Link to Medscape forum on Atwood

Medscape discussion board in response to Dr. Atwood's article:

http://boards.medscape.com/forums?14@208.jqpTaBfDaTz.0@.eec5f2f/0

Hawaiin Shirt therapy

I have heard of good ideas that in many cases seem to miraculously contribute to better health outcomes. Not the least of which is people in Hawaiian shirts giving everyone a hug as they came through the door. One hospital had a VCR and several comedy tapes (3 Stooges etc) that the volunteers could set up in a patient's room. (Sometimes not recommended for the post laparotomies.) An inpatient rehab facility had volunteers bring in a puppy for a few hours once per week to interact with the residents.
In relation to a discussion of healthfraud, I pose the following questions:
Do we need clinical studies to validate and specify any real and positive health impacts associated with these interventions before we can recommend them?
Who do we expect should provide and pay for this type of intervention?
How closely, or in what ways can hospital sponsored music, comedy, or puppy "therapy" (or even Hawaiian shirt therapy) be equated to hospital sponsored religious counseling, "prayer" therapy, therapeutic touch therapy, or other vitalism dependant interventions?

dras - who always wore a white lab coat in clinical practice, usually over something like a Calvin and Hobbes pattern scrubs top.

If acupuncture helps, why do we need to compare it to something else?

"Such an argument (for placebo control) is not relevant to an assessment of the clinical effectiveness of acupuncture because in everyday practice, patients benefit from placebo effects."

I do not agree with this argument. The studied intervention must be compared against something. Otherwise all that is demonstrated is that something is better than nothing. Should there then be any surprise in these outcomes?

The study may serve to demonstrate that acupuncture doesn't not work, but conversely no argument can be made here that it does. This no-need-for-placebo is prior presented by the author: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12449085) Does not placebo vs. acupuncture for pain have "psychological credibility" because any intervention will likely have an impact on a subjects surveyed perception of pain? We indeed may need to understand the ethics of using a sham in study, or be wary of discounting a potential beneficial intervention just because it hasn't been proved.

Seldom will doing something have worse outcomes than doing nothing when parameters can be so subjective. Please compare acupuncture to equal sessions of massage, meditation to soft music, or visits with one's hair stylist, but compare it to something. How else will we ever know whether poking little pins in people has any merit versus anything else we might do?

Until such a study takes place, we can not recommend acupuncture for headaches any more than we can massage, music, or even barber visits. Not saying that we shouldn't, after all, the study shows that doing something beyond standard treatment is in fact better than doing nothing.

-dras

The Dynatron STS

Dynatronics is a medical manufacturer based in SLC. I would not doubt they make an interferential unit you have used in a PT clinic. Their Dynatron STS is an interferential unit and complimentary computer software designed specifically to electrically stimulate the sympathetic system. I have had correspondence with the manufacturer and even visited their facility to see manufacture and real clinical use first-hand. The Dynatron STS probably should not be considered a quack device any more than many other electric therapy devices used by therapists (few or none will stand up to comprehensive scientific efficacy analysis). Because STS therapy is often directed toward the "incurable" idiopathic or multi-etiologic chronic pain sufferer, and treatment is frequent, long-term, and costly, it's often just what quacks like to order. The developing clinicians of the STS are not too interested in comparative studies and may cite patient population and individualized protocols as reasons against them. Worker's Compensation covers it sometimes, and that is likely why the State of Washington had the quackwatch published analysis done.

Rather than a quack device (akin to the zapper, or Diapulse), the Dynatron STS is more of an FDA approved electric stimulator that hasn't yet demonstrated a comparative and predictable positive cost-benefit ratio. It doesn't attest to depend on any action or intervention with life-force or qi etc. At worst, STS is a questionable technology or therapy protocol.

Nevertheless, state, VA, CMS, and private insurance technology assessments are an excellent source for verifiable information about technologies posing as legitimate medical treatment. I hope you and quackwatch will continue to site these references.

dras

Dynatron Therapy http://www.quackwatch.org/06ResearchProjects/dynatron.pdfProlotherapy (Sclerotherapy):Medicare Policyhttp://www.quackwatch.org/01QuackeryRelatedTopics/prolo.htmlAetna Policyhttp://www.aetna.com/cpb/data/PrtCPBA0207.html

Magnet Therapy - a testimonial

My Grandfather found a new bride some years ago (having long since separated from my Grandmother.) Along with the new wife came a sister-in-law who was a serious MLM distributor and believer in magnet therapy. In the months that followed the wedding my Grandfather would describe how magnets were incorporated into interior decorating, clothing, bedding, etc. throughout not only the home of his sister-in-law, but his own home and daily life. The sister-in-law was later diagnosed with cancer, about which I have few details only that she opted against any chemical, radiological, or surgical treatment in favor of magnets. The sister-in-law passed away three months after being diagnosed. My Grandfather has since recited how he, upon his sister-in-law's death, immediately removed every magnet from his life and threw them away convinced that magnets cause serious incurable cancer.

"Death by Medicine" rhetoric

Follows are my comments to some of Gary Null's rhetoric used to sell his health supplement products. These are pasted below. At the outset, his label of "orthodox medicine" is not comprehensible. This label is created by Null and others as a marketing tactic. My folly here is to accept his designation that an "orthodox" camp of ideals as he describes even exists. -dras

In every instance "orthodox" medical treatment's predictability for benefit is MUCH better than anything "alternative" Null has to sell. Show me each alternative medicine study Null cites in his spill, so I can match them with the studies for the "orthodox" medical equivalent. But, I would be wasting my time, Null is likely not interested except to use whatever means to push his products.

If 10-20% is proved, another 60-70% of "orthodox" medical treatment is based on sound, rational common sense that won't need a controlled trial to validate. By the way, has even 2% of what Null has to offer been "proved" in controlled trials? Null's entire statement here is counter-intuitive when applied to clinical medical practice. Does anyone really believe that 80%, or even the majority of the people who go to the doctor are worse off for going? I bet he hopes listeners are too deep in the shock-and-awe presentation to think rationally.

These fantastic, conspiracy laden statements exist to play on the fear of the unknown in an uninformed populace. A slimy sales tactic to get people to make illogical choices and take frivolous actions that are based solely on enticed emotions and passions. Please have Null specifically list all the "unnecessary or overused procedures." For every one, I bet "orthodox" medicine can list at least TEN very necessary and often used procedures. Again, if I was convinced he would even be interested.

Dale

"...Does orthodox medicine have the scientific basis to prove that it should stand alone, unchallenged, in offering remedies for the ills that we suffer from? Does an alternative approach have any scientific basis? Can it substantiate its value? Simple question, and legitimate ones concerning how the orthodox has been promoted without question and the alternative has been condemned without trial."Later, he commented as follows:"Look at the facts. Quote only 10-20% of all procedures [he did say earlier that these figures are from a 1978 study by the Office of Technology Assessment] currently used in medical practice have been shown to be efficacious by controlled trial. So you would think that by listening to a quackbuster or someone from the surgeon generals office or someone from the AMA that everything they are telling you is backed up by science. Not true. In fact, between 90 to 80 percent of all medical procedures would then be deemed be unproven. Well using their rules of attack and destroy as quackery and fraudulent anything that has not been proven, then the very defenders of orthodoxy must now turn, look in the mirror and ask the following question. You are the ultimate quacks.[That's not a question, but that's what he said.] And the government's own agency has shown you haven't proven your medicines are safe or your procedures effective. So you, through vaccines and any other procedure [sic] we can show you are using unproven methods and techniques and using the American public as human guinea pigs.""Does orthodox medicine work? In some cases, very well and is necessary. But has it been proven? Only 10-20%. The rest is a game, a guess with enormous potential for injury, damage and enormous expenses. When someone causes 400 billion dollars a year to be taken out of people's pockets where there is no benefit and only harm from unnecessary or overused procedures, and we have proven that, then that is the biggest scam in American history. And that's every year. We're talking about trillions of dollars in fraud. And yet we've seen no cry for investigations."

"Supreme Greens" plug on KSL morning show

G&A:

I am both saddened and sickened to hear my favorite morning hosts on the most credible news station giving eyewitness-like (albeit commercial) testimony of the unscientific, unfounded, dubious, and mostly nonsensical claims of health benefits associated with the Supreme Greens product.

Promoting this quackery is detrimental to your program and KSL. It truly compromises your integrity of anything you now promote, and reduces the credibility of any opinion you share on the air. Much worse, think about those who believe your words about this product in the hopes it actually will do what you claim.

Both of you should have at least stopped to question with common sense all of the gushing health statements you read about this product. Will a little green pill actually substitute all the health benefits of 5 vegetables? Will it make you loose weight? What actually (at the plasma or cellular level) does "detoxify the blood" mean. (Hint: NOTHING)

Please, please, please have KSL reconsider further promotions of this product. Use the "ask a doctor" link on the front page of the KSL website and present him/her with the promotional material, or otherwise get a true medical opinion. Money from advertising is one thing, but professional integrity should still play a role in everything about your morning show.

Most Sincerely,
-dras (Hoping to hear more carpet cleaning and cocoa ads.)

May 27, 2004
Hello, G&A:

A couple months ago a I requested removing Morning Show commercial spots for "Supreme Greens" product. They quickly dissappeared, thank you. Not meaning to belabor, but I thought you may be interested in a recent FDA warning:

The U.S. Food and Drug Administration has ordered ITV Direct to stop claiming in labeling and on its Web site that Supreme Greens with MSM. http://www.supreme-greens.info/ is effective against a long list of diseases and conditions. [Costello GT. Warning letter to Donald W. Barrett, Jr., April 19, 2004] http://www.fda.gov/foi/warning_letters/g4690d.htm
The FDA warning letter also identified nine "structure/function" claims and one nutrient claim that FDA officials believe are not supported by reliable scientific evidence...

Keep up the good work!

Yours Truly,
-dras
http://www.quackwatch.org/01QuackeryRelatedTopics/PhonyAds/info.html
Supreme Greens with MSM™
A show called "Today's Health" features the fast-talking "Dr. Alex Guerrero" (an acupuncturist, not a medical doctor) who asserts that "all disease is in the blood and over-acidification of the blood and tissues is the primary contributor to disease and sickness." According to Guerrero: (a) soil depletion has caused our diets to be nutrient deficient, which creates a huge nutritional deficiency in our diet; (b) yeasts, fungus, molds, bacteria, and viruses need an acidic environment to thrive and grow. Modern daily diets and lifestyles are conducive to such proliferation and growth; (c) Supreme Greens with MSM™ is a powerful formulation of organically grown grasses and vegetables, sprouted grains, blood purifying and immune enhancing herbs, and antioxidants; (d) fatigue, foggy thinking, acne, diabetes, and many other diseases are signs that the body is too acidic; and (e) the nourishment given to the body needs to have a minimum resonating frequency of 70 Megahertz. Typical American diets rarely resonate above 50 Megahertz, most supplements have a standard frequency of only 5-10 Megahertz, but Supreme Greens "resonates at an astonishing 250 Megahertz." Guerrero also claims to have conducted a five-year study which found that 192 out of 200 people with cancer and various other diseases, all of whom were diagnosed as terminal, survived because they took his product. After a "caller" to the program states that Supreme Greens caused her to shed 81 pounds in 8 months, Guerrero explains that weight loss occurs because the body no longer needs to have a layer of fat to protect itself against the effects of acidic body fluid. Web sites promoting the product also claim that a serving is equivalent to approximately two pounds of fresh vegetables, which is certainly not true. It contains some if the nutrients, but the pills do not contain the dietary fiber that accounts for much of the benefit obtained by eating vegetables. Like Barefoot, Guerrero recommends frequent testing of one's saliva to see whether the body is too acidic. However, saliva testing has no practical value in evaluating general health status.
Guerrero's claims are about as far-fetched as any I have ever encountered. The body's pH is kept within a narrow pH range by powerful biochemical mechanisms. It is not influenced by diet and does not go out-of-whack when people get sick. Nor do nutrients and body cells "resonate" as Guerrero describes. There is no logical reason to believe that taking Supreme Greens will cure any disease or cause people lose weight. Nor do I believe his claim that 192 out of 200 his "terminally ill patients" with a wide variety of disease are alive today because they took Supreme Greens. Claims as blatant as these violate federal and state laws against false advertising as well as the marketing of unapproved and misbranded drugs.