there is this one hopeful study trying to use it as a treatment for Autism (the current trendy target for alternative therapies where nothing is too insane to try including chemical castration). Though a brief look at the abstract implies to me that they took one implausible treatment added a second implausible treatment and decided that Implausible2 = Success.

Pain is a good candidate for effective use of Thai Massage; the end point is subjective and massage involves close contact which humans generally find inherently soothing. Hopefully any successes in the pain arena will not be parlayed into evidence that the treatment “works” for any other condition.

The main issue I have with all the literature I’ve been able to dig up so far is that only Thai Massage was included in the studys. The specific reason for using Thai Massage (at least traditionally) is the claims regarding redirecting and unblocking life energy. Remove that unscientific aspect and why wouldn’t any massage work just as well?

I’m perfectly sanguine about the possibility that Thai Massage may be beneficial for perception of pain and reliving stress for the reasons given above. Should we be saddled with the extra hypothesis about life force, with the implication that there is something mystical and magical going on; giving the added justification that the therapy could be of use beyond pain and stress (and whatever else massage is good for)?

I don’t think so.

As Michael pointed out in his post, even the Herald reporters aren’t approaching these “therapies” as medical treatments but more as a relaxing massage/spa  session (except for the leeches, but perhaps there are those out there who would consider this relaxing).

Frankly, after the above it should be “’nuff said”. But how does the Herald approach this wellspring of traditional medical wisdom?

Well, possibly this article is the most honest so far, explicitly calling the technique a “relaxation therapy”. The life force concept is only briefly and obliquely referenced and the main emphasis is that this is simply a massage.

Even so, there are vague hints that the procedure is beneficial to your health is way that go beyond simple massage.

Passages like:

“…the yoga-like stretches help to stimulate and move air through the body.

“Every vital part of the human body, from the heart to the lungs, needs good air flow to function well, and Thai massage is aimed at stimulating these air vessels in the body,” said Nucharee Weerawan”

Do subtly imply that the massage will not only relax you but will help your body to “function well” whatever that might mean in this context. Which in turn may lead people to be more open to the idea that the massage could be used to treat more serious ailments. Or maybe the population will actually think things through for themselves and see through more extravagant claims.

I’m hoping for the later.

Though reading further into the description of the massage given, it doesn’t sound especially pleasant. Despite the attempt at a positive spin in the last line.

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2012
01/13
CATEGORY
Alternative medicine
Medicine
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5 comments

Breaking News!: Have Constipation? Moxibustion Won’t Help!


ResearchBlogging.orgWhat’s Moxibustion, And why would you want to use it for constipation? The first I can answer, the second…not so much.

Moxibustion is the practice of burning ground up mugwort and applying the smouldering plant indirectly or directly to the skin to alleviate illness. In the indirect method acupuncture needles are inserted and the burning mugwort is used to heat either the skin or the needle. Direct methods are exactly what it sounds like, the mugwort is burned while sitting on the skin and your skin burns too. The amount of skin burning can vary – from minor to burns that will leave scars. On purpose.

Why would you want to subject yourself to this? Beats me.

But people do, and others study what it might be good for and publish papers about it. One of these turned up in my in-box this morning courtesy of BioMed Central Complementary and Alternative Medicine. With a title like “The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial” how could I ignore it?

Reading the study I was transported to a place where the underlying physical process of disease matters not a whit and where the sweat, facial features, , body energy, duration of disease, and pulse type are methods of determining treatment. To be fair other measures were also used, including stomach pain, stuffiness and duration of disease.

No indication was given of how “body energy” was measured. Stuffiness was not defined – I’m sure these are standard things that every doctor knows about.

Frankly, if you are using a magical treatment to unblock your magical life energy then this is the type of thing you should expect to be important.

The study itself was quite small, as the title suggests, only 25 participants. 12 in the treatment arm and 13 in the sham moxibustion arm. Now, how do you do sham moxibustion? Apparently, as it is the heat from burning the mugwart that is important, you just introduce an insulator to stop that heat reaching the patient.

Luckily the procedure used was the indirect acupuncture type, so those in the sham group didn’t wonder why no third degree burns where in evidence.

This approach leaves all the burny, smokey goodness of the mugwort though. Given the negative outcome of the study I suspected this would come up in the discussion. I was not disappointed.

We’ll get to that in a bit. First I want to cover how the patients were divided into “deficiency syndromes” and “excess syndromes”. Constipation in traditional Chinese and Korean medicine is apparently due to either a deficiency or excess of qi (chi), you know, the life energy. This is where checking out people’s faces and sweating etc comes in.

I’ll quote directly from the paper at this point:

“A patient with a deficiency syndrome has sunken, weak pulse, whereas a patient with an excess syndrome has superficial and broad pulse. The patients having symptoms such as a pale face, heavy sweat, and depression were considered to have a deficiency syndrome; the patients having symptoms such as a swollen face, little sweat, and chest pressure were considered to have an excess syndrome. Syndrome pattern differentiation was conducted by an OMD before randomization.”

Further on:

“Five participants were diagnosed with an excess syndrome, and twenty-one participants were diagnosed with a deficiency syndrome. In this study, the most prevalent symptoms for an excess syndrome were a strong body energy and superficial pulse; for a deficiency syndrome the symptoms were a long duration of disease and weak body energy.”

Given that “body energy” plays such a part in dividing the patients I was hoping at this point it would be defined and a method to assess it given. Alas, I was out of luck. Obviously it’s too basic to explain here.

To the results!

I already gave the game away: moxibustion was no different than sham moxibustion when it comes to improving symptoms of constipation. To their credit the authors admitted this could be because moxibustion is, in fact, ineffective. But then, maybe they chose the wrong acupuncture points (never mind that large well designed studies show that where you stick the needles has no effect on outcomes). Or perhaps the sample size was too small – I’ll give them this one, though if there was a significant effect then even a small sample should have shown it.

Then the inevitable, perhaps the sham moxibustion was effective after all. Because, you know, the smoke and stuff. And, oh yeah, the patients actually had “excess-cold” syndromes when normally you’d expect excesses to be warm – so maybe that has something to do with it…

Can you say “rationalising”?

The authors also note that while a number of adverse events have been reported for moxibustion, the patients in this group only experienced redness. Another quote:

“Previously reported adverse events related to moxibustion treatment include burns [no kidding, I thought that was a feature - not a bug], an itching sensation, infection, allergy and xerophthalmia [dry eyeballs]“

Dry eyeballs…. hmmm, better than a punctured lung.

The paper concludes with the obligatory call for larger more rigorous studies, despite the fact that this is an implausible treatment based on magical thinking. Oh well, such is the way of things nowadays.
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Park JE, Sul JU, Kang K, Shin BC, Hong KE, & Choi SM (2011). The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial. BMC complementary and alternative medicine, 11 (1) PMID: 22132755

2011
12/06
CATEGORY
Alternative medicine
Medicine
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Science
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2 comments

Lemon: The New Miracle Cure!


[EDIT: I'm still getting emails asking how best to consume lemons for their anti-cancer effect here's a disclaimer: Lemons Are NOT A Therapeutic Agent For Cancer Treatment. It Is A Hoax. This Post Is NOT Medical Advice. If you Have Medical Questions Please See A Doctor. Also Please Read the FULL Post Which Continues Past The Green Text]

The surprising benefits of lemon!

Institute of Health Sciences, 819 N. L.L.C. Charles Street Baltimore , MD 1201.
This is the latest in medicine, effective for cancer!

Read carefully & you be the judge.
Lemon(Citrus) is a miraculous product to kill cancer cells. It is 10,000 times stronger than chemotherapy.
Why do we not know about that? Because there are laboratories interested in making a synthetic version that will bring them huge profits. You can now help a friend in need by letting him/her know that lemon juice is beneficial in preventing the disease. Its taste is pleasant and it does not produce the horrific effects of chemotherapy. How many people will die while this closely guarded secret is kept, so as not to jeopardize the beneficial multimillionaires large corporations? As you know, the lemon tree is known for its varieties of lemons and limes. You can eat the fruit in different ways: you can eat the pulp, juice press, prepare drinks, sorbets, pastries, etc… It is credited with many virtues, but the most interesting is the effect it produces on cysts and tumors. This plant is a proven remedy against cancers of all types. Some say it is very useful in all variants of cancer. It is considered also as an anti microbial spectrum against bacterial infections and fungi, effective against internal parasites and worms, it regulates blood pressure which is too high and an antidepressant, combats stress and nervous disorders.
The source of this information is fascinating: it comes from one of the largest drug manufacturers in the world, says that after more than 20 laboratory tests since 1970, the extracts revealed that: It destroys the malignant cells in 12 cancers, including colon, breast, prostate, lung and pancreas … The compounds of this tree showed 10,000 times better than the product Adriamycin, a drug normally used chemotherapeutic in the world, slowing the growth of cancer cells. And what is even more astonishing: this type of therapy with lemon extract only destroys malignant cancer cells and it does not affect healthy cells.
Institute of Health Sciences, 819 N. L.L.C. Cause Street, Baltimore, MD1201
SEND TO EVERYONE … ! ! ! ! !

—————————————————————————————–

No, I haven’t turned to the dark side, yet. The above was sent to me by a workmate and I have reproduced it here, complete with eye catching colours. Searching the intertubes reveals that many people have perfected the art of the uncritical copy and paste[1]. Not everyone has “drunk the kool-aid” though[2].

Lets deconstruct shall we? This is going to be fun.

Initial reading of this “article” throws up numerous red flags that the claim is either wholly made up or exaggerated. First is the allusion to conspiracy, while drug companies can certainly act in nefarious ways[3] this article implies that scientists in general would close ranks and perpetuate the conspiracy. Otherwise why haven’t government funded scientists or otherwise drug company independent scientists picked this up?
Another is the fact that several authoritative sounding statements are made but there is no detail to back them up

1. lemons kill cancer: Well what part of the lemon? where is it most concentrated? what variety is best? how should it be prepared for maximum benefit? what dose?
2. A laboratory has tested it: Well who? Where? what papers were published? what was the experimental set up? was it in vitro or in vivo? what were the results exactly?
3. Lemons are 10,000 times better than chemotherapy. Really? not 8,000 or 12,000 but exactly 10,000? In all situations?

Many fruits and vegetables have potentially therapeutically beneficial compounds, there are promising anticancer compounds in broccoli[4]. But the levels found in the foods are often too low and too variable to be of therapeutic use. But that’s negative thinking, what matters is that the compounds are there and it’s all natural, practicalities are a downer.

This lack of interest in dose response permeates the altmed/pseudoscientific crowd, both in the positive and negative sense. There is no safe dose of toxic compounds[5] and no lower threshold of benefit for “good” compounds[6]. So questions such as “how many lemons would you have to eat to cure your cancer?” become in this context almost nonsensical. While we in the evidence based camp might ask whether it should be 10 or 100 or 1000 lemons, and is that per day? And for how long? Further, how does the concentration of the anticancer component vary with the nutrition of the plant from year to year, or even within a season? How about between plants? Is the component present in the flesh or the skin? Those in the vague, feel good altmed camp are content with the message “Eat Lemons”.

In a laboratory and medical setting active ingredients aren’t extracted from plants and purified or synthesised solely to generate profits for drug companies (though that’s a motivation don’t get me wrong) but to make it easier to work with and quantify the correct therapeutic doses and optimal delivery methods.

Additionally, labs have to get consent for testing drugs on humans so it’s likely that the tests alluded to, if they occurred at all, were on cell cultures. This method can indicate interesting directions for research but does not guarantee that it will turn into a useful therapy. The body is very complex and things that work in a petri dish do not necessarily work in the body. It could break down too fast, or not reach the right tissues effectively, or be modified by metabolic processes or excreted too efficiently or any number of other things. Basic science research is good at generating these sorts of leads but the journey from bench top to consumer is one fraught with pitfalls.  Few drugs that appear promising at the outset make it to market[7].

Another red flag is the number of other conditions it treats. Each of the ailments listed have different causes and treatments, it is highly unlikely that the same thing will combat both high blood pressure and parasites when these have absolutely nothing in common[8].
Also, much of the text is similar to an article about another “miraculous” fruit, Guyabano, fruit of the Graviola tree[9].

Points of similarity:
1. We don’t know about it because the drug companies are trying to make a synthetic version to patent.
2. You can help a friend by telling him to drink the juice, the taste is not bad and has no side effects.
3. A large drug company has conducted 20 tests on it since the 1970s.
3. Kills 12 types of cancer.
4. “The tree compounds proved to be up to 10,000 times stronger in slowing the growth of cancer cells than Adriamycin, a commonly used chemotherapeutic drug!”
5. Only kills cancer cells.

Curiously similar given it is a completely different plant being talked about.

Searching the “Health Sciences Institute” (not the Institute of Health Sciences) I couldn’t find anything about Lemon and cancer but a Graviola and cancer search turned up a similar looking article (requires a subscription[10] to read but I suspect it may well be the source of the information for the one at the address above)

So it looks like this is actually a mash up of at least two different claims. I think we are witnessing the birth of a new altmed mythology, right here.

None of this means that Lemons cannot be used as a basis for anti-cancer drugs, in fact I did actually find that there are at least a couple of citrus derived compounds being investigated for anticancer activity[11&12]. Even so, the likelihood that simply eating lemons will cure you of cancer seems quite low, for all the reasons given above.

Multiple lines of evidence appear to be converging on this being if not a scam then at least a confabulation. Well meaning people will forward items like this to friends and relatives without much thought. I consider this to be irresponsible behaviour. As I have pointed out before in the context of chain emails, if we truly want to help our loved ones it behoves us to investigate these claims before passing them on. Whom do we help by perpetuating falsehoods?

—
Footnotes:

1. Here, here, here, here, here, here, here, here, here, here, here- and about a thousand others. I’m so depressed right now.

2. While searching out instances of this rot I found a breast cancer forum that had posted it, as a joke to be ridiculed. Read it now, it shows how these ridiculous items are actually insulting to those affected by cancer.

3. Like ghost-writing research and review articles in their favour. Yes they are profit driven entities, and yes they can go too far to ensure those profits but they do crucial research and development and we need them.

4. Yanyan Li et al (2010), Sulforaphane, a Dietary Component of Broccoli/Broccoli Sprouts, Inhibits Breast Cancer Stem Cells
Clinical Cancer Research May 1, 2010 16; 2580

http://clincancerres.aacrjournals.org/content/16/9/2580.abstract

5. For example in the anti-vax movement.

6. Like homeopathy, even ZERO isn’t a small enough amount for there to be no benefit.

7. Shoot, I’ve been archiving wecite versions of pages I link to to make sure the don’t vanish without a trace but was too late for this one. http://brneurosci.org/drug-failures.html
8. Not withstanding that everything in the altmed world is linked, it’s all toxins or vibrations or pH or quantum or something.

9. http://guyabano.com/   [webcite]  – with another version containing even closer wording here: http://mybongabon.com/samut-sari/the-sour-sop-miraculous-natural-cancer-cell-killer-by-arlyn-roa/ [webcite].

10. 1-year risk-free membership, Brand-New Encyclopedia of HSI’s 100 Greatest Cures and FREE bonus reports :No More Sick Days: The Immune Discovery of the Decade” and “How to Survive the FDA’s 10 Deadliest Hush-ups” for just US$67. [webcite]. You can’t get more credible than that. [article webcite]

11. Chidambara Murthy K.N., et al(2011), Citrus Limonin and Its Glucoside Inhibit Colon Adenocarcinoma Cell Proliferation through Apoptosis.
Journal of Agricultural and Food Chemistry

http://www.ncbi.nlm.nih.gov/pubmed/21338095

12. Cazal, C.M., et al(2010), Evaluation of effect of triterpenes and limonoids on cell growth, cell cycle and apoptosis in human tumor cell line.
Anti-Cancer Agents in Medicinal Chemistry, 10(10):769-76.

http://www.ncbi.nlm.nih.gov/pubmed/21269253

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2011
03/07
CATEGORY
Alternative medicine
Medicine
Sciblogs
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34 comments

Amber Teething Beads: A Few Points to Consider


Being a new parent and a sceptic I have been on guard regarding dubious advice and practices. Parents, especially new parents like myself, are a vulnerable group. We tend to be full of anxiety that we are doing the “right thing” by our children. Where-ever you find a vulnerable group like this you also tend to find those who prey on such fears. I have actually been pleasantly surprised, despite my vigilance I have not yet been subjected to any dubious advice (that I’ve noticed). But early last week I was confronted by a practice from a fellow new parent that I found a little disturbing. I’m taking about using necklaces of amber beads to reduce the pain of teething for babies.

Teething can be an especially stressful time for parents and children, the child may be experiencing pain as the new teeth break through the gums. This means an irritable child and frazzled parents. Anything that promises to relieve or prevent this harrowing time is gratefully embraced.

On to the amber beads. This practice disturbs me for several reasons. First is safety, the necklace if left on the baby for long periods may pose a strangling hazard of it becomes caught on something. Most advertise that they are made to break easily to prevent this and that the beads are individually knotted onto the necklace to prevent scattering on breakage. However this still seems to leave a broken string of beads in reach of a baby, as as most people know – anything a baby can get it’s hands on goes straight into the mouth. So choking is also a concern[1&17].

Now, I’m not one to be a worry wart over every little potential hazard, used correctly under parental supervision I suspect that the likelihood of a tragedy of this kind is low. But not zero[15&16]. This coupled with the low possibility that the necklace actually does anything is what worries me. The second disturbing thing is that parents are accepting this via word of mouth and apparently not consulting their doctors before subjecting their child to an intervention of unknown safety and efficacy.

I have three main points I want to cover with regard to these amber beads that parents should consider before trying these beads (in addition to the physical safety above). The first relates to basic plausibility.

Before we get to that though it depends on which mechanism of action for the beads you subscribe to. There are several explanations regarding how the beads are supposed to work floating around the intertubes, many are of the tinfoil hat brigade variety, these will be ignored (but look here and here for a bit of a chuckle). Only one explanation I have found makes biological sense so that’s the one I’ll be focusing on.

That explanation is Succinic acid, baltic amber is known to contain between 3-8% succinic acid. According to proponents this is released from the beads and into your baby. The succinic acid then allegedly has an analgesic effect and so reduces the pain of teething. Here is where my first point regarding plausibility comes in:

Amber is tough, really tough. This is a material that has persisted for thousands and in some cases millions of years unchanged. Suffering through heating and cooling of innumerable climatic changes through the years. Yet this same tough unchanging material with happily give up it’s chemical components upon the gentle heating it receives on being placed next to your baby’s skin? Colour me unconvinced[1&2]. Related to this point amber has a hardness on the Mohs scale of between 1 and 3 [3], baltic amber which is usually touted as the therapeutic variety (because of the high succinic acid content) is at the high end of this scale 2 – 2.5. To put this in perspective, Tin has a hardness of about 1.5 and Gold is 2.5-3 [4]. But forget about this point, I don’t need it. Lets say for argument sake that clinically relevant amounts of succinic acid are released by the amber and absorbed by your baby’s skin.

My second point then, relates directly to the claims made for succinic acid. Succinic acid is made in the body (and in plants) as part of the citric acid cycle (aka krebs cylce)[5]. It is also use in the food and beverage industry as a food acid (additive #363 to be precise)[6]. Interestingly in this capacity there are recommendations from some quarters to avoid the substance[7]. Even so, apart from it’s early use as a topical treatment for rheumatic pain[8] there is no evidence that I could find (searching Pubmed at least, where I would expect a decent study to be referenced) that it is effective as either an anti-inflammatory or general analgesic. Let me be clear on that, I don’t mean low quality evidence, I don’t mean small poorly designed trials with equivocal effects, I mean nothing. Zip. Nada. In fact if anyone knows of any let me know because I find this complete lack quite surprising, I’m open to the idea that I was looking in the wrong place or was using incorrect search terms. So, unless there is late breaking news, it fails on that count as well. Meh, what do we care about evidence of efficacy anyway? Throw this point out too. Lets move on to my final argument, uh, I mean point to consider.

Lets say that a. the beads do indeed release succinic acid into your baby and b. this succinic acid has an analgesic effect once it enters your baby’s body. Doesn’t the very fact that an unknown amount of a drug[9] is being put into your baby’s body bother you? What is that I hear? It’s natural? Oh, well, that’s ok then. No wait, no it’s not. I don’t care what the origin of a compound is, the question is what are it’s effects on the body and do the benefits out weigh the risks. Ok, lets replace succinic acid with some other naturally occurring substance, salicylic acid. This is a compound with known anti-inflammatory properties[10]. Would you be happy with a product that introduced unknown levels of this compound into your baby? What if I said that overdoses with this compound could lead to a 1% chance of death?[11] It’s natural, it’s also the precursor to acetylsalicylic acid, otherwise known as Aspirin[12].

Now, lest I be accused of unnecessary fear mongering and drawing false comparisons I would like to admit that at present there is no evidence to suggest that succinic acid is hazardous, nor even that it is potentially hazardous[5]. This does not detract from my main point however, the point isn’t whether this particular compound is safe or not but that the reasoning[13] around it’s use is faulty and cannot be used as a substitute for evidence.

Based on the complete lack of plausibility on any level of efficacy any potential for harm, however small, must tip the balance of this equation away from the use of this product. Don’t trust me though, talk to your doctor, I suspect though that given the complete lack of reliable information on this topic they will be left to rely on their own philosophy of harm vs benefit. In the final analysis, there are not always clear answers[14], but developing good critical thinking skills will at least provide you with a small light in the darkness.

[Edit - I recently posted a follow-up article to this addressing some of the points raised in the comments below. It may be found Here]

[Update 20/07/12:  Commenter Heidi Pogner-Schultz has provided a thoughtful and researched perspective in support of amber beads (here), I disagree for reasons outlined in my reply to her (here). But this is exactly the type of reasoned evidence I was looking for so I thank her for the contribution.]

[Update 29/4/13: Apparently there is a chain email circulating blaming amber beads for a case of SIDS, a visitor mentioned this in the polling comments. This seemed implausible to me and a very brief check seems to back up my gut feeling. There is no reason to think that amber beads contribute to SIDS at all. For a more thorough break-down go here: http://www.hoax-slayer.com/amber-teething-necklace-sids.shtml . I am not one who feels we need to latch onto any reason to vilify our intellectual opponents and spreading misinformation (especially easily debunked misinformation) is a big no-no in my book.]

Informal Poll:

After reading the preceding post I wonder if you’d like to help me measure what sort of effect this research is having. Please indicate on the poll below your attitude to using Amber beads -

[Edit: Preliminary results from the poll - most consider their opinion unchanged, what a shock. Also the "Other" section is not for insults, if you wish to call me an idiot please do so in the comments of the post where you may be held up for ridicule.]

Footnotes:

1. http://www.3news.co.nz/Teething-necklaces-dangerous—sceptics/tabid/423/articleID/160820/Default.aspx

2. I found this paper that analysed the volatile out gassing of amber, succinic acid was not mentioned as an identified component. http://www.springerlink.com/content/865ku15055np3x78/

3. http://www.emporia.edu/earthsci/amber/physic.htm

4. http://en.wikipedia.org/wiki/Mohs_scale_of_mineral_hardness

5. http://www.accessdata.fda.gov/scripts/fcn/fcnDetailNavigation.cfm?rpt=scogsListing&id=339

6. http://en.wikipedia.org/wiki/List_of_food_additives,_Codex_Alimentarius

7. http://www.foodreactions.org/allergy/additives/300.html

8. http://en.wikipedia.org/wiki/Succinic_acid#History

9. If it has biologic activity that can be used in a therapeutic fashion, it’s a drug, no quibbling on that point please.

10. http://en.wikipedia.org/wiki/Salicylic_acid#Medicinal_and_cosmetic_uses

11. http://en.wikipedia.org/wiki/Salicylic_acid#Safety

12. http://en.wikipedia.org/wiki/Aspirin

13. ie “It’s got to be good, it’s natural.”. Don’t make me barf.

14. Who am I kidding, there are almost never clear answers. Who wants certainty anyway?

15. http://safekidspiercecounty.health.officelive.com/Documents/Choking%20and%20Suffocation%20Fact%20Sheet.pdf This is an american document but I don’t think necklaces become safer just because we’re in NZ.

16. http://www.nzchildren.co.nz/infant_mortality.php NZ infant mortality statistics.

17. http://www.bpac.org.nz/magazine/2010/april/docs/bpj_27_oral_pages_30-41.pdf See page 33.

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2011
02/21
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Is Acupuncture Worth a Punctured Lung? or Does the Risk Out Weigh the Benefit?


Friday’s issue of The New Zealand Medical Journal includes a case report of pneumothrorax in a recipient of acupuncture. For the interested layperson out there a pneumothorax in the collection of air in the space between the lung and chest wall leading in extreme cases to cardiac arrest. Acupuncture can result in pneumothorax when the needle is inserted into the lung tissue while the patient is breathing leading to the laceration of the lung and air being forced out of the lung and into the pleural cavity1. Mmm-mmm, gimmie some of that lung collapsing goodness.

Now lest I give the impression that complications from acupuncture use are common I will hasten to add that they are not. One paper estimates the rate of serious adverse events at approximately 1 per 20,ooo patients2. Though if we look at the rates of acupuncture use in the United States as an example, as of about 2007 approximately 1% of the population reported using acupuncture in the previous 12 months3. This translates to about 155 serious adverse effects per year. Another study found over 2% of patients reported adverse reactions that required treatment4, commonly for bleeding or pain. Multiply these figures by the likely worldwide numbers of people receiving acupuncture.

Lets compare this with the conventional medical field, the drug Terfenadine marketed under the trade name Seldane (Teldane here in NZ) was removed from the market in the US due to increased risk of cardiac arrhythmia when used in conjunction with certain other drugs. This expressed itself as a risk of 0.04 – 0.08 per million “defined daily doses”5. Once a replacement drug came on the market Terfenadine was taken off.

Pneumothorax as a complication from acupuncture is  rare even in this subgroup. More common is infection. As I’ve noted before6, the underlying theory of acupuncture is the manipulation of life energies (Qi or Chi), blockages or imbalances in which are the cause of disease. If such is the case then why should the treating physician7 bother with proper antiseptic technique? I suspect that most modern practitioners are however not so far down the rabbit-hole that they have thrown away germ theory completely, at least the outward practical side involved in cleaning and sterilising implements. Which is why even infections are still relatively infrequent.

I would like to point out however that given the implausibility of the treatment basis, coupled with the fact that most large well designed studies find no benefit beyond placebo does make the existence of any complications ethically troubling. If your treament is no more than an elaborate placebo, are you willing to suffer adverse effects because of it? As reported by Dr Novella of Science Based Medicine8, a recent review of acupuncture admitted that sham (placebo) acupuncture was as good a “real” acupuncture.

Lets delve into the definition of “sham” acupuncture a little more to give the proper context to this revelation. Whereas “real” acupuncture depends on the proper insertion of the needles in specific meridian points on the body sham acupuncture can be considered to be either the placement of needles into non-meridian points, or the use of implements that feel like needles to the patients but do not pierce the skin like toothpicks9. This indicates that it doesn’t matter where you stick the needles and it doesn’t even matter if you stick the needles. How then can we conclude that acupuncture works if you don’t need to perform the two defining characteristics of acupuncture?

Given this background I find it difficult to imagine why acupuncture continues to be recommended despite convincing evidence of efficacy and indisputable evidence of harm. All medical interventions carry some element of risk, this is then weighed against the potential for benefit. However when there is no benefit any amount of risk must make that equation lopsided with regard to harm. With that in mind, if you are attracted to acupuncture as a therapy let me recommend sham acupuncture as the way to go. All the placebo-y goodness of real acupuncture without the potential for the nasty drawbacks of infection, bleeding, pain or even pneumothorax.

Further reading:

Type “Acupuncture” and “Infection” or “Pneumothorax” into Pubmed as key words and you will find a variety of papers, a selection of which are below:

Acupuncture induced pneumothorax:a case report (not the report mentioned in the post)

Editorial:Acupuncture transmitted infections

Cutaneous Mycobacterium haemophilum infection in a kidney transplant recipient after acupuncture treatment.

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

Footnotes:

1. Clinical analysis on 38 cases of pneumothorax induced by acupuncture or acupoint injection

2. A cumulative review of the range and incidence of significant adverse events associated with acupuncture

3. http://nccam.nih.gov/health/acupuncture/introduction.htm

4. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form.

5. Detection and reporting of drug-induced proarrhythmias: room for improvement

6. Scepticon: Acupuncture

7. And here I use the term loosely.

8.Acupuncture Pseudoscience in the New England Journal of Medicine

9. I kid you not, here are a couple of the studies:
Description and Validation of a Noninvasive Placebo Acupuncture Procedure
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

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2010
08/16
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World Homeopathy Awareness


Just when I thought I wouldn’t have to worry about Homeopathy again any-time soon I discover that next week (April 10-16) is World Homeopathy Awareness Week. In theory I am right behind an initiative such as this as homeopaths do a surprisingly poor job of educating the public about what homeopathy actually is.

I suspect though that highlighting the fact that there is no active ingredient in most homeopathic preparations and that huge swathes of established science would have to be wrong for it to work will not feature prominently in the promotional materials.

For those not in the know homeopathy is based on two principles not found anywhere in science, like cures like, known as the “Law of Similars” and less is more or the “Law of Infinitesimals”. In a nutshell these two “Laws” state that a substance that causes similar symptoms to a disease will cure it and the more you dilute the substance the more powerful it becomes. In practice this means that homeopathic preparations can have some unusual starting ingredients (like duck liver) and are diluted to the point that no active ingredient is left in the final product.

A common dilution for preparations is 30C, or 30 consecutive 100 fold dilutions. At this level not only are the no molecules of active ingredient left there aren’t even any molecules of water left from the last dilution that contained any active ingredient.

Due to this fact homeopaths have been reduced to very fanciful explanations of how it might work, most involves invoking some sort of water “memory” effect. This isn’t impossible but neglects to mentions that if it is the case, then the water also remembers every poison it has come into contact with as well. How does it know which effect it should have? Should it kill or cure?

A study performed in 2008 and published in the New Zealand Medical Journal showed that while 85% of respondents believed they knew what homeopathy was less than 5% knew that there is no active ingredient in most preparations. I don’t expect this statistic to change due to any efforts on the part of homeopaths or those that sell generic remedies.

Here’s a pithy website dedicated to How Homeopathy Works.

For those with a high tolerance to brain melting gibberish here’s a video with one of the more confusing explanations of homeopathy:
Youtube Page direct

[UPDATE: Thanks to commenter Lizditz on Dr Steven Novella's blog about this I have been alerted to this great philosophy paper on Homeopathy; "Evidence and simplicity: Why we should reject homeopathy", go read it now.]

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2010
04/09
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Natural Health Expo(sed)?


Driving around Hamilton the past few weeks I couldn’t help but notice the signs sprinkled around the city for the “Natural Health Expo” which is to take place here this week end. As I perused the website for this event yesterday I was disturbed by the large number of anti-scientific “treatments” that will be showcased. Like my co-blogger Grant who has already posted on this, I was troubled by the amount of misinformation that will be leveled directly at consumers.

As I was pondering how to answer the bewildering array of AltMed that will be promoted I checked my email and found a great little article just published in Chiropractic & Osteopathy (made available through the open access publisher BioMed Central).

The paper, “Why do ineffective treatments seem helpful? A brief review” written by Steve E Hartman, looks at how practitioners and patients can fool themselves into thinking that ineffective medical interventions actually work. An excellent example of Evidence Based Medicine 101, Steve covers the cognitive biases that hinder our ability to draw logical conclusions in the medical sphere such as the Post Hoc, Ergo Propter Hoc logical fallacy, confirmation bias and cognitive dissonance. Also covered are explanations of how it can seem that a treatment has been directly responsible for improvement in a patient’s condition when it may not  have been.

The paper touches on disease natural history, which simply refers to how a particular malady might be expected to progress without treatment. Self limiting diseases such as colds, headaches and fatigue can be expected to get better on their own . If a patient is taking a treatment at the time, the treatment (rather than their own immune system) might erroneously be given the credit.

This combined with the overlapping arenas of the placebo effect and regression to the mean can be a powerful confounding factor when treatments are not being considered in light of scientifically controlled settings. The placebo effect is referred to frequently in common culture but regression to the mean is a less well known entity for the layman. Steven does a good job of explaining the concept, essentially people experience a variety of different intensities in their symptoms. Also they will tend to seek medical help when the symptoms become severe, knowing that the severity of the symptoms will tend to cluster about a mean value it is likely that whether treatment is sought or not the patient’s condition will tend to get better.

Thus the patient will feel relief and attribute that relief to what ever modality they are using at the time. Practitioners are not immune to these effects either and will in their practice see time and again that patients are getting better after their pet therapy is applied. In which case they will feel justified in proclaiming it works in the absence of confirming studies (or even in the face of disconfirming evidence).

The one aspect that I felt was missing from the paper, although it may have been obliquely implied, is the role of prior plausibility in evaluating treatments. Many modalities that will be on offer at the Natural Health expo are not only unusual they fly in the face of currently understood science. Scientific plausibility is our compass, without it we can become lost in the wilderness of fanciful ideas without any method of discerning the way forward. This concept is what separates Science Based Medicine from simply Evidence Based Medicine. The former takes the plausibility of a treatment into account when deciding the threshold of evidence needed before it can be considered effective. The later only measures outcomes and so is less able to distinguish true effects from chance outcomes.

Consider the following scenario: I claim to be able to influence the outcomes of coin tosses by virtue of what I had for breakfast on a particular day. If I have eggs then tails with predominate, lettuce produces more heads. Now without considering the plausibility of the setup we could run a trial, perform statistical analysis and find that my predictions are correct. But given that there is no good reason to suspect that my diet can influence a coin toss the positive is more likely to be because of chance than because of a real effect. In this case then a higher standard of evidence would need to be achieved than if I had said I could alter the probabilities be sticking a piece of gum to one side.

All-in-all though this a very nice paper and my complaint is a small one, given the probable readership of the journal the inclusion of plausibility may even have alienated those that might otherwise have been receptive to the other points presented. I recommend reading it for yourself, it is a very easy and informative read.

2009
10/15
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Vitamins and Exercise


I think it’s safe to say that in recent years the push to “Become Healthier” has become much stronger than it was previously. Statistics like 1/4 of New Zealand adults are obese and New Zealand being the “3rd Fattest” country in the world are used to promote a lifestyle that is aimed at making us healthier. Many of us have taken this message to heart (pun intended) and attempted to shape up but sometimes it’s not clear exactly what is healthy. The primary action people are urged to take is exercise and it’s a good one. There are many recognised benefits to regular exercise including reducing risk of Type II diabetes and possibly even reversing the condition.

Another item that is also touted as a general health promoter is antioxidants. Here’s where things start to get tricky, in order to reap the benefits of excersise there has to be some way that the fact that you are exerting yourself is communicated to the cells of your body. A promising candidate for this signal is ROS, or Reactive Oxygen Species. In other words – Oxidants. This brings up an interesting question, if you are taking antioxidants and exercising in your attempt to be healthy – what happens? A study released early this year suggests that the antioxidants reduce the beneficial effects of excersise in the body.

Researchers looked at two markers of insulin sensitivity: Glucose infusion rates and plasma adiponectin levels (high Glucose infusion rate and high adiponectin levels correlates with high insulin sensitivity = no diabetes for you). They found that taking two antioxidants (Vitamins C and E) while engaging in exercise (not literally, friends don’t let friends jog and pill-pop) actually reduced the before and after exercise difference in these markers. This result strengthens the evidence that ROS are involved in signalling changes in cells and that taking antioxidants interferes with this process.

The drawback of this study is that the participant numbers were quite small. The intial group was made up of forty men, 20 that had athletic backgrounds and 20 that didn’t. These where then split into two goups either recieving supplements or not. So the end was 4 groups of ten, not exactly a significant cross-section of the population. Even so the results are compelling and should be investigated further.

I think the moral still holds, beware of taking too many suplements, you don’t always know what the side effects will be.

2009
07/31
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Gardasil Follow-up: The Evil Toxins


My last post on Gardasil has garnered quite a bit of interest so I thought I would follow it up with a look at some of the other claims about this vaccine that are also geared towards warning women away from it. The focus of this entry is, as the title implies, the ingredients of the vaccine and their alleged toxicity. Now I would first like to make clear that I am not trying to argue that these compounds are not at all toxic, that would be an untenable position almost anything is toxic at the right (or wrong) dose. This brings up the heart of the issue though, the dose is key here, the claims by detractors of the vaccine imply that the amounts of the chemicals in the vaccine are above the toxic threshold. I, along with the medical community so I feel I’m in good company, consider this to be an incorrect conclusion.

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2009
04/30
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Matthias Rath – steal this chapter


A longer post than usual, luckily I didn’t have to write it. This post was written by Ben Goldacre of Bad Science blog fame, enjoy.

This is an extract from
BAD SCIENCE by Ben Goldacre
Published by Harper Perennial 2009.

You are free to copy it, paste it, bake it, reprint it, read it aloud, as long as you don’t change it – including this bit – so that people know that they can find more ideas for free at www.badscience.net

.

The Doctor Will Sue You Now

This chapter did not appear in the original edition of this book, because for fifteen months leading up to September 2008 the vitamin-pill entrepreneur Matthias Rath was suing me personally, and the Guardian, for libel. This strategy brought only mixed success. For all that nutritionists may fantasise in public that any critic is somehow a pawn of big pharma, in private they would do well to remember that, like many my age who work in the public sector, I don’t own a flat. The Guardian generously paid for the lawyers, and in September 2008 Rath dropped his case, which had cost in excess of £500,000 to defend. Rath has paid £220,000 already, and the rest will hopefully follow.  Nobody will ever repay me for the endless meetings, the time off work, or the days spent poring over tables filled with endlessly cross-referenced court documents.

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2009
04/14
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Herbal Medicines


It certainly seems that in recent years herbal style medicines have grown more popular and more widely available. I’m certainly not going to espouse the view that these medicines are a waste of time, that they do nothing or that they have no plausibility. However neither do I think that simply because they are seen as “natural” (whatever that means) that they are necessarily superior to drugs produced by pharmaceutical companies. The problem with herbal/natural remedies isn’t that there isn’t a plausible mechanism of action, (as in Homeopathy for instance) but that there is usually not enough good quality data to support their use for a particular indication. In addition, while drugs developed for the pharmaceutical industry must pass stringent safety and efficacy tests those that are labeled herbal supplements often get a free pass. So not only may there not be evidence that they work but no evidence that they are not harmful.

There also seems to be a disturbing corollary to promoting remedies despite lack of evidence and that is the continued use in the face of dis-confirming evidence. Recently good studies have been published refuting claims for benefits to taking either Ginkgo Biloba extract for cognitive function or Echinacea for colds. Though I expect this information to have zero impact on sales even if the results of the studies gain wide distribution.

Remedies that consist of preparations made from the raw plant also suffer from inherent variation between plants, both between individual plants and in the same individual over time. So even if there is an efficacious active ingredient the dose would not be controlled. If herbal remedies have an effect on the body then they are drugs, by definition, they should be treated as such. In other words they should be evaluated for safety and effectiveness, considered when taking other medications for potential interactions and dispensed by those who are trained to appreciate the risks/benefits and science based medicine.

Resources

http://www.theness.com/neurologicablog/?p=424

http://www.sciencebasedmedicine.org/?p=293

2008
12/08
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Are People Affected by Non-Ionising Radiation?


Modern living can have it’s drawbacks as well as it’s advantages, nobody died in plane crashes 500 years ago. Some of the disadvantages come as a direct result of our increase in scientific and technological knowledge, there would be no antibiotic resistant bacteria without antibiotics. Some people worry about ever more subtle forms of danger in the modern world, there are those who classify themselves as “Electrosensitive”. Electrosensitives consider the electromagnetic fields produced by electronic products such as computers, cell phones, T.V.s, well almost everything these days, to be harmful in general and to affect them in particular in a variety of ways. Symptoms may include but not be limited to: headache, fatigue, tinnitus, dizziness, memory deficits and irregular heart beat, in fact there are lists including over thirty symptoms ranging from asthma to epilepsy and Alzheimer’s.

Earlier this year researchers at the University of Regensburg conducted a study of self identified electrosensitive sufferers comparing their reactions to non-sufferers when exposed to a heat-emitting thermode and a cell phone. The sufferers experienced discomfort from both stimuli where as non-sufferers only experienced discomfort from the thermode. This was backed up by brain scans of the subjects which indicated that the pain experienced was real. Unfortunately the phone used in the experiment was fake, there were no electromagnetic fields being produced. The sufferers were not making up the pain they felt, it was real to them, but in the same way that a placebo treatment can (allegedly*) make people feel better it appears that the anticipation of pain by the sufferers lead them to feel it, in a sort of nocebo response to the sham phone.

It seems that while these electrosensitive people are not merely attention seeking, as the discomfort they feel is undoubtedly real, neither are they suffering from a disability brought on by exposure to fields that are generally considered harmless. What’s going on here? I have no idea but I’ll be interested to see how further research sheds light on this.

Resources

http://www.sciam.com/podcast/episode.cfm?id=cell-phones-sometimes-cause-real-pa-08-10-13

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WNP-4SB7TW1-4&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=993618adacb00f6dc3c58a70d580feb2

http://en.wikipedia.org/wiki/Electrical_sensitivity

http://www.electrosensitivity.org/

* It’s complicated, it could be that what we refer to as a placebo response doesn’t actually exist and is really a mislabelling of other factors that have nothing to do with response to treatment. Who knows.

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2008
11/21
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Psychological
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Frequency Specific Microcurrent Revisited


About two months ago I wrote a piece describing the practice of Frequency Specific Microcurrent therapy (FSM) and attempted to show why I thought the practice was at best the premature use of an unproven modality and at worst a new way of parting the afflicted from their cash. This post recently attracted a comment from a Chiropractor named Pamela Hall who wished to defend the technique. As the comment was lengthy and covered a number of interesting points I thought I would post my reply as a blog entry. First I would like to thank Pamela Hall, DC, for her comment and I hope that I can reply to her in as thoughtful and considerate a way as she has conducted herself. Her comment starts:

Research that meets the gold standard of large patient numbers, with controls costs millions of dollars. There is very little money available for treatment that won’t make the drug companies or some other big players in the medical-industrial complex a lot of money. This is why the research doesn’t get done on this scale. In fact in the 1930′s all electrical therapies, herbs, and homeopathy were banned. They were a threat to the profit of drug companies and the AMA.

Firstly there have been well designed studies on other modalities that “won’t make the drug companies … a lot of money” such as acupuncture, I don’t see why this one should be any different. Also you have presented a false dichotomy here, the choice is not between large definitive clinical trials and nothing at all, smaller pilot studies published in reputable journals will do. If you can provide that I will be greatly appreciative, the best I could find was a case study which vaguely mentioned “microcurrent” along with several other treatment options. Given the amount of time the treatment has been in use I don’t think this is unreasonable.

Those who are prejudiced against so called “alternative healing” fail to acknowledge that western medicine has used aspirin simply because it worked without knowing the reason why until rather recently. The common treatment for angina is nitroglycerin put under the tongue, and this treatment was taken from the realm of homeopathy.

I will gladly acknowledge that much of conventional medicine has come from herbal preparations, folk remedies and the like and that medicines may be used without knowledge of the method of action. However, that the active constituent of Willow bark, salicylic acid (the precursor to acetylsalicylic acid or Aspirin) was extracted and purified which enabled the creation of medicines of consistent dose and quality, is all because of science. Just because a treatment can be obtained from a particular tradition or practice (such as homeopathy) does not lend credence to any of the other methods common to that source, they all must be evaluated separately on their merits, or lack thereof as the case may be. Also, especially in the case of Aspirin, there is a plausible mechanism of action, where a metabolically active substance is introduced into the body and produces a biological effect.

You failed to mention the research done with the frequency for inflammation, using the same animal model as used to test most all of the anti-inflammatory drugs. FSM reduced inflammation by 64% in four minutes, and they never found a drug that reduced it more that 45%. Further more, all anti-inflammatory drugs have undesirable side effects some of which can be life threatening.

This is a fair point and I will accept it. I presume you are referring to this study, the reason I did not discuss it was essentially practical in nature, I could only find this one page abstract which was thin on details. There was nothing there I could dissect. Even If I could have found the full paper it is likely I would not have gone over it as I would have felt even less capable of interpreting it than the study I did present. You bring up another point though that I agree with, drugs do have side effects, as do almost all other types of treatments. As I pointed out in my original post the very fact that treatments have an effect on the body opens the possibility that that can have negative as well as positive effects. As far as I can determine the claim that FSM has no negative side effects can neither be proved or disproved, as you seem to confirm the data is simply not there.

You stated two frequencies are employed by Dr. McMakin, however, hundreds of frequencies are employed. There are always at least two frequencies applied at a time, one resonating with a specific tissue and one resonating with a specific condition.

This I think is simply a misunderstanding, I am aware that there are more than two frequencies that can be used, and I do allude to this fact in several places. My apologies for not being clear.

Microcurrent increases cellular energy by 500% and also increases protein synthesis. This is not what I would call a modest claim.

This may be true, here is the study (performed in 1982 and used as a reference for FSM everywhere), this study was on rat skin tissue in vitro and as such can not necessarily be extrapolated to treating the whole body or even significant parts of it for specific diseases. In addition I do not know how these increases affect other biological functioning or whether or not they are significant even in the context given. Indeed though there does seem to be a biological effect produced by the microcurrent and I refer you to my point above regarding potential harm. However my main point of disagreement with the treatment is the “Frequency Specific” part, in other words the claim that each disease has it’s own unique vibration that can be used to treat it, that is the real claim being made and that is the part that I find least convincing.

You state that Dr. Abrams was dismissed as a fraud in the 1920′s. You fail to mention that Dr. Abrams was investigated by Upton Sinclair, who according to Wikipedia, “was a Pulitzer Prize-winning prolific American author who wrote over 90 books in many genres and was widely considered to be one of the best investigators advocating socialist views. He achieved considerable popularity in the first half of the 20th century. He gained particular fame for his 1906 muckraking novel The Jungle, which dealt with conditions in the U.S. meat packing industry and caused a public uproar that partly contributed to the passage of the Pure Food and Drug Act and the Meat Inspection Act in 1906.”

Mr. Sinclair reported that “Albert Abrams was one of the most eminent practitioners in San Francisco, the head physician of large hospitals, recognized as the author of important discoveries.” Like many scientists who make major breakthroughs his ideas which involved a new paradigm in healing were met with disbelief and derision of his peers. Upton Sinclair was very skeptical when he first visited Abrams, and expected to be done in a couple of days. Instead he stayed and observed him for a couple of weeks, “and it might have been months or even years, if urgent duties had not called me home.” Sinclair considered Dr. Abrams to be a great scientist who had much to offer humankind.

No I did not, and would not have even had I been aware of his involvement. The opinions of a single author, even a “Pulitzer Prize-winning” one such as Mr. Sinclair would amount to anecdote. I read the biography of Mr. Sinclair and failed to note any mention of scientific training or any indication that he had any other expertise that might have been relevant, fame and popularity do not a reliable source make. Even if this had not been the case this point would have carried little weight as it is simply an appeal to authority and as such does not trump the decades of knowledge gained since his time. It is the consensus of scientific opinion that should be the more trust worthy authority here, the views of a single person, even a distinguished scientist (or author), are simply too prone to error and bias.

FSM is based on a new paradigm in healing. Dr. McMakin explains it well in simplified terms on a video clip now on her website: www.frequencyspecific.com. If you wish to have a better understanding of the scientific underpinnings of Frequency Specific Microcurrent, I suggest you read Energy Medicine: The Scientific Basis by James Oschman, Ph.D.

The trouble with new paradigms is that they must first prove themselves in the full sphere of scientific knowledge before they can be accepted. This means that they must either fit with the already established principles we have discovered in the realms of physics, chemistry and biology or provide a new underpinning that incorporates the known facts but explains them in a more complete and satisfying way that can be confirmed or falsified by experiment. When “Einsteinian” physics was discovered it did not overturn Newton, it added a new layer of complexity and richness to our understanding of the Universe.

Once again I would like to thank Pamela for her interest and for taking the time to comment without resorting to simple attacks. None of my points have been made in malice and if and offense is given it is with regret.

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2008
10/22
CATEGORY
Alternative medicine
Medicine
Questionable Techniques
Science
skepticism
Warped Science
11 comments

Frequency Specific Microcurrent


This week in my local community paper I had cause to once again raise my brow in surprise at the low bar for inclusion in this publication. I refer to a story written by a journalism student promoting a therapy known as FSM or Frequency Specific Microcurrent (not Flying Spaghetti Monster). I say promoting rather than reporting on as it seemed that the student merely parroted what she had been told of the treatment with nary a skeptical thought. I was unsure when I read this article whether I was looking at a news report or an advertisement for yet another brand of alternative health device. Though I should temper this by pointing out that it seems to be becoming endemic to the field of journalism as a whole rather than be unique to this student of it.

As I could find little in the way of information about this therapy at my usual sources on these sorts of claims (Quackwatch and Skepdic, both excellent resources) I thought I would do some investigation of my own and share the results here. A brief search of PubMed found a decided lack of peer review studies either published by the technology’s alleged inventor Carolyn McMakin, nor on the effectiveness of the therapy itself. So I decided to start with the website of the inventor herself.

The “therapy” consists of applying microamp current to selected areas of the patient’s body, the current is tuned to two different frequencies that historically were supposed to correspond to the resonant frequency of the disease and the tissue of interest. It is unclear whether the current version makes this claim but two frequencies are still employed, apparently providing a unique synergy that is useful for treating only specific ailments. Practically the current is produced by a battery operated device that allows the practitioner to set both the frequency and the current on two independent channels. This current is then transferred to the patient via conductive graphite gloves worn by the practitioner as they lay hands on the patient. The claims for the device itself are modest apparently due to FDA restrictions that apply to the classification of devices it falls under. This classification is that of TENS devices which stands for Transcutaneous Electric Nerve Stimulation, this class of machine can provide relief from certain types of pain simply by virtue of electrical stimulation, no frequencies are explicitly invoked.

However, the frequencies used have much wider claims associated with them, one I found amusing was “There is one frequency combination that so far is 100% effective in a small number of cases to take away kidney stone pain.”, I perhaps naively think that a treatment is either 100% effective or is useful in a small number of cases, combining these two seems to be trying to get the best of both worlds. To clarify I don’t think there are necessarily treatments that are always 100% effective but I do have the opinion that a more useful statement would have been how effective the treatment is for the majority of patients. Other claims include the ability to treat asthma, liver dysfunction and irritable bowel syndrome as well as scar removal.

On the website’s FAQ a simplistic history of the use electromagnetic therapy devices from the early 20th century is given and spoken of in glowing terms stating that “There were thousands of physicians using this technology at this time. They had journals and associations and were treating patients and doing research and sharing the effects of frequencies in articles and books.” This may or may not be true but has no relevance as to the effectiveness of the treatment, I have no doubt there are thousands of practitioners prescribing Homeopathic preparations right now. Dr. Albert Abrams is also referenced as a pioneer of these techniques despite his unusual practices having been exposed as fraud in the 1920s. In 1994 Dr. McMakin started using these frequencies on her chiropractic patients and reports that they “appeared to do exactly what they were alleged to do”.

In 1995 Dr. McMakin developed the therapy using a device and a list of reputedly medically useful frequencies that she apparently inherited from a Canadian osteopath. Two years later Dr. McMakin began teaching FSM according to her website “to see if the effects of FSM were reproducible.” (curious, I thought that’s what studies and controlled trials were for). Despite the order in which the story is related this appears to be before papers were presented to either the American Back Society or Topics in Clinical Chiropractic, both chiropractic based. The teaching of the technique consists of a three day course in “the use of frequency protocols, the differential diagnosis of pain generators and neurologic conditions.”. Were this technique developed by the medical mainstream I hope it would have undergone slightly more rigorous investigation before being tested on patients or taught to other practitioners.

Moving on, there are several papers listed on the website in support of this therapy of mixed quality. The most convincing papers deal with the use of the therapy for Fibromyalgia, in particular this study on “Cytokine changes with microcurrent treatment of fibromyalgia associated with cervical spine trauma“. Now I am not medically trained and readily admit that I am not qualified to accurately interpret the results of this study, however there are several points that I as a layman found concerning. First was the inclusion of only a single control subject who also received treatment. Second there seemed to have been quite a high drop-out rate for the trial (approximately 30%) leaving only 32 subjects to acquire meaningful data from. Thirdly, the use of specific frequencies in the treatment is probably the most controversial part and yet those that were chosen for the study are simply asserted to be the most effective with no reference to how this was done or what data lead to this conclusion. Fourthly, and this is less a criticism of the study itself, is the topic under study. I am given to understand that Fibromyalgia is characterised by periods of flares and remission which may complicate the data. I realise however that this trial may be considered a pilot study and so can not be held to the same standards as a large rigorous placebo/non-treated group controlled trial.

In addition the almost ubiquitous claim in pseudo-scientific medicine and quackery is made that there are no dangers or side effects from the treatment itself. As has been pointed out in other places a modality that affects biological systems is unlikely to be all benefit. If there is an effect then it is almost guaranteed there is a side-effect. The consideration undertaken in the use of valid medical interventions is whether the benefits are worth the accompanying risks.

Due to the nature of the therapy it is unclear exactly what is being tested/providing relief, a shaky theory of dubious plausibility based on the unscientific premise that tissues and diseases have “Frequencies” that if applied externally can enhance or inhibit functioning and so cure medical conditions or transcutaneous electric nerve stimulation that at least one doctor considers to be an uncontroversial treatment for pain. What does seem to be clear is that there seems to be more emphasis on promotion of this therapy than on testing it’s efficacy and introducing to the wider medical community a truly useful technique.

Finally, it seems to me that the evidence is not convincing that there is an effect here that can only be explained by appeals to the recovery of lost knowledge from a golden age of medical treatments that was squashed by a jealous Medical Establishment.

Resources

http://www.frequencyspecific.com

http://www.quackwatch.org/04ConsumerEducation/News/rife.html

http://www.americanartifacts.com/smma/abrams/abrams.htm

http://en.wikipedia.org/wiki/Fibromyalgia

http://en.wikipedia.org/wiki/Transcutaneous_Electrical_Nerve_Stimulator

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2008
08/11
CATEGORY
Alternative medicine
Hoaxes
Medicine
Psychological
Questionable Techniques
skepticism
Warped Science
49 comments
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Vital impulse synaptically flow through neurons, til they go. Lost without a trace not to some other place. The end may be final but our legacy is ample to ensure our continued existence though our life's a single instance.
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