How UTI's can cause depression

How UTI's can cause depression

As some may know I am infectious disease doctor. Urinary tract infections (UTI) butter my bread. Figuratively speaking. There is an enormous amount known about the pathophysiology of UTI’s and how E. coli  binds to uroepithelial cells to cause infection.  It is both a common and complex problem. But for all our knowledge, chronic and recurrent UTI’s remain a vexing problem.

One reason for recurrent UTI’s is not due to altered chi along meridians fixed by needles. That would be ridiculous. Much to my embarrassment, Clinical Infectious Disease (CID), the flagship journal of my specialty, published Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a markov chain monte carlo model  and included acupuncture in their analysis. Really.  They thought a pseudo-medical intervention divorced from reality to be worthy of consideration.

Based on two studies they estimated the acupuncture risk reduction for their analysis to be .68. This is a classic example of the difference between evidence and science-based medicine. A science-based consideration of reality, anatomy, physiology, microbiology would suggest that any real risk reduction by acupuncture should be zero.  Prior plausibility would suggest any  positive outcome in an acupuncture study would be a false positive.  As we have discussed at great length over the years at Science-Based Medicine, there is zero reason to suspect any true efficacy of acupuncture beyond study bias.

That being said the authors say

“Somewhat surprisingly, we found that acupuncture was the next most effective prevention method. Acupuncture’s high efficacy may be a function of publication bias, as there were fewer studies on acupuncture compared to other management”

and

“monthly acupuncture sessions were also effective at reducing UTI rate.”

The accompanying editorial says

“For example, in an individual case, a clinician and patient working together may opt to use acupuncture in combination with cranberry juice and self- directed therapy at the first sign of symptoms.”

Even though the study looked at cranberry pills not juice. I would so love to have the authors come up with a plausible explanation for how acupuncture may work for UTI prevention. Goodness gracious great balls of fire, an editorial in CID recommending two simultaneous worthless therapies. 

I used to have a slightly superior attitude about CID since it had been the only journal I regularly read that had not published an article favoring pseudo-medicine. No longer. And to add salt to the wounds, it comes out of the hospital where I did my fellowship. When ID falls for pseudo-medicine (because we are the best and brightest in medicine) we are indeed doomed.

I try and keep these entries brief so I will save a more complete analysis for SBM in two weeks. But in the meantime I am going to have look into treatment for reactive depression. I wonder if acupuncture would work…

Rationalization

Clin Infect Dis. 2014 Jan;58(2):147–60. doi: 10.1093/cid/cit646. Epub 2013 Sep 24. Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a markov chain monte carlo model. http://www.ncbi.nlm.nih.gov/pubmed/24065333

Acupuncture and ‘Eastern’ Medicine Science-Based Blog Articles http://sfsbm.org/13-sbm-blog/56-acupuncture-and-eastern-medicine.html

Cochrane Database Syst Rev. 2012 Oct 17;10:CD001321. doi: 10.1002/14651858.CD001321.pub5.
Cranberries for preventing urinary tract infections. http://www.ncbi.nlm.nih.gov/pubmed/23076891

Points of Interest: 1/13/2014
Points of Interest: 1/12/2014

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