Monday, February 6, 2017

Be Aware of Seven Questionable Clinics

     In the age of fake news, illicit Internet pharmacies, and proposed rollbacks to healthcare regulations, it is perhaps not surprising that clinics offering unsubstantiated or poorly administered medical treatments seem to be on the rise. Medscape reached out to experts to get their thoughts on seven clinics with questionable practices that may be worth further scrutiny.

      It is defined as the combining of conventional and complementary and/or alternative medicine, such as acupuncture. Mark A. Crislip, MD, an infectious disease specialist in Portland, Oregon says, "Their defining characteristic is pseudo-medicine and -science."

      He continues, "When you offer worthless therapies for money, that's fraud in the real world. Fortune tellers convicted of defrauding people of their money because they're possessed by evil demons just have to open an integrative medicine clinic and cruise. They'll never get punished."

      David H. Gorski the managing editor or Science-based Medicine, which addresses unfounded medical practices and beliefs, and professor of surgery and oncology at the Wayne State University School of Medicine says that IM represents one of the most exasperating trends in contemporary healthcare. "It misleads by building upon established health practices."

      Numerous clinics that say that they can treat patients' cancer outside of the normal tools of scientifically based medicine. According to Dr Gorski, "The most common clinics are those that espouse vague notions that cancer is caused by contamination of the body and can thereby be defeated through extensive "detoxification" protocols involving dietary restrictions, supplements, and coffee enemas, such as the Gonzalez Protocol. Often these dietary protocols are given alongside experimental drugs."

      Even in cases where patients have not responded to conventional medicine, for whom untested and alternative treatments may seem worth a try, there is still a considerable risk. Dr Gorski said, "You might lose the chance to put your affairs in order. You might lose your fortune that you might otherwise have passed on to your family. You may think your symptoms are bad now, but it can always be worse."

      Chelation therapy is the process by which heavy metals are removed from the blood.  It's use has been extended to cancer and autism. Dr. Gorski said, "There's the naturopath use of chelation therapy, where they often claim that many diseases or chronic illnesses are due to undefined toxins that are heavy metals. Never mind that it can be potentially dangerous. It can cause hypocalcemia or hypomagnesemia and also cause death due to cardiac arrest. Basically, it's all risk and no benefit."

      Unlicensed stem cell clinics have been described as medicine's Wild West. These clinics deal primarily with unapproved adipose-derived stem cells administered in an experimental treatment of undetermined therapeutic value that many believe flaunts the US Food and Drug Administration's rules for what constitutes a biologic agent. Online advertising for stem cell clinics often uses highly misleading language downplaying risks and promoting their curative value for a host of conditions, including multiple sclerosis, aging, Parkinson disease, stroke, and spinal cord injury.

      Paul S. Knoepfler, PhD, a professor of cell biology and human anatomy at UC Davis School of Medicine and author of the book, Stem Cells: An Insider's Guide said,
"There is essentially zero concrete evidence from properly controlled studies that what they are selling is safe and effective."

      In 2000, small but highly questionable study reported that seven subjects with major depression significantly improved after IV treatment with ketamine. There are at least 15 randomized controlled published studies and close to 20 open-label studies that showed no efficacy.

     There has been increasing criticism of ketamine clinics, specifically surrounding the sometimes high payments they solicit from desperate patients and the fact that they are often operated by anesthesiologists and emergency department doctors with little to no experience dealing with major psychiatric disorders. 

      The FDA approves testosterone replacement only for men who have low testosterone from disorders of the testicles, pituitary gland, or brain that cause hypogonadism. However, the pervasive direct-to-consumer "low T" advertising campaign has taken advantage of disease-mongering to extend treatment indications to often ambiguous symptoms associated with the normal aging process, such as decreased sense of vigor. They distort the truth without actually lying by exaggerating vague symptoms.

     In the last decade, prescriptions for testosterone have increased by 10- and 40-fold in the United States and Canada, respectively, with annual US sales alone to exceed $2 billion. Patients seeking out these clinics run the risk of being treated by practitioners who may not have the experience or interest to diagnose the true underlying causes of their symptoms, which may include depression, diabetes, or other common chronic diseases. Testosterone therapy has also been linked with an increased risk for venous thromboembolism and myocardial infarction, among other adverse outcomes.

     Bradley D. Anawalt, MD, chief of medicine at the University of Washington Medical Center, Seattle, and an expert in male reproductive endocrinology said, "It is helpful for men to know that daily exercise has many of the same benefits that are being advertised about testosterone therapy for 'low T,' including increased muscle and leanness, improved bone mass and strength, and for some men there is improved sexual function. 

      The fact that dental amalgam uses 50% metallic mercury content to bind silver, tin, and copper into a durable material commonly used in fillings may have come as a surprise to many
patients, who may be vaguely aware of mercury's role as a neurotoxin.  They fear that something theoretically deleterious for your health is being placed in their body.  It has led to the rise of amalgam filling removal clinics.

     According to Grant Ritchey, DDS, a dentist in private practice in Tonganoxie, Kansas, a contributor to the SBM blog, "If you have an amalgam filling, even if it's 20 or 30 years old, there is a small but measurable amount of mercury that's released by that filling every day. It is well, well below the threshold of safety, but you can measure it."

     Nevertheless, since the 1970s a growing movement attributes dental amalgam fillings to a wide variety of illnesses, from autism and multiple sclerosis to arthritis and Crohn disease. 

As a consequence, specialty amalgam removal clinics have formed to serve people who
believe their fillings are the source of their other health issues. 

     Ritchey said, "Some of what they do is science-based, but some of it is over the top. If they're making claims of curing disease or helping mitigate chronic illness, the evidence in the scientific literature does not support that at all."

    The American Dental Association still supports the continued use of dental amalgam. Nonetheless, dental amalgam use is falling globally, partly owing to continued fears and simple
cosmetic preferences for tooth-colored composite fillings. 

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