June 21st, 2007 by Dr. Val Jones in News, Opinion
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An interesting meta-analysis was recently published in the Annals of Internal Medicine. It showed that acupuncture for knee arthritis can reduce pain, but its effects are likely due to the placebo effect. The placebo effect is nicely described in Wikipedia:
A so-called placebo effect occurs when a patient’s symptoms are altered
in some way (i.e., alleviated or exacerbated) by an otherwise inert
treatment, due to the individual expecting or believing
that it will work. Some people consider this to be a remarkable aspect
of human physiology; others consider it to be an illusion arising from
the way medical experiments are conducted.
Because of the mind-body connection, we humans can actually alter our experience of pain if we will ourselves to do so. We experience more intense pain when we’re depressed or particularly fixated upon it (via boredom for example). And we experience less pain when we’re happy (take women immediately after giving birth – they barely even notice the Ob as she sews up their tears).
When it comes to pain management, there are many non-medical techniques that can improve the experience of pain, even if it doesn’t affect the physiology of it. And so if we can find ways to put ourselves in a frame of mind that minimizes the pain sensations, that can be really valuable.
But as far as the physiology of acupuncture is concerned, we have not yet been able to explain exactly how it works. I’ve often wondered if it may be due to the fact that the sharp pain fibers (stimulated by acupuncture needles in different locations) travel along slightly different nerve pathways than the fibers from the actual painful area for which one is getting the acupuncture. The pain input might subconsciously distract the mind from the duller (or more chronic) pain input from the arthritic joint (or other pain generator). This might explain why sham acupuncture works (meaning, putting the needles anywhere, rather than in certain specified meridians).
I’m sure some of you will disagree with this – and it’s only a theory. But it does seem that inserting tiny sharp needles into the skin improves pain sensations in knee arthritis – no matter where the needles are put. How do we explain this placebo effect? I’m not sure – but if the treatment is quite harmless, and seems to decrease pain, how important is it to have an explanation?
And by the way, I was just about to post this when I found another interesting article about acupuncture in the journal Circulation. In this study, they found that acupuncture (when performed 3-5 times a week for 30 minutes each time) was able to reduce blood pressure by about the same amount as a low dose ACE inhibitor pill. Interestingly, though, in this case the needles placed according to Traditional Chinese Medicine (in certain meridians) rather than sham acupuncture (random placement) decreased blood pressure significantly more. I wonder if the TCM placements are activating the autonomic nervous pathways in this case?
At this point the jury’s still out on how all this works. But acupuncture does have measurable effects – even if they’re due to the placebo effect and/or stimulation of the autonomic nervous system. The real question is: would you rather pop a pill each day or travel to and from an acupuncturist’s office 3-5 times a week for 30 minute treatment sessions?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 7th, 2007 by Dr. Val Jones in Quackery Exposed
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The global economy is a mixed blessing – while we may
benefit from access to less expensive goods and services, by using them we rely
on the quality standards of their country of origin. In an alarming expose, the New York Times
reveals how far behind China
is in the application of quality and safety standards to their food and
pharmaceutical products.
I have voiced concerns in this blog before about the
melamine/pet food scandal and the implications it may have for humans, as well
as the fact that many Chinese citizens trust western medicine over their own
traditional practices for matters of serious illness. But this latest Times article has further
described the risk that counterfeit Chinese products can pose to the global community:
Toxic syrup has
figured in at least eight mass poisonings around the world in the past two
decades. Researchers estimate that thousands have died. In many cases, the
precise origin of the poison has never been determined. But records and
interviews show that in three of the last four cases it was made in China, a major
source of counterfeit drugs.
“Everybody wants to
invest in the pharmaceutical industry and it is growing, but the regulators
can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”
… Families [in Panama] have
reported 365 deaths from the poison, 100 of which have been confirmed so far.
When it comes to your health and the safety of the medicines
you use, you’re only as safe as the weakest link in the manufacturing or regulatory
process. Prescription medications are
carefully regulated in the US,
but there is no such oversight in the herb and supplements market. So buyer beware… Check out places like consumerlab.com to get
some objective information about safety before you pop those “health pills.”
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 8th, 2007 by Dr. Val Jones in News, Quackery Exposed
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The number one Google news item today is a report of a mouse study (published in Nature Medicine, but apparently still embargoed to the public as it is not listed on their website) that suggested that an herbal supplement could (in combination with antibiotics) “eradicate” urinary tract infections.
In usual fashion, the buzz preceded the science, and now we have thousands of people on the lookout for forskolin (a root extract of coleus) tablets from the local health food store. Do these have any possible merit?
A recent review of the literature about this herb was conducted by the good docs at Harvard, and turned up “no conclusive evidence for its [forskolin’s] use for any health condition.”
My friend Dr. Charles also read the reports of this “miraculous” new cure – which posits that recurrent urinary tract infections are caused by pockets of bacteria that hide inside bladder walls. Dr. Charles rightly points out that there are many different points of entry for bacteria, and that an herb which (and we don’t know that it even does this) relaxes bladder walls would surely not affect the alternate routes of entry, hence it cannot be curative in all cases.
So my friends, I’m sorry to say that there is little justification for enthusiasm yet. But we will follow the research with interest, in case human subjects do indeed show benefit in the future.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 26th, 2007 by Dr. Val Jones in Medblogger Shout Outs
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Wow, this was one of the best rants I’ve heard in a while (thanks to Kevin MD for linking to this article in his blog) – looks as if this writer is neither friend to homeopathy nor big pharma:
“Some homeopaths [say] that their cures are not amenable to scientific proof. That’s fine, if you want to call the multimillion dollar industry what it is: faith healing…
Homeopathy rests on three unproven tenets: First, ‘Like treats like.’ Because arsenic causes shortness of breath, for example, homeopaths prescribe its ‘spirit’ to treat diseases such as asthma. Second, the arsenic or other active ingredient is diluted in water and then that dilution is diluted again and so on, dozens of times, guaranteeing—for better and worse—that even if the dose has no therapeutic value, it does no harm. And third, the potion is shaken vigorously so that it retains a ‘memory’ of the allegedly curative ingredient, a spirit-like essence that revives the body’s ‘vital force.’
So what about the fact that some homeopathic patients get better? Part of the effect comes from the ritual of consultation with a practitioner who treats the patient like a person rather than a body part on an assembly line. And just taking anything can help; the placebo effect is real. In gold-standard, double-blind studies, placebos presented as possible cures sometimes rival pharmaceuticals for effectiveness, or beat taking nothing at all.
Nor are the effects simply psychological. When volunteers took a placebo that they were told contained painkillers, they experienced relief, while researchers watching PET scans of the subjects’ brains tracked increased levels of the body’s own pain-relieving endorphins. In other studies, research subjects given placebos instead of antidepressants also showed chemical changes in their brains. FDA data for six top antidepressants showed that 80 percent of their effect was duplicated in placebo control groups.
Which brings us to the patient’s dilemma: Have faith in 19th century magic or rely on a pharmaceutical industry that suppresses negative outcomes (including death), promotes drugs for nonexistent diseases, repackages old drugs in new bottles to circumvent patent expirations, bribes doctors with perks and cash and hires ghost writers to author favorable studies? Given the hype, toxicity, and expense of many drugs and Big Pharma’s snake-oil tactics, the side effects of water (laced with “memory”) start looking pretty damn good. If your condition is relatively minor, self-limiting or untreatable, you may be a lot better off drinking homeopathy’s Kool-Aid-less Kool-Aid.”
Ouch. What do you think of Mr. Allen’s remarks?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 21st, 2007 by Dr. Val Jones in News
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Complementary and alternative medicine (CAM) is important and popular, but ignorance about its potential harms can be dangerous to consumers. Physician passivity about the subject may also be doing consumers a disservice. Two interesting articles underscore this:
From the NIH:
In spite of the high use of complementary and alternative medicine (CAM) among people age 50 or older, 69 percent of those who use CAM do not talk to their doctors about it…
A telephone survey, administered to a nationally representative group of 1,559 people age 50 or older, revealed some reasons why doctor-patient dialogue is lacking. Respondents most often did not discuss their CAM use with doctors because the physicians never asked (42 percent); they did not know that they should (30 percent); or there was not enough time during the office visit (19 percent).
From MSNBC:
If you’re banking on a daily vitamin to make up for any deficiencies in your diet, you may be getting a whole lot more — or less — than you bargained for.
Of 21 brands of multivitamins on the market in the United States and Canada selected by ConsumerLab.com and tested by independent laboratories, just 10 met the stated claims on their labels or satisfied other quality standards.
Most worrisome, according to ConsumerLab.com president Dr. Tod Cooperman, is that one product, The Vitamin Shoppe Multivitamins Especially for Women, was contaminated with lead.
The same product also contained just 54 percent of the 200 milligrams of calcium stated on the label.
The analysis also showed that Hero Nutritionals Yummi Bears, a multivitamin for children, had 216 percent of the labeled amount of vitamin A in the retinol form, delivering 5,400 International Units (IU) in a daily serving. That’s substantially more than the upper tolerable level set by the Institute of Medicine of 2,000 IU for kids ages 1 to 3 and 3,000 IU for those 4 to 8.
Because too much vitamin A can cause bone weakening and liver abnormalities, the Yummi Bears “could be potentially doing more harm than good,” Cooperman said. “Vitamin A is one of those vitamins where you really don’t want to get too much.”
It’s important for physicians to educate themselves about CAM therapies and make it a part of their practice to ask their patients about the supplements they take. The Natural Standard databases are a great resource for physicians and consumers, and will be available soon at Revolution Health. Natural Standard, initially created by a team of Harvard physicians, systematically reviews the evidence behind the efficacy claims of various herbal remedies and supplements.
What resources do you use to evaluate the safety and efficacy of the herbs and supplements you’re taking?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
