Don't do this: 150 medical practices that all fail, especially acupuncture

This is ineffective - and cruel.

Why do people keep doing things to their bodies that don't work, and that even hurt them? This seemingly self-destructive behavior is what allows bad medicine to thrive. One problem is that people are easily fooled by self-interested con artists selling snake oil: homeopathy and acupuncture fall into this category. Another problem is that even doctors can be fooled, especially when a practice seems to make sense.

One great example of this is stenting: the use of a small, flexible tube to re-open and hold open clogged arteries. This seems like such a reasonable idea–if a pipe is clogged, unclog it and put something in there to keep it clear. And it does work, sometimes, but the evidence shows that for people with minor blockage, it usually does more harm than good. A new article in The Atlantic, "When Evidence Says No, but Doctors Say Yes", explains that in a recent 5-year period in the U.S., "about half of all stent placements in stable patients were either definitely or possibly inappropriate," as shown in a new study. The authors also point out that stenting remains the go-to procedure for any patient with clogged arteries, even among physicians who have read the studies. The problem here is that stenting just seems so darned logical.

At least stents work some of the time. What about procedures and medications that don't work at all, and that sometimes cause harm? Five years ago, a team of scientists in Australia conducted a massive review of evidence for thousands of medical practices, and found 156 that either don't work or actually cause harm. Their list of ineffective and harmful procedures should be required reading for anyone who is considering a medical procedure.

I can't go through all 156 bad practices, but one group of procedures stands out as particularly ridiculous (by which I mean the original sense of the word, "deserving of ridicule"). These are the various uses of acupuncture, all of them ineffective, none of them with even the slightest plausibility, but all of them promoted by quacks acupuncturists. Here they are–and remember, each of these has been tested scientifically and shown to be either useless or, even worse, harmful:

1. Acupuncture for women in labor. From the study: "In the absence of sufficient evidence that proves either effectiveness or harm, acupuncture as a method of induction is not recommended."
2. Acupuncture for uterine fibroids. "There is no reliable proof of effectiveness of acupuncture for uterine fibroids." (Aside: if a woman has fibroids, multiple options are available, many quite effective. The claim that acupuncture might treat them is patently ridiculous.)
3. Acupuncture for irritable bowel syndrome. Studies have found "no significant effect of acupuncture on IBS global symptoms, pain, and quality of life compared with placebo." 
4. Acupuncture for otitis media with effusion (fluid in the middle ear). This condition is common in children, and acupuncturists are only too happy to plunge their needles into unsuspecting kids. The study found no evidence that this works, and concluded that "acupuncture should not be used for the management of patients with OME."
5. Acupuncture for lower urinary tract symptoms in men. This too doesn't work. I wonder where they stick the needles?
6. Acupuncture to treat hyperbilirubinaemia. This condition, commonly known as jaundice, is often seen in very young infants. The suggest that we treating babies with acupuncture is, frankly, primitive and terribly cruel. The study concluded starkly that "there is no evidence to support the use of acupuncture to treat hyperbilirubinaemia–NICE recommends that this treatment not be used in this population." (NICE is the Australian National Institute for Health and Clinical Excellence.)
7. Laser acupuncture for carpal tunnel syndrome. Multiple studies found that acupuncture doesn't work for this either. One study concluded that "more rigorous studies are needed." Why waste more time on this hopeless pursuit?
8. Acupuncture for depression. Lots of studies, most with a "high risk of bias," and all of them finding that acupuncture doesn't work for depression. This is depressing.
9. Acupuncture for osteoarthritis. Not surprising, acupuncture for arthritis is no better than placebo.
10. Acupuncture for Bell's palsy. Eight trials, none of them showing any reliable benefits. Subject patients to more of these trials would be cruel and unethical.

So there you have it: 10 out of the 156 bad medical practices involved acupuncture. If you want to see the rest of the list, check out the full study. As for acupuncture, this is by no means a complete list of the claims that acupuncturists make. Indeed, just last week a new study claimed that acupuncture helps treat migraines, prompting a rebuttal from UC San Francisco's Amy Gelfand, in the same journal, saying no, it doesn't. (Dr. Gelfand explained a lot more than that, but I'm summarizing.) The pro-acupuncture study was done in China, where virtually all acupuncture studies report positive results, and the lead author works at the Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine.

We should all thank Drs. Elshaug, Watt, Mundy, and Willis for their tireless effort in reviewing thousands of studies, so that the rest of us don't have to. Acupuncture studies will keep appearing, but there's no reason to believe anything new will emerge. It's time for people to stop fooling themselves about this particular brand of pre-scientific pseudoscience.

World's cutest mammal critically endangered because of Traditional Chinese Medicine

A pangolin. Photo (c) Christian Boix.

Pangolins, timid little anteaters that are covered with scales, are being hunted to extinction. Why? Because some humans think their scales can be used as medicine. Pangolin scales are made of keratin, the same stuff that makes fingernails and claws, and they have no more medicinal value than any other fingernails–which is to say, none at all.

Pangolins are gentle, toothless mammals that eat ants with their long, sticky tongues. They are covered with scales (sort of like a walking artichoke) which protect them from predators but not from humans, who simply pick them up to harvest them. Baby pangolins ride, adorably on their mothers' tails or backs, as shown in the picture here.

Photo by Firdia Lisnawati.

How could someone look at these creatures and want to kill them? And yet pangolins are being slaughtered in large numbers because some practitioners of traditional Chinese medicine (TCM) think (wrongly!) that pangolin scales can treat nervousness or palsy. They are also being killed for meat: regrettably, pangolin meat and fetuses are considered a delicacy by some people in China.

Just a few months ago, the CITES organization (Convention on International Trade in Endangered Species) banned trade in all eight species of pangolins. We can only hope that this blanket ban is not too late. Previously CITES had declared that Asian pangolins were endangered, but had allowed trade in African pangolins, but because the meat is indistinguishable, the limited ban did little to stop the widespread killing of Asian pangolins. Just before the CITES meeting, Annamiticus (@annamiticus) reported that in the first nine months of 2016, 18,670 tons of pangolin scales from 19 countries had been seized from smugglers, mostly in Hong Kong. And that's just the amount that was stopped; many more tons doubtless slipped through.

Despite the new CITES restrictions, trade in pangolins continues. In December, customs officials in Shanghai arrested 3 people who were attempting to smuggle over 3 tons of pangolin scales into China. That shipment alone represents 5,000 to 7,500 pangolins that were killed for their scales.

Next Saturday (18 February) is World Pangolin Day. Let's hope that the new CITES restrictions, and greater public awareness of the endangered pangolin, can save these gentle animals from extinction.

*note: perhaps it's not the "world's cutest mammal," but the pangolin is still worth saving.