Eds Guide to Alternative Therapies

Beta-mannan to reverse dysplasia of the cervix

Anti-Malignin antibody test for cancer

Colonic irrigation for autointoxication

Cranberry juice for bladder infections

Herxheimer reaction (Jansch-Herxheimer)

Salivary gland crystallization testing

Selenium and Vitamin E for Osgood-Schlatters

Ozone therapy (selected applications)

Vegan diet to prevent cancer(goes to another page)

Vitex (Chasteberry) for premenstrual syndrome

Venous angioplasty for multiple sclerosis

Yohimbine for erectile / ejaculatory dysfunction

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This page was last modified August 23, 2011.

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Im a board-certified anatomic and clinical pathologist and operator of the largest one-person medical information site on the web. As a pathologist, its my job (among others) to examine tissue, tell whats the matter, and predict the behavior of the disease and response to therapy. Like most other pathologists, Im extremely successful at this. Like most other pathologists, I take a lot of pride in this. (Call us arrogant if you like. I am an honest physician who engages in public debates. When I catch somebody deliberately deceiving the public, they never defend their cases on the facts, but almost always call me arrogant or elitist and claim I am secretly in the pay of the wicked pharmaceutical companies.) And if I screw up even once, Im in MAJOR trouble.

Unlike many M.D.s, Im open-minded about whats known as alternative medicine, i.e., therapies that are not recognized by mainstream medicine.During the 1980s, I reviewed alternative medicine and found there was little to recommend. As the alternative medical community has responded to pressure to defend its claims by the usual methods of science, some areas have improved.

This site aims to let the public know what empirical evidence is available for various alternative remedies, especially studies published in refereed journals. This will enable people who must make decisions to rely on more than anecdotes and advertising.

This site will always be under intensive construction. Only a fool pretends to know everything. I cannot buy or read a book, but I am interested in your personal experiences (anecdotes), and especially in real work by real scientists (i.e., people taking serious precautions against self-deception.) Unless you specify otherwise, Ill feel free to quote you.

I would be remiss without placing links toQuackwatch. The fact that I am less likely than some members to dismiss alternative claims out-of-hand probably reflects our differing life experience. Remember there are plenty of bad doctors in both mainstream medicine and alternative medicine.

Heres the ranking system that this site will use:

The remedy has a plausable mechanism and has been given some basic tests, and/or has solidly passed two good, clear, controlled studies

The remedy makes sense pathophysiologically, and there is at least impressive anecdotal evidence

The anecdotal evidence seemed interesting to me, but thats all there was.

I can see why somebody might have thought of this. But if this actually works better than a placebo and a little human kindness, we are all going to have to make some major readjustments in how we think about health and disease. Dont spend too much money, or get your hopes up.

Boldindicates the remedy has passed a controlled, reasonable-sounding study for this use.Underliningmeans it failed. Claims that lack substantial testing are unmarked.

Here are some things that are NOT alternative medicine.

Taking time with patients, getting to know them, communicating with them, showing some (real or pretended) interest, and being polite. The less that scientific physicians do this, the more we push patients toward the sweet-talking bunko artists.

Being aware of iatrogenic disease, which is inevitable nowadays. Today we have powerful surgical and pharmacological interventions. Surgery is surgery, and all effective drugs except the vitamins and hormones are at least semi-poisons. Hippocrates had no specific therapy for any specific disease. No longer can his dictim, First Do No Harm, be anything more than our wish for the distant future.

Being angry about the mainstream health-care systemand its wanton misuse to maximize personal or corporate gain in a system filled with perverse incentives for everyone involved. You should hear how we autopsy pathologists talk among ourselves after-hours.

I teach my students to treat patients holistically. Ask one of them whether Ive been successful.

Heres how to evaluate an alternative claim.The key is finding out whether anyone has tested the claim using controls.

For example, if you want to know what effect shark cartilage by mouth has on tumors in rats, you need to give some cancer-ridden rats cartilage tablets, and other cancer-ridden rats tablets that look the same but that do not contain cartilage or any other ingredient that is likely to be active (placebo). You have somebody else decide which rats get which tablets, by flipping a coin. When youve examined the rats (how long did they live, or what did the tumors look like at biopsy/autopsy, or whatever), describe each one. Only then do you, yourself, find which rat was in which group. If shark cartilage really works, the treated rats will live longer and/or be distinguishable in some other way from the sham-treated (control) rats.

People who believe their own claims will make every effort to do controlled studies.If their therapy works, it should pass some controlled study sooner or later. If positive results are obtained, some other scientist will always try to duplicate the work. If this succeeds, the claim is reproduced, and you can present a truthful, honest claim to the public.People who dont believe their own claims will start complaining about lack of funding, the Heisenberg uncertainty principle, placebos are valuable and ethical too, politics in science, social causation, you create your own reality, Thomas Kuhn, closed-minded medical establishment, persecuted geniuses, we will NEVER treat individual whole-persons as statistics, etc., etc.

Another very popular claim by charlatans, who admit they have no placebo-controlled studies, is to observe that the vast majority of todays therapies have not been placebo-controlled. These people either dont understand or are lying about the central model of a modern medical study –clinical equipoise. The control group isnt people receiving no treatment. It is people receiving the most popular standard treatment. To be ethical, there must also be a reason to think the treatment will be superior.

The Beautiful Truth / Dying to have known: In Max Gersons era, no child was ever cured of leukemia. To demand that in 2009 we randomize children with leukemia between the modern therapy that cures that vast majority, and a treatment group getting only a magic raw-liver-and-vegetable-based diet and coffee enemas, without even an animal model, would be a crime against humanity. Go ahead and call me an unspiritual corrupt brainwashed bigot if you want — Ive stopped answering my crank mail.

When lives are at stake, I dont think asking for a controlled study is asking too much. Do you?

If there are published, controlled studies, find out what they showed.

If the statistical effect is pronounced and reproducible, you can be confident we have something real. If it is not reproduced, there may have been some intentional or unintentional bias in the original lab.

CAUTION: As charlatans become more sophisticated, you occasionally find books that list refereed journal publications by the dozen. For example, somebody promoting oral superoxide dismutase to prevent aging will cite references to the substances activities in the body, the harmful effects of free radicals, and so forth. This is the old salesmans technique of telling a bunch of truths, so you wont notice the lies… (1) Superoxide dismutase isnt going to make it from your stomach into your cells, but will be destroyed; (2) free radicals may contribute to degenerative disease, but they do not cause aging; (3) animals that produce huge amounts of superoxide dismutase age as fast as others. If youre in doubt, feel free to phone the authors of the papers that are cited in the dubious book… Ive done so occasionally, and they have been VERY unhappy to learn that…

If there are NOT published, controlled studies, ask Why not?

Possibility 1: There is no reason to think it works.Either the therapymakes no sense biologically, or itfailed a pilot study(i.e., a tiny, no-cost study that a high-school kid could do as a science project), or the remedy is promoted byan individual who has failed to present a pilot study.

Possibility 2: Everybody knows it works.Id like to illustrate this with an example. I like working out, and in the late 1980s, I obtained an EMS unit that Id heard could accelerate my muscle growth. The anti-quackery literature listed this as fraudulent, but it made sense biologically, and I decided to do a pilot study, using the EMS unit only on the right side of my body. The end-point would be three people telling me (without my asking) that I was asymmetric. This took about a month. I decided to report my study in a letter to the JAMA, but first I went again to the refereed literature and I discovered an article that described EMS as generally known to be effective in accelerating muscle hypertrophy.

Possibility 3: Nobody stands to make a buck. Nowadays I really doubt it. The unpatentable alternative remedies that obviously work (melatonin, DHEA, creatine, St. Johns wort, strontium for osteoporosis) are widely marketed, presumably for just a modest profit.

In addition, ask whether the therapy makes sense

Scientific knowledge is always tentative (and thankfully, science is self-correcting in the long run.) But our current thinking about how the body works has shown great predictive power, not the least in my own success in predicting the course of disease from looking at tissue sections.

Any proposed mechanism of action can be wrong.For example, I was taught totally-wrong mechanisms of action for bismuth anti-ulcer remedies, dandruff shapoos, nitroglycerine for angina, and nitroprusside for hypertension. (I congratulate myself for having been skeptical as a student.) So if a proposed mechanism for an alternative remedy sounds wrong or even silly, dont dismiss the remedy out-of-hand.

Be skeptical about remedies that cannot work by any means presently known to science or religion.Im open to the reality of the supernatural — in fact, as a Christian, Im committed to it (though not necessarily to the effectiveness of intercessory prayer or laying-on-of-hands.) Enough of this for now.

I am not going to consideralternative systems of diagnosis. As a pathologist, I remain open-minded on the subject. If you know of any that show predictive value (i.e., you can predict which people in the community will and will not come down with XYZ better than I can), please let me know.

The fruit of the acai palm tree, which like everything else contains some biologically active molecules, was presented as a multi-level marketing scheme in 2004. Claims included weight loss and cleansing. The shady work of the marketers is now history, as is Oprahs successful lawsuit against them. A pilot study of acai for weight loss was a miserable and total failure (Nutr. J.10: 45, 2011). At least the juice seems not to be toxic or carcinogenic (Toxicology278: 46, 2010. There junk journal claims (adding it to cigarets prevents emphysma in mice), etc., etc.

Many people who have experienced acupuncture treatment believe that it caused physiologic changes beyond just suggestion and relaxation. As acupuncture moves from folk medicine into real scientific therapeutics, physicians will insist on sorting out the placebo effect and the cultural overlay.

Acupuncture appears to have effects on neurally-mediated reflexes. Because the reflexes are so subtle, studies will remain empirical for a long time to come. Positive studies will need to be replicated, especially since the strong feelings that some people have in favor of acupuncture may introduce bias. This will probably happen soon, but to date, there are no findings of effectiveness (i.e., this particular acupuncture procedure works in this particular situation) that are robust after being replicated in several different series.

Serious studies of whether traditional acupuncture is actually more effective than placebo now use sham acupuncture as the control. In sham acupuncture, the operator deliberately needles the wrong points. This isnt double-blind, but its a start. There are positive results (i.e., real acupuncture is significantly more effective than sham acupuncture) for nausea and vomiting after gynecologic surgery (weak), epicondylitis, anxiety in the emergency pre-hospital care setting, and even parental anxiety during anesthesia induction in a child. In one study of nausea and vomiting after tonsillectomy, the control group did better and the sham group did worse than those not treated at all.

In a few instances, acupuncture has proved superior to a standard medication. One example is an electrical technique for post-operative nausea and vomiting after cosmetic surgery. In another instance, stimulation of a particular needle-point proved as effective as a standard anti-emetic for post-operative nausea and vomiting in children. Another study obtained a similar result for children undergoing anesthesia in the dentists office.

In the anesthetized patient, the placebo phenomenon is less likely to be operating. Electro-acupuncture is now widely used in Europe to reduce the need for anesthetic agents, and the effect was strongly significant in a US double-blind study.

There are also numerous negative studies, in which particular techniques applied to particular clinical problems showed no significant effect. This is in spite of the fact that acupuncture proponents might be reluctant to share a negative study. An electrical technique failed for low back pain. Another electrical technique failed to reduce the need for anesthetics. A major study showed no effect for asthma. Urologists were unable to obtain any benefits by needling the kidney-ureter-bladder meridian. Minute sphere acupuncture failed to help postoperative pain or morphine use. Despite an apparent effect in one study of e addicts, acupuncture did not outperform relaxation or sham treatment for e addiction in a second study. Unlike some other complementary therapies, acupuncture did not show an effect in a major study of chronic low back pain. Although two non-blinded studies of acupuncture for tinnitus suggested an effect, four blinded ones showed no significant effect.

Some large studies have actually not included a sham-acupuncture group when it would be easy to do so. These do help make it clear that acupuncture is relatively safe. Recent studies without a sham control but with positive results compared to no-acupuncture include one for low back pain in the elderly, another for nausea and vomiting during cyclophosphamide infusion for rheumatic disease, another for wheelchair-users shoulder, another for childhood constipation, and another for labor pain. Two British studies found that a trip to the acupuncturist gave good results for chronic headache patients at relatively low cost to the health care system. The question was, Is this worth the money? rather than Is this anything more than a placebo? The authors characterized their own approach as pragmatic. In turn, there are ethical questions involved in placebo treatment, even to make people feel good.

Some studies of electroacupuncture claiming to show a benefit (i.e., for low back pain, nausea and vomiting of pregnancy, nausea and vomiting of myeloablative chemotherapy) have used as controls a non-electrical apparatus, which is not really blinding.

Physiologists are starting to characterize the reflexes involved in needle insertion. One surprising finding, awaiting confirmation, is the induction of mirror-image electrical activity when a myofascial trigger point is stimulated. Controlled studies showing no clinical benefit (for example, post-stroke leg spasticity) still showed curious reflex effects from treatment. Animals have reflexes in response to acupuncture treatment that may be abolished by certain medications.

Despite the training they receive, several acupuncturists examining the same patient are likely to recommend widely different needle placements. This was demonstrated in a test using a low-back- pain patient, and perhaps this is no different from other physicians. Practice is likely to become more standardized as the scientific work continues. Acupuncturists will need to decide how much to retain of the cultural trappings and imaginative physiology. We can expect that most will regard the theory as something to be treasured as a bygone ages attempt to understand the riddles of the body. Instead, its practitioners will recognize that the effects are really mediated by subtle reflexes that are not fundamentally unlike the other processes by which the body maintains its health.

Acupuncture seems to be safe overall. One acupuncturist perforated the right ventricle of the heart causing hemopericardium, and there have been several instances of pneumothorax. I have been pleasantly surprised with how few other complications have been reported during the last few years. My friends in oriental medicine asked me to mention that its now standard to use single-use, presterilized, disposable needles.

The anti-malarial drug artemisinin and its relatives are being promoted by the alternative-medicine community for cancer in general. There is some interest in their possible anti-cancer properties, and a few decent papers, mostly focusing on which patterns of gene expression predict that the drug will kill cells in tissue culture (Pharmacogenetics Journal6: 269, 2006). Theyre well-known to do this, because they are poisons, and the fact that they kill cancer cells (J. Med. Chem.49: 2731, 2006, from the Hop) should come as no surprise. Especially, they may have activity as angiogenesis blockers.

The foremost proponent in the US seems to be Dr. Henry Lai, whose professional degree is in psychology and who teaches in the department of bioengineering at U. Wash. His focus on the effects of non-ionizing fields on humans seems to have led him into fringe medicine, and he has been writing papers about artemisinin as an anti-cancer agent since 1995. He notes that breast cancer cells reportedly (a few old papers in obscure journals) tend to have more surface transferrin (iron-binder) than their benign counterparts. So artemisinin (which generates toxic free radicals when exposed to iron) could induce apoptosis selectively in breast cancer. He managed to demonstrate this effect in a culture of breast cancer cells awash in iron-binder (Life Sciences70: 49, 2001). Artemisinin alone was a dismal failure. At least hes honest. It sounds to me as if the breast cancer cells simply were more adherent for the iron-binder; the experiment does not support the claim that they have greatly increased transferrin surface levels. However, around this time, Dr. Lai speculated about how one could saturate the allegedly-increased transferrin molecules with enough iron, not mentioning that flooding the body with iron is itself dangerous. The iron-bearing pigment that accumulates in malaria is orders-of-magnitude richer in iron than one could possibly accumulate simply from having extra surface transferrin. (At least, both are ferric.)

Readers should know that there are no reports to date (despite ten years of interest, especially by Dr. Lai) of artemisinin inducing even a partial remission of any cancer in any animal system. The claim that there are 350 papers showing an effect on cancer is just another lie. The 88 that I found were mostly cell-culture studies without benign cells as controls. Conspiracy buffs who assume that the drug companies have shunned artemisinin since its a naturally-occurring substance and therefore less profitable should note that taxol (a similar case) became part of mainstream breast cancer therapy as soon as it proved to work.

There just might be an effect. Dr. Lai actually got a chance to try it as a breast cancer preventative in mice in 2006 (Cancer Letters231: 43, 2006). This was the only in vivo study I could find. He claimed an effect with p336: 1328, 1997). Thankfully, her illness subsided when her artemisinin was discontinued. Cause and effect? We cant prove it, but its worrisome.

If you want to try artermisinin for cancer prevention or treatment, its your decision.

UPDATE: 2011. The discussion continues. A correspondent who believes herself to have been cured of breast cancer entirely by artemisinin brought to my attention a very lively ongoing discussion as to whether the substance produces neurotoxicity (see Clin. Inf. Dis.43: 1618, 2006.) This actually does not reference the index case. Dr. Lai continues to publish both on animals and cell culture and has findings that are interesting. There are still no reports of cancer regression in an animal system, but Cancer Letters231: 43, 2006 (which is an elite journal) published the results of a model in which the treated animals got fewer / smaller tumors after treatment with a carcinogen (anti-cancer effect, altered carcinogen metabolism, or someting else?) Im going to stand by my statement, There just might be an effect, and wait with hope for the success of i, an investigator who is obviously a sincere and decent person.

Beta-mannan to reverse dysplasia of the cervix

Beta-mannans are presently being promoted by one individual as able to reverse most cases of dysplasia (pre-cancer) of the cervix. The principal promoter bases his claim on anecdotal evidence, but does claim 95% success.

Mannans are found in tomatoes and may have something to do with their empirical link to a lower rate of some cancers. They may prevent some of the mutations that accumulate to cause cancers. Its harder to see how they would reverse the mutations once they have happened. (Thatd be like reversing loss of virginity.) The promoter claims instead that beta-mannan stimulates the immune system, which is weak in Americans because of our alleged poor diet and smoking habits.

To his credit, the principal proponent has a side-note that urges women with frank cancer to get the required surgery.

People considering this complementary remedy need to know the facts.

The website list of the authors publications does not list a single publication in a refereed scientific journal. It lists only the Phantom Notes.

I searched the medical literature database from the NIH and there is exactly nothing to support the claim from ANY author, not even in the junk journals.

The authors page about Medical Opinions about Beta-Mannan does not even have anecdotal support from another physician, and admits there is exactly nothing published in the scientific literature to support his claim. For this reason, he compares himself to Alexander Fleming, who discovered penicillin about a decade before it came into widespread use.

Until I see a publication, Ill reserve final judgement. But Im very much afraid this one wont work out.

The principal promoter of this complementary remedy is none other than the author of the old Phantom Notes, which I found very helpful when I was on my surgery rotation. They were a superb resource; curiously, we had to send away for them and get them delived to us by mail. A few months later, a sheaf of Bible Prophecy stuff that proved the truth of the Christian religion was mailed to our PO boxes from The Phantom. My Jewish friends especially did not appreciate this. Bible Prophecy still appears on the beta mannan for cervical dysplasia site. Again, youll need to draw your own conclusions. In September 2003, a correspondent shared with me the court decision in a lawsuit against Dr. _______ for plagairism in connection with the Phantom notes. The judge had some very harsh things to say about him even back in the 1970s.

Anti-Malignin Antibody Test for Cancer

See mynotes. This allegedly is an extremely sensitive and specific way of determining whether cancer is present in the body, and its proponents talk about its making pap smears, mammograms, and so forth obsolete. But after more than 20 years, only the original discoverer has described this substance as really existing. In a short (unrefereed) letter in Lancet announcing that his serum stains three different kinds of cancer cells, the discoverer failed to mention any control using any benign cells. (If the fundamental idea is correct, benign cells would be unstained.) Im ready to draw the obvious conclusion. To the labs credit, there is no talk of conspiracies or cover-ups or persecution.

There is presently an online promotion of a secret natural remedy for both type I and type II diabetes. Youll have to find the site yourself, but the claims are obviously bogus.

A supposed scientific article is appended to the site. It is clear that this was not accepted for publication, even by a non-refereed junk journal. For starters, the composition of the remedy is not given. Second, the authors mention at least three previous studies but do not cite references. Third, there are no controls. There are also illiterate expressions. (There is a remarkable phenotypic difference in Type 2 Diabetes. The connective importance of the genetic and environment causes of type 2 diabetes varies between people.) These people claim, in their ad, to make pancreatic islands regrow, but there are no tissue studies in the article. This is a sensational claim, and if there were any reason to think it were true, some scientific journal would have grabbed up the evidence. The shabby quality of the work is shown by the ad page, which states The clinical study further concluded, … treatment with _____ partially brought about a regenerative capability for the damaged endocrine tissues as evidenced by increased islet cell numbers and resulted in restoration of near normal architecture of pancreatic islet(sic.). Anyone who reads the fine print will see that this is simply untrue. The study cited shows nothing of the sort, but simply makes this statement about a second, unreferenced study. Even the name of the independent lab that supposedly did the tests is concealed from the reader.

If you want to send these people a few hundred dollars for their secret mix, that is your business.

Right now (2005), current articles in the genuine scientific literature on the use of natural remedies for diabetes are conspicuous by their absence. For a review of how herbalists design complementary therapy for diabetics, see Acta. Diab.41: 91, 2004. The ten most frequently suggested herbal remedies were gymnema, psyllium, funagreek, bilberry, garlic, Chinese ginseng, dandelion, burdock, prickly pear cactus, and bitter melon. The ten most frequently recommended dietary supplements were biotin, vanadium, chromium, vitamin B6, vitamin C, vitamin E, zinc, selenium, alpha-lipoic acid, and fructo-oligosaccharides. The reviewers felt some of these might help at least some. This is far from the grandiose claims made by the current promotion.

Bromelain / pineapple for goiter and so forth

Bromelain is an enzyme in pineapple that, as it happens, pathologists use in blood bank testing. In July 2010 I was alerted to promotion of magic pineapple juice, especially as a treatment for goiter (enlarged thyroid gland). This is very, very surprising. If enough bromelain were to get through your gut mucosa to have any effect, it would start by gravely altering your red cell antigens, like it does in lab.

Just to be sure, I ran a check of the NIH database that would find any study — even a mouse study in a bottom-class junk journal — on bromelain / pineapple and thyroid disease. Exactly nothing.

Various plants contain various chemicals that can enlarge thyroid glands. There may perhaps be something in some plant that has as as-yet-unknown effect on thyroid glands. The burden of proof is on the person trying to sell you the magic pineapple extract. Its your money.

If you have a goiter, the most important thing to find out is Why? Common nodular goiter often responds well to conventional treatment with thyroid supplementation. Medical disease of the thyroid is likely to kill if not diagnosed properly. And of course theres plenty of thyroid cancer. Its your life.

Follow-up: When I originally heard of the claim, I did not believe that