Archive for February, 2010

A More Balanced View

General, News, Western Medicine | Posted by Philip
Feb 28 2010

Remember how I wrote about biased headlines? (http://qi-spot.com/2010/02/09/another-biased-headline/)  In that previous article, I had mentioned that one can subtly affect comprehension by careful(?) selection of words to use in a headline.  The headline in question then read “Researcher Warns on Herbal Medicines”.  Only when you read the article itself will you see that it actually warns against misuse of herbal medicines or potential side effects from mixing with western meds.  The typical reaction, however, is to just glance over the headline – giving one the impression that herbal medicines PER SE are something generally unsafe and thus there is a need to warn the public about it.

Compare that with this headline: “Mixing medicine with herbal remedies can be risky.” (http://news.medill.northwestern.edu/chicago/news.aspx?id=158237)  This is much better and not misleading at all.

A few quotes from the article proves the spirit of the writer’s intent.  Allow me to refresh you:

Dr. Arshad Jahangir, a cardiologist at the Mayo Clinic in Phoenix/Scottsdale Arizona, who wrote the review, said the main reason patients look to herbal remedies is because they want to preserve their health.
“They think it’s natural and probably safe to use,” he said. “We’re not saying anywhere in the review that people should not take these products. But they should, at the very least, consult with their doctors who can look at their other medications and identify the potential for harm.”Herbal medications readily found over-the-counter can adversely affect the way prescription drugs are absorbed by the body by either enhancing or reducing their effectiveness.” (emphasis mine)

Yes! The article fits the headline!  And for the record, I perfectly agree. Next we see that integration between “eastern” and “western” medicine is promoted.  (albeit in a method I don’t agree with 100%, but I’ll take what is given.)

Christina Ferrari-Noonan, an acupuncturist and herbalist at Ancient Healing Chicago downtown, said patients who want to take herbal remedies should consult their doctors first.

“Patients should definitely go by the physician’s recommendation and see what they’re comfortable with,” she said. “There are definitely a lot of over-the-counter herbs that can be considered dangerous.”

Ferrari-Noonan, who has a background in Eastern and Western medicine, said herbalists should work in conjunction with doctors “We’re diagnosticians in traditional medicine not in western medicine,” she said. “Patients need to go their doctor first to get diagnosed. That diagnosis needs to be in place, and then as herbalists, we can go from there. Blood tests are especially valuable as a starting point.”

What I don’t agree with is the last sentence.  At times, people present with discomforts that cannot be classified in western medicine (how do you translate “Spleen Qi deficiency leading to weakness of the four limbs” into western medicine?  It isn’t CFS, it isn’t a movement disorder, etc etc) or do not appear in blood tests.

Jahangir agreed that herbalists and physicians should work together. “We’re not at war with herbalists and they are not against what we do,” he said. “Our goals are common, which is to serve our patients and to give them medicine or products that will do the job it’s supposed to do without causing harm.”

Tell that to the skeptics who insist that only commercial pharmaceuticals are worthwhile.

Mary Helen Lee, an herbalist at Chicago’s White Moon Healing Center, said herbal supplements could be beneficial as a compliment to chemical-based drugs, if taken correctly. “It’s definitely possible to take herbs to reverse the toxic side effects and lessen the harm the chemicals medications can have on your body,” she said. (I do this a lot with cancer patients on chemotherapy – Phil)

Lee said incorrect dosage amounts could also cause problems. “Either people are taking too much or too little, which can have a major effect,” she said. “Obviously, there are some dangerous herbs out there and people should be cautious. Patients should see a professional and get the correct herb and the correct dose for their problem.”

Experts agree that the biggest mistake people make is to self-diagnose on the Internet and treat themselves with over-the-counter herbal remedies without consulting doctors first. (emphasis mine)

“The Internet can be very helpful in educating yourself about herbs and possible effects, but it can also be very dangerous,” Ferrari-Noonan said.

So there you have it – a more balanced view that can be summarized thus:

a) herbs can work if used properly

b) always tell any healthcare professional about everything you’re doing for your health.  If they become biased against you because of that, then it’s time to find another provider.

c) never self medicate – there ARE herbal scammers out there who are only out to sell you stuff.

d) physicians of all traditions CAN and SHOULD work together.

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More Magic Numbers: This Time It’s Celebrex

News, Western Medicine | Posted by Philip
Feb 22 2010

Sweet Mother of God.  How can anyone have the gall to accuse Traditional Chinese Medicine of having little or no “evidence” to back it up when the “evidence” for some western medicine is even more immaterial than how these skeptics perceive qi.  Qi is hardly immaterial, by the way.

Doc Accused of Faking Celebrex Study from nbcconnecticut.com states that a physician was able to publish a clinical study saying that the drug had post surgical benefits…with NO patients enrolled in the study.

All of a sudden “evidence based” and “peer review” lose their luster.

These skeptics say Chinese medicine relies more on anecdotal evidence or small sample size.  Right now I’ll take small sample size over NO sample size.

Here’s the article:

A Massachusetts doc, who is also a former member of Pfizer Inc.’s speakers’ bureau, is accused of launching what is being called “one of the biggest research frauds in medical history,” according to The Day of New London.  And he has agreed to plead guilty, according to a Massachusetts newspaper.
Dr. Scott Reuben, who is accused of faking medical research studies, including some that were published in medical journals, was charged with health care fraud Thursday in federal court in Boston, according to the U.S. Department of Justice.
He’s accused of accepting a $75,000 grant from Pfizer to research the effectiveness of the pain medication Celebrex for a 2005 study, the Day reports.
His research, which the Day reports was pioneering at the the time, indicated that there are post-surgery benefits from painkillers. But no patients were actually enrolled in the study, according to a U.S. Department of Justice news release.

Health care fraud.  $75,000 grant.  For the nth time, I recall a famous comment by “some guy who knows some guy”… I’ve quoted that comment in the post previous to this one so forgive me if I’m too tired of copying and pasting it.

The Wall Street Journal reports that he also falsified information about Pfizer’s Bextra and on Merck’s Vioxx.
“Anesthesia & Analgesia” had to retract 10 papers Reuben wrote and medical experts say at least 21 journal articles by the anesthesiologist appear to be fabricated, the Day reports.
Reuben was the chief of acute pain at Baystate Medical Center inSpringfield, Massachusetts, and The Day reports that the hospital let him go last March, after an audit revealed he had been inventing data for as many as 13 years.

Reuben has reached an agreement in which he will plead guilty and prosecutors will recommend a more lenient sentence…

He would also have to forfeit assets of at least $50,000 he got from allegedly fake research, the Journal reports.

The Republican, of Springfield, Massachusetts, reports that Reuben has signed a plea agreement and must return $420,000 to pharmaceutical companies.

Here’s how I see it.  We can say that this guy is just ONE bad apple and should not be used as a basis to judge western medicine as a whole.  In that case we can also say that cases of Chinese medicine causing problems are also due to isolated bad apples.  On the other hand if we are to accept these events as being representative of the pharmaceutical industry in general, then such industry has no right to accuse Chinese medicine for being wanting of evidence.  Either way, the truth is somewhere in the middle: be critical, be wary.  Caveat Emptor, it is said.

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Another Big Pharma Cover Up

News, Western Medicine | Posted by Philip
Feb 21 2010

And people wonder why I, despite being an MD, no longer am able to fully trust “peer reviewed” journals and “evidence based” medicine.

From cnbc.com: Senate Report: Avandia Maker Knew of Cardiac Risks (http://www.cnbc.com/id/35498711)

NEW YORK – A Senate report said Saturday that drug maker GlaxoSmithKline knew of possible heart attack risks tied to Avandia, its diabetes medication, years before such evidence became public.
Sen. Max Baucus, chairman of the Senate Finance Committee, and Chuck Grassley, the committee’s ranking Republican, released the report, which follows a two-year inquiry, on Saturday. They are also asking the U.S. Food and Drug Administration why it allowed a clinical trial of Avandia to continue even after the agency estimated that the drug caused 83,000 heart attacks between 1999 and 2007.
83,000 in eight years.  If this were an “herbal medicine”, you’d see the Big Pharma skeptics scream their lungs out calling for a ban.

The agency ordered a warning to be included on Avandia’s label in 2007, saying that it might increase the risk of heart attacks, though the data on those risk was inconclusive.

Soon afterwards Sen. Grassley, one of the FDA’s toughest critics in Congress, disclosed that the agency’s internal safety experts came within one vote of recommending a withdrawal of Avandia.

These guys are so quick to approve new drugs, and so reluctant to withdraw them.  I guess they don’t want to blemish their record too much.

The Senate report suggests sharp disagreements remain at the FDA over how to handle Avandia’s risks.

In a letter to FDA Commissioner Margaret Hamburg that was also released Saturday, the senators said the committee’s report was based on researchers’ studies of Avandia, internal GlaxoSmithKline documents and FDA documents. They said committee investigators had interviewed GlaxoSmithKline and agency employees as well as what it called anonymous whistleblowers.

Based on its knowledge of the heart attack risks, GlaxoSmithKline “had a duty to sufficiently warn patients and the FDA of its concerns in a timely manner,” the report said.

I guess people haven’t learned from the debacles concerning Bextra and Vioxx (Vioxx and Bextra Studies allegedly fabricated)

Instead, the company tried to downplay findings that the drug could increase cardiovascular risks while also working to downplay findings that a rival medication might reduce such risks, it said.

GlaxoSmithKline said in a statement the drug is safe. It said the committee report took data out of context from analyses of Avandia.

Going back to my favorite comment (from http://qi-spot.com/2010/01/27/some-guy-no-evidence-for-acupuncture-real-world-lots-of-evidence/): “the company that did the testing probably is in the work of acupuncture. You think they’re gonna release something that says anything EXCEPT “acupuncture works”?”

It could just as easily read, “the company that did the testing probably is in the work of acupuncture manufacturing a particular drug.  You think they’re gonna release something that says anything except “acupuncture works”? “this drug works and is safe”?

In May 2007, the New England Journal of Medicine published an analysis of dozens of studies on nearly 28,000 people who had taken Avandia. The journal said there was a 43 percent higher risk of heart attack for those taking Avandia compared to people taking other diabetes drugs or no diabetes medication. The findings raised concerns because two-thirds of the people with Type 2 diabetes, the most common form, die of heart problems.

And in true Spin Doctoring fashion:

“Contrary to the assertions in the report, and consistent with the FDA-approved labeling, the scientific evidence simply does not establish that Avandia increases cardiovascular ischemic risk or causes myocardial ischemic events,” GlaxoSmithKline said.

…okay.

In their letter to Hamburg, the senators said the documents the committee reviewed included an analysis conducted by two safety officials at the agency. The analysis compared Avandia to Takeda Pharmaceutical’s diabetes drug Actos, and found that Avandia has an increased risk of heart attack and heart failure. Actos is co-promoted by Pfizer Inc.

Here’s a thought.  Maybe Avandia IS safe but the other drug company just wants to shut it down so it can sell it’s own drug.  Yeah that’s it!  Still doesn’t bode well for the trust factor, eh.

So what is being done?  Is the drug being withdrawn like Bextra or Vioxx?

At FDA’s request, Glaxo agreed in 2007 to conduct a six-year study between its drug and Actos, to give a definitive picture of Avandia’s safety. The study, which will involve 16,000 participants, is still enrolling patients.

But FDA researchers quoted in the report called the study “unethical and exploitative,” since patients will continue taking Avandia, a drug with known risks, over Actos, which has not shown any links to heart prblems (sic).

All together now: “oooooookay…”

DA spokesman George Strait said the FDA is reviewing new data on Avandia and will present those findings to an advisory committee this summer.

“Meanwhile, Commissioner Hamburg is reaching out to ensure that she has a complete understanding and awareness of all of the data and issues concerning this drug,” Strait said.

Avandia was Glaxo’s third best-selling drug in 2006 with revenue of $2.2 billion. But the safety concerns disclosed the following year slashed revenue to $1.2 billion by the end of 2008.

*wink and snicker*

And people wonder why I trust herbal formulas in use in China for 2000 years over these newfangled “scientific” drugs.  The only science that’s obvious is spinning, number crunching, and marketing.

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Society of Fetal Medicine: Acupuncture Treats Depression

Acupuncture, Research | Posted by Philip
Feb 21 2010

Now before we wonder how fetuses in mommies get depression, let me clarify that what is mentioned here is depression of the mother-to-be.

Two New Studies Show Acupuncture Can Relieve Pain and Depression

The first study we have already mentioned (Scientists Find How Acupuncture Deactivates Pain (well, one of the ways) ) so let’s go to the second one:

Meanwhile, a study that was included in the 30th annual meeting of the Society for Maternal-Fetal Medicine in Chicago revealed that depression among pregnant women can be effectively treated with acupuncture.
I can’t get over a previous comment (see Some Guy: “No evidence for acupuncture”; Real World: “Lots of Evidence!“) where a commenter says that “the company that did the testing probably is in the work of acupuncture.  You think they’re gonna release anything that says anything EXCEPT “acupuncture works”?”  By that logic, then that whole society must be in the “work of acupuncture”.  It also means we should not take western medicine studies at their word because the company that did the testing is probably in the work of… selling western medicines.  Duh to the max.

Depression during pregnancy poses a tough dilemma for would-be mothers because anti-depression drugs can disrupt normal development of the fetus.
Nothing we don’t already know.
Experts at the acupuncture New York center suggest that the risk of miscarriage may increase upon intake of anti-depressants, especially Selective Serotonin Reuptake Inhibitors (SSRIs).
Mothers who take anti-depression medication during pregnancy are also prone to give birth prematurely to underweight and sickly infants.
“The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy,” Dr. Rosa Schyner, one of the authors of the study, said.
I wish the online text would specify what article it is…  (http://www.live-pr.com/en/two-new-studies-show-acupuncture-can-r1048405456.htm)
Previous studies providing scientific evidence validating the efficacy of acupuncture are plentiful.
Dr. Mike Cummings, Medical Director of the British Medical Acupuncture Society, pointed that decades of brain imaging data have already shown results like those of Dr. Asghar and Schyner’s studies.
*sarcasm alert* REALLY?!?!!? WOW, I didn’t KNOW THAT!!! (or as a blind, biased skeptic, I refuse to accept it)
He said that activity of primitive brain parts linked with pain and suffering decrease with acupuncture.
Dr. Cummings also said that acupuncture “appears to be particularly effective at treating pain and the suffering related to pain, but it may also have some effects on mood disorders, such as depression, through its general effects on the brain.”

Given that the qi sensations associated with REAL acupuncture are easily explained by stimulation of certain sensory fibers, and that all sensory stimuli pass through the hypothalamus, and that the hypothalamus is a collection of nuclei that affect everything from circadian rhythm to effecting the pituitary, I’m not surprised.

I still wish I could FIND the actual article and not just rely on the press release.  Google time.

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Another Biased Headline

News | Posted by Philip
Feb 09 2010

“Researcher Warns on Herbal Medicines”

(http://www.abc.net.au/news/stories/2010/02/08/2813236.htm)

Looking at the above headline, what thoughts enter your head?  Obviously it is an attempt to ingrain into the public mind that herbal medicines are dangerous per se.  Sadly, that’s not what the article says.

A forensic pathologist thinks some people’s embarrassment about taking herbal medicines can leave them vulnerable to taking a lethal cocktail of drugs.
Professor Roger Byard of Adelaide University has published a research paper on the dangers of herbal medicines when taken in large quantities, injected or combined with use of prescription drugs.
He has found it can lead to serious illnesses, worsen pre-existing conditions or cause death.
Professor Byard says people are often reluctant to tell their doctor they are taking herbal medicines for fear of ridicule, but it can be a fatal mistake.
Opening sentence: he’s not saying herbal medicines are bad, but that not telling your MD about your use of them can be.  That makes perfect sense because of drug-drug interaction.
“Although obviously a number of herbal substances are quite safe, you don’t know what’s in the package sometimes and there may be interactions, so it is important to talk to your doctor,” he said.
He says his research was sparked by the death of a young man who had injected a Chinese medicine chan su, which contains a toxin from toads.
“The materials that can be added include heavy metals, there’ve been cases of mercury poisoning and arsenic poisoning, lead poisoning, also sometimes the manufacturers will add western pharmaceutical agents, so they’ll add drugs that we manufacture to the herbal medicines to actually increase their effect,” he said.
Note it says that the young man “had injected” not “had been injected with”.  Could this be a case of self-medication?  If so, then he is right again: the message is that herbs can be safe, but some dangerous ones must be administered under the guidance of a qualified practitioner.  That’s something I’ve been saying for years.
Also, be careful of adulterated herbs or herbal products – hence the need for regulation by people who KNOW the herbs.
I generally tell my patients to never get over-the-counter chinese herbal preparations unless a) prescribed by a professional and b) from reliable factories.  If it just says “made in China” it’s probably fake.
Now back to the bias.  Again, the media is subtly manipulating thoughts via headline.  It could easily say “Scientist warns against dangers of abusing herbs.”  Instead, the title seems to imply that herbs are dangerous and that Professor Byard is warning against herbs in general.  In fact, the good Professor is warning against the same thing we do!
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