Sadly, the Washington Post once again falls for acupuncture pseudoscience

It’s like playing whac-a-mole. No matter how many times I write a column showing that some wildly implausible practice is nonsense, new articles pop up claiming “Hey, look at this! It really works!”

So I’m going to try to whack another mole, because people can be harmed by bad information, especially when it comes in the form of medical advice.

Recently the Washington Post ran a column under the headline, “Does acupuncture work for chronic pain? Here’s what the science says.” (The column first appeared back in July, but the Post’s website promoted it again just last week.)

Before giving you the Post’s answer, let me give you the correct answer. No! Not “maybe” or “sometimes” or “we’re not sure.” Acupuncture doesn’t treat anything, and it carries a real risk of harm, particularly from infections. I’ll get to that below.

I’ve written on this topic many times before (in 2013, in 2012, in 2010, and more), and I’ve even called out the Washington Post for their pro-acupuncture pseudoscience (see this column, which I wrote in 2016). The physicians over at Science-Based Medicine have debunked more acupuncture studies than I can count; they’ve even created a special webpage (which I highly recommend) dedicated to explaining the bogus claims that acupuncture proponents make.

Acupuncture, in case you don’t know this, is a practice where people who call themselves acupuncturists (they are not doctors) stick needles into your body to “treat” various conditions. The claim is that these needles can manipulate your vital life force, or “qi”, which runs along supposed acupuncture lines throughout your body.

That’s just wrong. Modern biology has taught us a whole lot about human physiology, and there just aren’t any lines with mystical forces flowing through them. There are nerve fibers, true, but acupuncturists don’t use those. (And if their needles were piercing nerves, it would hurt like heck.)

Acupuncture and qi are part of Traditional Chinese Medicine, or TCM, a collection of largely ineffective and sometimes very harmful folk beliefs. TCM’s popularity started to grow in the mid-20th century when Chairman Mao launched a propaganda campaign pushing it. Mao himself never used TCM, but his government couldn’t afford real medicine, so they convinced people that inexpensive folk medicine was just as good. It wasn’t.

But I digress.

Acupuncturists claim to treat many conditions, but they especially like to claim that they can treat chronic pain, for at least a couple of reasons. First, pain is inherently subjective, so the only way to measure if a treatment is working is to ask the patient. This makes it hard to study objectively. And second, pain symptoms usually wax and wane, even without any treatment. Patients usually want treatment when the pain is at its worst, which means once the pain subsides, the patients will give credit to whatever they were doing at that time. So pain is fertile ground for people selling quack treatments.

Now let’s get to that column in the Washington Post. The column promises to tell you “what the science says,” and it quickly gets to the point, saying yes, it does! First it puts forward the logically flawed (and non-scientific) claim that hey, the U.S. Medicare system now covers acupuncture for back pain, so it must be effective.

Ugh, where do I start? Well, like it or not, Medicare approval of a treatment doesn’t mean the treatment works. (And conversely, some treatments that work are approved for coverage by Medicare.) So that’s just a logical fallacy. I wish it were true that Medicare was purely science-driven, but both the federal and state government have been lobbied for years by acupuncturists (and other purveyors of dubious therapies) to provide public tax dollars to cover their practices. For a deeper dive into these lobbying efforts, I recommend the lengthy takedown by Jann Bellamy explaining that acupuncture is “legalized quackery.”

The Post article then goes on to discuss the science, for which it relies primarily on a single study, a meta-analysis published in 2019 by Andrew Vickers. (The column was written by Dr. Trisha Pasricha, who has sterling credentials, including training at Johns Hopkins Medicine where I also work. Alas, good credentials don’t always mean that you can trust the holder of those credentials, and this is one of those instances.)

Vickers has published multiple meta-analyses, and if he’s shown anything, it’s how easy it is to cherry-pick from the (extensive) acupuncture literature and find studies that prove whatever point you want to make. The Post column asserts that Vickers used 39 “high-quality” studies, but that is debatable. Many of the studies were done in China, which (as Science-Based Medicine physicians David Gorksi and Steven Novella have pointed out) virtually never publishes a negative study of acupuncture.

I’ve done a deep dive into one of Vickers meta-analyses of acupuncture–an earlier one–for one of my medical school classes, where I use it to illustrate how bad studies can be mis-reported by scientists themselves and by the media. I don’t have time to go through it here, but among other problems, Vickers doesn’t seem to understand how placebo controls work.

Here’s what I mean by cherry-picking. Vickers went through 100’s of studies to pick the 39 that he included. One of those supposedly high-quality studies looked at acupuncture for knee arthritis. That study found that both acupuncture and sham acupuncture (the placebo arm) and the same small effect on knee pain, and that patients who received no treatment at all reported more pain than patients. The authors of the study (and Vickers) concluded–wrongly–that because acupuncture was better than nothing, it must be working. Wrong! If you don’t beat the placebo, then your treatment fails.

For a drug trial, failing to beat the placebo means the game is over. But with acupuncture, it means “more studies are needed,” and the whac-a-mole game continues.

Oh, and I should add that as far as knee arthritis goes, the reduction in pain in both the acupuncture and placebo group was much less than has been reported in studies that use ibuprofen.

That’s right, ibuprofen is far better than acupuncture. Not to mention cheaper and more convenient.

If this weren’t enough, a more recent study has already contradicted the Vickers study as physician-blogger Steven Novella pointed out in a recent column. Novella wrote that “the evidence is too low quality to conclude that acupuncture works, as desperate as proponents are to say we can reach that conclusion.” So no, Dr. Pasricha, the latest science does not say that acupuncture works. Quite the opposite.

I’m still understating how badly acupuncture has failed every well-designed study to test its effectiveness. Studies have shown that placing the needles in random locations works just as well as using so-called acupuncture points. Other studies showed that sham acupuncture, where the needles don’t pierce the skin but where subjects believe they did, also works just as well. And “expert” acupuncturists can’t agree on the locations of acupuncture points.

And don’t get me started on acupuncture and the risk of infection. Acupuncturists aren’t trained in real medicine, and they don’t use proper sterile procedures. This means that they don’t necessarily sterilize their hands, or your skin at all of those points where they’re plunging needles into you. There have been thousands reports of infections due to acupuncture (dating back decades), some of them fatal. And because acupuncturists aren’t part of the medical system, we can be virtually certain that infections are under-reported.

Acupuncture isn’t going away any time soon, because people are making money from it, and no matter how many studies show that it’s nothing more than a fiction, those people will keep insisting on more studies. Plus they can point to hundreds of poorly-done studies that claim to show benefits, and argue–as the Post column does too–that “more research is needed.” I’m not making this up: that precise phrase appears in Dr. Pasricha’s article.

There are even scientific journals entirely devoted to acupuncture (here and here, for example), and they make money too, for the for-profit publishers that produce them. So you can be sure that more studies are coming, and some of them will be positive, even though acupuncture is utterly ineffective.

Even so, the Washington Post can and should do better. Here’s my (free) advice for those considering acupuncture: save your money, and just take some ibuprofen.

The WHO's endorsement of TCM may have helped cause the coronavirus pandemic

About a year and a half ago, I wrote an article titled "WHO endorses Traditional Chinese Medicine. Expect deaths to rise." It went somewhat viral, with over 100,000 views, and then went quiet until last week, when it was revived on Twitter, which has driven thousands of new views to it. Multiple people asked me to re-visit it, in light of the coronavirus and its possible origin in a live animal market in China.

The deaths I was referring to in that title were the deaths of animals (as I'll explain below), not people. What I didn't write about–and what Twitter is buzzing about now–is the possibility that live animal markets in China, such as the one where the Covid-19 virus may have first infected humans, include bats sold for their use in traditional Chinese medicine, or TCM. We now know that the coronavirus almost certainly originated in bats. It's entirely possible–indeed, it seems very likely–that TCM is responsible for the emergence of the Covid-19 coronavirus.

The title of my article might have been more prescient than I guessed at the time.

Indeed, a just-published scientific paper pins the blame for Covid-19 squarely on TCM. The paper argues that

"a live or recently deceased infected bat species was handled by traders because of its value in TCM, and that such an infected individual, or the still infective bat or bat products, may have been the route by which the virus entered the exotic meat market in Wuhan."

Let's back up a bit and review the World Health Organization's involvement in this debacle. Just one year ago, the WHO added a chapter on TCM to its official International Classification of Diseases (ICD-11) for the first time. It apparently took this action after strong lobbying pressure from China: as a 2018 story in Nature pointed out:

"Over the past few years, [China] has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market."

This action by the WHO was the result of a long effort by its previous director (she left in 2017), Margaret Chan, who "worked closely with China" to get the WHO to endorse TCM.

Many scientists decried this action. The editors of Scientific American called it a "bad idea." Nature warned that it could "backfire," writing that it

"risks legitimizing an unfounded underlying philosophy and some unscientific practice.... Whatever its aims, the WHO’s chapter [on TCM] is unlikely to do anything other than fuel the expanding sales of largely unproven treatments."

TCM is not medicine. It's little more than a set of traditional beliefs (or a philosophy, as Nature called it) about various concoctions and their effect on one's health. Most of these beliefs have no evidence whatsoever that they provide any health benefits. Many of them derive from a pre-scientific view (which is not at all unique to China) that eating an animal gives one some of the properties of that animal. This is utter nonsense, of course.

Unfortunately, TCM is far from harmless, as I pointed out in my 2018 article. TCM has led to the horrific slaughter of the last remaining rhinoceroses in Africa in order to hack off their horns, which are sold to become part of elixirs that some people mistakenly think confer strength, virility, or other health benefits. Two years ago, National Geographic ran a heart-wrenching photo essay showing some of the awful results of rhinoceros poaching in Africa; take a look at these photos here (warning: these are very graphic).

TCM is behind the slaughter of the last remaining wild tigers, which are virtually extinct now in Asia, so that men can foolishly eat their bones, claws, and genitals in the mistaken belief that tiger parts will make them virile. Here too, National Geographic has details and photographs of cruel "tiger farms" that are almost too painful to look at.

TCM has also nearly wiped out pangolins, a completely harmless, gentle animal that has been killed in vast numbers because TCM practioners believe, wrongly, that its scale have some medicinal value. (They don't.) For more about this harmful practice, see this article I wrote in 2017.

And donkeys too: the Independent reported last November that "half the global population of donkeys could be wiped out in just five years, due to a surge in demand for their hides, which are used in traditional Chinese medicine." The world's donkey population is now in a state of crisis, according to the article, because of soaring demand in China for donkey hides, which are used to make eijao (donkey hide glue), a popular TCM product with no evidence that it has any medical benefits. Literally millions of donkeys are being slaughtered for nothing.

Before people accuse me of cultural insensitivity, let me add that there's no legitimate reason to use terms such as "Chinese" medicine, or American, Italian, Spanish, Indian, or [insert your favorite nationality] medicine. There's just medicine–if a treatment works, then it's medicine. If something doesn't work, then it's not medicine and we shouldn't sell it to people with false claims.

TCM has been a scam for decades: it was revived and heavily promoted in China by former dictator Mao Zedong, who didn't believe in it himself, but pushed it as a cheap alternative to real medicine. I won't go over that again here, but see these stories from Alan Levinovitz in Slate and David Gorski at Science-based Medicine.

The WHO is under new leadership now, but I see no sign that it's revising its endorsement of TCM, which is still lauded on the WHO website. Now we see that, in addition to the pointless slaughter of thousands of animals, some of which are likely to go extinct as a result, TCM might also create conditions that lead to new human pandemic diseases.

The new scientific paper that I mentioned above–the one that explains why trading in bat species for TCM may have caused the current pandemic, concludes that "a change in these practices is highly recommended."

That would be the understatement of the year.

It's sadly ironic that the WHO, which has in many ways been leading the fight against the Covid-19 virus, may have contributed to the conditions (live animal markets trading in wild animals) that allowed the virus to jump into the human population. It's too late to prevent that, but it's not too late for the WHO to take steps to prevent the next pandemic: they can and should remove TCM from their official guidelines.

As for China, they should recognize that the profits they make from the sales of animal parts for TCM are vastly outweighed by the harm these practices cause. China should stop promoting TCM, and it should ban the killing of wild animals for spurious medical reasons.

Russian homeopathy, hiding in plain sight

It turns out that Russia has its very own brand of bogus medicine:"release-active drugs," or RADs. Dozens of scientific articles have been published claiming that these substances can be used to treat or cure a remarkably broad range of illnesses, including:

"... influenza, hemorrhagic fever, meningococcal meningitis, herpes, HIV, diabetes, erectile dysfunction, sleep disorders, obesity, chronic inflammatory joint diseases, attention deficit hyperactivity disorder, ..., alcoholism, allergies, and many other health problems." 

If this sounds too good to be true, that's because it is.

Thanks to a new report published in the journal BMJ Evidence-Based Medicine (provocatively titled "Drug discovery today: no molecules required") we now know that RADs aren't drugs at all, because they don't actually contain anything. As the new study reveals,

"The problem [with RADs] is that typical dilutions of the active ingredient are so high (from 1:10²⁴ to 1:10¹⁹⁹¹) that no molecules of the initial antibodies should be present in the ‘drug’ itself."

In other words, RADs are simply homeopathy by another name. As I've written many times before, homeopathy is one of the most patently absurd forms of pseudoscience, and although it's been debunked countless times, it remains popular due in part to commercial interests that profit handsomely from selling ineffective but expensive sugar pills.

RADs are produced by a single Russian company, with the odd name "OOO NPF Materia Medica Holding." The papers promoting the benefits of RADs are authored by a variety of Russian authors, but they are nearly all co-authored by or associated with one person, Oleg Epstein, who is also the company's founder.

Epstein and his Russian compatriots have been very clever about disguising the fact that their "release-active drugs" aren't drugs at all. Their papers are full of scientific jargon, which has no doubt helped them get their work past reviewers who (as every scientist who has published papers knows) can sometimes be a bit lazy.

They've also taken advantage of–one might say abused–the U.S. clinical trials system, ClinicalTrials.gov, by registering 22 studies of RADs there, such as this one.

The authors of the BMJ report (Alexander Panchin, Nikita Khromov-Borisov, and Evgenia Dueva, all Russian, though Dueva is based in Canada) are unsparingly blunt in revealing how Epstein has manipulated the scientific system in Russia to gain approval (and lucrative sales) of his so-called drugs. For example, Epstein has published 90 papers on RADs in a single journal, including 48 in a special issue that he edited himself.

Panchin and colleagues also took a closer look at 6 papers about RADs that were published in English-language journals, all co-authored by Epstein. They report that

"the articles contained misleading descriptions of active substance concentrations, severe flaws in study design and methodology, as well as concealed conflict of interests.... the authors did not mention that MMH manufactures and sells RADs and holds the corresponding patents. Epstein was not mentioned as the founder and CEO of MMH."

They contacted all of these journals, and only one journal, PLoS ONE, went so far as to retract the bogus science on RADs. Kudos to PLoS ONE for doing so. The other journals, some of them published by reputable scientific publishers including Elsevier, Wiley, and Springer, either didn't respond or refused to take action.

Fortunately for consumers, RADs haven't yet spread into U.S. and European markets, although their manufacturers are trying. In a recent letter published in a the Journal of Medical Virology, Epstein and his co-authors write that

"Currently we are in the process of approving evaluation requirements for our products, taking into account their peculiarities and allowing their potential authorization in the USA and Europe."

Buyer beware. The Russian quacks are coming.

The federal government is wasting over half a billion dollars a year on chiropractic and osteopathic manipulation

A book on the abuses of chiropractic,
written by a former chiropractor

Here's a quick way for the U.S. government to save over half a billion dollars. Stop paying for coverage of medical procedures that have little or no evidence to support them.

The Centers for Medicare and Medicaid Services (CMS) now releases annual reports of how much it spends, broken down according to the procedures. Their latest data, for the year 2015, reveals that Medicare spent $564,165,721 on pseudoscientific medical practices.

I'm talking about chiropractic and osteopathic manipulation. These are similar but distinct belief systems, both involving bones, and both with little high-quality evidence to back them up. Most people think that chiropractors' spinal "adjustments" can relieve pain from injured or aching backs. It turns out that it's just an elaborate placebo: a back rub at home is likely to work just as well. And that home treatment is probably safer–I'll get to that below.

Osteopathic manipulative therapy (OMT) was invented out of whole cloth in the mid-19th century by Andrew Still. Still believed that every part of the body was linked by a mysterious "myofascial continuity" and that manipulating it could treat a vast range of aches, pains, and other ailments. Most of this is not true. (There is some evidence that OMT can be beneficial in carefully selected cases of lower back pain, but the evidence is quite thin (see this review), and the CMS codes don't distinguish different uses of OMT.)

Osteopathic manipulation is what Larry Nassar, the now-convicted sexual predator, claimed he was doing to the hundreds of young girls whom he molested over the years when he was a sports doctor at Michigan State University and a doctor for the U.S. Olympic gymnastics team. (Osteopathic physicians, which is what Nassar was, generally practice real medicine, and I don't mean to suggest that any of them endorse Nassar's awful abuses. However, OMT is a relic of their pseudoscientific past, and Medicare should not be covering it.)

Chiropractic is no better than OMT. It was invented by D.D. Palmer in the 1890s, around the same time that Andrew Still was concocting OMT.  Palmer mistakenly believed that misalignments of the spine, which he called subluxations, caused a vast range of health problems, even infectious diseases. As retired chiropractor Samuel Homola has written,

there is "no evidence at all to support chiropractic subluxation theory," 

but thanks to clever marketing, chiropractors have convinced millions of people to see them on a regular basis. (See chirobase.org for much, much more.)

Even more alarming is that chiropractic adjustments carry a small but frightening risk of causing a stroke, as a result of tearing the vertebral artery, as I've written about before. In fact, the American Heart Association issued a warning in 2014 that "neck manipulation may be associated with stroke". Not surprisingly, the chiropractors association strenuously denied this, but the evidence speaks otherwise. Indeed, a 2015 study that I described when it appeared showed that Medicare patients–the same cohort whom we are paying half a billion dollars a year to provide chiropractic treatments–suffered a significantly higher risk of stroke after seeing a chiropractor than those who instead saw a real doctor.

And a 2003 study in the journal Neurology show an equally alarming increased risk of stroke due to tears in the vertebral artery after chiropractic in younger patients. The lead author of that study, Dr. Wade Smith, warned that

"physicians and patients should be aware of spinal manipulation therapy as a rare but potentially causal factor in stroke."

[Update: note that a 2016 study, in the journal Cureus, found that the link between chiropractic neck manipulation and arterial dissection was not causal; i.e., that chiropractic did not appear to cause arterial tears. However, concerns remain, as demonstrated in this 2017 case report of cerebral hemorrhage following chiropractic activator treatment.]

The 2015 numbers from the Centers for Medicare and Medicaid Services show that the vast majority of the wasted funds, $545 million, went to chiropractic treatments, with another $19 million going to osteopathic manipulation. Neither amount is justified by scientific evidence.

Let's stop wasting our money on procedures that don't help, and may harm, Medicare patients. If we want to help patients, let's insist that Medicare spend our money on real medicine.

Gwyneth! How did you learn so much about health?

Gwyneth Paltrow has invented stickers that promote healing. Yes, stickers. Little circular stick-on thingies that you might give to your 1st-grader as a reward for doing her homework.

Gwyneth, though, has discovered something much deeper about stickers. If you make them with just the right materials, and then stick them on your body in the right places, they "rebalance the energy frequency in our bodies."

(A quick warning: if you follow the links in this article, put down your coffee first. You might laugh so hard that you'll spill it all over yourself.)

Until a day or two ago, Gwyneth Paltrow's Goop website–a "lifestyle" business that sells all things Gwyneth–advertised these stickers as using "NASA space suit material," which presumably was the source of their magic healing properties. Then Gizmodo called someone at NASA to check out this claim, and got a very clear answer.

Nope. Goop's stickers are not made of space suit material. (Not that space suit material has healing properties in the first place–it doesn't.) Gizmodo's quote from a former NASA scientist, Mark Shelhamer, sums it up nicely:

“Wow,” Shelhamer told Gizmodo. “What a load of BS this is.”   

Goop quickly updated their site, and now they don't claim anything about NASA space suits in their stickers. But they didn't dial back any of their magical healing claims. Here's what Goop says now, in an article called "Wearable Stickers that Promote Healing (Really!)":

"Human bodies operate at an ideal energetic frequency, but everyday stresses and anxiety can throw off our internal balance, depleting our energy reserves and weakening our immune systems. Body Vibes stickers come pre-programmed to an ideal frequency, allowing them to target imbalances."

Wow. What gobbledygook. I see what that NASA scientist meant. But wait, there's more! Goop tells us:

"Studies have shown that when your frequency slips, your immune system is compromised, which opens the door to getting sick."

Studies? No such studies exist. People don't have a "frequency," and there's nothing to "slip." I think it's fair to say that the Goop claims about these stickers are so ridiculous that they're not even wrong.

These stickers are powerful, though, so you must be careful. Goop warns that

"We recommend starting with 1 or 2 for sensitive people. Wearing more than 4 may cause some dilution of the individual frequencies."

Oh boy.

Paltrow sells these magic stickers (and all of her products) using pictures of beautiful models doing healthy activities while wearing stickers. This is part of Goop's appeal: Paltrow is suggesting, in essence, "I'm beautiful and healthy and I'm in my forties, so I know the medical secrets that will keep you beautiful too."

Of course, the special Goop stickers aren't cheap: they cost $60 for a 10-pack.

Not surprisingly, Goop sells lots of overpriced dietary supplements too, such as a bottle of multivitamins with fish oil for $90, which comes with claims about keeping the immune system strong. Almost no one needs these supplements, and they don't do anything for your immune system, as I've explained before.

It took me just a few seconds to find that you can get a sheet with about 50 "dreams come true" stickers at stickersgalore.com for less than $2. These don't come with any wild health claims, but they do make kids happy. I recommend trying these before you get the Goop stickers.

Goop's (and Gwyneth's) claims about their stickers are so ridiculous, so laughably nutty, that I can't really feel sorry for the people who fall for them. Anyone who can afford to waste $60 for a pack of stickers probably has too much money and not enough sense. It's just too bad that they're giving their money to a wealthy actress rather than donating it to some worthy cause.

Finally, I should note that I've always liked Paltrow as an actress, in movies such as Emma and Shakespeare in Love from the 1990s through the recent Iron Man franchise. But why would her acting skills make her an expert on human health? They don't.

NIH will spend $37 million to study discredited treatment that may harm patients

What do you do when you've spent $30 million to study a highly controversial, possibly harmful treatment, only to learn that it doesn't work?

If you're NIH's alternative medicine center, you double down. More than double, actually: NIH's NCCIH* just announced they will spend another $37 million to study chelation as a treatment for heart disease. Or to be more specific, Mount Sinai of Florida and Duke University issued a press release this past week proudly announcing that they'd won a $37 million grant to launch TACT2, the second Trial to Assess Chelation Therapy. TACT2 will be a followup study from TACT, which ended in 2012 after largely failing, as I'll explain below.

Chelation is a harsh chemical treatment, using a chemical called disodium EDTA, that is sometimes used to treat lead poisoning, because it can help to remove heavy metals from the blood. Some people think that this can somehow remove plaques from arteries, a sort of Roto-Rooter for your circulation, which in turn might improve cardiovascular health. This turns out to be wrong.

(Chelation is also promoted, tragically, as a treatment for autism. Anti-vax doctors who think that mercury causes autism have been pushing this for years. In 2014, the FDA issued a warning for parents to beware of this dangerous and ineffective therapy.)

Let's briefly review what TACT was, and some of its problems. There are far too many to list here, but I'll refer readers to a lengthy article published in 2008 by Dr. Kimball Atwood and colleagues for details. That article, which called for a halt to TACT, explained that:

• a series of randomized trials in the 1990s found no evidence that chelation worked for coronary artery disease
• most of the early advocates of chelation (in the 1960s) were also outspoken advocates for Laetrile and other ineffective therapies
• at least 30 deaths have been report associated with EDTA, but the doctors pushing its continued usage deny that any deaths have occurred.
• the scientific literature has shown that the underlying "heavy metals" hypothesis is implausible
• the TACT study includes "nearly 100 co-investigators who, in our opinion, are unsuitable to care for human subjects or to report trial data ... several have been disciplined, for substandard practices, by state medical boards; several have been involved in insurance fraud; at least 3 are convicted felons."
• "The researchers failed to inform the subjects that one risk of the treatment was death." (from The Chicago Tribune.)

Atwood and colleagues called for a halt to the TACT study, saying it was "pointless, dangerous, unethical, and wasteful."

The TACT study was indeed halted in 2008 for these and other ethical concerns, but it was quietly resumed about a year later. Then in 2012, the final results were reported. Although the results were almost entirely negative, the lead investigator, Gervasio Lamas, claimed that there was a benefit for a sliver of patients: people with diabetes who had a prior heart attack. That's the group he plans to focus on in the new TACT2 trial.

As Forbes writer Matt Herper explained in 2012, most doctors were highly skeptical of these results. Cardiologist Steve Nissen of the Cleveland Clinic said "It would be tragic if the result of this was a widespread use of chelation." Science blogger (and cancer doctor) Orac provided a detailed analysis of the results at the time, explaining why the study essentially failed to prove any benefit for chelation. Most of the results were not statistically significant, and the best the study could claim was very marginal significance for a small benefit, a result that could easily be explained by bias, which was rampant in this study.

TACT2 is being run by the same doctor, Gervasio Lamas, who recruited questionable practitioners into the first trial. There's no reason to think the second trial will be run any better. The new trial will subject 1,200 diabetic heart attack survivors to chelation therapy in an effort to prove that chelation helps prevent a second heart attack. Not only is this extremely unlikely to provide any benefit, it also exposes the patients to serious risks that Lamas and his colleagues don't seem to acknowledge, and probably won't tell the patients about.

NIH should pull the plug on this enormous ($37 million) and dangerous trial before it begins. If potential patients are informed correctly that there is a serious risk of harm with virtually no chance of benefit, then hopefully they will simply refuse to enroll. That would be the best outcome for everyone.

*In case you're wondering what NCCIH is, it's the new acronym for the former National Center for Complementary and Alternative Medicine, NCCAM. Last year it was renamed. The new name is the National Center for Crackpot and Implausible Hypotheses, Or maybe it's the National Center for Complementary and Integrative Medicine, you decide.

Someone needs to tell Michael Phelps to stop bruising himself

It happens every four years. No, not the Olympics, though of course that happens too. I'm talking about new wackadoodle performance enhancement fads. In the 2008 and 2012 Olympics, it was magic tape, which we saw plastered across the arms and legs of many swimmers. This year it's "cupping," a crude technique that leaves nasty red or purple welts all over your body. Michael Phelps, one of the best male swimmers in Olympic history, featured these lovely welts in photos this week, and you can catch a glimpse of him getting the treatment in the UnderArmour "Rule Yourself" ad featuring Phelps (which is otherwise an excellent ad).

Phelps isn't the only one. Former Olympic swimmer Natalie Coughlin and gymnast Alex Naddour have displayed the distinctive circular welts too.

The New York Times, USA Today, and People all ran articles yesterday explaining what those nasty red bruises were all over Phelps' torso and shoulders. USA Today reported, unquestioningly, that athletes use cupping "to relieve tension in their muscles." The NY Times (from which we might expect a bit more skepticism) reported blithely that "Physiologically, cupping is thought to draw blood to the affected area, reducing soreness and speeding healing of overworked muscles." People used the same argument, and then added this bit of illogic:

"given that Phelps took home his 23rd Olympic medal last night, it's tough to argue."

No, it's not. Cupping is ridiculous. There's no scientific or medical evidence that it provides any benefit. The NY Times did express a bit of doubt (though not much), summarizing two small experiments that showed that cupping worked no better than placebo. But the Times couldn't help itself, and went back to quoting anecdotal evidence from true believers.

Rather than review the evidence here, I refer you to a thorough takedown of cupping written last month by Orac, a well-known science blogger who is also a surgeon:

"Among the silliest of alternative medicine therapies is something called cupping.... The suction from cupping breaks capillaries, which is why not infrequently there are bruises left in the shape of the cups afterward."

As Orac points out, repeated cupping in the same spot can destroy your skin and lead to dangerous infections. Another physician, Dr. Harriett Hall, in an article for Slate in 2012, made similar points.

I'm not sure who told Michael Phelps that cupping would help him swim faster, but I am sure that it's terrible advice–definitely not helpful and maybe harmful.

I know athletes are notoriously superstitious, and they get some psychological benefits from the various rituals they use to prepare for competition. There's no harm in believing that magic tape, or a lucky shirt, or always stepping onto the field with your left foot first–or whatever–will help you win. But Michael Phelps and his fellow Olympians should run as fast as possible from unproven treatments (and make no mistake, cupping is one of these) that can only cause them harm.

Washington Post's Science section descends into pseudoscience

The Washington Post has some bad news about migraines.

Every Tuesday, the Washington Post has a special section devoted to Health and Science. It’s usually my favorite section, with features such as “medical mysteries” and highlights of the latest news from the world of science.

Not this week. Instead, the front page of the section featured a lengthy article that was a long anecdote by a woman who firmly believes that acupuncture cured her migraines. The title gave me a feeling of dread: “Acupuncture needles stung, but they cured my migraines” (the online version linked here has a different title). As I feared, there wasn't a whit of science in it.

Let’s get one thing out of the way first: acupuncture is rank pseudoscience. It’s based on a primitive, pre-scientific notion of a “vital force” (for which no evidence exists), usually called qi, that runs through the body along meridians (no evidence for these either). Plunging needles into the meridians is supposed to manipulate this vital force and cure all sorts of things, ranging from pain to infections to cancer. All of this is nonsense. If you want to know more, I recommend Acupuncture Watch; or see Ben Kavoussi’s article explaining how postmodernism, with its notion that all truth is relative, has allowed acupuncture and other mystical, archaic beliefs to gain traction in medical practice; or check out Jann Bellamy’s discussion of acupuncture as “legalized quackery”.

I’ve written about the nonsense that is called acupuncture before (in 2013, and in 2012, and in 2010), so I won’t rehash that here. But it’s really disheartening to see a great (or once-great?) newspaper devote a large chunk of its weekly science section to pseudoscience.

Back to this week’s nonsense article. In this lengthy piece, author Margarita Gokun Silver describes how she began to experience debilitating migraines after the age of 40, which grew worse over time. She tried pain relievers, which worked at first but then stopped working. One expensive pill worked for the migrations but gave her severe nausea. Eventually, she writes, “exhausted by these side effects, I turned again to the Internet.”

Great. Now, there’s nothing wrong with looking for solutions in the Internet–we all do it. But this is an article in the Washington Post Science section! Nowhere does the author describe anything resembling actual science. Instead, she describes how she discovered a “breakthrough” in her yoga class, when another yoga student suggested acupuncture. She decided to give it a try.

(You might be wondering, who is Margarita Gokun Silver? She describes herself as a writer, novelist, and painter–not a scientist or a doctor.)

After several acupuncture sessions, the author tells us, her migraines seemed less frequent, and eventually she decided she was cured. She still gets migraines, but when they get bad she uses acupuncture again. This, she tells us, is her cure.

The entire story is a classic example of how we can fool ourselves into thinking that whatever we tried last is what worked. Migraines come and go, and this woman’s story is not unusual. She had a long series of bad migraines that eventually subsided, and she still gets them. When they were at their worst, she tried everything she could find, and when the episodes became less frequent, she gave full credit to acupuncture. She might just as well have tried chocolate milk, and then written an article claiming “chocolate milk cured my migraines!”

I don’t blame the author (well, not much) for wrongly believing that correlation equals causation. But we have scientific methods that are really, really good at figuring out if a treatment works. Scientists have already looked at this particularly claim, and the bottom line is that acupuncture doesn’t cure migraines. If you don’t believe me, then read the article about treating migraines by Dr. Steven Novella, a Yale neurologist who specializes in headaches, and look at his summary of how not to treat migraines, which points out that

“acupuncture proponents have been able to change the rules of clinical research so that essentially negative or worthless studies of acupuncture are presented as positive.”

Last week's Washington Post Science section was a major fail. I can't imagine why they gave a lengthy forum to a non-scientist to write about pseudoscience. If they wanted to feature a story about migraines, there's plenty of good science out there, even if there's no magical cure. What's next, Washington Post? Will you invite Jenny McCarthy to write about vaccines and autism, or Gwyneth Paltrow to discuss detox treatments? I sure hope not.

Internet quack Joe Mercola is worried. Dr. Oz to the rescue!

Dr. Oz interviews Joe Mercola on his show.

After a series of studies showing that vitamins and supplements are usually a waste of money, including my recent article on the top 6 vitamins you shouldn’t take, internet supplement salesman Joe Mercola is worried.  He should be: his Internet-driven empire is largely based on sales of vitamins and supplements, for which his claims range from merely implausible to dangerously untrue, including:

• Himalayan salt is far better for you than regular salt. Coincidentally, Mercola sells the good salt.
• Vitamin D is "the new silver bullet for cancer." No, it's not.  Not even a little bit.
• Homeopathy cured a boy of autism. Of course Mercola doesn't provide any proof of this, only a testimonial.  This is not even remotely plausible, since homeopathic preparations are just sugar pills.

I could provide many more examples, but this should be enough to demonstrate that I'm not making this stuff up.

Mercola is also one of the loudest voices and worst offenders in the anti-vaccine movement. Among other misinformation, he claims that the hepatitis vaccine causes autism, and his website urges people to use his supplements instead of getting vaccinated.

So how do I know Mercola is worried? He's appearing on the Dr. Oz Show on Monday, February 10 (the day after I'm writing this) to talk about multivitamins. Apparently his 10 minute segment wasn't enough, so he posted an article on his website with the "Information I couldn't share" on Dr. Oz's show.

Does the article explain why multivitamins are actually good for you?  Well, no. Most of the article is a big red herring, in which he argues that supplements should not be regulated as drugs, because "we have all the regulations we need." Then he contradicts himself and says that the FDA already regulates supplements. (It doesn't - or to be more precise, the FDA does not require supplement makers to prove their products work. It can only step in if the products start to kill people. This is what Mercola calls regulation.) Besides, he says, supplements are harmless. As evidence, he cites a press release from a pseudoscientific organization that claims "no deaths from supplements in 27 years."

Not surprisingly, Mercola doesn't cite any actual science to support his claims. In contrast, several very large studies in major medical journals, cited in my own columns last month and last October, show that routine supplementation with multivitamins, especially with the megadoses that many people take, can indeed cause genuine harm. Those same studies showed that if you don't have a deficiency, there's simply no benefit to taking most vitamins.  Mercola's response is to cite opinion pieces from his own website that simply assert, without any evidence, that the studies are wrong.

In other words, Mercola's response is "Oh yeah?" He then goes off on a tangent and launches an irrelevant ad hominem attack on noted vaccine expert Dr. Paul Offit.

Why has Dr. Oz repeatedly had Joe Mercola on his show? This is a tough one. Does Oz believe that autism is caused by vaccines, something Mercola has claimed repeatedly over the years?  Does he understand that Mercola's anti-vaccination campaign leads to genuine harm? Does he know that the FDA has repeatedly issued warnings to Mercola to demand that he stop making false claims about his vitamins and supplements, as Chicago Magazine reported?

Or does Dr. Oz keep inviting Mercola back because he knows Mercola has a big audience that will increase his own viewership?

Despite my past criticism of Dr. Oz, I still think he has a better grasp of science than Joe Mercola. He also reassures viewers constantly that he doesn't sell the products that appear on his show. And yet Oz is giving a platform to someone who makes huge profits selling products based on unproven claims. By having Mercola on his show, Oz is giving him free publicity and helping him sell those same products. And whether or not Oz agrees with Mercola, he is helping to give credibility to Mercola's wildly inaccurate and dangerous anti-vaccine claims.

What Works for Knee Pain? Good Medicine, Bad Medicine, and Wasted Money

Knee pain is a very common problem, affecting young and old alike.  Among athletes, knees take a beating, particularly in sports that involve running and twisting.  Among older people, the cartilage that provides a cushion in our knees often just wears out, producing chronic stiffness and pain.

I've had knee problems myself, so I was interested to see an article posted on CNN, with content from Harvard Medical School called "Alternative Treatments for Knee Pain."  Would it describe "alternative" medicine, as in "complementary and alternative medicine," or would it present real medicine for knee pain?

A little of both, as it turns out.  But it does more: it inadvertently illustrates one of the major flaws with the U.S. health system.  We don't discriminate between effective and ineffective treatments, and some doctors seem content to let patients try anything, regardless of efficacy or cost.

The article describes several treatments for knee pain, and for each one it turns to Eric Berkson, M.D., for an opinion on how well the treatment works.  Berkson is an orthopaedic surgeon at Massachusetts General Hospital and an Instructor in Orthopaedic Surgery at Harvard Medical School.

Despite these excellent credentials, Dr. Berkson doesn't seem to have a firm command of science-based medicine. The article starts out strong, recommending the most effective therapies, but then wanders into unproven therapies, and concludes with Berkson making an unscientific recommendation for the most wildly ineffective treatment of all: acupuncture.  Let's look quickly at each "alternative."

The most effective treatments, according to Dr. Berkson, are physical therapy and weight loss.  Berkson is on solid scientific ground here: physical therapy strengthens the muscles around the knee, relieving some stress on the joint, and weight loss does the same thing by reducing the load directly.  If you stopped reading at this point, you'd be in great shape.

Next is a discussion of chondroitin and glucosamine, two very popular supplements that are often used to treat joint pain.  After many years of competing claims about these supplements, NIH conducted a large, $12.5 million study called GAIT to test whether these supplements worked for knee pain. The researchers looked at glucosamine and chondroitin separately and together, and compared them to a standard pain reliever (celecoxib, brand name Celebrex®, an NSAID) and to a placebo.

The conclusion: celecoxib worked, but the supplements did not.  In a small subset of patients with moderate to severe pain, there was a hint of a benefit for glucosamine-condroitin, but it wasn't significant.  For patients with mild pain, though, only celecoxib was better than a placebo.

Despite this large and compelling study, Berkson says

"there's a lot of evidence that they [glucosamine and chondroitin] work, but only in a certain percentage of patients." 

Perhaps he's referring to patients with moderate to severe pain from the GAIT study, but the article doesn't explain if that's what he means.  And then Berkson recommends them anyway, saying "there's little downside to trying the supplements."  Especially if it makes the patient think the doctor is helping.

The article then describes three different treatments that involve injections of various substances into the knee.  To keep this brief, I'll just consider the first: viscosupplementation, a fancy name which means that hyaluronic acid is injected into the knee. It's supposed to help lubricate the joint, which sounds plausible: after all, we lubricate machines to keep them running smoothly.  Shouldn't some "grease" help our knees?

For hyalonuric acid, the answer is simply no.  A large review just last year, involving over 12,000 patients (Rutjes et al. 2012) shows that hyaluronic acid has little or no benefit, and possibly causes harm.  Their conclusion:

"In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events."

Berkson's own colleagues, the American Academy of Orthopaedic Surgeons, just issued a 1200-page report on treatments for knee osteoarthritis, and they found strong evidence against the use of hyalonuric acid.  To be specific, the AAOS says "We cannot recommend using hyaluronic acid for patients with osteoarthritis of the knee."  They label this a "strong" recommendation.

Despite the the advice of his own professional organization, Dr. Berkson says

"I have some patients who think [hyalonuric acid is] a miracle drug that keeps their symptoms at bay.  Given that the risks of injection are very low, it makes sense to try it if insurance will pay."

Oh my.  Here we have a medical expert recommending an expensive treatment - he estimates the cost is about $1500 - despite the evidence, apparently because he has patients who think it works.  Paying for expensive, ineffective procedures is a poor way to treat patients and a great way to run up costs.

(Aside: I might seem to be picking on Dr. Berkson here, but I think his responses are probably typical of many practicing doctors.  Not to excuse him, but it's easy to follow your instincts and to rely on anecdotes from patients.)

After briefly discussing two other injection therapies, the CNN/Harvard article addresses one last alternative: acupuncture.  It quotes Berkson again, this time saying:

"Acupuncture works in some patients, although I don't think science knows exactly why it works. It's worth trying if other things aren't working for you."

Despite Dr. Berkson's comment, the science doesn't support him.  Acupuncture for knee pain, and for other pain, simply doesn't work.  (See this article for a lengthy discussion, with citations.)  Just to pretend for a second: in order for acupuncture to work, there would have to be lines of force (called "meridians") through which a mystical, apparently unmeasurable life force ("qi") flows, and furthermore you'd have to be able to manipulate this life force by plunging needles into the skin.  There is no support whatsoever for these ideas in human biology and physiology.

The American Academy of Orthopaedic Surgeon's report addresses acupuncture too, stating that "We cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee."

Dr. Berkson's recommendation is akin to a shrug: while admitting that he doesn't know why it might work, he just says to give it a try.  His own professional organization, after an extensive review of the scientific evidence, disagrees.

The CNN Health article, with "content provided by the faculty of the Harvard Medical School," demonstrates in a microcosm how health care dollars are wasted in the U.S.  First it recommends the most effective and least expensive treatments: weight loss and exercise.  Both of these involve lifestyle changes that are difficult for many people.  The article then suggests alternative treatments for knee pain that include:

1. Glucosamine and chondroitin supplements - ineffective but cheap. 
2. Knee injections of hyalonuric acid - ineffective and very expensive.
3. Acupuncture - ineffective, wildly implausible, and sort of cheap.

Despite the evidence against them, the doctor quoted throughout the article recommends trying all three, especially if (as is common) the patient doesn't have to pay the bills.

Science only supports three treatments for knee pain, as physician Harriet Hall summarized in her recent blog post: exercise, weight loss, and NSAIDs.  The "alternatives" described by CNN, no matter how appealing they sound, are a waste of time and money.

Maryland legislature scores one for science

Just one month ago, I wrote a post entitled "Naturopathic shenanigans in the Maryland State legislature," about the efforts of naturopaths to get a new law passed in the state of Maryland that would license them to practice medicine.  This effort to get a set of pseudoscientific practices certified as "medicine" has been pursued by naturopaths across the U.S., and Maryland is just one of their latest targets.  I was dismayed when I learned that laws had been introduced in both houses of the Maryland legislature to give naturopaths what they wanted.

Well, the votes just came in, and the law was unanimously defeated in committee in both the House and Senate.  Without knowing precisely what happened (or if any of them read my article, either here or on the Forbes magazine site) I cannot explain why the legislators voted as they did, but after my previous article I want to give them a rousing cheer of approval.  Hurrah!  Sometimes lawmakers get it right, and when they do, they deserve our applause.

Congress holds an anti-vaccine hearing

I was in my car yesterday listening to C-SPAN (yes, I do that sometimes), when to my stunned surprise I heard Congressman Dan Burton launch into a diatribe on how mercury in vaccines causes autism.  No, this was not a replay of a recording from a decade ago.  The hearing was held just a few days ago by the Committee on Oversight and Government Reform.

Congressman Burton used this hearing to rehash a series of some of the most thoroughly discredited anti-vaccine positions of the past decade.  Burton is a firm believer in the myth that vaccines cause autism, and he arrogantly holds the position that he knows the truth better than the thousands of scientists who have spent much of the past decade doing real science that proves him wrong.  

In a classic political move, the committee called on scientists Alan Guttmacher from the NIH and Colleen Boyle from the CDC to testify, but in fact the committee just wanted to bully the scientists.  Committee members lectured the scientists, throwing out bad science claims, often disguised as questions, thick and fast.  Alas, Guttmacher and Boyle weren't prepared for this kind of rapid-fire assault by pseudoscience.

Burton himself was the worst offender, offering anecdotes and bad science with an air of authority.  He stated bluntly: 

“I’m convinced that the mercury in vaccinations is a contributing factor to neurological diseases such as autism."

No, it isn't.  Dozens of studies, involving hundreds of thousands of children, have found the same thing: there is no link whatsoever between thimerosal and autism, or between vaccines and autism.  And Burton went off the deep end with this: 

"It wasn’t so bad when a child gets one or two or three vaccines… Mercury accumulates in the brain until it has to be chelated.” 

Bang bang, two false claims in 10 seconds.  First he claims that mercury from vaccines "accumulates in the brain", a statement with no scientific support at all. Then he claims that chelation therapy is the solution - a radical, potentially very harmful treatment that no sensible parent would ever force on their child.  Unfortunately, some quack doctors have experimented with chelation therapy on autistic children, despite that fact that it can cause deadly liver and kidney damage, and one of them caused the death of a 5-year-old boy in 2005.

Burton also claimed that single-shot vials would "eliminate the possibilty of neurological damage from vaccines" - a claim that was invented out of thin air by the discredited anti-vax doctor Andrew Wakefield, whose fraudulent 1998 study was the spark that started the current wave of anti-vax hysteria.

Congressman Bill Posey from Florida was just as bad as Burton, demanding a study of vaccinated versus unvaccinated children, a standard talking point of the anti-vax movement.  (Congressman Posey: do you even realize that your question is almost identical to what Jenny McCarthy asked five years ago, on the Larry King Live show?)  Here's his question to the CDC's Boyle:

"I wonder if the CDC has conducted or facilitated a study comparing vaccinated children with unvaccinated children yet - have you done that?"

Dr. Boyle wasn't prepared for this.  She tried to point out that many studies have been done looking at the relation between vaccines and autism, but she didn't get very far before interrupted, thus: 

Rep. Posey: “So clearly, definitely, unequivocally, you have studied vaccinated versus unvaccinated?” 

Dr. Boyle: “We have not studied vaccinated versus unvaccinated." 

Posey: “Never mind. Stop there. That was the meaning of my question. You wasted two minutes of my time."

Dr. Boyle simply wasn't prepared for a Congressman who was parroting anti-vax activists.  It's too late now, but her response should have been this:

Congressman Posey, only an extremely unethical scientist would consider conducting such a study.  To compare vaccinated versus unvaccinated children in the manner you suggest, one would have to withhold vaccines from young children.  We know from decades of evidence, involving tens of millions of children, that vaccines save lives.  Few if any medical interventions are more effective than vaccines. 

But Congressman, the scientific community has done observational studies of vaccinated versus unvaccinated children, comparing autism rates in children whose parents chose not to vaccinate.  Those studies show that autism rates were slightly higher in unvaccinated children.  That's right, vaccinated children had autism at a lower rate. 

So no, Congressman Posey, the CDC hasn't done a study of vaccinated versus unvaccinated children.  Only a corrupt dictatorship could impose a study like that on its people.  Is that what you want?

To make matters worse, the House committee invited Mark Blaxill to testify.  Blaxill is a well-known anti-vaccine activist whose organization, SafeMinds, seems to revolve around the bogus claim that mercury in vaccines causes autism.  His organization urges parents not to vaccinate their children, and giving him such a prominent platform only serves to spread misinformation among parents of young children.  

Blaxill's central claim is that that we're in the midst of an autism epidemic: 

"For a long time, reported U.S. autism rates were low, estimated at about 1 in 10,000. Then around 1990 something new and terrible happened to a generation of children. Autism rates didn’t just rise, they multiplied," claimed Blaxill in his written testimony.

His entire argument builds on this.  Yet multiple studies, looking carefully and objectively at the data, indicate that all or nearly all of the rise in autism cases is due to increasing diagnoses, which in turn is due to multiple factors: a dramatically broading of the definition of autism in the early 1990s, a greater awareness of the condition, and a greater willingness of doctors and parents to accept the diagnosis.  For an objective summary of the evidence, see the articles by neurologist Steven Novella here and here, which summarize a dozen epidemiological studies.  The weight of the evidence shows that the actual incidence of autism is either stable or possibly rising very slowly.  There is no "autism epidemic."

It's also worth pointing out that Blaxill is a conspiracy theorist who claims that the "CDC has actively covered up the evidence surrounding autism’s environmental causes."  

Congress has every right to conduct oversight into medical research at the NIH and the CDC.  But when Dan Burton, Bob Posey, and others decide in advance what the science says, and abuse their power to demand "answers" that validate their badly mistaken beliefs, people can be harmed. Over the past decade, the anti-vaccine movement has successfully convinced millions of parents to leave their kids unvaccinated, and the result has been serious outbreaks of whooping cough, haemophilus, measles, chicken pox, and mumps around the U.S. and Europe.  

Some anti-vax parents claim that these childhood illnesses aren't so bad.  I wish they would talk to the parents of young children who have died in recent whooping cough outbreaks.  These illnesses can be deadly.

Message to Congress: science isn't easy, and autism is complicated.  Don't criticize science when it doesn't give you the answer you thought you knew.  That's not how science works.  Thousands of scientists are now trying to identify the causes of autism, and they've made progress, especially on the genetic front.  The answer might not be simple, but we will find it.