November - In recent years there has been increasing recognition of the importance of vitamin D not only in preventing bone problems in rickets, but also in reducing the risk of heart disease, cancer, and other diseases.  The American Academy of Pediatrics has doubled the recommended intake of vitamin D for children, to 400 units per day (Wagner et al., Pediatrics 122, 1142-1152 (2008) Paper) News story.  Vitamin D can be formed in skin exposed to sunlight, and is present in some food, but most children will not get the recommended amount without taking vitamin supplements.

November – Genistein is a soy isoflavone that some women take for relief of post-menopausal symptoms.  However, a new study found that this could be dangerous for some women being treated for breast cancer (Ju et al., Carcinogenesis 29, 2162-2168 (2008) Abstract) News story.  The researchers found that genistein could interfere with the action of the cancer drug letrozole (an aromatase inhibitor).

November – Two new reviews raise doubts about the value of acupuncture for various conditions.  Yuan and coworkers (Spine 33, E887-E900 (2008) Abstract) reviewed studies on low back pain.  Although acupuncture appeared more effective than no treatment, it was not more effective than sham (fake) acupuncture, indicating that benefits are placebo effects.  Yang and coworkers (Acta Obstet. Gynecol. 87, 1114-1122 (2008) Abstract) examined acupuncture, acupressure, and moxibustion for dysmenorrhea (severe menstrual pain).  They concluded that “Because of low methodological quality and small sample size, there is no convincing evidence for acupuncture in the treatment of primary dysmenorrhea.”

November – Two other papers reported new clinical trials of acupuncture.  Brinkhaus and colleagues reported that acupuncture appeared to have benefits in treatment of allergic rhinitis (Ann. Allergy Asthma Immunol. 101, 535-543 (2008) Abstract).  However, since there was no comparison group receiving sham acupuncture, the results could have been due to the placebo effect.  Smith et al. (Obstet. Gynecol. 112, 1067-1074 (2008) Abstract) tested whether acupuncture could be used to induce labor.  In this case a sham control was used, and there was no difference between real and sham acupuncture.

November – The National Center for Complementary and Alternative Medicine has posted an article entitled CAM and Hepatitis C: A Focus on Herbal Supplements.  Herbs and supplements discussed in the article are milk thistle, ginseng, thymus extract, colloidal silver, licorice root, and others.  The conclusion is that “No CAM treatment has yet been proven effective for treating hepatitis C or its complications.  It is important not to replace conventional medical therapy for hepatitis C with an unproven CAM therapy.”

November – Alternative approaches to reduction of blood pressure were reviewed by Nahas (Can. Fam. Physician 54, 1529-1533 (2008) Paper).  The author concludes, “Evidence from systematic reviews supports the blood pressure–lowering effects of coenzyme Q10, polyphenol-rich dark chocolate, Qigong, slow breathing, and transcendental meditation. Vitamin D deficiency is associated with hypertension and cardiovascular risk; supplementation lowered blood pressure in 2 trials. Acupuncture reduced blood pressure in 3 trials; in 1 of these it was no better than an invasive placebo. Melatonin was effective in 2 small trials, but caution is warranted in patients taking pharmacotherapy.”

November 1 – Probiotics are microorganisms taken for their supposed health benefits.  Kligler and Cohrssen provided a review of this subject in American Family Physician (78, 1073-1078 (2008) Abstract).  The authors feel that there is potential use for probiotics in treatment of diarrhea, irritable bowel syndrome, and atopic dermatitis.  However, they also point out that there is no good evidence for use in vaginal candidiasis (yeast infection), stomach infection by Helicobacter pylori (a cause of ulcers), inflammatory bowel disease, and upper respiratory infections.  An editorial in the same issue, by Sanders (p. 1026), cautions that “Different strains of the same species of probiotic may have different physiologic effects…Furthermore, some products claiming to be probiotics are not actually probiotics because they lack evidence to support the effectiveness of the specific strains being used.”

November 5 – Zhang and coworkers reported a study of whether folic acid, vitamin B₆, and vitamin B₁₂, taken in combination, could reduce the risk of cancer (JAMA 300, 2012-2021 (2008) Paper).  The study followed 5442 women for about 7 years.  There was no effect of the vitamins on overall cancer risk or on the risk of breast cancer.

November 12 – Yet another study showing that antioxidant vitamin supplements are not useful in preventing disease has been published by Sesso and colleagues (JAMA 300, 2123-2133 (2008) Paper) News story.  The authors followed more than 14,000 male physicians over age 50 for an average of 8 years, with half of them receiving vitamin C and vitamin E supplements.  There was no benefit of the supplements in the prevention of heart disease.  Moreover, vitamin E appeared to have increased the risk of stroke.

November 19 – A large study of the herb Ginkgo biloba for the prevention of dementia and Alzheimer’s disease was published by DeKosky and coworkers (JAMA 300, 2253-2262 (2008) Paper) Press release News story.  More than 3000 subjects, age 75 or older, were given ginkgo or placebo pills for an average of about 6 years.  There was no benefit of the herb in preventing or slowing the onset of dementia.

November 28 – One of the many unconventional cancer treatments that have been prominent in recent decades is that advocated by Nicholas Gonzalez.  While the Gonzalez method, involving digestive enzymes, other supplements, and coffee enemas, seems implausible, the National Center for Complementary and Alternative Medicine and the National Cancer Institute agreed to carry out a clinical trial of the Gonzalez method for patients with pancreatic cancer.  In an essay on the Science-Based Medicine blog, Kimball Atwood provided an updated analysis of this trial.  The trial, which began in 1999, was terminated in 2005.  Atwood concluded that the reason for the termination was that “the data convincingly demonstrated that the regimen was inferior to standard treatment of cancer of the pancreas.”

December – Acupuncture continued to be the subject of many reviews.  In a Commentary (Am. J. Med. 121, 1027-1028 (2008)), E. Ernst pointed out that “After discarding reviews that are based on only 3 or fewer primary studies, only 2 evidence-based indications emerge: nausea/vomiting and headache. Even this evidence has to be interpreted with caution; recent trials using the above-mentioned ‘stage-dagger’ devices as placebos suggest that acupuncture has no specific effects in either of these conditions…for the first time in its long history, acupuncture has been submitted to rigorous science—and conclusively failed the test.”   Sun and Gan (Anesth. Analg. 107, 2038-2047 (2008) Abstract News story) concluded that “needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.”  A review by Abraham (J. Perioper. Pract. 18, 543-551 (2008) Abstract) concluded that that “Overall the article suggests that acupuncture and acupressure are ineffective in preventing and managing PONV” (postoperative nausea and vomiting).  Usichenko and others (Anaesthesia 63, 1343-1348 (2008) Abstract) found that “the evidence that auricular [ear] acupuncture reduces postoperative pain is promising but not compelling.”

December – The U.S. Food and Drug Administration (FDA) has issued new Guidelines concerning dietary supplements.  The guidelines note that it is required that “a manufacturer of a dietary supplement making a nutritional deficiency, structure/function, or general well-being claim have substantiation that the claim is truthful and not misleading.”  The new guidelines are “intended to describe the amount, type, and quality of evidence FDA recommends a manufacturer have to substantiate a claim.”  Many examples of adequate and inadequate evidence are described.

December – A controlled trial of ginkgo biloba for mild to moderate dementia found no benefits (McCarney et al., Int. J. Geriatri. Psychiatry 23, 1222-1230 (2008) Abstract).  Study participants received a ginkgo extract or placebo for six months.

December – Relf and others reviewed trials of low-level laser therapy (eCAM 5, 383-389 (2008) Paper), many of which indicated benefits compared to placebo.  However, they found that while the trials were supposedly blinded, in most cases it might have been possible for patients to know whether or not they were receiving laser treatment.  Thus, the placebo effect cannot be ruled out.  More careful studies are needed to demonstrate the value of this technique.

December – New data on use of complementary and alternative medicine (CAM) in the United States in 2007 has been released by the National Center for Complementary and Alternative Medicine and the National Center for Health Statistics (Report (24 page pdf file);  Fact sheet).  The report concluded that about 40% of adults and 12% of children used at least one CAM therapy in the previous year.  Most commonly used by adults were “nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%).”  Compared to a 2002 survey, there were increases in the use of acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy and yoga,  probably due in part to increased state licensure of acupuncture, massage therapy, and naturopathy.  A Critique by A. Comarow points out that the figures are inflated by including categories that are hardly unconventional, such as massage and deep breathing exercises.  “The number of people using therapies that a reasonable person would consider CAM, such as Far Eastern medicine, homeopathy, and energy healing, is tiny.”

December – A new study has found that reduction of stress through psychological intervention improves the survival rate of breast cancer patients (Andersen et al. (2008) Cancer 113, 3450-3458 Abstract) News story.  The study followed 227 women for an average of 11 years.  However, the results conflict with other studies that found no benefit of counseling.  A Critique of the study has been posted.