It is always gratifying to see regulatory agencies actually do their job. If those regulatory agencies whose job it is to protect the public from false or harmful medical advertising, products, or services thoroughly did their job, so-called “alternative medicine” would cease to exist.

Recently the Advertising Standards Authority (ASA) in the UK issued a judgment about advertising for homeopathy http://www.asa.org.uk/Rulings/Adjudications/2013/7/Society-of-Homeopaths/SHP_ADJ_157043.aspx , specifically by the Society of Homeopaths. They had been receiving a number of complaints. After thorough investigation, and considering the response from the homeopaths, they came to two basic conclusions: homeopaths are engaging in false advertising by claiming that homeopathy is a proven treatment for specific indications when the evidence does not support those claims, and homeopaths sometimes “discourage essential medical treatment for conditions for which medical supervision should be sought.”

The ASA specifically investigated the following advertising and claims:

1. ad (a) could discourage essential treatment for depression, a medical condition for which medical supervision should be sought, and misleadingly implied that homeopathic remedies could alleviate symptoms of depression;

2. ad (b) could discourage essential treatment for conditions for which medical supervision should be sought; and

3. the claims in ad (b) that homeopathy could treat the following medical conditions were misleading and could be substantiated:

a. Allergies and upper respiratory tract infections;

b. Ankle sprain;

c. Bronchitis;

d. Childhood diarrhoea;

e. Chronic fatigue;

f. Ear infections;

g. Fibromyalgia;

h. Hay fever;

i. Influenza;

j. Osteoarthritis;

k. Premenstrual syndrome;

l. Rheumatic diseases;

m. Sinusitis;

n. Vertigo.

After reviewing the evidence provided by the Society for Homeopaths each decision was upheld. In other words, the Society was given the opportunity to provide evidence to substantiate their claims. After reviewing that evidence the ASA concluded that the evidence did not adequately support the efficacy claims being made. (For some reason a specific description of the evidence for Vertigo is missing from the page, which seems like a simple oversight.)

Since I’ve been on a bit of a roll with respect to acupuncture over the last week or so, I thought I’d just round out the trilogy with one more post. One myth that acupuncture apologists like to promote relentlessly is that acupuncture is completely harmless, that it almost never causes complications or problems. While it’s true that acupuncture is relatively safe, it still involves sticking needles into the skin, and, given that, it would be delusional to think that there couldn’t be injury caused by that. Rarely, however, have I seen a story like this from Canada reported in the National Post, Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung. It is the story of what happened to Kim Ribble-Orr, a world-class judoka who had competed in the Olympics in 2000 and harboring dreams of competing in the Olympics again, as a mixed martial artist. Those dreams were cast in doubt by a stray acupuncture needle:

When a massage therapist tried to treat the headaches she suffered after a 2006 car crash with acupuncture, however, he set off a cascade of health problems that would shatter Ms. Ribble-Orr’s sports-centred life — and raise questions about the popular needle therapy.

The therapist accidentally pierced Ms. Ribble-Orr’s left lung during acupuncture treatment that was later deemed unnecessary and ill-advised, causing the organ to collapse and leaving it permanently damaged. An Ontario court has just upheld the one-year disciplinary suspension imposed on therapist Scott Spurrell, rejecting his appeal in a case that highlights a rare but well-documented side effect of acupuncture.

Mr. Spurrell, who learned the ancient Chinese art on weekends at a local university, had no reason to stick the needle in his patient’s chest, and had wrongly advised Ms. Ribble-Orr that the chest pain and other symptoms she reported later were likely just from a muscle spasm, a discipline tribunal ruled.

Ribble-Orr had suffered many injuries due to her competition, including a dislocated elbow and shoulder, a broken hand, head injuries and repeated knee injuries. She had overcome them all to compete again, but appears unable to overcome this one. Basically, what happened is that in 2006, Ribble-Or was trying to get into mixed martial arts competition and was eying a job as a police officer. However, she was also recovering from injuries suffered in an auto collision and seeing Scott Spurrell, a massage therapist who had learned acupuncture during a weekend course at a local university. She was suffering from pounding headaches, and Spurrell convinced her that he could relieve those headaches by inserting a two inch needle, according to the disciplinary ruling, “into a muscle located between the clavicle bone and ribs.” From the description, it’s not clear to me exactly which muscle they meant, although it could conceivably have been the scalenes, the sternocleidomastoid, or perhaps even just the pectoralis major. Whatever muscle Spurrell was targeting, going between the clavicle and the ribs is basically where surgeons stick the needle when trying to place central venous catheter into the subclavian vein, and, yes, a pneumothorax is a known potential complication of placing such lines. What also puzzles me is how on earth Spurrell could have stuck the needle in deep enough to cause a pneumothorax? It would be one thing if Ribble-Orr were a fragile little old lady, but she wasn’t. She was an athlete, presumably with well-developed musculature. It would take a lot to get a needle through all of that muscle to get to the pleural cavity.

snip

All medicine is a risk-benefit analysis. All effective treatments have risks, and those risks have to be weighed against the potential benefits. When the benefits are significant (e.g., saving life), then greater risks are tolerable. When the potential benefits are minimal, then even minor risks might not be acceptable. When the potential benefits are none, no risk is acceptable. That is the case for acupuncture. It does not work, no matter how much acupuncturists try to prove it does.

I wrote this poem in a public toilet after my 6 month old baby fell asleep. I was in town on my own a lot with her and the first time I fed her someone commented that I should stay home. Baby's need breastfed every 2-3 hours often. It's impossible to run home. It's a stupid argument anyway. But I was embarrassed and for 6 months took her into toilets when I was alone without the support of boyfriend, friends, mum etc. I hate that I did that but I was nervous, tired and felt awkward. And now I find it weird that our TVs, media etc never show breastfeeding in soaps, cartoons, anything. That we and the US are so bloody scared of it. It's weird. I find our culture weird and even weirder, when people are so strapped for cash. It is costing parents a huge amount of money paying for something which most of us, those of us who are lucky enough for our bodies to do so, get for free. I have a lot of mates who complain they're broke but stop breastfeeding cos they feel awkward, and pay for formula. Why are we paying billionaire companies for something our bodies produce for FREE. It's really good marketing that we feel so wrong doing something like this I think. And it makes me sadder every day. Next we'll be buying sweat in bottles from Tescos and rubbing it on our skin paying for electronic books to read nighttime stories. Oh, wait...

More Tooth Fairy Science: Acupuncture does not improve in vitro fertilization success rates, no matter what acupuncturists say

Here we go again.

Oh, well. These things come in waves, and sometimes I have theme weeks. Right now, this week appears to be developing into a week of quackademic medicine involving dubious acupuncture studies. Yesterday, it was acupuncture for lymphedema after breast cancer surgery, a study coming right about what is rapidly becoming the Barad-dûr of cancer quackademia, Memorial Sloan-Kettering Cancer Center. How a hospital that is so awesome in every other way can have such a blind spot bigger than the Eye of Sauron, I don’t know, but it does, and the result is a steady stream of embarrassing forays into quackademic medicine like yesterday’s.

Of course, there is one institution that far surpasses even MSKCC in the power of its quackademic woo, and that is the University of Maryland, home to Brian Berman, king of acupuncture quackademia, and my Google Alerts did there job and, well, alerted me to a new meta-analysis published online late last week in the Journal of Human Reproduction Update. Berman is the corresponding author (of course!), and a research associate by the name of Eric Manheimer is the lead author, and together with other colleagues, they have produced yet another fine analysis of tooth fairy medicine entitled, The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis.

Now, remember all the things I said about the utter lack of prior plausibility for acupuncture for treating lymphedema? You remember, how there’s no plausible biological mechanism that would lead one even to suspect that sticking needles into parts of the body completely unrelated to the physiological mechanisms that result in lymphedema after mehanical interruption of regional lymphatics by surgery? All of that goes double—nay, triple!—for using acupuncture for infertility and improving the pregnancy rates after in vitro fertilization (IVF). I mean, seriously. Think about it. How on earth would sticking needles into the skin improve the odds of conception after this procedure? It wouldn’t, and it doesn’t. That doesn’t stop acupuncturists and acupuncture apologists from heavily selling acupuncture as somehow managing to do just that, against all physiology and reality.

So here’s how the systematic review is being sold:

Acupuncture, when used as a complementary or adjuvant therapy for in vitro fertilization (IVF), may be beneficial depending on the baseline pregnancy rates of a fertility clinic, according to research from the University of Maryland School of Medicine. The analysis from the University of Maryland Center for Integrative Medicine is published in the June 27 online edition of the journal Human Reproduction Update.

“Our systematic review of current acupuncture/IVF research found that for IVF clinics with baseline pregnancy rates higher than average (32 percent or greater) adding acupuncture had no benefit,” says Eric Manheimer, lead author and research associate at the University of Maryland Center for Integrative Medicine. “However, at IVF clinics with baseline pregnancy rates lower than average (less than 32 percent) adding acupuncture seemed to increase IVF pregnancy success rates. We saw a direct association between the baseline pregnancy success rate and the effects of adding acupuncture: the lower the baseline pregnancy rate at the clinic, the more adjuvant acupuncture seemed to increase the pregnancy rate.”

It’s hard not to be a bit snarky here and say that if your clinic is doing well with its pregnancy rate, then obviously you don’t need mumbo-jumbo. However, if you’re not doing so well, maybe some bread and circuses will help.