I usually start these blog entries with an idea and then see where the research takes me. Certainly I go down many rat holes. Thanks to the recent reversal of reproductive rights by the SCOTUS, with perhaps more to come, I wondered what SCAM alternatives were available when/if reality-based reproductive interventions were no longer an option. I wonder no longer.

There are four aspects of reproduction I will consider, along with some rat holes: contraception, infertility, erectile dysfunction, and pregnancy termination.

As I start this, my assumption was there would be few SCAM approaches to pregnancy prevention, as SCAMs have no efficacy when there is a hard end point to the intervention. There are no SCAM therapies for the infections I see most days as many have almost 100% mortality rates. No one, I would hope, would use a SCAM for the sole treatment of endocarditis or meningitis although there is the occasional person who will rely solely on SCAMs for cancer treatment. It does not end well.

I have told this story before, but I first learned about SCAMs early in my practice when I was called to see a case of wet gangrene of the leg. A young female had a sarcoma of her leg that would have likely been cured with amputation. She chose naturopathy instead and the cancer advanced until most of her leg was cancer, much of it dead and putrefying. That is why they called me, not there was anything I could do. She refused any care (she was admitted because she had passed out) and that night the cancer eroded into an artery and she bled out. That is where I first encountered naturopathy and the first of many cases where cancer denial was an important aspect of the patients care.

Like SCAM cancer therapies, it is obvious when contraception fails. I would think pregnancy would be harder to deny than cancer, but I will not be surprised if the comments have stories that demonstrate otherwise. The if only they had used our SCAM sooner gambit is unlikely to be a convincing argument as to why birth control failed.

Before I wander the SCAMs, though, I wondered how people avoided pregnancy in the era before oral contraceptives. Sure, there are barrier methods, abstinence (like that ever works), and the rhythm method. And you know what we call people who use the rhythm method for contraception? Parents.

If you visit the old towns of the West, it appears that most of the hotels and restaurants were once bordellos. I wonder where they found all the workers for these bordellos. It would seem that most of the female population of the Old West would have to be employed in these houses of ill repute.

But how did the prostitutes, and others, avoid pregnancy? Were there, for lack of a better term, natural forms of birth control? Or were the bordellos filled with their offspring? Besides a variety of barrier methods (half a lemon used as a cervical cap!), the techniques used were not that different than modern SCAM ideas:

Roman women put a leather pouch filled with cats liver on their left foot during sexual intercourse to prevent pregnancy. Some women believed that spitting three times into a frogs mouth was a good method of birth control. European women thought that they could prevent pregnancy by turning backwards a wheel of a mill at midnight. And, in many cultures women constantly wore various necklaces and amulets, which were supposed to have the power of controlling the act of conception. Women were advised to hold their breath and draw their bodies back during sex in order to stop the sperm from entering her body. It was also suggested a woman to jump backwards seven times after sexual intercourse or take something to cause sneezing.

As one website noted:

Until modern contraceptives were invented, women relied on all kinds of ancient birth control methods that had inconsistent results. Some were even dangerous, including the use of heavy metals such as mercury, lead, and arsenic, which did prevent conception but also led to organ failure and brain damage.

I was also amazed to learn that the relationship between ovulation and menses was not discovered until the 1930s, so that method of contraception was unknown for most of human history.

Also used were:

syringes to inject mercury, arsenic, and vinegar into the body to induce abortions or treat diseases.

Much to my amusement, one Boston brothel had:

a homeopathic doctor considered to be crackpotty at the time, according to Beaudry. He prescribed unusual remedies for the women, most likely for treating sexually transmitted diseases and inducing abortions.

He would likely be considered crackpotty today.

One would think, wouldnt one, that if acupuncture is efficacious in aiding in pregnancy and given its numerous alleged salubrious effects on female and male reproductive physiology, acupuncture and traditional Chinese pseudo-medicine could also be used for contraception. I can think of one application where acupuncture might be efficacious, but there are no acupuncture points on the genitals.

While I was not surprised to find zero papers on the Pubmeds on using acupuncture for birth control, I could also not find any with a general Google search.

There are no SCAMs that are touted for contraception. Not acupuncture, not homeopathy, not chiropractic, not naturopathy. No surprise. There would be no way to rationalize away pregnancy.

One site mentioned in passing, stone seed root, thistle, wild carrot seed, and ginger root as potential contraceptives. I would suggest not.

Since, as noted above, the goal is to adjust and harmonize the state of the female body from a holistic approach and there is no useful form of SCAM contraception, the harmonized state appears to be barefoot and pregnant.

Infertility has a complex differential diagnosis with a variety of anatomical and hormonal abnormalities leading to an inability to conceive. It also makes for a huge literature, although like most of the SCAM literature, high-quality studies are few and far between. I am going to discuss a few I find instructive and or amusing.

SCAM providers are fond of claiming that their raison detre is to help return the body to its optimal state of homeostasis or as one review noted, to adjust and harmonize the state of the female body from a holistic approach.

There are a vast number of SCAMs that are used as an adjunctive therapy for infertility. In China, not unsurprisingly, Traditional Chinese Pseudo Medicine, especially acupuncture and moxibustion, are used as primary treatment for infertility. And, as is always the case in studies out of China, the studies are uniformly positive.

It is a massive literature of Tooth Fairy science and I will note here an infertility study that was randomized and double-blind comparing real acupuncture with placebo acupuncture (same thing) in patients undergoing IVF treatment. The results? No difference, really; p=0.038. But what was amusing was that the pregnancy was increased in the placebo group:

The overall pregnancy rate was significantly higher in the placebo acupuncture group than that in the real acupuncture group (55.1 versus 43.8%, respectively).

But there is no real acupuncture, as I have argued before. And their conclusion? Not that doing two interventions with no reality-based reason for efficacy is going to lead to random noise that looks significant. Nope:

Placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert.

LOL. What is inert is the critical thinking functions of the researchers.

Reading even the meta-analysis is the usual mess, because acupuncture, as always, is a heterogeneous intervention, with traditional, electro, cat gut, and warm being some of the variations used and compared. It is quite the mess for drawing any conclusions about whether a specific intervention is effective. But as I have mentioned before, it is not the specific intervention that is allegedly useful, it is the concept of acupuncture that is allegedly effective.

But if limited to quality studies, the efficacy of acupuncture is not impressive:

There was no statistically significant difference between the acupuncture group and no acupuncture (intervention) controls around the time of embryo transfer (ET; risk ratio, RR, 1.24, 95% confidence interval, CI, 1.02-1.50) or in unblinded trials, trials blinded to physicians and double-blind trials (95% CI 1.26-1.88, 0.82-1.33 and 0.89-1.25, respectively). This was also the case when comparing acupuncture with sham acupuncture controls around the time of ET (RR, 1.03, 95% CI 0.87-1.22) or when restricting to unblinded trials, trials blinded to physicians and double-blind trials (95% CI 0.80-2.02, 0.82-1.18 and 0.77-1.17, respectively).

Much of the primary literature is in China and, for example, I could not find the Chinese Journal of Family Planning and similar journals to see the details about the effects of TCM retention enema on tubal obstructive infertility. Yes. Really.

A warm enema containing Chinese medicine is administered before going to bed to treat fallopian tube adhesion. The drug can be absorbed directly by rectal mucosa, which is beneficial to improve the congestion, edema, adhesion, and hyperplasia of local tissues, and thus restoring the function of the fallopian tube.

What continues to amaze me is how health care professionals, well versed in anatomy, physiology, biochemistry, etc., apply the techniques of reality on fiction. It only happens in medicine. You do not see engineers trying to apply the physics of Warner Brothers cartoons to the building of bridges and tunnels. There is no alternative engineering or aviation but doctors continue to act like acupuncture and other SCAMs are not ludicrous.

Huge numbers of herbal preparations have been tried for male and female infertility, more than I have time to review except to note the efficacy is often secondary endpoints like cervical mucus consistency or sperm motility and concentration, not conception rates.

Chiropractic has been used for infertility but:

There are very few original data articles documenting responses of infertile females treated with spinal manipulation.

And:

In the absence of a robust body of primary data literature, the use of spinal manipulation the management of female infertility should be approached with caution.

The Journal of Vertebral Subluxation Research (not on Pubmed as Pubmed does not list science fiction) has papers purporting to show benefit of chiropractic in infertile patients. And, to no ones surprise, chiropractors tout the benefits of their interventions on the web.

I can find next to nothing on Pubmed using homeopathy or naturopathy for infertility. Well, for homeopathy preparations it would be exactly nothing.

The acupoints for erectile dysfunction are distant from the problematic organ, in one study being, slightly below the navel, slightly above the hairline at the back of the head, between the inside ankle bone and the achilles tendon, in the inside wrist. And the results?

No definite conclusions can be drawn.

A conclusion supported in the most recent meta-analysis where:

Low quality evidence shows beneficial effect of acupuncture as adjunctive treatment for people mainly with psychogenic ED.

And the best results were:

Acupuncture combined with tadalafil appeared to have better effect on increasing cure rate.

Lol. It takes a Western medicine to get the best results.

There is the also creepy Clinical Holistic Medicine: Holistic Sexology and Acupressure Through the Vagina (Hippocratic Pelvic Massage).

Noted in one clinical study:

The most difficult problem of this procedure seems to be that it makes it very difficult to be sure that the procedure and all the involved steps are always necessary and rational.

Eye roll and head shake.

There is nothing on the PubMeds for using chiropractic, homeopathy or naturopathy for ED, but no shortage of websites promoting their use.

I wondered about homeopathy, so I picked a website at random. The first suggestion is Agnus castus:

This remedy may be helpful if problems with impotence develop after a man has led a life of intense and frequent sexual activity for many years. A cold sensation felt in the genitals is a strong indication for Agnus castus. People who need this remedy are often very anxious about their health and loss of abilities and may have problems with memory and concentration. This remedy is one of the best homeopathic medicine for ED.

Agnus castus is the chaste berry, which one site says:

The fruit has been historically used for reducing sexual desire.

As one site notes:

The leaves of this plant were used to adorn the beds of Greek women during the absence of their husbands so as to prevent any impure thoughts from entering their minds and also by medieval monks to repress sexual desire. In the actual provings the remedy has shown that it does repress sexual instinct and desire.

And:

Agnus castus is indicated for promiscuous young people who have abused their sexual energies through either homosexual or heterosexual multiple contacts and who have contracted repeated venereal infections, especially gonorrhea.

Huh? Homeopathic teaching is that a product that causes the symptoms undergoes serial dilution and succussion to make a more potent medication. Somehow a medication that reduces sexual desire increases libido when homeopathized? Writing these entries leads to some of the weirdest stuff.

While no trials can be identified in the Pubmeds, acupuncture was used for abortions in China although it was unreliable. Cue Louie. Acupuncture does have forbidden points. Specifically if you stimulate:

San Yin Chiao (SP6) in conjunction with He Gu (LI4). The abortion is generally realized within 24 hours.

But thats in humans, in Wistar rats stimulating the forbidden points does nothing:

We found no evidence that acupuncture in LI4-SP6 and sacral points could be harmful to the pregnancy outcome in Wistar rats.

But then, why would it? Was trying to confirm or deny a fiction worth abusing and killing rats? I doubt it.

I have often wondered how they map human acupoints and meridians onto animals; evidently so do acupuncturists in search of One Acupuncture. One Acupuncture to rule them all, One Acupuncture to find them, One Acupuncture to bring them all and in the darkness bind them, I suppose.

Moving toward a neuroanatomically accurate veterinary acupuncture system requires rethinking current atlases and embarking upon a systematic analysis of the human points in terms of where, if at all, corresponding sites exist in the nonhuman.

Good luck with that. Because you might run into issues such as those with Boa constrictors, although why one would want to torture a snake with acupuncture is uncertain.

Thus, the objective of this study was to map and describe the main points of acupuncture in the species Boa constrictor, and their indications to promote the balance of this species. The unprecedented result of the mapping was the discovery of specific acupoints with individual location indications without distribution in specific meridians and dispersedly distributed in the body.

Careful, clever, scientists, they measured the heart rate:

HR was obtained by counting heart rate.

And if you wondered how they found acupuncture points?

Use of the electrostimulator and location of EL points 30 10/100 Hz NKLpoints of Brazilian origin. The EL30 is an electronic device that is intended exclusively for non-invasive applications in the technique called electro-acupuncture. It was conceived as a point detection instrument, where an electrostimulation therapy, used in different media with a purpose of detection and determination of qualities as stimulus conditions for different species and for different points. It was traversed with an exploratory tip of the animals body points to an occurrence of an audible signal indicating the localized point and an impedance. The sensitivity controller has been adjusted to find a better setting.

More animal abuse for no good reason. But I digress. Again.

Consistency not being a strong point in acupuncture, when acupuncture was used as an adjunct to medical abortion they used Hegu (LI 4), Sanyinjiao (SP 6), Neiguan (PC 6) and Kunlun (BL 60). I suspect the increased efficacy was due to BL 60.

Acupuncturists can get quite wiggens over the forbidden points, going as far as to suggest the auricular acupuncture should be avoided in pregnancy. I would add it should be avoided when not pregnant as well. Several reviews suggest acupuncture is safe in pregnancy when correctly applied, whatever correctly applied might be.

While I can find papers where acupuncture is purported to prevent spontaneous abortion, and I can find nothing to confirm the abortifacient effects of acupuncture.

I can find nothing on using homeopathy, chiropractic or naturopathic techniques to induce abortion, although they allege they can help prevent spontaneous abortion/miscarriage. The one-way street that is SCAM.

Herbs? Theres a problem. I will admit, I am not one for social media. Twitter is a time suck and Facebook opaque and pointless. I certainly do not grok the concept of influencers. So TikTok? So out of my geezer understanding. But, per the Rolling Stone (geezer cred?) TikTok is a popular source for information on DYI abortions using pennyroyal, blue cohosh, and mugwort. Herbs that are not efficacious but are certainly toxic and could be fatal. As one PubMed review noted:

the ingestion of plants to induce abortion involves the risk of severe morbidity and mortality.

Hard to believe, but when it comes to medical advice it is suggested:

not to listen to what you hear on TikTok.

It is a question with no real answer: would a SCAM provider be any better?

It turns out self-managed abortion is not that uncommon, with 7% of US women of reproductive age (kind of redundant, women not in their reproductive age are unlikely to need an abortion) going the DYI route, often with herbs and without success.

With the Handmaidens Tale decision this year, I expect DYI abortions will only increase with resultant morbidity and mortality. Desperate people will do desperate things.

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and the President of the Society for Science-Based Medicinewhere he blogs under the name sbmsdictator.He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly, the Attending Most Likely To Tell It Like It Is by the medical residents at his hospital.His growing multi-media empire can be found at edgydoc.com.

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