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No drug is free of risks, or the potential for causing harm. Every decision to take a drug needs to consider expected benefits and known risks. One of the ways we can reduce harms is by studying drug use rigorously. Only by understanding the “real world” effects of drugs can we understand the true risks (and benefits) and design strategies to reduce the risk of iatrogenic harm — that is, harms caused by the intervention itself. Adverse events related to drug treatments are common. Some lead to hospitalization. Studies suggest 28% of events are avoidable in the community setting, and 42% are avoidable in long-term care settings. That’s a tremendous amount of possible harm from something prescribed to help. A new study published this week shows that adverse drug events (ADEs) continue to cause significant problems, sending over a million Americans to the emergency room every year.
In vitro fertilization (IVF) is the only option for many couples who want to have their own genetic child. This is an expensive procedure – it can cost up to $20,000 per attempt, with about a 40% success rate overall.
Couples going for IVF are often desperate to have their own child, and the uncertainty of success can be emotionally and financially draining. For this reason they are an especially vulnerable population when it comes to optional services (“add-on services”) that promise to increase the chances of success.
A recent BMJ article reviewed the evidence for 38 IVF add-on services typically offered in the UK: “Lack of evidence for interventions offered in UK fertility centres.” The title gives away the punch line – of the 38 services they reviewed, only one had any compelling published evidence of efficacy, endometrial scratch (causing minor trauma to the uterine wall to enhance the probability of embryo implantation). Even then the evidence was only “moderate.” The authors write:
Our appraisal of the evidence shows only one intervention, endometrial scratching, for which the review evidence robustly supports an increase in live birth rate, yet even this evidence is of only moderate quality, and the observed benefit is only in women with more than two previous embryo transfers.
That could easily be just random noise in the research. If you look at 38 different treatments, what are the odds that at random one of them will have an excess of false positive studies, and only in one subgroup (which is a red flag)?
Posted in: Acupuncture, Science and Medicine
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BrainPlus IQ: If it turns your brain blue, consult a doctor.
I got an email urging me to check out a wonderful new product that boosts brain performance: it “doubles IQ, skyrockets energy levels, and connects areas of the brain not previously connected.” It is BrainPlus IQ, a dietary supplement that falls into the category of nootropics, substances that enhance cognition and memory. After looking into it, my first thought was that if it doubles your IQ you might become smart enough to realize you have been scammed. The advertising for this product is as reprehensible as anything I have seen (and I have seen a lot).
The link in the email was to a “Discovery” website article titled “Anderson Cooper: Stephen Hawking Predicts, “This Pill Will Change Humanity” and It’s What I Credit My $20 Million Net Worth To.” According to the article, Stephen Hawking said his brain is sharper than ever because he uses BrainPlus IQ. It quotes Denzel Washington, saying he gave a speech at a science convention (unnamed) in New York City, saying BrainPlus IQ enabled him to memorize movie lines after reading them just once. He brought to the stage MIT scientist Peter Molnar, who said he had tested BrainPlus IQ against Adderall in 1,000 patients and found it was 600% more effective and subjects doubled their IQ in 10 days. It has “absolutely no harmful ingredients, it’s non-addictive, and 79% of participants double their IQ within 24 hours.” It was supposedly described as “Viagra for the brain” in Forbes magazine. (more…)
Functional Medicine practitioners like to make patients think that this diagram actually means something.
I’ve frequently written about a form of medicine often practiced by those who bill themselves as practicing “complementary and alternative medicine” (CAM) or “integrative medicine” (or, as I like to refer to it, “integrating” quackery with medicine). I’m referring to something called “functional medicine” or, sometimes, “functional wellness,” which Wally Sampson first introduced to readers of this blog way back in 2008, and continued to educate our readers over multiple posts. Over the years, I’ve tried to explain why the term “functional medicine” (FM) is really a misnomer, how in reality it is a form of “personalized medicine” gone haywire, or, as I like to refer to it, as “making it up as you go along.” Unfortunately, thanks largely to its greatest popularizer, Dr. Mark Hyman, FM is popular, so much so that Bill and Hillary Clinton count Hyman as one of their medical advisors and the Cleveland Clinic, not satisfied with embracing prescientific traditional Chinese medicine, has gone “all in” for FM by hiring Dr. Hyman two years ago to set up a functional medicine clinic. Unfortunately, it’s been “wildly successful” there.
Unfortunately its success is not deserved, at least from a scientific standpoint.
(more…)
Editor’s note: With Mark Crislip away on yet another vacation, we present an inaugural guest post from Abby Campbell, a practicing MD, Ph.D and contributor at HealthyButSmart.com. Welcome Abby!
Ball-and-stick diagram of the phenibut molecule
On average for the past year, phenibut has been typed into google 49,500 times a month. Phenibut is a supposed wonder drug that claims to promote sociability and lessen anxiety.
When people run that search in Google, they find stores that sell phenibut, as well as blogs and forums where people discuss and make recommendations for the use of phenibut. The main qualification of these people is that they themselves have taken the drug.
What a searcher doesn’t find is any reference to any credible research. Yet another supplement market has been born driven by anecdotal social marketing, and no one seems to care about the evidence.
Phenibut is a designer drug which was synthesized by a group of Russian scientists in the 1960s. Perekalin and his colleagues in St. Petersburg added a phenyl ring to butyric acid to make what we now call phenibut. The addition of the phenyl group to the butyric acid enables the compound to cross the blood-brain barrier and enter the brain.
This basic chemical structure of the compound explains the origins of the name ‘phenibut’. Phenibut is also known as fenibut and is sold under the brand names of Noofen and Citrocard.
Phenibut is structurally similar to the neurotransmitter GABA (gamma amino butyric acid). GABA occurs naturally in the human nervous system and has a calming effect on the brain.
GABA itself does not cross the blood brain barrier and so is not viable as a drug or supplement to reduce anxiety. The addition of the phenyl ring by the Russian scientists overcame the problem of penetration into the brain. However this means that phenibut is not totally identical to human GABA which means that we can’t just extrapolate information on GABA to phenibut, as some websites have done. (more…)
Today is the American Thanksgiving holiday and SBM is taking the day off. Speaking of thanks, thank you to all of our readers and to those of you who take time to comment. Thanks to all of you who patiently explain to a neighbor why homeopathy does not (and cannot) work, complain to your pharmacy about its selling dubious dietary supplements, warn a friend about the dangers of chiropractic neck manipulation, refuse the reiki “treatment” at your local hospital (and explain why), write to your state representative opposing naturopathic licensing, stand up for vaccination, and for all the myriad other ways you support the rational application of science to health care.
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A human brain showing fronto-temporal lobe degeneration, often associated with dementia
Dementia is a significant health burden of increasing significance as our population ages. Worldwide the prevalence of dementia is 5-7% in people 60 years and older, with risk doubling every 5 years after age 60. About 5.4 million Americans are living with dementia.
Dementia is a general category referring to a chronic decline in overall cognitive function. The most common cause of dementia is Alzheimer’s disease, accounting for about half of cases. There is also a category of mild cognitive impairment (or cognitive impairment not dementia) that is milder and does not meet the diagnostic criteria for full dementia.
There is some good news, however. A recent study published in JAMA finds that in the US the prevalence of dementia in those 65 and older declined between 2000 and 2012, from 11.6 to 8.8%. This is both statistically significant and clinically significant.
This also mirrors evidence from other countries also showing a decline in dementia prevalence over the last 20 years, including the UK, Denmark, and Sweden.
The big question, of course, is what is causing this decline? If we can determine the major factors then perhaps we could use that knowledge to further decrease dementia risk.
Posted in: Neuroscience/Mental Health
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No one will ever need to write about homeopathy again. Edzard Ernst has said it all in his new book Homeopathy: The Undiluted Facts.
Far too many trees have died in the service of praising or debunking homeopathy in the two centuries since Hahnemann invented it. The forests can celebrate, because this is the definitive book about homeopathy. It is neither “for” nor “against” homeopathy; it is explanatory. It is dispassionate and as unbiased as it could possibly be. It says good things about homeopathy, shows how arguments for and against it have been flawed, and contains nothing that the most ardent homeopaths should be able to complain about (but complain they surely will, because the facts Ernst reports are not what they want the world to hear). (more…)
Posted in: Book & movie reviews, Homeopathy
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It’s been a long time since I’ve encountered Glenn Sabin. You might remember him, though. He runs a consulting firm, FON Therapeutics, which is dedicated to the promotion of “integrative” health, or, as I like to put it, the “integration of pseudoscience and quackery with science-based medicine. What I remember most about Sabin is how he once proclaimed that “integrative medicine” was a brand, not a specialty. Unfortunately, he was correct in his assessment. Basically, he declared, “CAM [complementary and alternative medicine] is dead. The evolution of evidence-based, personalized integrative medicine, and its implementation in clinic, lives on.” The reason CAM was being killed by its advocates was, of course, because the term CAM contains the word “alternative” in it, and that was a barrier to mainstream acceptance. It didn’t bother Sabin one whit that there’s a lot of unscientific and unproven quackery in the CAM that has mostly become integrative medicine:
It’s true that not all stress reduction techniques, say, Reiki, boast a solid evidence base. But many clinicians who offer services like Reiki do so because they’ve observed it helping many of their patients to relax, thus lessening their need for certain medications. They rationalize that since the intervention is not potentially harmful and their patient is more relaxed and reporting beneficial value, then what difference does it really make if we don’t yet know exactly how it works?
To him, “integrative” health and medicine were the future, mainly because the connotation is much more favorable. To paraphrase how I put it at the time, no longer were CAM practitioners content to have their favorite quackery be “complementary” to real medicine. After all, “complementary” implied a subsidiary position. Medicine was the cake, and their nostrums were just the icing, and that wasn’t anywhere good enough. Those promoting CAM craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine. The term “integrative medicine” served their purpose perfectly. No longer were their treatments merely “complementary” to real medicine. Oh, no. Now they were “integrating” their treatments with those of science- and evidence-based medicine! The implication, the very, very, very intentional implication, was that alternative medicine was co-equal to science- and evidence-based medicine, an equal partner in the “integrating.”
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According to the authors of the latest study claiming to demonstrate effectiveness of homeopathic remedies, colds are common in the pediatric population. They further explain that colds and cough symptoms are a frequent impetus for parents to seek pediatric medical care. Finally, they add that evidence in support of decongestants, antihistamines and cough suppressants for the treatment of pediatric cold symptoms is lacking and that there are significant potential risks with their use in young children.
All of this is true and information I give to medical learners and patient caregivers all the time. I only wish they had quit while they were ahead. Sadly, the authors of “A randomized controlled trial of a homeopathic syrup in the treatment of cold symptoms in young children” continued:
One option for treating cold symptoms in young children is with homeopathy. Because the concentrations of active ingredients in homeopathic medications are extremely dilute, they are generally considered to be safe. However, there is a widely held belief that any efficacy related to use of homeopathic remedies is related to a placebo effect.
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