NIH opens the floodgates to creating super-viruses

Some scientists really want to earn their "mad scientist" label. Ever since Mary Shelley's Frankenstein, novelists and screenwriters have shown us the dangers of letting mad scientists pursue their dreams without any controls. Of course, those stories are fiction.

In the microbial world, though, technology has caught up with fiction. Scientists today can create viruses from scratch, as they've already done with the polio virus, back in 2002. Using the tools of modern genomics, virologists and microbiologists can make pathogens much, much more deadly. But would anyone really want to do this? The answer, it turns out, is yes.

A few years ago, some virologists had the clever idea of modifying the bird flu virus to make it more deadly to humans. What would it take, they wondered, to turn the bird flu into a human flu? They decided to give it a try, and they announced their plans to the world. Then, just a few months later, they published results showing that they had succeeded, at least partially, using a bird flu called H7N9.

That wasn't even their first try. Only a year earlier, they did the same thing using a different flu virus (H5N1). Both of these bird flu strains have killed people, but the wild-type version of the virus rarely infects humans. The scientists running these experiments aimed to create a strain that could get into humans much more easily.

Many scientists were mortified. 18 leading microbiologists and infectious disease experts, including Nobel laureate Sir Richard Roberts, formed the Cambridge Working Group to oppose efforts to create super-viruses in the lab. Hundreds of other scientists, including 3 more Nobel laureates, joined the group as charter members.

In response to the concerns raised by scientists and other public health experts, NIH announced a moratorium on these so-called "gain of function" (GOF) experiments, at least in the U.S. (The scientists leading the charge for GOF experiments were based primarily in The Netherlands, although they did get some funding from NIH.) The NIH convened an expert panel, the NSABB, who commissioned a 1,000-page report and then issued their own report, which was released in May of 2016.

The NSABB panel avoids taking very strong positions, but they do raise some alarms. Here's their definition of "research of concern," for example:

"...research that could generate a pathogen that is: 1) highly transmissible and likely capable of wide and uncontrollable spread in human populations; and 2) highly virulent and likely to cause significant morbidity and/or mortality in humans." 

This does not sound like a good idea! So what does the NSABB recommend? Well, this:

"Research proposals involving GOF research of concern ... should receive an additional, multidisciplinary review, prior to determining whether they are acceptable for funding."

I can't argue that research like this doesn't need "additional" review–but the wording here suggests that at least some experiments like this might be worth funding. Mad scientists must be rubbing their hands together in glee.

And finally, just last week NIH announced it will end the moratorium on gain-of-function research. (They made this announcement just a week before Christmas, when many people are probably not paying attention. Coincidence? Perhaps.) In his statement announcing the end of the moratorium, NIH Director Francis Collins wrote:

"I am confident that the thoughtful review process ... will help to facilitate the safe, secure, and responsible conduct of this type of research in a manner that maximizes the benefits to public health."

I am not so confident. Harvard's Marc Lipsitch, one of the leaders of the Cambridge Working Group, commented that "we don't need to do these dangerous experiments. Indeed there are many ways that can (and have) been used to answer the public health question with greater generality, little to no safety risk, and much lower cost."

But just in case there is some question, let's weigh the pluses and minuses, shall we?
Pluses:

• Creating novel pathogens might lead to insights in the basic biology of viruses and bacteria.
• Creating hard-to-kill pathogens might help us develop better anti-virals and anti-bacterials, although more effective strategies already exist.

Minuses:

• The viruses could accidentally escape, and millions of people could die.
• The viruses could get into the wrong hands, and millions of people could die.

I don't know about you, Dr. Collins, but I'm leaning towards banning such research permanently.

Better diagnosis of infections

This week I'm not posting an article here because I wrote a piece for BloombergView, the online magazine published by Bloomberg, the company founded by Michael Bloomberg. The article is titled "Make Way for Better Germ Tests." Check it out here.

New York governor must decide today about law that protects doctors offering bogus treatments for Chronic Lyme Disease

Lyme disease is carried by tiny ticks; lower right above.

On Monday, the day this article appears, New York will get a new law that protects doctors who offer illegitimate therapies for a non-existent disease—unless Governor Andrew Cuomo vetoes it. The law is written to protect doctors who offer expensive treatments that provide no benefit, and it is being supported by advocacy groups who are thoroughly convinced that these treatments work.

What is this about? Lyme disease. A cadre of doctors has emerged in recent years who specialize in treating something they call Chronic Lyme Disease. They call themselves “Lyme literate,” and some of them have built their entire practices around CLD. Unfortunately for them, and sadly for their patients, this disease does not exist. 

First, I should be clear that Lyme disease is a real illness. It’s caused by a bacterium known as Borrelia burgdorferi, a small spirochete carried by ticks. (Aside: I was part of the scientific team that first sequenced this bacterium.) In most cases, Lyme disease responds well to a short treatment with antibiotics, and patients are fully cured. (See this excellent short video from Dr. Paul Auwaerter of Johns Hopkins School of Medicine.) Lyme disease ticks are really tiny, about the size of a poppy seed, and many people get bitten without realizing it. The ticks are carried by deer, and the disease has become more common as deer populations have exploded in suburban areas of the northeastern U.S.

Claims about "chronic" Lyme aren't new. As reported by Patricia Callahan and Trine Tsouderos in the Chicago Tribune back in 2010, 

“doctors around the country are telling patients with common medical problems such as back pain, poor concentration and fatigue that their ailments stem from a chronic form of Lyme disease that can evade standard treatment and wreak havoc for years. To fight what they believe is a persistent infection, the doctors often order months or years of intravenous antibiotics, which can cost tens of thousands of dollars.”

Long-term antibiotic usage doesn’t help, as multiple studies have shown (for example, Klempner et al. here and here). Even worse, it can create drug-resistant bacteria and other very serious, even fatal, complications.

But let’s not get distracted. The NY law is emphatically not providing support for Lyme disease patients, or funding new research into Lyme disease treatments. This law has one purpose: to protect doctors who want to use unproven, possibly dangerous therapies on unsuspecting or confused patients. Callahan and Tsouderos documented multiple cases where doctors told patients with other diseases—such as Lou Gehrig’s disease—that they had Lyme, and then treated them with expensive, unapproved drugs.

The New York legislature, apparently convinced by advocacy groups that chronic Lyme disease is real, passed a law whose sole purpose is to protect ill-informed doctors who want to use unproven (often expensive) therapies on sick patients. These groups are lobbying like crazy to convince Governor Cuomo to sign the law, claiming that it will protect Lyme patients. If anything, it will do the opposite. The law itself

“prohibits the investigation of any claim of medical professional misconduct based solely on treatment that is not universally accepted by the medical profession… including, but not limited to, the treatment of Lyme disease.”

So there it is: no funding for Lyme disease research or treatment. And the language is so broad that it protects almost any treatment, no matter how crazy—all the practitioner has to do is point out that the treatment is “not universally accepted.” An accurate name for this law might be the "freedom to experiment on unsuspecting patients act.”

Let's hope Cuomo rejects this law today. Otherwise, New York may become a haven for illicit, unscientific, and possibly harmful medical practices.

How to stop Ebola: ban air travel from West African countries

Countries in which Ebola virus has appeared in the past.

I never thought I’d find myself agreeing with Louisiana governor Bobby Jindal. But this week, Governor Jindal called for a ban on air travel to the U.S. from the countries where the epidemic is present. He’s right: a flight ban is the best way to keep Ebola from spreading. 

In the world of infectious diseases, we often hear the phrase that the next epidemic is “one flight away” from the U.S. That’s true—but we don’t usually know where that flight will originate, so we can’t simply ban all flights to the U.S. from everywhere. With Ebola, though, we know the source: the epidemic is confined to Liberia, Sierra Leone, and Guinea. 

As the Ebola crisis has grown in West Africa, the need to stop its spread has grown ever more urgent. The number of cases is now over 20,000, and the CDC estimates that by January, Liberia and Sierra Leone will have 1.4 million people with Ebola infections. These are frightening numbers.

The Ebola virus has no treatment and no cure, although some promising research is under way (as I’ve written about previously). According to the WHO, the Ebola fatality rate is 50%. This makes it one of the deadliest diseases known to affect humans.

And now, alarmingly, Ebola has appeared in the U.S., in an airplane passenger who traveled from Liberia to Texas. This one individual has exposed as many as 114 others, all of whom are now being followed by the CDC.

In a press briefing yesterday, CDC Director Tom Frieden offered this reassurance:

“We know how to stop outbreaks of Ebola.  In this country, we have health care infection control and public health systems that are tried and true and will stop before there's any widespread transmission.  The core of that, the way to stop Ebola in its tracks is contact tracing, and follow-up.”

Dr. Frieden is correct that we can stop an outbreak, if we can find everyone exposed and quarantine those who might be infected. But he dismissed the notion of simply banning travel: 

“Although we might wish we could seal ourselves off from the world, there are Americans who have the right of return.  There are many other people who have the right to enter into this country.”

I'm not arguing that we should “seal ourselves off from the world." (Nor, I suspect, is Governor Jindal.) We are arguing to seal off just three small countries in West Africa, until the epidemic passes. This would not be a difficult ban to implement and enforce. For Americans who wish to return from those countries, we can require a quarantine protocol, which the CDC already has in place at many airports. As Jindal said:

"How exactly would stopping the entry of people potentially carrying the Ebola virus be counterproductive? This seems to be an obvious step to protect public health in the United States.”

CDC Director Frieden also revealed yesterday that in the month of September, screening at airports in African countries has turned away 77 people who had signs of possible Ebola infection, including 17 in the month of September. Although Frieden used this example to illustrate the effectiveness of CDC’s screening program, it also shows that sick people are trying to board planes to the U.S. As the outbreak grows, it will grow increasingly difficult to keep all Ebola-infected passengers—who don't show signs of infection for several days—off those planes.

Director Frieden is correct that we can stop outbreaks of Ebola here, because we live in a modern country with good infection control systems. But prevention is better than control. So much as I hate to admit it, Bobby Jindal is right: we need a travel ban if we want to keep the Ebola virus out of the U.S.

Raw milk enthusiasts want you to drink a bacterial stew. Yum.

Sometimes it is astonishing how ignorant people can be. Now it's the turn of fans of "raw milk," a new fad that is sweeping the U.S.

I still remember reading milk cartons as a kid, and asking my parents what "pasteurized" meant. While I don't remember exactly what they said, I'm sure they told me that it made the milk safe by killing bacteria. Even as a kid, I understood that bacteria in my milk were probably a bad thing.

Louis Pasteur is one of the most famous scientists in history, and rightly so. In 1862, he invented the process of heating milk to kill the bacteria in it. Pasteurization, as we now call it, has saved millions of lives in the 150 years since. Pasteur also created the first vaccine for rabies. He was a true giant.

Fans of raw milk appear to be stunningly unaware of Pasteur's achievements, and equally ignorant of the dangers of bacterial infections. Many of the health and safety claims for raw milk can be found on sites such as RealMilk.com, a site that is chock full of

• Conspiracy theories: the Government is hiding the truth from you.
• Denialism: raw milk never hurt anyone, and even protects you against bacteria.
• Shifting the blame: infections are caused by other contaminated foods, not raw milk.

One of the more chilling facts about RealMilk.com is their emphasis on feeding raw milk to infants, who are at the greatest risk of dying from infections.  Their "Campaign for Real Milk" advocates

"universal access to clean raw whole milk from pasture-fed cows, especially access for pregnant and nursing mothers and for babies and growing children."

We have plenty of good science about raw milk. CDC review of infectious disease outbreaks across the U.S. from 1993-2006 found that

Langer et al., Emerging Infectious Diseases 18:3 (2012).

Among other findings, a

"The rate of outbreaks caused by unpasteurized milk (often called raw milk) and products made from it was 150 times greater than outbreaks linked to pasteurized milk."

Dr. Robert Tauxe, an infectious disease specialist at the CDC, debunks some of the myths about raw milk in an article freely available on Medscape. John Snyder and Mark Crislip have both written compellingly about the dangers of raw milk at sciencebasedmedicine.org.

If I were being cynical, I might say that the wild-eyed proponents of raw milk deserve whatever infections they get. But their children don't. 3-year-old Kylee Young, who the Washington Post wrote about this past Sunday, didn't deserve to suffer kidney failure and a stroke after her mother fed her raw milk that was infected with E. coli O157:H7. Kylee can no longer walk or talk and needs constant care. Her mother now says

"If I had known what I know now, I would never have fed [raw milk] to my daughter." 

Louis Pasteur and his wife had five children, three of whom died of childhood infections. These tragedies were Pasteur's motivation for studying infectious disease. Thanks to his work 150 years ago, no one today needs to die from drinking unpasteurized milk. The raw milk movement insists, despite the evidence, that they know better.

So go ahead, drink your raw milk and eat a paleo diet too, while you're at it. But don't ask our modern medical system to pay for your treatment when you get sick. And most of all, don't subject innocent children to the unnecessary risks of raw milk.

Should a doctor fire an anti-vax patient?

The anti-vaccination movement continues to grow, despite the retraction and thorough discrediting of the 1998 scientific study that spurred much of its growth.  The stubborn persistence of anti-vaxxers shows how difficult it is to dispel misinformation once that information is out there, even after dozens of new studies and millions of dollars in research that demonstrate that vaccines are safe.

One of the most dangerous trends is the growing number of parents who refuse to vaccinate their kids, or who choose "alternative" vaccine schedules, such as the one promoted aggressively by Robert Sears (who goes by "Dr. Bob").  Sears appears to have simply invented this alternative schedule without bothering to conduct any scientific studies, in part to promote sales of his 2007 book, The Vaccine Book: Making the Right Decision for Your Child.  Vaccine expert Dr. Paul Offit explained, in a 2009 article in the journal Pediatrics, why Dr. Sears' schedule was a very poor choice for children and for the public health.  After thoroughly dismantling Sears' anti-science positions, Offit concludes, "Sears has a poor grasp of the scientific method."  That's an understatement.

Other doctors, perhaps jealous of all the attention that Sears has gained through his anti-vaccine writings and television appearances, have created their own alternative vaccine schedules.  One of them, Donald Miller, even goes so far as to say that vaccines cause childhood cancer, despite the complete lack of evidence for this wild claim.  Somehow Sears, Miller, and others like them have managed to convince many parents that their children don't need vaccines.

In response to parents who don't want to vaccinate, many of whom show up with Dr. Bob's schedule in hand, pediatricians have struggled to find an effective response.  Parents can be utterly convinced by the misinformation they find on the Internet, which is all too easy to find.  (For example, Googling "vaccine" brings up the National Vaccine Information Center, a hotbed of anti-vaccine propaganda and pseudoscience, on the first page of hits.)  By the time parents arrive with their babies for the first vaccine, convincing them to change their minds can be nearly impossible.

Perhaps in frustration, doctors have started to "fire" their patients if they refuse to vaccinate.  As reported by Shirley Wang in The Wall St. Journal last week, 20-30% of doctors in two different surveys, in Connecticut and the Midwest, reported having to kick patients out of their practices because of vaccine refusal.  These numbers have roughly doubled over the past ten years, according to the American Academy of Pediatrics.

Is firing a patient the right thing to do? It's a difficult question.  On the one hand, doctors should do everything they can to make sure kids are vaccinated.   If a doctor kicks a parent out, that parent may find another doctor who doesn't insist on vaccinating children, which ultimately harms the children.  Doctors have to spend more time educating parents about the tremendous benefit of vaccines, about the very strong evidence (based on tens of millions of doses) for vaccine safety, and about the frightening consequences of infection with meningitis, hepatitis, measles, polio, and other vaccine-preventable diseases.

On the other hand, unvaccinated children bring diseases into the pediatrician's office, where they can spread them to other children.  Some of these other children are too young to be vaccinated, and childhood infections can be extremely dangerous, even fatal, in the very young.  From this perspective, "firing" a patient might be the only responsible action, after first trying to convince the parents to vaccinate.  I know that I wouldn't want to bring my child to a doctor's office where unvaccinated children were in the same room.

I understand how nervous a parent can be about vaccinations.  I will never forget the day my older daughter got her first vaccine: the needle looked huge compared to her tiny leg, and she screamed when the doctor gave her the shot.  But she was fine a few minutes later, and she'll be protected against a dangerous infection for her entire life.  Vaccines have been so successful at eliminating childhood infections that parents no longer see these infections as a threat.  Ironically, the very success of vaccines has allowed the anti-vaccine movement to sway so many people.

Doctors may have to keep firing the parents of their young patients, but I hope they'll first make every effort to educate them.  They need to explain that vaccines do not cause autism, nor do the ingredients in vaccines, and that scientific studies involving hundreds of thousands of patients support these conclusions.  They should also explain that many of the anti-vaccination claims on the Internet started when Andrew Wakefield published one small study of 12 patients, now retracted, claiming a link between the MMR vaccine and autism.  Investigations later revealed that he was paid by lawyers to recruit patients for a lawsuit against vaccine makers, that he didn't reveal these payments to his co-authors or the patients, and that he manipulated the data.  Since then, the anti-vaccine movement has exploded and we've experienced multiple outbreaks of measles, mumps, and other illnesses linked directly to unvaccinated children.

Doctors interviewed by the Wall St. Journal reported that they had convinced at least some parents to follow the recommended vaccine schedule.  Perhaps that's the best we can hope for.  If we're going to avoid a return to the era when children routinely died from infections, we must keep trying.

A surprising triumph in the fight against polio

Source: polioeradication.org

The last case of polio in India occurred exactly one year ago, on January 13, 2011.  In the decades-long battle against this devastating disease, this is one of the best pieces of news in a long time.  Just two years ago, health officials counted 741 polio infections in India, and it seemed that the battle was far from over.  It may yet be, but in 2010 the cases dropped dramatically, to just 42, and last year there was only one, on January 13.


As recently as the 1950s, polio was a dreaded, incurable disease that killed or paralyzed millions of children each year.  The U.S. alone had 58,000 cases in 1952. Then came the invention of a vaccine by Jonas Salk, one of the great medical breakthroughs of the 20th century.  By the 1960s, widespread vaccination campaigns had virtually eliminated polio from Europe and the U.S.  Polio lingered in the U.S., mainly in the Amish population who refused to accept vaccinations, but it finally disappeared in 1979.

The worldwide campaign to eliminate polio started in 1988, when 350,000 infections were recorded.  Polio is extremely difficult to control, because a large majority of infected people show no symptoms, but they can still spread the virus.  Vaccination campaigns need to treat everyone who comes in contact with an infected individual in order to break the cycle of transmission.  This is especially hard to do in remote areas of poor countries, especially when the populace is suspicious and uncooperative.

The greatest challenge in India came in the desperately poor, crowded regions of the north, where health care, hygiene, and education are all very poor.  The vaccination efforts were made even more difficult by conspiracy theories among the Muslim population.  As Simon Denyer wrote in the Washington Post this week:

"Rumors spread among the region's numerous Muslims that the polio vaccination campaign was an American conspiracy to wipe them out, by making their sons impotent and their daughters infertile.... Vaccinators were stoned as they approached Muslim neighborhoods. 'The general mind-set was that the immunization campaign was aimed at ending our lineage,' said Anwar Ahmad, the head of a madrassa in a Muslim neighborhood in the city of Meerut."

The campaign turned around after UNICEF and Rotary international launched a major education effort that first convinced Muslim leaders, and then everyone else, that the vaccine would benefit their communities.  With this success in India, polio is now endemic in only three countries in the world: Afghanistan, Pakistan, and Nigeria.  The same rumors and conspiracy theories that plagued India have spread within Muslim populations in these countries as well, but India shows that the misinformation - and polio - can be defeated.

Unfortunately, even here in the U.S. we have our own conspiracy theorists: the anti-vaccination zealots over at Age of Autism, where Dan Olmsted and Mark Blaxill recently posted a series of articles claiming that polio is "a harmless intestinal bug" that only causes disease when triggered by pesticides or by arsenic.  Never mind that there is no evidence to back this truly wacky assertion; these two anti-vaxxers seem happy to invent facts to support their single-minded campaign against all vaccines, even when the vaccines are demonstrably saving tens of thousands of lives.

Polio is still with us, and it could return.  Besides the 3 countries with endemic polio, 9 other countries continue to suffer polio cases that were imported from endemic countries.  Without widespread vaccination in those countries, polio could re-establish itself in any of them.

If polio stays out of India, we can thank the thousands of health care workers who traveled to remote villages, in extremely difficult conditions, to dispense lifesaving vaccines.  Their heroic efforts have paid off for everyone.  We should also thank the combined efforts of the WHO, UNICEF, Rotary International, the Gates Foundation, and the CDC, all of whom are backing the worldwide effort to eradicate polio.  Let's root for humanity to win this one.

The worst quackery of 2011: battlefield acupuncture

Pseudoscience continued to thrive in 2011, making my choice for the worst quackery of the year a difficult one.  So much nonsense!  Promoters of both new age and old-time hocus pocus continued to sell their unscientific therapies, as they have for decades (or centuries), including homeopathy, Ayurveda, acupuncture, qigong, reiki, magnet therapy, and a cornucopia of special "super foods", all guaranteed to cure whatever ails you.  These various alternatives to medicine are just as ridiculous today as when they were invented, decades or centuries ago.

How can anyone choose the worst practice among so many false claims?  Well, those that cause real harm to patients are worse than those that are merely useless.  I also decided to give extra weight to newer forms of mumbo jumbo.  But I could have chosen differently, and I encourage readers to nominate their own favorites in the Comments section.

And the 2011 winner of the worst quackery award is: battlefield acupuncture.  This particular bizarre medical practice offers a trifecta of ills:

1. It offers no medical benefit and carries a real risk of harm for some patients.
2. The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year.
3. The patients are wounded combat veterans who have no choice about where to get treatment.

Battlefield acupuncture has a growing number of supporters in the U.S. Defense Department (especially Richard Niemtzow, its proud inventor), who are determined to see it delivered to as many troops as possible.  I've written about this before, but it's in the news again this month, in Wired magazine.  In battlefield acupuncture, the "doctor" (no competent doctor would do this) sticks needles into the patient's ear to relieve pain.  Yes, that's right: needles in the ear.

Battlefield acupuncture was invented out of whole cloth by military doctor Richard Niemtzow, who runs an acupuncture clinic out of Andrews Air Force Base in Maryland.  Niemtzow appears to be the leading advocate for the use of acupuncture on wounded soldiers, and he has been disturbingly effective.  The military publication Stars and Stripes reported in August that the Air Force has

"launched a program to train more than 30 military doctors to use acupuncture in the war zone and at their base clinics. The program will be expanded next year with the Air Force, Army and Navy combining funds for two courses to certify 60 active-duty physicians as medical acupuncturists."

Multiple scientific studies have shown clearly that acupuncture doesn't work. The benefit is the same no matter where you place the needles, or even if you use toothpicks that don't pierce the skin.  (See a summary here, with multiple references.)  Acupuncture points and "meridians" - the pathways that acupuncturists claim to manipulate with their needles - don't even exist.

Acupuncture carries a real risk of harm, too, primarily from infection.  Acupuncturists don't practice sterile procedure, as I've pointed out before.  They claim that they do, because they think that using sterilized needles is sufficient.  Wrong again.  Sterile procedure requires that every site of needle insertion be properly sterilized, because most infections are caused by bacteria already present on the skin.  As reported last year in BMJ:

"Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure."  

Pretty serious harm from a procedure with no real benefit.

The evidence for "auricular acupuncture" - sticking needles in the ear - is less than zero.  This shouldn't be surprising, since Neimtzow just pulled this wacky theory out of thin air - but he and his converts have repeatedly asserted that it works, although they offer nothing more than anecdotes.  Niemtzow has even claimed that 18th-century pirates pierced their ears to improve their night vision.  Yes, really.  Now he's piercing the ears of wounded soldiers.

A big part of the Wired story is how the billionaire founders of the Samueli Institute, an institute dedicated to pseudoscience, have used their political muscle to obtain millions of dollars in Defense Department earmarks to support acupuncture research.  ($7.6 million in 2010, for example.)  Make no mistake, there's plenty of money in acupuncture, as in the rest of the alt-med industry.

But the real harm is in treating wounded soldiers by sticking needles in their ears, instead of offering real treatments.  To their credit, some soldiers are not fooled by Niemtzow's claims.  As a veteran over at Military.com said,

"In civilian medicine, this [battlefield acupuncture] would be called malpractice. This smacks of using military personnel in the field as guinea pigs. That's a dangerous game. If the pain of severe trauma isn't treated effectively in a timely manner, shock and even death can follow."

That discussion appeared in 2008, but three years later, Andrews Air Force Base has a full-time acupuncture clinic, and the military is training more doctors in this dangerous, ineffective, and highly unethical practice.  For this, battlefield acupuncture gets my award for the worst quackery of 2011.

(For further reading, see David Gorski's excellent takedown of battlefield acupuncture from 2008.)

Does NIH recommend acupuncture?

"NIH recommends acupuncture" - that's the headline on a recent web article on an acupuncturists' website. Now, I know that NIH has granted millions of dollars to acupuncture researchers who have tried their best to prove it works, but I didn't think NIH officially endorsed it. For one thing, despite these wasted millions, the best evidence shows that acupuncture doesn't work, not even a little bit.

What the article was referring to illustrates the dangers of NIH's far-too-gentle treatment of acupuncture and other "alternative" practices. It also shows how promoters of questionable or downright bogus practices can distort the facts to suit their own ends.

What the acupuncturists found was an NIH news site that ran an article called "Understanding acupuncture: time to try it?" (Note the question mark.) The article was written by Harrison Wein, a science writer at NIH who interviewed a handful of researchers, most of them promoters of acupuncture themselves who are funded by NCCAM.

(I've written about NCCAM before, so here I'll just remind readers that it was created by Congress as a way to earmark funds for bad science that can't pass muster in normal peer review. NCCAM grants over $200 million per year to its stable of mediocre scientists.)

Wein did a very poor job of describing the complete implausibility of acupuncture, but he did at least point out that sham acupuncture works just as well as "real", and it doesn't even matter if you use toothpicks that don't pierce the skin. So does his article endorse acupuncture? In a sidebar titled "If you want to try acupuncture," it says:

• "Don’t use acupuncture as a replacement for conventional care"
• "Don’t rely on a diagnosis of disease by an acupuncturist who doesn’t have conventional medical training"

and a few similar things, none of them recommendations for acupuncture. The article concludes by asking the question again:

"Should you try acupuncture? Studies have found it to be very safe, with few side effects. If you’re thinking about it, talk to your doctor."

So no, not an endorsement. Just a much-too-gentle recommendation to talk to your doctor first. The writer (Wein) regurgitates the claims of acupuncture promoters hook, line, and sinker - and he doesn't cite any evidence for his statement that it is "very safe." In fact, acupuncture often causes infections, sometimes serious ones. And as I wrote last month in The Atlantic: in 1995, a 40-year-old Norwegian woman visited an acupuncturist for relief from fibromyalgia. As described in The Lancet, she died two hours later, and an autopsy revealed that the needle had punctured her left ventricle.

Think that's just one unfortunate anecdote? Well, in the journal BMJ last year, researchers reported that acupuncture infections are a significant problem worldwide, and that they have been under-reported for years. Infections caused by acupuncturists have led to "joint destruction, multi-organ failure, flesh-eating disease and paralysis" as well as hepatitis B and C and mycobacteriosis.

So I don't agree that acupuncture is "very safe." After I gave an interview on Minnesota Public Radio last month, I was attacked by acupuncturists claiming that they don't use "dirty needles" (which I never claimed) - but in saying this, the attackers reveal their own ignorance. Needles aren't the problem: it's that every site on the skin as well as the acupuncturists hands that need to be sterilized. You see a photo on the website of the American College of Acupuncture and Oriental Medicine of a bare-handed person inserting needles into someone's skin. In case they remove it after reading this article, here it is:

All this should be beside the point, though, because acupuncture simply doesn't work. One of the acupuncture researchers (funded by NCCAM) interviewed in the NIH news story, Karen Sherman, had this response to the data showing that toothpicks work as well as needles:

"For example, when researchers have compared inserting needles with just pressing a toothpick onto acupuncture points, they’ve often found both treatments to be successful. But Sherman questions whether these are really controls. Many traditional acupuncturists would consider them true treatments, too. The important thing, in their view, is to hit the right spot, not necessarily how deep you go."

So when the evidence doesn't show what she likes, Dr. Sherman changes the definition of placebo. This is called "moving the goalpost," and it's a classic sign of bad science (and a bad scientist). Actually, she goes even further, saying "I don’t really think you can come up with a great placebo needling." In other words, in Dr. Sherman's world, acupuncture can't really be tested. I guess it's just magic.

Even though the NIH article doesn't recommend acupuncture, it uncritically repeats some ridiculous claims, such as:

"… the body contains a delicate balance of 2 opposing and inseparable forces: yin and yang. Yin represents the cold, slow or passive principle. Yang represents the hot, excited or active principle. Health is achieved through balancing the 2. Disease comes from an imbalance that leads to a blockage in the flow of qi—the vital energy or life force thought to regulate your spiritual, emotional, mental and physical health. Acupuncture is intended to remove blockages in the flow of qi and restore and maintain health."

I want to laugh at this, but it appears on an honest-to-goodness NIH website. As my colleagues at Science-Based Medicine put it, "acupuncture is a pre-scientific superstition." It does not deserve our respect, nor should we take it seriously.

There's no scientific evidence whatsoever that "the flow of qi" has any physiological basis. The passage above should have been followed with a bit of real information, such as: "Scientifically, there is no more evidence for qi than there is for the tooth fairy or Santa Claus. However, some researchers argue that Santa Claus is quite a bit more plausible." But that would perhaps be hoping for too much backbone from NIH. Note to NIH: don't give pseudoscientists the imprimatur of legitimacy by repeating their claims. And pay better attention to what you allow on your website.