I’ve been blogging for over 13 years now, and periodically I find my self saying something along the lines of, “I thought I had encountered every form of quackery, but I was wrong.” This is yet another of those times. I also find myself sometimes saying that I would have written about a case or a topic before, but real life intervened. This, too, is another of those times, with the real life intervention being my travel to Chicago for the Society of Surgical Oncology meeting, which is why there was no post yesterday. Meeting or no meeting, this particular case is so bizarre that I felt obligated to mention it. Also, because it shows how the sort of pseudoscientific quackery and rubbish (such as jade eggs intended to be stuck up women’s vaginas) promoted by Gwyneth Paltrow through her “health and wellness business” Goop, which includes everything from silly stickers that claim to rebalance your energy to psychic vampire repellent to a “wellness conference” In Goop Health that promoted a wide variety of quackery up to and including featuring an “holistic psychiatrist” who is not just antivaccine but an HIV/AIDS denialist, just harmless twaddle about health and beauty. It can be deadly. For instance, there’s a form of apitherapy (treatment involving bee products like honey, venom, or pollen) known as bee venom acupuncture.
So let’s go back to a 2016 New York Times interview with Gwyneth Paltrow. It’s a typical fluff celebrity interview. At one point we learn:
I’m always the guinea pig to try everything. I’ve got to try them all. I love acupuncture. Also, I just heard of a service called a sound bath, which might be too hippie-ish even for the likes of me. It’s some new healing modality. I might not be able to handle it.
But generally, I’m open to anything. I’ve been stung by bees. It’s a thousands of years old treatment called apitherapy. People use it to get rid of inflammation and scarring. It’s actually pretty incredible if you research it. But, man, it’s painful. I haven’t done cryotherapy yet, but I do want to try that.
Yes, intentionally letting oneself be stung by bees on “acupuncture points” along “acupuncture meridians” would indeed be painful. I mean, holy hell, at least even Senator Tom Harkin, the man responsible for the abomination that is the National Center for Complementary and Integrative Health, only used bee pollen, believing that it cured his allergies. On the other hand, one must be fair and note that apitherapy includes more than just bee venom acupuncture or even just bee venom products. It includes anything related to bees, including honey and pollen. Still, Paltrow clearly said that she let herself be stung by bees, meaning that the form of apitherapy she used was at least similar to bee venom acupuncture, probably without the layering on of acupuncture woo on top of the bee venom woo.
Now, fast forward to 2018, with news reports about an unfortunate woman from Spain:
A woman in Spain died after undergoing a supposedly routine “bee acupuncture” treatment and then suffering an allergic reaction that put her in a coma.
The alternative medicine procedure is more or less what its name conjures up: Instead of a needle, an acupuncture practitioner injects bee venom into the body at certain points. In some instances, live bees are used to sting and inject venom into the person directly.
The case in Spain involved live bees, according to the Journal of Investigational Allergology and Clinical Immunology, a Spanish medical journal. The patient, a 55-year-old woman, had already been going to such bee acupuncture sessions every four weeks over a two-year period to treat stiff muscles and stress, the journal stated.
In fairness, we have no idea whether this unfortunate victim of rank quackery first learned of bee venom through Gwyneth Paltrow. Quackery like this has many messengers promoting it. However, Paltrow’s endorsement of the procedure could easily lead others to harm, because injecting bee venom is not a benign procedure. Before I discuss the “evidence base” (if you can call it that) for bee venom therapy, let’s quote from the case report:
We report the case of a 55-year-old woman who had been attending apitherapy sessions every 4 weeks for 2 years with good tolerance. She decided to receive apitherapy to improve muscular contractures and stress. She had no clinical record of any other diseases (eg, asthma, heart disease), other risk factors, previous reactions of any kind with hymenoptera, or atopy. During an apitherapy session, she developed wheezing, dyspnea, and sudden loss of consciousness immediately after a live bee sting. An ambulance was called, although it took 30 minutes to arrive. The apitherapy clinic personnel administered methylprednisolone. No adrenaline was available. When the ambulance arrived, the patient’s systolic pressure had dropped to 42 mmHg and her heart rate had increased to 110 bpm. Oxygen saturation was not reported. Treatment was administered immediately and consisted of a double dose of adrenaline (0.5 mg each), saline infusion, intravenous corticosteroids, and antihistamines. During transfer to our hospital, the patient’s blood pressure and heart rate stabilized, although her Glasgow Coma Scale score was 6; therefore, she was intubated. At admission, a computed tomography scan was compatible with watershed stroke, while the results of an EKG, chest x-ray, and basic blood analyses were normal. Unfortunately, tryptase was not determined during the acute episode. Basal serum tryptase was normal. During admission, in vitro tests were performed 3 days after the reaction, as soon as our allergy department was consulted (Table). In vivo tests could not be performed because the patient had received antihistamine and her clinical situation was problematic. The patient died some weeks later of multiorgan failure. Persistent hypotension during severe anaphylaxis had caused a massive watershed stroke and permanent coma with multiorgan impairment.
So basically, here we have the case of a woman typical of those using alternative medicine, someone who sounds like one of the “worried well.” Basically, she sounded as though she were pretty healthy, but with some vague complaints, and that she was using bee venom acupuncture to treat them. She underwent routine bee venom treatments and over time apparently became sensitized to the bee venom. Then, because she was at what was probably an “integrative medicine” clinic, the clinic apparently didn’t have a crash cart, or at least didn’t have one of the key drugs that every crash cart needs to stock: Epinephrine. As a result, when the woman had an anaphylactic reaction to the bee venom and became hypotensive to a level not compatible with life if not reversed quickly, they couldn’t treat her adequately. (Hint: Steroids are NOT enough.) They also apparently didn’t have antihistamines (at least initial treatment with antihistamines was not mentioned). The single most important drug to have on hand, though, is epinephrine. It’s why people with severe food allergies and, yes, bee sting allergies carry an epinephrine autoinjector like an EpiPen around with them. Minutes, even seconds, count, and this woman went 30 minutes without effective treatment for her anaphylactic shock. Her profound hypotension (low blood pressure) resulted in a severe stroke and multiorgan damage that she could not recover from.
Leaving aside for a moment the lack of evidence that bee venom acupuncture is effective for anything, for a clinic administering bee venom subcutaneously to patients not to have epinephrine on hand in a properly stocked crash cart to treat an anaphylactic reaction was not just malpractice. No, it was criminal malpractice. It’s not as though allergies to bee stings are not well known to be common enough that you have to be ready to treat them. Moreover, just because this women had undergone apparently many sessions does not mean that she could not over time become sensitized to the bee venom and eventually develop an allergic reaction. Indeed, we can never know for sure, as the case report does not say, but I help but speculate that before her anaphylactic reaction this woman had likely developed slowly increasing signs of an allergic reaction to the bee venom, maybe a bit of hives, maybe a little tightness in her chest or flushing, before the session where she suffered final “big one” that were either not recorded, ignored, or dismissed as part of the therapy “working.”
As the case report authors note:
Previous tolerance to bee stings does not prevent hypersensitivity reaction; however, repeated exposure favors a higher risk of sensitization.
Exactly. A certain percentage of patients who undergo bee venom acupuncture (or any bee venom treatment) will become sensitized to bee venom, as this woman was.
There actually exists something called the American Apitherapy Society. A quick look at its website reveals many of the hallmarks of quackery, most prominent of which is the claim that the “products of the honeybee,” such as bee venom, honey, pollen, royal jelly, propolis, and beeswax, can treat just about everything:
Immune system dysfunction or problems
- Multiple Sclerosis (MS)
- Rheumatoid arthritis
- Hay fever
- ALS (Lou Gehrig’s Disease)
- Scar pain
- Tendonitis, bursitis
- Spinal pain
- Bacterial, viral, and fungal illnesses
- Wounds, acute and chronic
- Malignant (cancer)
And, of course, the American Apitherapy Society features many testimonials of people supposedly “cured” (or at least helped) with multiple sclerosis, injuries, rheumatoid arthritis, pain, skin cancer, and, of course, Lyme disease. In fairness, it is quite possible that there could be medicinal substances in various “products of the hive,” but, if there are, certainly the American Apitherapy Society doesn’t provide compelling evidence for their efficacy. A search of PubMed finds around 158 articles on apitherapy, but most are either preclinical studies in cell culture or some in animal studies or highly speculative. There are a handful of clinical trials, nearly all of them looking at either honey or bee pollen. In terms of using actual bee venom, there is a crappy open label, single arm trial of 11 patients testing bee venom acupuncture as a treatment for Parkinson’s disease and another crappy single-blind randomized trial using apitherapy for central post stroke pain. There is one small randomized trial suggesting benefit of apitherapy in localized plaque psoriasis, but I am underwhelmed, and, as far as I can tell, none of these studies used actual bee stings, but rather instead used diluted bee venom.
As I’ve discussed many times before, acupuncture is a http://www.dcscience.net/2013/05/30/acupuncture-is-a-theatrical-placebo-the-end-of-a-myth/
. It doesn’t matter where you stick the needles or even if you stick the needles in (as long as the needle tips touch the skin); the effect is the same. You can even use toothpicks instead of needles! No matter how much acupuncture advocates try to claim that it is effective, the totality of evidence says otherwise.
So “bee venom acupuncture” is nothing more than apitherapy gussied up with acupuncture terminology, in much the same way that “electroacupuncture” is really transcutaneous electrical nerve stimulation gussied up with acupuncture terminology co-opting acupuncture points or “biopuncture” is (hilariously) homeopathy gussied up with acupuncture, because apparently just one form of quackery wasn’t enough. In any case, “bee venom acupuncture” is just apitherapy. (Yes, it needs to be repeated.) There does exist a review article in (of course!) Evidence-Based Complementary and Alternative Medicine (an oxymoron if ever there was one) claiming to find some evidence of efficacy, but it included a bunch of low quality studies and seemed to bend over backwards to include studies from journals such as The Journal of Korean Society for Acupuncture and Moxibustion and The Journal of Korean Oriental Medicine. Naturally, the authors proclaim bee venom acupuncture to be “promising” and urge more study.
I prefer the conclusion of the authors of the case report:
Our data enable us to conclude that measures to identify sensitized patients at risk should be implemented before each apitherapy sting. Patients should be fully informed of the dangers of apitherapy before undergoing it. Apitherapy practitioners should be trained in managing severe reactions and should be able to ensure they perform their techniques in a safe environment, with adequate facilities for management of anaphylaxis and rapid access to an intensive care unit in order to prevent suboptimal management, such as delays in treatment (the patient waited 30 minutes before receiving intramuscular adrenaline). However, these measures may not be possible. Therefore, the risks of undergoing apitherapy may exceed the presumed benefits, leading us to conclude that this practice is both unsafe and unadvisable.
Basically, they’re saying that bee venom acupuncture’s risks outweigh its potential benefits, but that if it’s going to be done the practitioner should know how to manage an anaphylactic reaction (ha!), an ambulance and ICU should be rapidly available, and patients should be informed how potentially dangerous this treatment can be. Personally, I’d say not to do it at all, but I suppose a case can be made for mitigating harm if people are going to be stubborn and ignorant enough to use a treatment with no scientifically proven benefits that can potentially kill you if you’re unlucky enough to be allergic to bee stings or to develop such an allergy while undergoing treatment. Again, the potential benefits of bee venom treatment (none demonstrated in anything resembling rigorous trials) are far outweighed by the danger.
Thanks, Gwyneth Paltrow, for popularizing this sort of nonsense. Oh, and Kate Middleton, Victoria Beckham, Simon Cowell and Kylie Minogue, too, although at least they just apply it to the skin and don’t combine it with acupuncture. Even so, application of an allergen to the skin can cause an anaphylactic reaction, too. Celebrity pseudoscience and stupidity are universal.