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Empower Health: Week 1

So last week I noticed, with more than a little consternation, that the Vancouver Sun has begun publishing a feature it calls Empower Health:

Better health is not a destination. Your health is a journey of small steps, things you can do to improve your mental and physical well-being.

Empowered Health is a new locally produced television program that shows you the path to better health with weekly tips on eating better, improving your fitness and navigating the minefield of the health care system and the dozens of complementary and alternative therapies and practices.

Those of you who don’t know much about Vancouver aside from the excellent work that the Vancouver Skeptics do here may be unaware that it is a city full of woo-woo nonsense. One can’t walk a city block without stumbling over a reflexologist or a chiropractor or some other snake-oil peddler trying to separate fools from their money. Because Vancouver has a large population of young, well-educated and upwardly mobile people, it has succumbed to the stereotypical west-coast syndrome of buying wholesale into “alternative” practices. Add to that a large immigrant population bringing practices from their countries of origin and a well-developed sense of fascination with anything “exotic”, and you have a perfect recipe for this kind of hucksterism.

Now, ordinarily the only thing I read the Sun for is local news and Canucks coverage, but I figured I wouldn’t be doing my duty as a local skeptic if I didn’t take a swing at the glass jaw they’re dangling out there. So I will try, every week, to digest the claims made in these articles.

Supplements: The tool your diet may be missing

Even if you live an active lifestyle and maintain a balanced diet, you may be missing key ingredients that keep your body healthy and prevent long-term illnesses. It’s becoming easier and easier to fill those gaps with natural health food products, or supplements.

Okay first off I have to admit that I have a strong anti-supplement bias. I’m not sure what it is about them that irk me as much as they do, but I’ve always been quite opposed to the idea of introducing food supplements as part of a regular diet. If you cannot access a variety of healthful foods, or you have some kind of medical indication that requires more than a healthy diet can provide (e.g., osteoporosis, pregnancy, menopause, anemia), then by all means use supplements.

My objection comes when people advocate the use of supplements as simply “part of a healthy lifestyle”. I think of them like I think of any other medication – you should only take it if it is needed, and you should do whatever you can to reduce your need for it as quickly as possible. This article is vague enough that it doesn’t make any specific health claims (except for plant sterols, which seems to be supported by some evidence), so it escapes the skeptical lash.

Overall rating: 3/5 – would have liked to see some discussion of how you would determine whether or not you need supplements aside from “talk to your doctor”.

Q & A: Chiropractic

Q: What are the educational and training requirements to qualify to practice? Please see this site for information regarding accreditation.
A: Chiropractic profession is only one that established international education standards which allows portability of licensure and practice.

Q: Who certifies and regulates chiropractors? Private body, provincial of federal government?
A: Regulation of health care is the exclusive authority of each provincial government. In B.C. this is done by the Ministry of Health through the Health Professions Act. For chiropractic doctors, this is known as the College of Chiropractors of BC.

So there’s only one question I care about here, and it doesn’t get asked until last:

Q: What does the scientific literature say about the effectiveness of this practice?

Of course I already know the answer – chiropractic is a system based on ridiculous and faulty premises that have been refined to the point of self-abnegation, and aside from treatment of back soreness doesn’t deliver on the vast majority of its promises. The scientific evidence is anything but encouraging about the validity of chiropractic. Let’s see what the Sun says:

A: In B.C. chiropractic was established and regulated by the B.C. government in 1934; WCB legislation, 1950; ICBC legislation, 1972; Medical Services Plan, 1965.

Now I’m sure that’s an answer to some question, but it’s certainly not an answer to this one. Any time someone ducks the ‘scientific evidence’ question like this, offering testimonials or accreditation or mechanism instead of peer-reviewed science, your skeptical hackles should be raised, and follow-up questions should be dripping from your tongue.

Overall rating: 1/5 – there was only one relevant question, and they didn’t answer it.

See her today and you’d never guess 56-year old Kathy McLaughlin ever struggled to be healthy. She eats well, hikes regularly and plays tennis two or three times a week. And yet today McLaughlin is thankful to be alive. Just after her 40th birthday, McLaughlin was diagnosed with Hodgkin’s Lymphoma. She began a treatment that included chemotherapy. Over the next couple of months she beat back the cancer.

Okay so I was prepared to hate this article and spit blue blazes about how reckless and irresponsible it is to hold up one anecdote as “health advice”. But I read this piece and there’s really not that much to object to. It’s the story of a woman who followed her doctor’s advice for the cancer, and then relied on diet and exercise to manage the side-effects of her illness and treatment:

Gunn helped McLaughlin establish an integrated health care plan designed to minimize the strain on her liver. The plan combined a gentler form of chemotherapy, vitamin D supplements, meditation, yoga, and an overhaul of her already-healthy diet.

As much as I hate the word “integrated”, which usually signifies that evidence-based medicine is being “integrated” with predatory nonsense, that doesn’t appear to be the case here. She looks as though she got sound advice about taking care of herself through lifestyle factors. The “gentler form of chemotherapy” may not have required the intervention of the “integrated medicine” specialist – chemotherapy doses are often adjusted by the prescribing oncologist if the adverse events are severe enough.

Overall rating: 4.5/5 – stays away from woo, and while it doesn’t specifically denounce woo-peddlers (and someone could misunderstand what the word “integrated” means), that is not really a reasonable criticism of an anecdote like this.

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Comments

  1. katie says

    Yeah, I loved going to undergrad in a really hippie town (yay for farmer’s markets!). But the undercurrent of woo was always painful. A local paper printed this gem: “A scientist will tell you that something organic is just something with carbon in it. We know it’s so much more”.

    And I’m with you on the supplements, but there have been a few notable exceptions based on doc’s advice. I’m not a huge proponent of vitamin D, but it does seem that an awful lot of Canadians (particularly those of colour) are deficient: http://www.cbc.ca/news/health/story/2010/03/23/vitamin-d-levels-canada.html.

  2. Bean says

    Check out the Centre for Science in the Public Interest (CSPI). They release a no-bullshite Nutrition Action newsletter that makes the same assessment about supplements. I find them pretty good at doing what they claim to do. Their articles are evidence-based and do a good job of debunking health myths about supplements, “superfoods” and foods that are supposed to have magical properties. It’s good stuff.

  3. Dianne says

    Just after her 40th birthday, McLaughlin was diagnosed with Hodgkin’s Lymphoma. She began a treatment that included chemotherapy.

    Sigh. I don’t have Canadian numbers, but the 5-year relative survival for HL in a 40-49 year old in the US is 82.7% and in Germany it’s 88.3%*. The Canadian numbers are probably somewhere between those two. Surviving HL is the norm, not the exception and the reason is chemotherapy, not whatever woo the patient takes in addition to chemo.

    *Not yet published data. I can get some older data on survival in the US if you want something that the reviewers have already proofed though.

  4. Dianne says

    Ah, didn’t read far enough before commenting. A “gentler” form of chemotherapy could mean trouble, depending on what exactly she’s talking about. What exactly was the “gentler” chemotherapy in question and has it been validated in HL? Did her disease justify going with a less intensive chemotherapy? Her age is against her-40 is old for HL-but her gender is on her side-women tend to do better than men with HL. Other factors, we don’t have the information to evaluate. Clearly it worked for her-she’s 15 years out from the HL. But implicitly suggesting to patients that they should demand a gentler chemotherapy (whatever that means) is not good health policy. Gentler often (but not always) means less effective and someone with poor prognosis disease who insisted on, say, ABVD rather than BEACOPP or doxil rather than adriamycin in their combination chemo, could be setting themselves up for the combination of both side effects and ineffective treatment.

  5. says

    ‘Gentler’ could also mean a dose adjustment though. If she was experiencing toxicity (her toenails fell off, for example) it is not at all uncommon to pare down the dosage a bit. My point is that her oncologist is more than likely the one to make that call – I sincerely that ze would have monkeyed with the chemo if there was a risk to hir patient.

    I disagree with your characterization that this piece suggests that patients should be demanding gentler chemo as a rule. If there is unacceptable toxicity, then it is a good idea to discuss what your options are, which may include changing drug regimens or adjusting the dosage to tolerable levels.

  6. Dianne says

    Dosage decreases do have to occur in chemotherapy administration. Chemo is definitely toxic. One of the first successful drugs for HL was actually an altered prep of mustard gas. I can just imagine how much fun the conversation between the first doctor to give it and the first patient to receive it must have been…But decreasing the dose also decreases efficacy and oncologists hate to do it. Sometimes it has to be done, but it’s definitely a trade off and I don’t see that being pointed out in the article.

    Or maybe I’m being unreasonable because we’re talking about Hodgkin’s. I’ve had some very US specific problems with treating patients with HL and tend to get upset at the mere thought of someone not taking optimal treatment when they can. So, sorry if I’m overreacting and if you’re ever in the mood for a horror story from the US I can tell you (in HIPAA compliant fictionalization) what happened with the patient I’m upset about.

  7. says

    I’m certainly not offended or upset, I am just saying that “milder” could mean a whole bunch of things. Anyone who says that a HL patient should NOT get chemo needs to be sent out to sea on an ice floe.

  8. lordshipmayhem says

    I’m not sure what it is about them that irk me as much as they do, but I’ve always been quite opposed to the idea of introducing food supplements as part of a regular diet.

    Probably because supplements tend to fall into one of three categories: they have either (1) not been proven to work, (2) been proven not to work, or (3) been proven to be more of a hazard than a help.

    The ones that have been proven to work, tend to have been added to our regularly consumed food somehow, in a way that we receive a dosage that is both safe and effective, like iodine in salt and fluoride in water.

  9. Dianne says

    The majority of the US population is, apparently, of the opinion that a person with HL who is not a citizen should not receive treatment in the US, no matter whether it is impossible for her to return home for treatment or not. Under a death penalty at home for disagreeing with the local dictator? Too bad: now you’re under one here too for daring to get sick. Willing and in fact preferring to get treated at home but too sick to travel? That’s what you get for having an imperfect immune system. From a country too poor to have a bone marrow transplant program and failed first line chemo? Not our problem. Be grateful we gave you the stuff that didn’t work. Can’t afford a $500 per dose pill that’s a critical part of the regiment? Your own fault for not being in the 1%.

    I’m not sure there’ll be enough room on the ice floe.

  10. Dianne says

    There are some situations in which supplements are safe and effective. For example, folic acid to prevent neural tube defects in pregnancy. Unfortunately, nothing is side effect free. Folic acid-a water soluble vitamin that seems like it should be completely harmless as you’ll just pee out what’s not needed-can lead to an increased rate of twin pregnancies. There are certainly worse things in the world than twin pregnancies-NTD for example-but a twin pregnancy is harder physically and more dangerous than a singleton pregnancy.

    The problem is people hear “vitamin” or “supplement” and think “harmless” whereas a “drug” sounds dangerous. For example, suppose you told someone that you had a drug that could reduce their risk of blindness and acne but increase their risk of cancer (if they smoke), birth defects, and osteoporosis. Does it sound good? The drug in question is vitamin A, beta-carotene. Like most fat soluble vitamins, it’s good only in limited quantities and over- or underdose is dangerous. Very little in life is completely safe and certainly virtually no “natural” treatments are.

  11. bryanfeir says

    The Skeptic’s Dictionary has an entire rather long page on supplements. The general opinion of the author (who is not a doctor, but who quotes several for evidence) is that unless you’re starving, it is highly unlikely that you actually need supplements.

  12. ischemgeek says

    I won’t lie: The reason for the delayed comment on this one is that I had to walk away from it for a day. Long story short: A member of my immediate family was diagnosed with lymphoma less than a week ago, so that last story hits close to home and got my woo-rage in overdrive. I nearly said entirely unfounded stuff that I would have regretted, but thankfully, I realized I was being rash and took a break before I hit submit.

    After I got some emotional distance and re-read the article, I’d probably call it a 3.5/5. I would have liked to see emphasis on the fact that all of her “integrated” therapies are stuff that conventional medicine already recommends: Stuff like eating right, exercising, taking care of your mental health, etc. I would also have liked to see more emphasis on talking over everything with your doctor and I’d like to see it state explicitly that ‘natural’ stuff can mess with medications.

    That said, it didn’t peddle anything bad (homeopathy, Gershon therapy, or chiropractic would have had me cursing, flailing, and foaming at the mouth) and didn’t demonize conventional medicine, so I’m pleasantly surprised.

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