What is Truth?

I wrote a post for Science-Based Medicine about how offering Integrative Medicine programs seems to lead to telling lies about your products.

Sometimes recognizing a lie is simple. If you offer reiki, homeopathy, acupuncture or craniosacral therapy to treat any disease you are lying to your patients and almost certainly to yourself, as these therapies are not based on reality and do nothing.

In part what separates those who subscribe to the notion of science-based medicine and those who practice pseudo-medicine is explicit criteria for accepting evidence of therapeutic efficacy combined with an understanding of all the logical fallacies to which we are prone.

The most compelling evidence are randomized, placebo controlled, double blind studies. The least compelling is personal experience and testimonial. I do not consider making stuff up as evidence, a standard not always shared. For most people the order is reversed, and so often it is the story of the friends cousin who had their disease cured with some pseudo-medicine that many would find as compelling evidence, and what to you have to say to THAT, Mr. Smarty Pants Skeptic?

I take Feynmans quote to heart:

The first principle is that you must not fool yourself – and you are the easiest person to fool.

Those who practice pseudo-medicine have to ignore it.

What is true in medicine can be tricky and in the real world it can blur from white through grey to gray to black. It depends on how willing one is to extrapolate from minimal data to day-to-day patient care. For example, the Huffington Post has a essay today entitled "The Truth About Treating Lyme Disease".

The author describes himself as someone who

integrates Western medicine with his extensive knowledge of traditional Chinese, Tibetan, Ayurvedic, homeopathic, and complementary medical systems.

I recognize immediately that there is going to be a difference between the author, who uses the fantasy-based system that is homeopathy, and me as to what evidence constitutes 'truth' in the treatment of any disease.

The author notes that Lyme can be cured with antibiotics, but then wanders off what I would consider the reality path:

While the bacterium triggers the initial flu-like symptoms, other chronic health conditions can make this degenerative disease much worse. Compounding co-factors include: chronic inflammation, immune suppression, co-infections from viruses, parasites, other bacteria, and fungi; and elevated levels of heavy metals and toxins.

Do heavy metals and toxins worsen Lyme? Not in any clinical trials I can find on PubMed. But heavy metals and toxins need to be removed. And how to remove those heavy metals and toxins?

Keys to Detox

Published clinical studies demonstrate that the supplement Modified Citrus Pectin (MCP), a highly bio-available form of pectin, safely removes toxic metals such as lead, mercury, and arsenic from the body without disrupting essential minerals.

The few clinical trials published using MCP as a chelator could best be described as interesting, rather than definitive, especially if you use the more reasonable cutoff of a p = 0.005 as 'significant'. The data to support use of MCP for chelation is thin, the clinial data to support the need to do so for Lyme is nonexistent.

The author also suggests

Lyme bacterium, co-infections, and their toxic by-products hide within the nervous system, including the brain, and create a special challenge to treat. So compounds that penetrate the blood-brain barrier are critical. Artemisinin, an active ingredient from Artemisia annua (wormwood) and its derivative artesunate, can achieve this.

Artemisinin is an anti-malarial, used by some to treat co-infection with Babesia, another tick bourne infection, which lives in red blood cells not the brain. There are zero PubMed references for its efficacy against Lyme. As to the CNS of artemisinin levels, most of the studies concerned their neurotoxic potential (probably taken care of by the MCP? (sarcasm)) and the closest I could find on cerebral spinal fluid (CSF) levels was for intravenous administration:

No artesunate was detectable in CSF. In both studies, DHA levels in CSF increased with time while dihydroartemisinin levels in plasma fell. Dihydroartemisinin might accumulate in CSF during frequent artesunate dosing.

Historical curiosity: wormwood is famous for being in absinthe and, unfairly, being neurotoxic:

more specifically as a result of thujone, a monoterpene ketone often present in the essential oil of wormwood. If threshold concentrations are exceeded, thujone does in fact exhibit neurotoxic properties leading to dose-dependent tonic-clonic seizures in animals, likely caused by GABA type A receptor modulation. Research has shown that the concentrations of thujone present in absinthe were not sufficient to exceed these thresholds.

So reccomending artemisinin for treating CNS Lyme or co-infections is to me a weird kind of 'truth', given its lack of supporting data. Also curious is

a growing body of data suggests that Lyme bacterium build protective biofilm matrixes in the digestive tract and elsewhere in the body to shield themselves from treatments as well as immune surveillance.

A growing body in PubMed is 4 papers, none of which mentions the human, as opposed to tick, gastrointestinal tract. If there are human studies to show biofilm matrixes by Lyme in the human digestive tract I can't find them, making a

multitargeted strategy of breaking up biofilms with specific enzymes, fighting the infections with antimicrobial agents, and following with detoxification and probiotic treatment

another interesting example of a therapeutic 'truth' for which I can find no supporting references. Probably me and my inability to find the supporting documentation. My Google and PubMed-fu may be weak.

Truth in medicine is an evidently a malleable concept, lacking criteria for a firm characterization. I would consider much of the therapeutic advice advocated in the article as having little to do with medical truth as I understand it: supported by good scientific plausibility and study.

Points of Interest 7/13/2014
Points of Interest 7/12/2014