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Reference: Hellmuth J, Rabinovici GD, Miller BL. The Rise of Pseudomedicine for Dementia and Brain Health. JAMA. Published online January 25, 2019. doi:10.1001/jama.2018.21560

This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director.

Bottom line, chosen from the paper

Pseudomedicine refers to supplements and medical interventions that exist within the law and are often promoted as scientifically supported treatments, but lack credible efficacy data. Practitioners of pseudomedicine often appeal to health concerns, promote individual testimony as established fact, advocate for unproven therapies, and achieve financial gains

Feynman coined the term “cargo cult science” to describe endeavors that follow “…the apparent precepts and forms of scientific investigation, but they’re missing something essential…Cargo cult science is apparent in material promoting some brain health supplements; “evidence” is presented in a scientific-appearing format that lacks actual substance and rigor. Feynman suggested 1 feature of scientific integrity is “bending over backwards to show how [the study] may be wrong…,” which is a feature that is often lacking when interventions are promoted for financial gain”

Health care professionals have the responsibility to learn about common pseudomedicine interventions. If a patient or family member inquiries about such an intervention, clinicians can take several steps, [for example]

  • Understand that motivations to pursue such interventions often come from a desire to obtain the best medical care, and convey that understanding to the patients.

  • Provide honest scientific interpretation of any supporting evidence, along with the associated risks and costs. This approach creates a productive dialogue, rather than dismissing any inquiries outright.

Implications for value improvement – Clinicians need to take the initiative in helping patients  identify dietary supplements claiming to prevent dementia that are based on pseudo evidence

Even if a health service does not fund a dietary supplement, health professionals should feel a responsibility to advise individuals thinking about buying them with their own money that the evidence on which these supplements are advertised is unreliable even though randomised trails are quoted.