Acupuncture–Still a Placebo After All These Years

Posted on January 2, 2012 by skeptvet

The scientific evidence supporting the effectiveness of acupuncture is far weaker than is widely supposed, even among those committed to science and science-based medicine. It has been repeatedly shown that the measurable physiological effects and apparent clinical benefits of sticking needles into people or animals are non-specific and do not depend on putting those needles in any particular place or even actually penetrating the skin (since fake needles and even jabbing the skin in random places with toothpicks work just as well as “real” acupuncture). Over and over again, research has shown that even with the inability to truly blind therapists to whether or not they acupuncture they are giving is real or fake (which is an important potential source of bias), acupuncture works no better than placebo, even for the symptom most often cited as one acupuncture is proven to treat, pain.

Sadly, facts are relatively impotent in the face of belief, and the accumulation of evidence against any real physical benefits from acupuncture doesn’t seem to have much impact on the popularity of the practice, which is still quite low but higher than one might expect for a placebo treatment. Nevertheless, I maintain a perverse belief that the truth matters and that facts have meaning, so I guess I will keep looking for and sharing them. Another study has recently been published which demonstrates yet again that 1) sham acupuncture is just as effective as “real” acupuncture, 2) patients’ beliefs about acupuncture strongly affects whether it seems to them to help, and 3) the individual doctor, and presumably their manner or how they present the therapy, has more of an effect on whether the patient feels better than whether or not the patient actually had acupuncture or a placebo treatment.

White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G.Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain. 2011 Dec 12. [Epub ahead of print]

The nonspecific effects of acupuncture are well documented; we wished to quantify these factors in osteoarthritic (OA) pain, examining needling, the consultation, and the practitioner. In a prospective randomised, single-blind, placebo-controlled, multifactorial, mixed-methods trial, 221 patients with OA awaiting joint replacement surgery were recruited. Interventions were acupuncture, Streitberger placebo acupuncture, and mock electrical stimulation, each with empathic or nonempathic consultations…

Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture…or mock stimulation… Empathic consultations did not affect pain…but practitioner 3 achieved greater analgesia than practitioner 2… Qualitative analysis indicated that patients’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked…Improvements occurred from baseline, but acupuncture has no specific efficacy over either placebo. The individual practitioner and the patient’s belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient’s belief (independently). Beliefs about treatment veracity shape how patients self-report outcome, complicating and confounding study interpretation.

 

Posted in Acupuncture | 1 Comment

SELECT–An Example of why clinical trials aren’t just the icing, they are the cake

Posted on January 2, 2012 by skeptvet

Why Do We Really Need Clinical Trials?
A point I make over and over again when talking about new or alternative therapies that are not supported by good clinical trial evidence is that lower-level evidence, such as theoretical justifications, anecdotes, and pre-clinical research like in vitro studies and animal model testing, can only be suggestive, never reliable proof of safety or efficacy. It is necessary to begin evaluating a new therapy by showing a plausible theory for why it would work and then moving on to demonstrate that it actually could work through pre-clinical research. But this kind of evidence alone is not sufficient to support using the therapy in real patients except under experimental conditions, or under when the urgency to intervene is great enough to balance the significant uncertainty about the effects of the intervention.

In support of this conclusion, we can consider the inherent unreliability of individual human judgments and all the many ways in which inadequately controlled research can mislead us (for example). And we can reflect on how promising results in early trials often melt away when better, larger, more rigorous studies are done that better control for bias (the so-called Decline Effect). And it is not at all difficult to compile a large list of examples of the harm inadequately studied medical interventions can cause (for example).

But what I’d like to do here is focus on a particularly good specific example of why thorough clinical trial evaluation of promising ideas is not just a nice extra to confirm what we already believe is true, it is the only way to genuinely know whether our treatments to more good than harm.

SELECT-What Is It About?
The Selenium and Vitamin E Cancer Prevention Trial (SELECT) was initiated because, according to the National Cancer Institute (NCI) at the National Institutes of Health (NIH), “Evidence from epidemiologic studies, observational studies, and clinical trials looking at preventing cancers other than prostate cancer had suggested that selenium and/or Vitamin E might prevent prostate cancer.” The NCI describes some of the specific studies that suggested selenium and Vitamin E supplementation might protect against prostate cancer.

Selenium-
Selenium is a nonmetallic trace element found in food, especially plant foods such as rice and wheat, seafood, meat, and Brazil nuts. Selenium is an antioxidant and may help control cell damage that could lead to cancer.

The Nutritional Prevention of Cancer (NPC) study, first reported in 1996, included 1,312 men and women who had a history of non-melanoma skin cancer. Results of the trial showed that men who took selenium to prevent new non-melanoma skin cancers received no benefit from selenium in preventing that disease. However, approximately 60 percent fewer new cases of prostate cancer were observed among men who had taken selenium for six and one-half years than among men who took placebo (1). In a 2002 follow-up report, the data showed that men who took selenium for more than seven and one-half years had about 52 percent fewer new cases of prostate cancer than men who took placebo (2). This trial was one of the reasons for studying selenium in SELECT.

Vitamin E-
Vitamin E is in a wide range of foods, especially vegetables, vegetable oils, nuts, and egg yolks. Vitamin E, like selenium, is an antioxidant, which may help control cell damage that can lead to cancer.

In the 1998 study of 29,133 male cigarette smokers in Finland (known as the Alpha-Tocopherol, Beta-Carotene Trial, or ATBC), 32 percent fewer new cases of prostate cancer and 40 percent fewer deaths from prostate cancer were observed among men who took Vitamin E in the form of alpha-tocopherol to prevent lung cancer than among men who took a placebo.

So in 2001, the trial began enrolling subjects in a randomized, blinded, placebo-controlled prospective clinical trial to see if supplementation of selenium and Vitamin E, or a combination of the two, would reduce the incidence of prostate cancer. By 2004, over 35,000 men in the United States, Canada, and Puerto Rico had been enrolled. The subjects were randomly assigned to receive: 

    • Selenium and Vitamin E
    • Selenium and a placebo
    • Vitamin E and a placebo, or
    • Two placebos. Two placebos were used in the trial: one looked like a selenium capsule; the other looked like a Vitamin E capsule. Each placebo contained only inactive ingredients. Neither the participants nor the researchers knew who received the selenium and Vitamin E, or the placebos, a process known as blinding or masking.

The trial was originally planned for between 7 and 12 years of supplementation and then subsequent followup to monitor for the development of prostate cancer, and it was designed to detect a 25% reduction in the incidence of prostate cancer, which was felt to be an achievable and  clinically meaningful difference.

So How Did It Work Out?
In 2008 the investigators reviewed the data up to that point and found no sign of a protective effect from selenium or Vitamin E, separately or taken together. It was judged unlikely that the 25% reduction in risk that was the criteria for effect in the study would be seen even if the study continued, so the supplementation portion of the study as halted. The subjects were told which supplement or placebo they had been given and were instructed to stop taking their supplements.

At that time, a greater number of cases of prostate cancer had developed in the group taking only Vitamin E than in the other groups. However, the difference did not reach statistical significance, so the investigators could not say whether it was a meaningful difference or only the result of chance.

Subsequently, the men have continued to be monitored, and the difference in the rate of prostate cancer between men who had been taking only Vitamin E supplements and the other men in the study has continued to grow even after they stopped taking the supplement. The difference is now statistically significant, so it likely represents a real biological phenomenon, not simply random chance. Men who were in the Vitamin E alone group have developed prostate cancer at a rate 17% higher than the men in the other groups.

Those men who took selenium alone or selenium and Vitamin E also have a higher rate of prostate cancer than those men who received the placebos, but this difference is not yet statistically significant. No other differences suggesting a beneficial or harmful effect of either supplement have been detected.

So Why Didn’t It Work Out As Expected?
From a biological point of view, the reason why Vitamin E supplementation turned out to be a risk factor for development or prostate cancer instead of a protective factor aren’t yet known. Nor is it clear why a statistically significant increase in risk hasn’t yet been found for those men who took Vitamin E and selenium together. There are, of course, theories as to how precisely Vitamin E influences prostate cancer risk, and the NCI has solicited research proposals from other investigators to use the data and samples collected in SELECT to investigate this question.

But from the point of view of epistemology, how we figure out what works and what doesn’t, there are a number of reasons why the finding shouldn’t be entirely surprising. For one thing, new ideas often turn out to be wrong. The degree of plausibility to the underlying theory and the amount of supportive pre-clinical research evidence are useful in determining roughly how promising an idea is, but ultimately the proof is in the multiple replicated independent high-quality randomized clinical trial pudding. Given the incredible number of complex, interacting factors involved in the development of each particular disease, it shouldn’t surprise us when even a reasonable hypothesis with limited support from observational trials and the like is actually false.

And as it turns out, the preliminary evidence which suggested the need for the SELECT in the first place didn’t work out so well either. As already mentions, “results of the [Nutritional Prevention of Cancer] trial showed that men who took selenium to prevent new non-melanoma skin cancers received no benefit from selenium in preventing that disease.” And there has since been some indication of potential harm, though the data is conflicting; “Since the start of SELECT, four studies have been published on the effect of selenium on blood glucose and risk of diabetes. Two studies suggested that higher levels of selenium taken from supplements or received naturally were associated with an increased risk of diabetes. One study showed no such association, and one showed that people with higher levels of selenium in their blood had a reduced risk of diabetes (3-6).”

As for Vitamin E, the NCI states, “There are no clinical trials that show a benefit from taking vitamin E to reduce the risk of prostate cancer or any other cancer or heart disease (7, 8, 9-13).” And the subjects in the ATBC trial who took Vitamin E had a 50% increase in the occurrence of hemorrhagic strokes, an 18% increase in the occurrence of lung cancer, and an 8% overall greater mortality than control subjects. So not only were the initial promising results suggesting a benefit for prostate cancer not correct, there were fewer benefits and greater risks than expected in terms of other diseases as well.

The Bottom Line
The moral of this story is simple and shouldn’t be controversial: While a plausible theory and suggestive preclinical evidence may suggest a new therapy could be beneficial, only rigorous, high-quality clinical trials can determine if this is actually true. Good ideas turn out to be wrong often enough that our initial enthusiasm with the ideas themselves and with supportive preliminary research data should always be tempered by an understanding that these lower levels of evidence are inherently less reliable than the slow, expensive, complicated process of rigorous clinical studies. And bad ideas, those without a plausible theoretical foundation or supportive pre-clinical evidence, are even less likely to bear fruit when properly examined.

Of course, such high-quality studies may not always be possible. As a veterinarian, I can never expect to have a 7-year prospective study of 35,000 subjects to rely on.  So the temptation to act on lesser evidence is understandable. But therapies used without higher-quality evidence to support them are inevitably going to be more likely to fail or to cause harm than therapies that have been more thoroughly studied. We must accept this and factor that knowledge into our clinical decisions. If the need to intervene is great enough, it can be justifiable to employ therapies without high-quality clinical trial evidence to support them. However, we must convey the real degree of uncertainty to our patients or clients, and we must be especially vigilant and honest about potential failures or unintended consequences.

It is common to see sweeping and confident claims of benefit and safety for alternative therapies that, when examined, turn out to be based on suggestive evidence often much weaker than that which led the NCI to study the effect of selenium and Vitamin E on prostate cancer risk. CAM advocates have gotten quite good at throwing up publication references to support their claims, and the hassle factor involved in examining those papers in detail to see what level of evidence they actually provide can discourage anyone from thoroughly investigating these claims. This, of course, leaves the impression that there is good evidence to support what CAM advocates are saying, not only in the minds of the general public but in the minds of physicians, veterinarians, nurses, and others who should know better.

I think much of the success of the “integrative medicine” meme has been based on the lack of an adequate understanding among health professionals about the serious limitations of low-level evidence. The SELECT illustrates nicely how even a plausible intervention with enough low-level evidence to justify a major clinical trial can prove not only less helpful than originally hoped but even actively harmful. The same principle applies to an even greater degree to less plausible hypotheses. High-quality clinical trials are not simply icing on the cake confirming what we already know, they are the cake without which we know a lot less than we usually think.

References

1. Clark LC, Combs GF Jr., Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial: Nutritional Prevention of Cancer Study Group. JAMA 1996; 276(24):1957-1963

2. Duffield-Lillico AJ, Reid ME, Turnbull BW, et al. Baseline characteristics and the effect of selenium supplementation on cancer incidence in a randomized clinical trial: A summary report of the Nutritional Prevention of Cancer Trial. Cancer Epidemiology, Biomarkers & Prevention 2002; 11(7):630-639.

3. Stranges et al. Effects of Long-Term Use of Selenium Supplements on the Incidence of Type 2 Diabetes. Annals of Internal Medicine; 147:217-233, 2007.

4. Bleys J et al. Serum Selenium and Diabetes in U.S. Adults. Diabetes Care; 30:829-834, 2007.

5. Rajpathak et al. Toenail Selenium and Cardiovascular Disease in Men with Diabetes. Journal of the American College of Nutrition; 24: 250-256, 2005.

6. Czernichowet et al. Antioxidant supplementation does not affect fasting plasma glucose in the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) study in France: association with dietary intake and plasma concentrations. American Journal of Clinical Nutrition; 84:395-9, 2006.

7. Lippman SM, Klein EA, Goodman PJ, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers. JAMA 2009; 301(1). Published online December 9, 2008. Print edition January 2009.

8. EA Klein, IM Thompson, CM Tangen, et al. Vitamin E and the Risk of Prostate Cancer: Results of The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011; 306(14) 1549-1556.

9. Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. New England Journal of Medicine. 2000;342:154-60.

10. Sesso HD, Buring JE, Christen WG, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA. 2008; 300(18):2123-33.

11. Lee IM, Cook NR, Gaziano JM, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA. 2005; 294(1):56-65.

12. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: A randomized controlled trial. JAMA 2005; 293(11):1338-1347.

13. Miller ER III, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: High-dosage vitamin E supplementation may increase all-cause mortality. Annals of Internal Medicine 2005; 142(1):37-46.

 

Posted in Herbs and Supplements | Leave a comment

What if There Were Rules for Science Journalism?

Posted on December 12, 2011 by skeptvet

I’ve often complained about the role of the media in perpetuating misunderstandings about the nature of science and promoting pseudoscience. Journalists rarely have training in science, and those who do have the training and expertise to cover science stories accurately are finding it harder and harder to get jobs. As Carl Sagan famously said, ” We live in a society exquisitely dependent on science and technology, in which hardly anyone knows anything about science and technology. This is a clear prescription for disaster.” Yet once we leave school, somewhere in our teens or twenties for most of us, the media is really the only source of information about science and technology most of us have. If the media cannot report on science issues accurately, is it any wonder ignorance and misunderstanding of science is so widespread.

I recently read an article by Fiona Fox, CEO of the Science Media Centre, which is an information and resource center for journalists and scientists focused on improving the accuracy of science journalism.

What if There Were Rules for Science Journalism?

The article was originally published in New Scientist magazine and appeared today on Slate.com. Ms. Fox begins  by illustrating the seriousness of the problem with an example all too familiar to proponents of science based medicine–the bogus link between childhood vaccination and autism.

When the press gets it wrong on science, the results can be devastating. The furor over MMR, which started in 1998 after a rogue doctor claimed a link between the vaccine and autism, is the best-known example of how poor reporting can cause harm. Vaccination rates dropped to 80 percent, and cases of measles in England and Wales rose from 56 in 1998 to 1,370 in 2008.

The media were not solely responsible for the MMR scare, but some of the news values that caused the problem are alive and well: the appetite for a great scare story; the desire to overstate a claim made by one expert in a single small study; the reluctance to put one alarming piece of research into its wider, more revealing context; journalistic “balance”—which creates the impression of a significant divide in scientific opinion where there is none; the love of the maverick; and so on.

All of the problems she lists are common in media coverage of alternative medicine as well. An impression of scientific legitimacy can easily be manufactured through “false balance” and an exaggeration of the evidentiary value of low-quality evidence. And the love of a heartwarming narrative, including mavericks proven right and miracle cures, lead people to accept pseudoscientific ideas despite the scientific and  rational reasons to reject them.

Ms. Fox then goes on to provide a sample of a checklist of guideline that journalists could use to avoid misleading the public when reporting on scientific issues: 

  • Every story on new research should include the sample size and highlight where it may be too small to draw general conclusions.
  • Any increase in risk should be reported in absolute terms as well as percentages: For example, a “50 percent increase” in risk or a “doubling” of risk could merely mean an increase from 1 in 1,000 to 1.5 or 2 in 1,000
  • A story about medical research should provide a realistic time frame for the work’s translation into a treatment or cure.
  • [Such stories] should emphasize what stage findings are at: If it is a small study in mice, it is just the beginning; if it’s a huge clinical trial involving thousands of people, it is more significant.
  • Stories about shocking findings should include the wider context: The first study to find something unusual is inevitably very preliminary; the 50th study to show the same thing may be justifiably alarming
  • Articles should mention where the story has come from: a conference lecture, an interview with a scientist, or a study in a peer-reviewed journal, for example.

As a member of the American Society of Veterinary Journalists (ASVJ), I am interested in encouraging the most accurate media coverage of veterinary medical issues. As usual, this effort in the veterinary field is smaller and less fully developed than similar efforts in the human medical domain, but the problems and the goals are much the same. The better our clients understand the science underlying our recommendations, including the inevitable degree of uncertainty involved in any scientific endeavor, the better they will be able to work with veterinarians as partners to manage the health and well-being of their pets. And the more clearly people comprehend both the strengths and limitations of scientific evidence, the more difficult it will be to sell them pseudoscience and nonsense.

The media plays a key role in interpreting and disseminating scientific information, and the sort of guidelines Ms. Fox is suggesting would be a great step towards improving the quality of science journalism. I would very much like to see organizations such as the ASVJ and the Evidence-Based Veterinary Medicine Association (EBVMA) involved in developing and promoting such standards for the general press.

Posted in General | 8 Comments

Homeopathy Swims With the Fishes

Posted on December 7, 2011 by skeptvet

In case you were wondering, and I’m sure you were, the Australian homeopathy practice Homeopathy Plus has finally answered the burning question, “Can fish be treated with homeopathy?” Not surprisingly, the answer is “Yes.”

Now the principle of potentization, in which a homeopathic remedy gets more powerful the more it is diluted and succussed (aka whacked on a leatherbound book), would seem to present a problem for treating aquatic animals. One would think that a potentially helpful remedy diluted to, for example, 30C (meaning there is no conceivable chance of a single molecule of the original ingredient remaining) could become a devastating poison wiping out all life if dropped into the ocean and diluted so much more. However, there is no need to worry as homeopathic remedies are not only able to cure the true underlying cause of diseases modern medicine can’t touch, but they are completely safe as well. As the experts say,

Homoeopathy works with any living thing, so fish can also be successfully treated by it. Remedies can even be used preventatively for certain fish diseases.

Rather than trying to drop a pill down the mouth of a wriggling fish, though, there is an easier way – just medicate the water in which it swims.

There is a caution to bear in mind, however.

The only thing to remember is that your fish should not swim forever in the medicated water as they, just like us, can experience an aggravation.

To avoid this, make sure the water is exposed to sunlight as it weakens and eventually destroys the effects of homeopathic remedies.

Good to know. The magic memory of water is destroyed by ultraviolet rays. However, an “aggravation” does sound bad. I thought homeopathy wasn’t supposed to have side effects? Oh, here’s how the folks at Homeopathy Plus describe what to expect with homeopathic treatment.

Once you have taken your first dose of a homeopathic remedy, one of the following seven things will happen

  • A curative response – your symptoms get better and go away.
  • A similar aggravation – your symptoms first worsen and then improve.
  • A dissimilar aggravation – new symptoms appear for a short time but your old ones stay the same.
  • Accessory symptoms – your symptoms improve but in the process a new one appears for a short period.
  • Return of old symptoms – your existing symptoms improve but in the process, old symptoms from the past return for a short period.
  • A surrogate discharge or eruption appears for a short time.
  • Absolutely nothing happens.

What do they mean? Plenty to a homeopath! Each response reveals whether or not the correct remedy has been prescribed and provides valuable information your homeopath will use to adjust your treatment and help return you to health.

Ok, so your symptoms can go away, get worse, be replaced by new ones, or not change in any way, and all of these are ok! In fact, for all of these responses, except new symptoms and no change, the homeopaths conclude that the correct remedy was applied. And it may have been the correct remedy even if nothing changes at all, but you might simply be “insensitive” to it. But no matter what happens, nothing is ever a sign of failure, since we know,

Homeopathy is an amazing system of medicine with all the necessary checks and balances to guide both patient and practitioner on their journey to improved health. Used with skill and wisdom, it triggers deep healing, strengthens vitality, creates immunity, and improves resistance to future disease. It is God’s gift to a suffering humanity, waiting for us to take advantage of it.

 

Posted in Homeopathy, Humor | 7 Comments

Raw Pet Diets Often Contaminated with Dangerous Bacteria: Campylobacter

Posted on December 6, 2011 by skeptvet

I have written previously about the issue of raw pet food diets, pointing out the lack of any significant evidence to support claims that these diets are beneficial for pets the many risks such diets can pose, such as nutritional inadequacy, and the exposure of both pets and their owners to disease-causing organisms such as Salmonella and E. coli. A new study adds an important potential concern to this list of risks.

Acke, E. Midwinter, J. Collins-Emerson, J. French, N. Campylobacter species and multilocus sequence types from commercial raw meat diets for pets. Abstract, 2011 Congress of the European College of Veterinary Internal Medicine. J Vet Int Med 2011;25(6):1496.

Campylobacter is a significant cause of foodborne illness in humans, and it is most commonly acquired from undercooked meat and poultry. Pets can be infected with Campylobacter and can be source of infection for people.

The authors tested 50 samples of raw meat pet diets acquired from supermarkets and pet stores in New Zealand for the presence of Campylobacter. Twenty of these diets (42%) tested positive for Campylobacter, and over half of the bacteria identified were the type most commonly associated with illness in humans.

While bacterial contamination is a potential risk for any food with animal ingredients, the risk is considerably higher if these ingredients are not cooked. And while cases of human illness associated with raw pet diet do not appear to be common, such illnesses can be very serious. Given that there are no established benefits to feeding raw meat diets to our pets, it is difficult to justify such risks.

Posted in Nutrition | 7 Comments

Burzynski Cancer Clinic Update

Posted on November 30, 2011 by skeptvet

Per the ever informative Orac at Respectful Insolence, the Burzynski Cancer Clinic has backed down—well, sort of. The clinic has apparently fired Marc Stephens and disavowed his specific threats against Andy Lewis, but it has reaffirmed that the original post at issue was inaccurate and that the clinic’s lawyers will be contacting the bloggers involved.

The press release also asserted that there is, in fact, scientific evidence to support the benefit of the therapy they employ. The list of evidence provided consists mostly of unpublished abstracts, case reports, and other sources at fairly high risk for bias. Orac has promised to review these and see if there is any substance to them, and I will keep an eye out for that analysis. So far, it looks like the Streisand Effect has at least partially done its job in forcing the clinic to throw Marc Stephens under the bus for his outrageous behavior, but the threat of litigation is still there so the organization bears watching.

Here is the text of the clinic’s press release as posted on Respectfl Insolence:

The Burzynski Clinic is issuing the following public statement regarding recent internet activity between U.K. bloggers who have provided inaccurate information regarding the Clinic and Marc Stephens.

Marc Stephens was recently hired by the Burzynski Clinic as an independent contractor to provide web optimization services and to attempt to stop the dissemination of false and inaccurate information concerning Dr. Burzynski and the Clinic.

We understand that Marc Stephens sent a google map picture of a blogger’s house to the blogger and made personal comments to bloggers. Dr. Burzynski and the Clinic feel that such actions were not appropriate. Dr. Buzynski and the Burzynski Clinic apologize for these comments. Marc Stephens no longer has a professional relationship with the Burzynski Clinic.

These bloggers will be contacted by attorneys representing the Clinic informing them of the specific factual statements contained in these blogs which the Clinic believes are false and defamatory, including the following

A. Antineoplastons are made from urine. False – Antineoplastons are synthesized from chemicals

B. That Dr. Burzynski falsely claims to have a PhD. – False. In fact, Dr. Burzynski has a Ph.D. from the Medical Academy of Lublin and a copy of an official affadavit will be put up at the Burzynski Clinic website (www.cancermed.com).

C. There are no scientific studies supporting antineoplaston treatment since 2006. False – below is alist of publications and abstracts providing the results of the FDA-approved clinical trials since 2006 which demonstrate the treatment’s efficacy on a wide variety of brain tumors.

U.K. bloggers made factual misstatements about the clinic as a response to a funding campaign relating to a U.K. patient named Laura Hyman who was diagnosed with glioblastoma multiforme, a deadly form of cancer. She commenced treatment at the Clinic in August 2011. We are happy to report that Laura is doing well on antineoplaston treatment and that her tumor is shrinking. Her personal blog about her treatment by the Burzynski Clinic is at www.hopeforlaura.com.

Eleven (11) phase II FDA-approved clinical trials using antineoplastons for various forms of brain tumors have been completed. Based on the positive results the FDA has granted permission to undertake phase III clinical trials. The results fo these trials are detailed in the Burzynski Research Institute’s SEC (Securities and Exchange Commission) filings available at (http://finance.yahoo.com/q/sec?s=bzyr.ob)

Contact: Renee Trimble, Director of Public Relations

Reneetrimble@burzynskiclinic.com

 

Posted in Law, Regulation, and Politics | 2 Comments

Hit a Nerve: Dr. Andrew Jones’ Followers Attack

Posted on November 29, 2011 by skeptvet

In early 2010, I wrote a post listing warning signs of quack therapies, and in this post I made brief reference to Dr. Andrew Jones, who has created a successful business marketing books, DVDs, newsletters and other sources of “secret” wisdom about animal health that less enlightened veterinarians don’t want clients to know about. Then in November of last year, I reported that Dr. Jones had been repeatedly sanctioned and fined by the veterinary licensing authorities in British Colombia for unethical and illegal marketing activities. On several occasions he acknowledged these violations in writing and vowed to comply with the authorities’ guidelines, but he repeatedly violated these promises. Eventually, Dr. Jones gave up his veterinary license so that he could continue his aggressive marketing business without being restricted by the rules other veterinarians must follow.

Like many alternative medicine practitioners, Dr. Jones offers advice that ranges from routine and well-accepted principles of well-care and nutrition, which all veterinarians offer their clients despite his claims that his insights are somehow special secrets the veterinary profession wishes to suppress, to unproven assertions about benefits from untested therapies (such as herbal remedies), to outright quackery such as homeopathy.

Dr. Jones recently Googled himself and found my article, and while none of the information can possibly be a surprise to him, it apparently hit a nerve. Not surprisingly, he made no effort at all to provide a factual defense of the “secret” remedies he recommends or any justification for his behavior. Instead, he simply rehashes the irrelevant issue of anonymity, which I have addressed in detail before. Here’s his response.

It appears that Dr Skeptvet, if this person really is a veterinarian, has a strong dislike of me.

We are all entitled to our opinions, but when they become public on the internet, I feel that the author should be public.

So this is an entire blog dedicated to bashing and discrediting alternative veterinary medicine, yet the author is anonymous.

Hmmm

I could have started my Internet business anonymously, and never had to deal with all of the ‘challenges’…in fact I would likely then still be practicing.

But that goes against all I believe in…

You have always known who I am, what I do, and even where I live

I have been very transparent and truthful.

Do you have to agree with me?

No

Do you have to buy anything from me?

No

But do I at least have ‘the balls’ to put myself out there?

Yes

Best Wishes,

Dr Andrew Jones, DVM

P.S. Ultimately it comes down to results..not what is said on the internet, but whether or not some of what I discuss actually helps dogs and cats.

My book, Veterinary Secrets Revealed literally has over 1000 testimonials from ‘real’ dog and cat owners.

So what does this boil down to?

1. Since he cannot begin to imagine why I,  the British Columbia Veterinary Medical Association (BCVMA) for that matter, would disagree with what he does, the only motive must be personal dislike for him.

2. He is a brave man for publically selling unproven or even clearly bogus therapies under his own name, and internet anonymity is far worse than selling therapies that don’t work or branding the rest of the veterinary profession as greedy tools of Big Pharma who want to deny their patients access to his treatments.

3. He can provide testimonials that claim his treatments work, so they must actually work and science is irrelevant.

Despite the fact that facts are of no interest to Dr. Jones, including the fact that he has been repeatedly judged guilty of violating the law and of reneging on promises to abide by the rules governing veterinary licensure in his country, he is still required to put his personal version of the Quack Miranda Warning.

DISCLAIMER: This information is for educational
 purposes only and is not intended to replace the
 advice of your own veterinarian. Dr Andrew Jones
 resigned from the College of Veterinarians of
 B.C. effective December 1 2010, meaning he
 cannot answer specific questions about your
 pet’s medical issues or make specific medical
 recommendations for your pet.

There is no question that Dr. Jones has a loyal following, which resembles a personality cult in its expressions of blind loyalty and vicious condemnation of anyone with the temerity to doubt their leader. Here are some of the comments made on Dr. Jones’ site and here by his defenders.

I’m not thrilled about vets but I trust you implicitly. You are definitely a doctor of good practices, no matter if you have a license or not.

You run into “JERKS” every where you go.
 Seems to me you ran into one more in your life to add to your list.
 

This idiot must not have much to do, or the jam to say who he is.
 That makes him a weak minded, useless piece of dog poop!

As a life long animal lover I have met many vets and only trusted 3 of them. I have never met you, but I would have loved to have you as my pets Doctor!

What a spineless excuse for a human being. This person thinks people will believe these lies about you.
 

I’m am truly sorry for the outright lying that is being put on the internet.
 I for one believe in who you are as a person and secondly how you treat animals is nothing but exceptional. It’s too bad your home doesn’t give you the respect you deserve and have earned.

every individual that challenged the establishment through history has been ousted by the establishment…Dr Merkola is in the same boat, as well as Dr Weil, and so many others( for humans)… As you know, the attacks come out of fear and ignorance- nothing more..

This sceptivet sounds suspiciously like another site run by an individual calling themselves ‘scepticat’ or ‘sceptikat’- a highly volatile dictatorial site run by a wannabe megalomaniac. A truly disturbed person with a anger management issue venting via their little site to their own personal herd of sycophants. I would dismiss them like a fly on your arm. Just troubled souls with no purpose.

Just another stooge for corporate interests such as big pharma

I cannot believe what this idiot has put up on the internet and I would do my best to shut him down.

I really find your blog quite upsetting…Why you have to be so anti is very unfair, and abhorrent. More like large companies likely to lose revenue pulling strings on the veterinary regulatory body .. There is no profit in healthy animals…

Jehovah created all of the real foods & spices for treating specific diseases. It is admirable that some vets as well as medical doctors are returning to the idea that real foods & spices are an alternative to the poisons that big pharmaceuticals invented to increase their profits and destroy their customers.

You are a lying scumbag…… eat dog shit and die !!!! you evil money monger !!!!

These comments all share the usual characteristics of blind faith in alternative therapies and distrust of scientific medicine.

1. Personal loyalty to individual authority figures and personal attacks on critics, with no reference to facts, evidence, or any substantive argument about ideas.

2. A refusal to even consider any criticism or contradictory evidence as valid in any way.

3. A reflexive and automatic assumption that any criticism must be motivated by personal antipathy, greed, fear, psychological disturbance, or anything other than a reasoned, thoughtful consideration of the evidence leading to a conclusion that their ideas are wrong.

4. Dismissal of the entirety of scientific medicine and all its accomplishments as meaningless fictions generated by the evil pharmaceutical industry or some other bogeyman.

There isn’t much use in responding to such vacuous and personal attacks since there is no indication that any of these folks have any interest in reasoned arguments or scientific evidence. How exactly I could be “lying” when all I did was repeat the coclusions of the BCVMA reports (many of which Dr. Jones acknowledged as truthful in writing) is a bit of a mystery. As far as the issue of anonymity, the mindless personal comments of Dr. Jones and his followers do more than I could to explain why one might blog under a pseudonym, but I’ll just repeat what I’ve said before on the subject in the FAQ for this blog:

Who are you and why don’t you blog under your real name?

It doesn’t matter who I am. My ideas and arguments should be judged on their own strengths and weaknesses, not on the basis of whatever prejudices you may have about me as a person. Am I more likely to be right if I am a woman or a man? Does my analysis of scientific research suddenly become more or less accurate if you discover where I went to school, where I practice, or what color I am? These are irrelevant facts that people use to distract from the points I make rather than deal with them directly. I choose to blog under a pseudonym primarily so that the focus remains on the issues, ideas, and facts under discussion, not on irrelevant personal details about me.

I also choose to blog as the SkeptVet because it makes it a little easier to write about individual patients and questions that my clients ask me while still protecting their privacy. This blog grew out of my efforts to become better informed about alternative medicine and to respond thoughtfully and accurately to my clients’ questions. My clients certainly know my views on the subjects I discuss here because these discussions are simply a part of my ongoing effort to provide my clients, and the public in general, with scientific, evidence-based information. I often refer existing and potential clients to my website, so there is no question of my hiding this information from them.

I have no particular desire for attention or notoriety, but I am certainly willing to take responsibility for the statements I make here. While it is (barely) possible to blog completely anonymously, it requires a great deal of effort, and I have not made that effort (though given the amount of angry, even hysterical hate mail I get, I sometimes wish I had). It is relatively easy to discover my identity. But before you try, ask yourself if it is really relevant to the merits of my argument, or if it is just going to make it easier to dismiss what I say by applying your pre-existing biases and prejudices to me.

As for other accusations, I will repeat that unlike Dr. Jones my Internet presence is entirely non-commercial. I write these articles in my free time to provide a counterweight to the almost universally commercial sources of information on the Internet so that pet owners can have all the facts and arguments to consider when making decisions. I make no money from these efforts, and I lose no money to Dr. Jones or anyone else because they choose to sell therapies that I choose not to employ because they lack convincing evidence of safety and/or efficacy. Despite the vacuous personal abuse I receive as a result, I feel people have a right to an independent source of information and criticism of unproven or quack methods.

The timing of this outburst is particularly interesting, coinciding as it does with the recent attempts by the Burzynski Cancer Clinic to threaten and intimidate critics and to respond to criticism with empty vituperation rather than logic and facts. Such responses resemble the reaction of religious fundamentalists to criticism of their beliefs, which only highlights the ultimately faith-based nature of much belief in alternative medicine, which is impervious to any rational argument or discussion. Fortunately, most pet owners, and even many proponents of alternative veterinary medicine, are far more reasonable and open to substantive debate than these folks appear to be, and so these alternative methods will still have to prove themselves to the majority on the basis of real scientific evidence, not just the passionate faith of their adherents.

 

Posted in General | 24 Comments

Burzynski Clinic Attack Dog Marc Stephens Continues Bizarre Threatening Tirade Against Skeptical Bloggers

Posted on November 28, 2011 by skeptvet

The initial threats of litigation against Andy Lewis at the Quackometer, for his critical essay concerning the questionable therapies and ethical practices of the Burzynski Cancer Clinic, have been superseded by a bizarre rant against a multitude of skeptical bloggers, complete with pictures!

Orac at Respectful Insolence has reposted the attack for all to see, but here’s a sample:

Andy Lewis,  Just so you know that I am very serious.  I copied Renee Trimble the Director of Public Relations, and Azad Rastegar the spokesperson for the Burzynski Clinic.  You and your supporters can stop asking if I am an attorney.  Again, I represent the Burzynski Clinic, Burzynski Research Institute, and Dr. Stanislaw Burzynski.  If your articles remain online I will pursue you in court to the highest extent of the law…

You are apart of a network started by Michael Shermer called “Skeptic Society”–http://www.skeptic.com/, which is a nonprofit 501(c)(3) educational organization that examines….alien abductions”.  Your network is linked to other fraudulent websites and individuals, such as, quackwatch.com, ratbags.com, the21stfloor, Peter Bowditch, Rhys Morgan, Stephen Barrett, Dr. Saul Green, etc…

Your Skeptic network uses the quackwatch.com website as the Bible to your mission of lying to the public.  You are not posting your “opinion” and “concern for public health”, you and your network are posting malicious propaganda against my client which stretches back over 10 years…

If your articles remain online I will pursue you in court to the highest extent of the law.

Threats to your family? You mentioned to me that you just had a child.  I advised you to spend more time with your child instead of lying to the public.  I also advised that you will be affected financially once a lawsuit is filed against you. Why would you be so selfish and inconsiderate to your family to go through the stressful and financial burden of multiple court proceedings knowing that you are posting lies and propaganda?

It would be easy to dismiss this guy as a hysterical loon, despite his attempts to intimidate people exercising their right to free speech and providing the public with the information they deserve when asked to spend large sums of money on dubious therapies. But it is doubly conccerning that the Burzynski Clinic itself has not yet made any effort to distance itself from this individual or these tactics. Is this the response of a legitimate scientist or a legitimate healthcare facility?

A detailed discussion of the Dr. Burzynski and his controversial, and unproven aproach to cancer treatment has also been posted on Science-Based Medicine.

Posted in Law, Regulation, and Politics | 1 Comment

Veterinary News Network (VNN) Video Discussing Raw Pet Diets

Posted on November 24, 2011 by skeptvet

Here is a brief video discussing the topic of raw diets for pets. It is nicely produced

 

 

 

Posted in Nutrition | 7 Comments

Burzynski Cancer Clinic Threatens Critical Blogger with legal Action

Posted on November 24, 2011 by skeptvet

Some of you may remember when I was obliquely threatened with litigation for posting a detailed critique of a talk given by Dr. Shelley Epstein on the scientific evidence for homeopathy. And certainly most of you will know about the British Chiropractic Association libel suit against scientist and author Simon Singh attempting to stifle his public criticism of treatment claims made by the BCA, and the legal troubles faced by Dr. Stephen Barrett of Quackwatch. CAM advocates are notorious for resorting to litigation when unable to defend their claims and practices with scientific evidence.

Fortunately, the lack of factual evidence demonstrating the truth of these claims and, in the United States at least, the principles of Free Speech and Freedom of the Press, generally prevent such attempts at censorship-by-lawsuit from succeeding. It is important, however, that those of us dedicated to defending science and challenging unproven or bogus medical claims expose such transparent efforts to silence criticism of quackery.

The well-known blog the Quackometer recently wrote an expose of the Burzynski Clinic, an operation in Texas which takes large sums of money from desperate people with cancer to provide them with an untested alternative treatment. The clinic, and the “lone genius” behind it, Dr. Stanislaw Burzynski, have responded by threatening the author of the Quackometer expose. I am joining other science-based medicine blogs in publicizing this attempt to silence substantive criticism with litigious bluster rather than facts and logic because I recognize the real danger such threats present to free speech, journalistic freedom, and the kind of vigorous debate necessary to separate good ideas from bad ones in medicine. I encourage others concerned about open scientific debate and the rights of journalists to investigate and expose dubious medical practices to spread the word about this attempt to intimidate critics and suppress debate.

 

Posted in Law, Regulation, and Politics | 1 Comment