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Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

The Irony of being listed on BadBusiness dot org

Thu, 20 Apr 2017 13:45:19 -0400 by

 

Late entry 15:12 4-20-2017 – Badbusiness dot org does not appear to be a valid site for criticism of legitimate business problems.

Badbusiness dot org is a site that appears to be set up with the same goal as my blog, so it is ironic that their most recent article is about my blog (roguemedic.com). On their front page, they do state –
 

Please note that (badbusiness dot org) does not guarantee the authenticity or verifiability of complaints posted by its users.[1]

 

The person/people/business writing about me should be the focus of badbusiness dot org. The person/people/business behind the article appears to have three complaints. I will address the second complaint first, then the third, since these second complaint appears to be the reason for concluding the first.
 

This character will defame pharmaceutical companies online with no evidence or proof.[2]

 

The first irony of this complaint is that it is on a site set up to criticize bad business, but it is a complaint that I am criticizing bad business by someone defending the bad business of some pharmaceutical companies.

I am very critical of those who endanger patients with inadequately tested medications and/or with medications that have evidence of producing more harm than benefit.

The second irony is that I am accused of not providing evidence. I provide evidence. My critics provide excuses. The people, and companies, I criticize are the ones who do not provide evidence. If they did provide valid evidence, I would write about someone else.

Do you want to be a guinea pig for people who do not care enough to provide treatment that is safe? Do you want to be a guinea pig for people who do not care enough to provide treatment that works? Do you want snake oil?

I have been threatened with a law suit from SWAT Fuel, Inc. for writing that their product appears to be just another health food scam. I responded by challenging SWAT Fuel, Inc. to sue me and let the evidence speak in court. I provided links to evidence.[3],[4]

I have not heard anything in the six months since I responded. Apparently, SWAT Fuel, Inc. recognizes that the evidence supports my criticism. Maybe the lawyers for SWAT Fuel, Inc. probably were awaiting the final outcome of the Tobinick lawsuit.

The Tobinick lawsuit? I have criticized Dr. Edward Tobinick for doing the same thing SWAT Fuel does, only with a medical license. Dr. Tobinick is a doctor, but he is making claims that are not supported by valid evidence. Dr. Tobinick sued Dr. Steven Novella, Yale University, and Science-Based Medicine to stop valid criticism of Dr. Tobinick’s magical treatment.[5],[6],[7]

Dr. Tobinick appealed the decision against him, but his case was so bad, he was ordered to pay a significant part of Dr. Novella’s legal expenses.[8]

An apparent minion of Dr. Tobinick has accused me of many things, including being a terrorist for my criticism of Dr. Tobinick.[9],[10]

I also criticize acupuncture, homeopathy, Reiki, faith healing, and other alternative medicine for a lack of evidence of safety and a lack of evidence of benefit.

I provide evidence. My critics provide excuses.
 

The third complaint is that I aim to frighten, intimidate, and cause emotional distress to those who harm patients.

Based on what they claim, the goal of badbusiness dot org appears to be the same as mine –
 

Bad business postings are reports from your average consumers (our users) who are fed up with corporate bullies, and with overall BS. If it’s bad business, people oughta know.[11]

Why is badbusiness dot org posting a complaint by someone defending the bad business of some pharmaceutical companies whining about valid criticism?
 

What was the primary point from this defender of the bad business of some pharmaceutical companies?

1. I am accused of being an asshole – the biggest asshole.

Gosh. Last month I was a terrorist, but now I am only an asshole. I never expected to please everyone, but I have aggressively criticized bad patient care and bad business. Our patients are more important than my reputation.

If that makes me an asshole, then I would rather be an asshole than defend bad patient care and/or defend bad business.

Why is badbusiness dot org providing a forum for companies upset by valid criticism?

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PS – I attempted to comment, and post a link to this response, on the site. I received the following reply.
 

Your comment has been blocked because the blog owner has set their spam filter to not allow comments from users behind proxies.

If you are a regular commenter or you feel that your comment should not have been blocked, please contact the blog owner and ask them to modify this setting.

 

If resolving conflicts is part of their goal, preventing communication does not seem to be a reasonable approach.

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Footnotes:

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[1] Badbusiness dot org
homepage

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[2] Timothy Noonan of RogueMedic.com is bad business
badbusiness dot org
By admin
March 24th, 2017
Article

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[3] How to scam the police – SWAT Fuel
Thu, 26 Jul 2012
Rogue Medic
Article

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[4] SWAT Fuel – Suing Me to Defend Their Scam
Thu, 06 Oct 2016
Rogue Medic
Article

–

[5] Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Thu, 24 Jul 2014
Rogue Medic
Article

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[6] Tobinick Lawsuit Update – Justice Has Prevailed
Science-Based Medicine
sbmadmin
October 6, 2015
Article

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[7] Tobinick v. Novella
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF FLORIDA
CASE NO. 9:14-CV-80781-ROSENBERG/BRANNON
Decision

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[8] Edward Tobinick et al. v. Steven Novella et al.
Case number 15-14889
U.S. Court of Appeals for the Eleventh Circuit
Decision

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[9] When Minions Attack
Sun, 26 Feb 2017
Rogue Medic
Article

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[10] The Boy Who Cried Terrorist
Wed, 01 Mar 2017
Rogue Medic
Article

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[11] Badbusiness dot org
homepage

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Filed Under: 'Alternative' Medicine, Evidence, Heresy, Lawsuit

The Boy Who Cried Terrorist

Wed, 01 Mar 2017 16:10:19 -0500 by
 
This is the latest comment from Frederick Blum in response to what I wrote about his absurd defense of Dr. Tobinick.[1].[2] As you can see, in labeling appropriate respect for patients as terrorism, Frederick Blum completely lacks perspective.
 

I think a more apt description of what you are is ” Rogue Terrorist ” . Forget ” Rogue Medic. ” It’s not really you. Think about it.[3]

 

Think like Frederick Blum?

That might be torture.

If you honestly think that I am a terrorist, turn me in.

Go ahead.

It may be even worse to not turn in a terrorist, than to treat patients with inadequately tested medications.
 

If you see something, say something 1
 

“War is peace. Freedom is slavery. Ignorance is strength.”[4]

 

What do terrorists do?
 

You hide behind a cowardly mask exactly as terrorists do.[3]

 

Cowardly?

I have allowed Frederick Blum a forum to make baseless accusations.

I have responded with evidence.

I have not made threats.

Frederick Blum calls this cowardly?
 

You fabricate lies about people and assault them with ad hominem attacks, also exactly as terrorists do.[3]

 

Frederick Blum, provide some sort of evidence to support your imaginative accusations.

I have stated that Dr. Tobinick has failed to produce valid evidence of safety.

Do you have any evidence to show that this is not completely true?

I have stated that Dr. Tobinick has failed to produce valid evidence of efficacy.

Do you have any evidence to show that this is not completely true?

I have not lied.

I have criticized Dr. Tobinick for a failure to provide evidence of safety and efficacy. Using safe and effective treatments is an important part of what separates ethical medical practice from alternative medicine.

If people conclude that Dr. Tobinick is unethical because of what I have written, that is only reasonable.

Neither of you have provided even an iota to suggest any other conclusion.

By the way, have terrorists switched from killing people to using honest criticism? I wish it were so.
 

Really, you’re just another unremarkable terrorist.[3]

 

Is your unremarkable remark intentionally ironic?
 

You should change your anonymous cowardly handle to ” Rogue Terrorist. ” At least in doing so you would be honest about yourself.[1]

 

Without valid evidence of safety, we must conclude that Dr. Tobinick cannot honestly demonstrate safety.

Without valid evidence of benefit, we must conclude that Dr. Tobinick cannot honestly demonstrate any benefit.

If Dr. Tobinick’s treatment is safe and effective, why hide the evidence?

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Footnotes:

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[1] Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Thu, 24 Jul 2014
Rogue Medic
Article

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[2] When Minions Attack
Sun, 26 Feb 2017
Rogue Medic
Article

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[3] The comment where Blum cried Terrorist
comment on Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Frederick Blum
Comment

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[4] 1984
George Orwell
Free Full Text from The University of Adelaide Library

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Filed Under: 'Alternative' Medicine, Censorship, Conspiracy Theories, Critical Judgment, Ethics, Evidence, Heresy, Research, Science

When Minions Attack

Sun, 26 Feb 2017 15:45:45 -0500 by
Minion vampire 1a
Image credit.
 

In the comments to Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish,[1] Frederick Blum (sometimes Frederick S. Blum) states that he does not like my criticism of Dr. Edward Tobinick for using inadequately tested treatment, on patients.
 

The fact that you’ve censored my comments speaks volumes about the kind of person you are, ” Rogue Medic.”[2]

 

I have not censored Frederick Blum’s comments. All comments are moderated. Not all spam is caught by the spam filter.

Since Frederick Blum’s earlier, similarly absurd, comment was approved and appeared in the comments hours before this comment, what leads Frederick Blum to conclude that this is censorship?
 

What are you afraid of being found out for, that you’re no more than a charlatan ?[2]

 

You chose to use the word charlatan. Since the topic is Dr. Tobinick, is this use of charlatan a Freudian slip?
 

Frederick Blum also obsesses about my use of a pseudonym, although I provide links to valid evidence and Frederick Blum only makes excuses to distract from the absence of valid evidence for Dr. Tobinick’s treatment.

Frederick Blum complains that it is wrong to criticize Dr. Tobinick for his failure to post valid evidence, since Dr. Tobinick uses his real name.

Is valid evidence less valid when I use a pseudonym?

No.

This gullibility is one of the primary reasons scams are so successful.

Bernie Madoff, perhaps the biggest thief of all time, had people, like Frederick Blum, defending his business. A lot of people trusted that con man for the same reason.

What was Bernie Madoff’s motto?
 

Also to his advantage, Madoff was adept at both selfpromotion and client relations. His corporate slogan, “The Owner’s Name Is on the Door,” would reinforce his managerial image, as well as provide his growing list of wealthy clients with a reassuring declaration—a personal acknowledgement of his fiduciary responsibility to them.[3]

 

Is Dr. Tobinick a medical, and much more dangerous, version of Bernie Madoff? Is Dr. Tobinick’s name on the door just a confidence gimmick?
 

You can’t hide the truth about yourself forever. Eventually it is seen for what it really is – the truth.[2]

 

We would be able to determine the truth about Dr. Tobinick, if Dr. Tobinick would adequately test his treatment.

Is the treatment safe, as Dr. Tobinick uses it?

Is the treatment better than a placebo, as Dr. Tobinick uses it?

Is the treatment as good as any adequately tested treatments, as Dr. Tobinick uses it?

The only suppression of the truth is from Dr. Tobinick and his worshipers, such as Frederick Blum.

What is the treatment?
 

The list of conditions for which Tobinick claims or even has patented use of Enbrel include Alzheimer’s, stroke, traumatic brain injury, Parkinson’s disease, carpal tunnel syndrome, brain tumor, spinal cord injury, and back pain. That quite impressive for a doctor who isn’t even a neurologist. Tobinick is an internist who, prior to curing a long list of neurological diseases, specialized in laser hair removal.[4]

 

Why doesn’t everyone go to a laser hair removal specialist for inadequately tested treatments?

I am sure that the FDA and the insurance companies are being unreasonable in wanting evidence of safety and efficacy.
 

And, the truth is that you have devised a falsified and libelous campaign against someone who is not only innocent but a truly great medical scientist with a proven honest intelligence that surpasses almost everybody else in medicine today, Dr. Edward Tobinick, only to further your own loathsome self serving agenda.[2]

A proven honest intelligence? Where did you come up with that nonsense? If an intelligent person uses a dangerous treatment, the treatment is still dangerous.

Go ahead. I dare you, Frederick Blum. Stop making excuses and provide evidence to back up your unsupportable claims.

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Footnotes:

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[1] Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Thu, 24 Jul 2014
Rogue Medic
Article

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[2] Censorship comment by Frederick Blum
comment

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[3] Catastrophe: The Story of Bernard L. Madoff, the Man Who Swindled the World
Deborah Strober & Gerald Strober
Kindle Locations 1077-1079
Phoenix Books, Inc.

From the website of Bernie Madoff – http://www.madoff.com on December 15, 2008. In Appendix A (Kindle Locations 2760-2765)
 

The Owner’s Name is on the Door

In an era of faceless organizations owned by other equally faceless organizations, Bernard L. Madoff Investment Securities LLC harks back to an earlier era in the financial world: The owner’s name is on the door. Clients know that Bernard Madoff has a personal interest in maintaining the unblemished record of value, fair-dealing, and high ethical standards that has always been the firm’s hallmark.

 

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[4] Enbrel for Stroke and Alzheimer’s
Science-Based Medicine
Steven Novella
May 8, 2013
Article

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Filed Under: 'Alternative' Medicine, Censorship, Conspiracy Theories, Critical Judgment, Ethics, Evidence, Heresy, Research, Science

I helped a Naturopath kill my son, because I believe in Quackery

Tue, 24 Jan 2017 16:00:48 -0500 by

tamara-ryan-lovett1

 
Would you kill this kid?

Like clapping for Tinkerbell, killing children for superstition is part of keeping reality at bay.

Am I too harsh?

7 year old Ryan Lovett died of strep, meningitis, and pneumonia. His slow death, over 10 days, is reported to have been extremely painful. His death was also preventable with real medicine, so I am not even remotely harsh.

Ryan Lovett’s mother is a true believer in magic. Defending her irrational beliefs means avoiding everything that has valid evidence of benefit. Oddly, she did call 911, after her son started seizing. Ryan Lovett could not be resuscitated by EMS.

Ryan Lovett’s mother took him to a Naturopathic clinic for an echinacea mixture. Meanwhile, her neighbor, not trained in the deadly art of Naturopathy, was trying to convince Ryan Lovett’s mother to take Ryan to a real hospital.
 

La Pointe (Barbara La Pointe, a former friend of Lovett’s who used to take Ryan to her home on weekends) testified she visited Ryan and his mother the day before he died. She described Ryan as being “in a state of supreme suffering” and offered to take the mother and son to a hospital or doctor, but Lovett refused.[1]

 

Naturopaths claim that they will tell patients to go to a real doctor if the patient has a serious illness, which requires real medicine, not the usual self-limiting illness that patients recover from in spite of the Naturopath’s prescriptions.

Ryan Lovett will tell you that doesn’t work. No, Ryan Lovett can’t tell you, because nobody at Naturopathic clinic did what Naturopaths claim their extensive training in quackery prepares them to do – send the patient to a real doctor.

The neighbor was much smarter than everyone at the Naturopathic clinic, since she does not appear to have been indoctrinated in the death before medicine quackery of Naturopathy.
 

Ryan did not have a birth certificate and had never seen a doctor because his mother “did not believe in conventional medicine,”[1]

 

Evil conventional medicine? Pediatricians use evidence based medicine on their own kids and on themselves. They will even give you copies of research articles that show that their treatments do work. Medicine works even when the manufacturer is not able to influence the results of the research.
 


 

“The court specifically found that Tamara Lovett actually knew how sick he was and simply refused to do something and therefore gambled with his life,” he (Prosecutor Jonathan Hak) told reporters.[1]

 

That is a misunderstanding of medicine and gambling. Medicine is probabilistic. No treatment is 100% successful, so it depends on being prescribed for the right condition, in the right dose, having the fewest side effects, or having side effects that are least likely to make the patient worse, . . . , in order to make it more likely that the patient has a good outcome. That is gambling (putting the odds in the favor of the patient). Medical education is what helps the doctor, PA, NP, nurse, paramedic, EMT to assess the patient in a way that identifies the actual medical condition, to understand the risks and benefits of the available treatments, and to decide what is best for that individual patient.

Evidence-based medical education is better at putting the odds in favor of a good outcome than anything else.

Ryan Lovett’s mother wasn’t gambling, she was praying that her superstition had real magic powers. Maybe Ryan Lovett’s mother was praying that Ryan had a self-limiting illness, which would get better as long as the Naturopathic chemicals did not poison Ryan. Why take Ryan to the Naturopathic clinic at all, if the Naturopathic clinic just sells chemicals that are merely supposed to distract people and make the Naturopath money?
 

Doctors testified the infection would have been treatable had the boy, who also had meningitis and pneumonia, been taken to a doctor and given antibiotics.[1]

 

But this is just one rare case, so it is not fair to criticize Naturopaths for scamming the gullible. The Quack didn’t know the kid would die.
 

Canadians across the country have kept a close eye on the case. It is one of several in southern Alberta involving parents who were charged criminally after their children died of conditions that could have been treated with conventional medicine.[1]

 

Some people just can’t deal with reality.

Reality will eventually kill us, regardless of what we do. In the mean time, we can increase the odds of living a long healthy life by avoiding unnecessary treatment and limiting the treatments we do use to stuff that has valid evidence that it really works.

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Footnotes:

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[1] Tamara Lovett found guilty of negligence, failure to provide necessaries of life in death of 7-year-old son
By Meghan Grant, Drew Anderson,
CBC News
Posted: Jan 23, 2017 5:00 AM MT
Last Updated: Jan 23, 2017 5:33 PM MT
Article

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Filed Under: 'Alternative' Medicine, Anti-Science, Children, Critical Judgment, Evidence, Heresy, Risk Management

Acupuncture vs intravenous morphine in the management of acute pain in the ED

Thu, 11 Aug 2016 20:30:47 -0400 by
ResearchBlogging.org
 

What does elaborate placebo mean?

An elaborate placebo is a placebo that does better than a pill, or injection, apparently because the patient has more invested in the belief the placebo will work. An injection of a placebo (saline solution) may be more effective than a pill of real pain medicine because of the ceremony involved in giving the placebo through IV (IntraVenous) access. A placebo that is more expensive tends to have more of an effect than a less expensive placebo.[1],[2]

Acupuncture requires a lot of investment on the part of the patient. A more elaborate placebo might be fire walking. I don’t know of any research on fire walking as a treatment for pain, but I would not be surprised if it is extremely effective.
 

fire walking 1
Image credit. Do not try at home.
 

We know that acupuncture is just a placebo because research shows that sham (fake/placebo) acupuncture works just as well as real acupuncture. Sham acupuncture generally means using toothpicks (rather than needles), not penetrating the skin, but always using locations that are not qi points.[3],[4] There is also a study using fake needles at the qi points.[5] *

If the essence of acupuncture is the magic of the qi points, but the same effect is produced when staying away from the qi points, the qi points are not doing anything.

This study did not use a sham acupuncture group. We have no reason to expect real acupuncture to provide more pain relief than sham acupuncture, so how should we use this information?

Should we have people providing fake acupuncture in the ED (Emergency Department)?

If so, how should we do this?

Since it is not the acupuncture, but the patient’s reaction to the ceremony of the placebo that appears to be providing the pain relief, how many different ways might we vary the treatment to improve the placebo effect?

Should we set up a fire walking pit?

What are the ethical concerns of using placebo medicine, when the placebo appears to provide similar, but safer, relief than real medicine?

What are the ethical concerns of using deception to treat patients?
 

Acupuncture versus intravenous morphine in the management of acute pain in the emergency department 1 with caption
 

Overall, 89 patients (29.3%) experienced minor adverse effects: 85 (56.6%) in morphine group and 4 (2.6%) in acupuncture group; the difference was signi ficant between the 2 groups (Table 3). The most frequent adverse effect was dizziness in the morphine group (42%) and needle breakage in the acupuncture group (2%). No major adverse effect was recorded during the study protocol. (See Table 4.)[6]

 

If we ignore the problems with this study and with the problem of lying to patients to make them feel better, can we expect research journals to look more like alternative medicine magazines with article titles like –

How to lie to patients, so that . . . .

What is the best scam to relieve pain?

How much integrity do we sacrifice?

Since the ED does not appear to be the source of the increase in opioid addiction, should we sacrifice any integrity in pursuit of placebo treatments?

We have an epidemic of opioid addiction because of excessive prescriptions for long-term pain.

The answer is not to try to create an epidemic of magical thinking.
 

This paper was also covered by –

Emergency Medicine Literature of Note

NEJM Journal Watch Emergency Medicine

Life in the Fast Lane

Science-Based Medicine

And thank you to Dr. Ryan Radecki of Emergency Medicine Literature of Note for providing me with a copy of the paper.

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Footnotes:

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[1] Placebo effect of medication cost in Parkinson disease: a randomized double-blind study.
Espay AJ, Norris MM, Eliassen JC, Dwivedi A, Smith MS, Banks C, Allendorfer JB, Lang AE, Fleck DE, Linke MJ, Szaflarski JP.
Neurology. 2015 Feb 24;84(8):794-802. doi: 10.1212/WNL.0000000000001282. Epub 2015 Jan 28.
PMID: 25632091

Free Full Text from PubMed Central
 

CONCLUSION: Expensive placebo significantly improved motor function and decreased brain activation in a direction and magnitude comparable to, albeit less than, levodopa. Perceptions of cost are capable of altering the placebo response in clinical studies.

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[2] Commercial features of placebo and therapeutic efficacy.
Waber RL, Shiv B, Carmon Z, Ariely D.
JAMA. 2008 Mar 5;299(9):1016-7. doi: 10.1001/jama.299.9.1016. No abstract available.
PMID: 18319411

Free Full Text in PDF format from Duke.edu
 

These results are consistent with described phenomena of commercial variables affecting quality expectations1 and expectations influencing therapeutic efficacy.4 Placebo responses to commercial features have many potential clinical implications. For example, they may help explain the popularity of high-cost medical therapies (eg, cyclooxygenase 2 inhibitors) over inexpensive, widely available alternatives (eg, over-the-counter nonsteroidal anti-inflammatory drugs) and why patients switching from branded medications may report that their generic equivalents are less effective.

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[3] Acupuncture for Menopausal Hot Flashes: A Randomized Trial.
Ee C, Xue C, Chondros P, Myers SP, French SD, Teede H, Pirotta M.
Ann Intern Med. 2016 Feb 2;164(3):146-54. doi: 10.7326/M15-1380. Epub 2016 Jan 19.
PMID: 26784863

Free Full Text in PDF format from carolinashealthcare.org

 

CONCLUSION: Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs.

 

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[4] A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA.
Arch Intern Med. 2009 May 11;169(9):858-66. doi: 10.1001/archinternmed.2009.65.
PMID: 19433697

Free Full Text from PubMed Central
 

In conclusion, acupuncture-like treatments significantly improved function in persons with chronic low back pain. However, the finding that benefits of real acupuncture needling were no greater than those of non-insertive stimulation raises questions about acupuncture’s purported mechanism of action.

 

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[5] Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial.
Goldman RH, Stason WB, Park SK, Kim R, Schnyer RN, Davis RB, Legedza AT, Kaptchuk TJ.
Clin J Pain. 2008 Mar-Apr;24(3):211-8.
PMID: 18287826

* Correction 01-08-2019 – I was wrong to include this study in those that used fake qi points. In this study real acupuncture sites were used, but not real needles, so this study only examined the justification for using needles, not the effect of the locations. The other studies[3],[4] did use fake acupuncture locations and did show that the location also does not matter.

In a twist that the acupuncturist cannot explain, the patients outcomes were significantly better in the group that did not use real needles.
 

The sham group improved significantly more than the true acupuncture group during the treatment period, but this advantage was not sustained 1 month after treatment ended. The difference in pain between sham and true acupuncture groups at the end of treatment (0.75 points on 10-point scale), although statistically significant, probably does not represent a clinically discernible difference.

 

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[6] Acupuncture vs intravenous morphine in the management of acute pain in the ED.
Grissa MH, Baccouche H, Boubaker H, Beltaief K, Bzeouich N, Fredj N, Msolli MA, Boukef R, Bouida W, Nouira S.
Am J Emerg Med. 2016 Jul 20. pii: S0735-6757(16)30422-3. doi: 10.1016/j.ajem.2016.07.028. [Epub ahead of print]
PMID: 27475042

ClinicalTrials.gov page for this study.

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Grissa, M., Baccouche, H., Boubaker, H., Beltaief, K., Bzeouich, N., Fredj, N., Msolli, M., Boukef, R., Bouida, W., & Nouira, S. (2016). Acupuncture vs intravenous morphine in the management of acute pain in the ED The American Journal of Emergency Medicine DOI: 10.1016/j.ajem.2016.07.028

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Espay, A., Norris, M., Eliassen, J., Dwivedi, A., Smith, M., Banks, C., Allendorfer, J., Lang, A., Fleck, D., Linke, M., & Szaflarski, J. (2015). Placebo effect of medication cost in Parkinson disease: A randomized double-blind study Neurology, 84 (8), 794-802 DOI: 10.1212/WNL.0000000000001282

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Waber RL, Shiv B, Carmon Z, Ariely D. (2008). Commercial Features of Placebo and Therapeutic Efficacy JAMA, 299 (9) DOI: 10.1001/jama.299.9.1016

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Ee, C., Xue, C., Chondros, P., Myers, S., French, S., Teede, H., & Pirotta, M. (2016). Acupuncture for Menopausal Hot Flashes Annals of Internal Medicine, 164 (3) DOI: 10.7326/M15-1380

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Cherkin, D., Sherman, K., Avins, A., Erro, J., Ichikawa, L., Barlow, W., Delaney, K., Hawkes, R., Hamilton, L., Pressman, A., Khalsa, P., & Deyo, R. (2009). A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain Archives of Internal Medicine, 169 (9) DOI: 10.1001/archinternmed.2009.65

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Goldman, R., Stason, W., Park, S., Kim, R., Schnyer, R., Davis, R., Legedza, A., & Kaptchuk, T. (2008). Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use The Clinical Journal of Pain, 24 (3), 211-218 DOI: 10.1097/AJP.0b013e31815ec20f

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Filed Under: 'Alternative' Medicine, Correction, Critical Judgment, EBM, Heresy, Morphine, Pain Management, Research Blogging

Natural Alternatives to the EpiPen, Because We Believe in Parachutes

Wed, 23 Dec 2015 13:45:23 -0500 by
 

The evidence for epinephrine (Adrenaline in Commonwealth countries) in anaphylaxis is not the highest quality available, but that does not mean that the use of epinephrine to treat anaphylaxis is not EBM (Evidence Based Medicine).
 

Evidence Pyramid

Evidence Pyramid


Image credit.
 

The patients are not randomized to placebo vs. epinephrine treatments, but EBM is not limited to placebo studies[1] – unless you believe that the Parachute Study is valid evidence, rather than just satire.[2]

It is entirely appropriate to use logical fallacy for satire, since humor is not expected to be based on valid evidence. It is definitely not appropriate to use logical fallacy as scientific evidence. Logic is essential to science, while logical fallacy and the avoidance of rational analysis are essential to deception.

What does the Parachute study have to do with Natural Alternatives to Epipen?[3] The evidence supporting epinephrine is even weaker than the evidence supporting parachutes, since one of the advantages of parachutes is that their use can be adequately studied without using human subjects. Therefore we actually have excellent evidence that parachutes will deploy as expected (with the obvious error bars that apply to valid science), will slow the descent (again, with the obvious error bars that apply to valid science), et cetera.
 

Even the most dimwitted purveyor of “natural” cures should know that and stay away from “natural” treatments for anaphylaxis, while the smarter snake oil salesmen also know that you can’t afford to mess around with a medical condition that can cause such rapid deterioration from seemingly perfectly health to dead. It’s not good for business.[4]

 

Ignoring the pathetic absence of evidence for alternative medicine, what is the evidence that epinephrine does improve outcomes?

There is an excellent discussion of the evidence in an article available for free at PubMed Central.
 

International guidelines concur that epinephrine (adrenaline) is the medication of first choice in anaphylaxis because it is the only medication that reduces hospitalization and death.[5]

 

There is no reduction of hospitalization and death with Benadryl (diphenhydramine), with any of the steroids, or with any alternative medicine. Go read the full paper.

Also, go read the analysis of the problems in the article advocating the use of Natural Alternatives to Epipen at Respectful Insolence.

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Footnotes:

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[1] Evidence based medicine: what it is and what it isn’t.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS.
BMJ. 1996 Jan 13;312(7023):71-2.
PMID: 8555924 [PubMed – indexed for MEDLINE]

Free Full Text from PubMed Central.
 

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

 

Maybe the opponents of Evidence Based Medicine do not understand that using judgment to apply the best evidence to the patient is essential to EBM.

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[2] Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
Smith GC, Pell JP.
BMJ. 2003 Dec 20;327(7429):1459-61. Review.
PMID: 14684649 [PubMed – indexed for MEDLINE]

Free Full Text from PubMed Central.

The authors searched the literature for parachute research, but eliminated all studies without control groups, which suggests that EBM has some sort of requirement that all research include a control group. That is one of the logical fallacies employed by the authors for humorous intent.
 

We excluded studies that had no control group.

 

Those who cite the parachute study as valid evidence do not seem to understand this sleight of hand. EBM does not exclude studies that have no control group. EBM even includes expert opinion.

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[3] Natural Alternatives to Epipen
Gazette Review
Dec 18, 2015
Adam Trent
Cached article

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[4] Worst idea ever: “Natural” alternatives to the Epipen
Respectful Insolence
Posted by Orac
December 22, 2015
Article

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[5] 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines.
Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, El-Gamal YM, Brown SG, Park HS, Sheikh A.
World Allergy Organ J. 2015 Oct 28;8(1):32. doi: 10.1186/s40413-015-0080-1. eCollection 2015.
PMID: 26525001

Free Full Text from PubMed Central.

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Filed Under: 'Alternative' Medicine, EBM, Epinephrine, Evidence, Heresy

Baby with cancer improving using chemotherapy does not get worse after meeting Pope Francis

Tue, 24 Nov 2015 10:00:16 -0500 by
 

Doesn’t get worse with real medicine? Continues to get better with real medicine?

It’s a miracle!

Who would expect a baby with a benign tumor, that is improving with chemotherapy, to continue to get better after benign picked up by Pope Francis? Apparently, many in the news media expected the baby to deteriorate and die after meeting the pope, because they are claiming that this is a miracle.
 

cinderella-godmother-with-wand_e19f31391
Fairy Godmother image credit.
 

Cancer treatment saves lives and we need to improve the treatment of the many types of cancer that exist, especially the ones that do not respond well to medicine, yet. It is a mockery of medicine and science to avoid giving credit where it is due – to the doctors, nurses, and others involved in the care of this baby.
 

When the baby was born, she failed a hearing test — the reason her tumor was diagnosed — and doctors were concerned she might not be able to see, speak or swallow. But In December, doctors at The Children’s Hospital of Philadelphia determined that the rare tumor on her brain stem was benign but still pressing on vital nerves.[1]

 

She has been receiving treatment since long before meeting Pope Francis.
 

This summer, little Gianna pulled out her feeding tube, is starting to eat solid food and doctors know she can see. Chemotherapy treatments that she must undergo every couple of weeks have reduced the size of the tumor, though it is still causing paralysis on one side of her face.[1]

 

If the article is correct, she was getting better long before meeting Pope Francis.

Maybe they wanted to give credit to Pope Francis because of his recent record with cancer that is not benign.
 

A Phoenix-area teen with a rare form of cancer, and who was blessed by Pope Francis in June as part of a dream granted by the Make-A-Wish Foundation, died early Friday morning, her mother announced. Jazmin Negrete was 15.[2]

 

If you want to donate to someone helping children with cancer, there are plenty of cancer organizations genuinely improving the care of patients with cancer.

A miracle is something that is not yet explained by science.

Unless we expect people with cancer to suddenly get worse when meeting Pope Francis, there is nothing unexplained about a cancer patient improving with chemotherapy. It is also not a surprise that a child dying of stomach cancer continued to die after meeting Pope Francis.

What is the excuse for the death of Jazmin Negrete? Are the miracle advocates going to claim that she didn’t believe enough? That is what the alternative medicine pushers claim when their miracles don’t work and that is what a lot of religious people claim when prayers don’t work, but is anyone a jerk enough to use that excuse here?

The reality is that there is no reason to believe that Pope Francis had any effect on either of these cancer patients. He didn’t save the child who was getting better before he picked her up and he didn’t kill the child who was dying before he blessed her. That is not miraculous.

It is sad that people are this desperate to reject reality.

I expect that Gianna Masciantonio will continue to improve with appropriate medical care.

My condolences to the family of Jazmin Negrete.

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Footnotes:

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[1] Pope makes dream come true for parents of sick baby
Posted: Sunday, September 27, 2015 10:15 pm
By Peg Quann, Staff writer
Bucks County Courier Times
Article

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[2] Tolleson teen, blessed by pope, succumbs to cancer
Justin Sayers
The Republic | azcentral.com
5:35 p.m. MST November 20, 2015
Article

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Filed Under: 'Alternative' Medicine, Heresy, Miracles

Imagine if Ebola Spread in America

Sun, 24 Aug 2014 13:30:58 -0400 by
 
What if there were an Ebola epidemic in America?

In the aftermath of the spread of Ebola in America, would we have Congressional hearings like this?
 


 

 

Dr. Oz – My show is about hope.[1]

 

Translation – Hope sells.

You can rape people who are desperate, but as long as you give them hope, it is OK.[2]
 

A traditional healer, practicing naturopathy in Sierra Leone, appears to be the main reason for the spread of Ebola from Guinea into Sierra Leone.
 

“She was claiming to have powers to heal Ebola. Cases from Guinea were crossing into Sierra Leone for treatment,” Mohamed Vandi, the top medical official in the hard-hit district of Kenema, told AFP.[3]

 

It is a mistake to state that Ebola never would have spread, but this was just another alternative medicine practitioner selling hope, fortunately with a much smaller audience than Dr. Oz.
 

“It is a disease that spreads very fast, without regard for academic or economic status, political affiliation, age, ethnic grouping, gender or religion.”[3]

 

Ebola also doesn’t care about hope. Hope helped to spread Ebola.
 

The other end of the alternative medicine market is fear. People preach that there are government conspiracies so evil that the conspirators kill anyone who might expose the conspiracy, but can’t manage to keep Mike Adams[4] from spreading paranoia.

Blame the CDC (Centers for Disease Control and Prevention) for everything.
 

Alternative medicine and conspiracy theories are all fun and games, until someone spreads a deadly epidemic.

They assume that we are supposed to be healthy, and they sell empowerment to be healthy, but they blame the victim when the quackery does not work.
 

Based on what is known to date, I do not worry overmuch about the spread of Ebola in the US. Direct contact is not a very efficient way to transmit infections, especially infections that are rapidly fatal.[5]

 

Ebola requires more than good health to prevent transmission, but the people promising hope and trying to scare us away from real doctors do not seem to understand that.

Is it easy to become infected with Ebola?

Only if we do not know what we are doing and do not have appropriate PPE (Personal Protective Equipment). Quacks believe in magic, because they do not understand science.
 

Thirty year of following infection control procedures and I have yet to catch an infection from a patient. I remember at the start of the AIDS epidemic there were those who refused to care for AIDS patients due to worries of catching the disease. It never worried me since I knew the modes of transmission and I did not partake of those behaviors.[5]

 

We should ignore the quacks and listen to people who understand what they are doing, but it is difficult to resist the temptation to believe in magic – Naturopathy, herbalism, homeopathy, Reiki, acupuncture, . . . .

It is also difficult to resist the temptation of an easy explanation. Conspiracy theories provide simple explanations for complex problems. As with the belief in magic, this is not a new problem.

Explanations exist; they have existed for all time; there is always a well-known solution to every human problem — neat, plausible, and wrong. H.L. Mencken.

We continue to enrich those who promote hope. We continue to enrich those who spread fear. We continue to ignore those who try to understand, because understanding requires work, and that is asking too much. We need to ask for evidence, examine the evidence critically, and not fall for things because they appeal to our biases.
 

For a more information from Science-Based Medicine read – Ebola outbreaks: Science versus fear mongering and quackery

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Footnotes:

–

[1] Weight-Loss Product Advertising – Witnesses testified on ways to protect consumers from false and deceptive advertising of weight-loss products.
June 17, 2014
C-SPAN
Page with embedded video.

–

[2] Dr. Oz Shows How He Lies with Bad Research
Tue, 17 Jun 2014
Rogue Medic
Article

–

[3] Sierra Leone’s 365 Ebola deaths traced back to traditional healer
AFP | 20 August, 2014 08:26
Times LIVE
Article

–

[4] Mike Adams is a Dangerous Loon
Steven Novella
July 25, 2014
Neurologica
Article

–

[5] Yet another plague panic
by Mark Crislip
August 8, 2014
Science-Based Medicine
Article

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Filed Under: 'Alternative' Medicine, Heresy, Unicorn Medicine
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