July – The National Center for Complementary and Alternative Medicine (NCCAM) has updated two articles in its “Backgrounder” series:

 Ayurvedic Medicine: An Introduction.  The section on “Scientific evidence” states: “Most clinical trials (i.e., studies in people) of Ayurvedic approaches have been small, had problems with research design, lacked appropriate control groups, or had other issues that affected how meaningful the results were.  Therefore, scientific evidence for the effectiveness of Ayurvedic practices varies, and more rigorous research is needed to determine which practices are safe and effective.”  The article also notes concerns with the safety of many Ayurvedic medications [see August 27 story below].  A weakness in the article is that while it explains some of the Ayurvedic concepts, such as the three doshas, it does not point out that modern scientific knowledge of the human body does not support these concepts.

Reiki: An Introduction.  The article provides some information on the claims and practices of Reiki.  However, it fails to point out that concepts such as the flow of energy through space from practitioner to subject are inconsistent with scientific knowledge.  It also fails to emphasize out that, other than possible placebo effects, or the relaxing effects of slight touch, there is no evidence for the claimed effects of Reiki.  It merely states that “Reiki has not been well studied scientifically.”

 July – NCCAM has a new “Get the Facts” article entitled Fibromyalgia and CAM: At a Glance.  The section concerning scientific evidence reads as follows:According to reviewers who have assessed the research on CAM and fibromyalgia, much of the research is still preliminary, and evidence of effectiveness for the various therapies used is limited.

    * Research on acupuncture—stimulation of anatomical points with thin metallic needles—for fibromyalgia has produced mixed results. One review article notes that three studies found some evidence to support the use of electroacupuncture (in which the needles are pulsed with electric current). However, the effects of electroacupuncture in these studies were mostly short lived, and two studies of traditional acupuncture had negative results.

    * Some researchers believe that low levels of magnesium may contribute to fibromyalgia. However, there is no conclusive scientific evidence that magnesium supplements relieve fibromyalgia symptoms. Two small studies had conflicting results.

    * A review of the research on massage therapy for fibromyalgia notes only modest, preliminary support. Two studies had some positive findings, but two others found either no benefits or only short-term improvements.

    * Supplements containing the amino acid derivative SAMe are used for a variety of conditions. Although several small studies of SAMe for fibromyalgia have had mixed results, there is some evidence of a benefit. Reviewers conclude that more research is needed.

July – A review on studies of acupuncture for Parkinson’s Disease (Lam et al., J. Altern. Complement. Med. 14, 663-671 (2008) Abstract) concluded that “There is evidence indicating the potential effectiveness of acupuncture for treating IPD [idiopathic Parkinson’s disease].  The results were limited by the methodological flaws, unknowns in concealment of allocation, number of dropouts, and blinding methods in the studies.  Large, well-designed, placebo-controlled RCTs [randomized controlled trials] with rigorous methods of randomization and adequately concealed allocation, as well as intention-to-treat data analysis are needed.”

July – While Lyme disease is a recognized medical condition, responding to a short course of antibiotic treatment, the existence of a long-lasting, persistent infection is controversial.  P. Baker reviewed the subject in an article entitled “Perspectives on ‘Chronic Lyme Disease’” (Am. J. Med. 121, 562-564 (2008) Paper).  He noted that “In the absence of direct evidence that these conditions are the result of a persistent infection, some mistakenly advocate extended antibiotic therapy (≥6 months), which can do great harm and has resulted in at least 1 death.”

July 8 – Newspaper stories discussed a proposed federal research project to test whether chelation of mercury could be beneficial for children with autism Story.  The idea that low levels of mercury in vaccines are responsible for autism has been contradicted by numerous scientific studies, as discussed in our previous news pages.  Many medical researchers are opposed to the new study, since it has no scientific justification and will present some risk to the children being treated.  Administrators have responded that many parents are already using chelation treatments, so that it is important to have a rigorous trial of its safety and effectiveness.  [Update: in September the study was cancelled.]

July 17 – A two-year trial of 322 moderately obese subjects compared three types of diets (Shai et al., New Engl. J. Med. 359, 229-241 (2008) Paper) News story.  Subjects lost an average of 10.3 pounds on a low-carbohydrate diet (40% fat), 9.7 pounds on the Mediterranean diet (33% fat), and 6.3 pounds on a low-fat diet (30% fat).  Improvements in cholesterol were greatest for the low-carbohydrate diet.  Stephen Barrett, in his Consumer Health Digest, wrote, “Many news reports have represented this study as showing that Atkins was right…However, such conclusions are simplistic…The amount of weight lost was small, differences among the groups were not large, and the study was done with close monitoring and may not reflect what happens when people diet on their own.  The study merely adds to the evidence that a 40%-fat, low carbohydrate diet can be an alternative to a 30%-fat diet, which is moderate rather than low in fat.”  Those who followed the advice in Atkins’ books “probably consumed 50% to 60% fat.”

July 17 – An analysis by Mark Crisplin in the Science-Based Medicine blog examines a paper, noted previously (January-February News), that supposedly showed that chiropractic is not linked to higher incidence of stroke (Cassidy et al., Spine 33, S176-S183 (2008) Abstract).  The paper claimed that apparent risk was “likely due to patients with headache and neck pain from VBA [vertebrobasilar artery] dissection seeking care before their stroke.”  According to Crisplin, the results of the paper, based largely on strokes in the elderly, are misleading because most strokes in the elderly are due to other causes, and “strokes due to chiropractic could be lost in the sea of strokes due to other reasons.”  However, “One would predict that if there were an association between chiropractic and stroke you would most easily find it in the young and the effect would be most noticeable in the first day or so after the chiropractic visit.  And this article confirms this association.”

August 4 – The Food and Drug Administration (FDA) has released an article entitled FDA 101: Dietary Supplements.  The article gives some general advice, and discusses the regulation and safety of dietary supplements.  Information on how to report adverse effects or make other complaints is also provided.

August 8 – A paper by Narkar and coworkers (Cell 134, 405-415 (2008) Abstract) reported interesting effects of the compound AICAR Press release.  This compound, which causes an increase in the activity of a regulatory enzyme (AMPK), was found to produce effects on muscle development in mice similar to effects of exercise.  It is speculated that this might lead to a drug that can provide people the benefits of endurance exercise (including treatment of obesity).  However, while AICAR appears to be safe for humans, it is not known that it can produce effects in humans similar to those that were reported for mice.

August 12 – High doses (mega-doses) of vitamin C (ascorbate) have been proposed to be useful for prevention and treatment of various diseases, but most of these claims have not been substantiated.  With vitamin C consumed orally, it is difficult to raise the blood level beyond a certain point, and higher doses simply get excreted by the body.  However, with intravenous treatment, one can achieve much higher blood levels.  An animal study by Chen and coworkers (Proc. Natl. Acad. Sci. 105, 11105-11109 (2008) Paper) suggests that high levels of intravenous vitamin C may be useful in treatment of cancer.  A Commentary by Frei and Lawson (pp. 11037-11038) discusses the findings.  A Letter from P. Borst (Proc. Natl. Acad. Sci. 105, E95), criticizing Frei and Lawson’s article, and a Reply from Frei et al. (Proc. Natl. Acad. Sci. 105, E96) were published later.

August 23 – The Alexander technique, which involves awareness of posture and muscle use, was the subject of a study by Little et al. (BMJ 337, 1884 (2008) Paper).  Subjects with low back pain received lessons (either 6 or 24) in the Alexander technique, massage, or usual care; half of each group also received prescription for exercise.  Reductions in pain after one year were greatest for 24 lessons of Alexander technique, or for 6 lessons plus exercise.  An editorial by van Tulder (BMJ 337, a974 (2008)) discussed the findings.  He noted that “Because the trial compared the Alexander technique with massage it is unclear whether this technique is more effective than different kinds of exercise.”

August 27 – Saper and other examined 230 Ayurvedic medicines being sold over the Internet (JAMA 300, 915-923 (2008) Paper) News story.  About 20% contained toxic metals such as lead, mercury, and arsenic.  Of special concern were rasa shastra remedies.  The same group had previously found dangerous metals in Ayurvedic medicines being sold in stores near Boston.

August 29 – An interesting Commentary by Murphy et al. is entitled “How can chiropractic become a respected mainstream profession? The example of podiatry” (Chiropractic & Osteopathy 16, 10 (2008)).  The authors recommend that chiropractors become “a profession of non-surgical spine specialists.”  They also criticize chiropractic education for “the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of ‘innate intelligence’ flowing through spinal nerves, with spinal subluxations impeding this flow.”