Papers by Michael McCulloch, LAc MPH PhD
Integrative cancer therapies, 2017
Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnos... more Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnosis, comorbidities, and demographics. Interventions sought include acupuncture, massage, herbs, diet, and exercise, usually combined with conventional therapies. It is not known what proportion of TCM practitioners care for cancer patients, their cancer specific training or caseload, what interventions they employ, their outcomes, and their communication patterns with conventional oncologists. A survey was mailed to all 2213 licensed acupuncturists in the 9-county San Francisco Bay Area gathering descriptive statistics. A total of 472 (21%) responded by mail or web-based Research Electronic Data Capture (REDCap) tool. Most respondents (77%) reported caring for patients with cancer, with 29% reporting having 6 to 10 years of practice experience, and 44.2% having 0 to 20 hours of training specific to the needs of patients with cancer. Improving quality of life was reported by 94% as what th...
Integrative Cancer Therapies, 2016
Background Chinese herbal medicines reportedly increase efficacy and minimize toxicity of chemoth... more Background Chinese herbal medicines reportedly increase efficacy and minimize toxicity of chemotherapy; however, little attention has been paid to how poor study quality can bias outcomes. Methods We systematically searched MEDLINE, TCMLARS, EMBASE, and Cochrane Library for randomized controlled trials of Chinese herbal medicines combined with fluorouracil-based chemotherapy compared with the same chemotherapy alone. We screened for eligibility, extracted data, and pooled data with random-effects meta-analysis. Outcome measures were survival, toxicity, tumor response, performance status, quality of life, and Cochrane Risk of Bias (ROB) criteria to critically evaluate the quality of reporting in the randomized trials included in the meta-analysis. Results We found 36 potentially eligible studies, with only 3 (those with low ROB) qualifying for meta-analysis. Two reported chemotherapy-related diarrhea reduced by 57% (relative risk [RR] = 0.43; 95% CI = 0.19-1.01; I(2) test for variation in RR due to heterogeneity = 0.0%), with nonsignificant results. Two reported white blood cell toxicity reduced by 66% (RR = 0.34; 95% CI = 0.16-0.72; I(2) test for variation in RR due to heterogeneity = 0.0%), with statistically significant results. Stratifying analysis by studies with high versus low ROB, we found substantial overestimation of benefit: Studies with high ROB overestimated by nearly 2-fold reduction of platelet toxicity by Chinese herbal medicines (RR = 0.35, 95% CI = 0.15-0.84 vs RR = 0.65, 95% CI = 0.11-3.92). Studies with high ROB overestimated by nearly 2-fold reduction of vomiting toxicity (RR = 0.45, 95% CI = 0.33-0.61 vs RR = 0.87, 95% CI = 0.48-1.58). And, studies with high ROB overestimated by 21% the reduction in diarrhea toxicity (RR = 0.34, 95% CI = 0.20-0.58 vs RR = 0.43, 95% CI = 0.19-1.01). Studies with high ROB also overestimated by 16% improvement in tumor response (RR = 1.39, 95% CI = 1.18-1.63 vs RR = 1.20; 95% CI = 0.81-1.79). Not accounting for ROB would have exaggerated evidence of benefit and failed to detect nonsignificance of results. Conclusions In the present analysis, involving 36 studies, 2593 patients, 20 outcomes, 36 medical institutions, and 271 named research authors, 92% of the data points were from studies at high ROB. Given the poor quality of the data in studies identified, it cannot be concluded whether combining Chinese herbs with chemotherapy reduces toxicity of chemotherapy.
SSRN Electronic Journal, 2000
Scent lineups are a powerful tool in the investigation of crimes. With proper procedures, both fo... more Scent lineups are a powerful tool in the investigation of crimes. With proper procedures, both forensic and judicial, scent lineups can be valuable evidence for a jury to consider. Unfortunately, many courts have been willing to admit poorly conducted procedures, even if giving lip service to the fact that the scent lineup was deficient by saying that its admission was harmless error. The tendency of some courts to view scent lineups as an extension of scent tracking has resulted in admission of scent lineup evidence under inappropriate standards. Tracking cases have set foundational requirements from long-held social and judicial assumptions about the accuracy of dogs. Although no specific set of training procedures or testing protocols need be imposed for the conduct of scent lineups, protocols with elements that have produced highly reliable results should be developed by law enforcement authorities and insisted upon by courts. The authors believe that scent lineups under such protocols can now satisfy the Daubert standard for admissibility of scientific evidence, though perhaps not the Frye standard (because of the lack of general acceptance in the scientific community). Because the possibility of a false identification cannot be completely eliminated, corroboration by other evidence should be required, probably at a clear and convincing level.
Journal of Veterinary Behavior: Clinical Applications and Research, 2010
Early detection of cancers, although essential for treatment effectiveness, can be difficult to a... more Early detection of cancers, although essential for treatment effectiveness, can be difficult to achieve, and some tests introduce additional health risks. New, non-invasive detection methods with greater sensitivity and specificity are needed. Several authors have published research suggesting that dogs may be able to detect lung, breast, prostate, ovarian, and melanoma cancers by smelling skin lesions, urine, exhaled breath, and surgically extracted tumors. We conducted a systematic search using the PubMed and EMBASE databases to identify all known published data on canine scent detection of cancers. Of 531 potentially relevant publications, 11 full text articles were examined, and 5 were selected for inclusion in the review. Two studies involved dogs detecting breast cancer (sensitivity 88% using exhaled breath and 22% using urine; specificity was 98% and 20%, respectively), 1 involved bladder cancer (41% of urine samples detected), 1 involved melanoma (75-85.7% of in situ tumors detected), 1 involved lung cancer (sensitivity 99% and specificity 99% using exhaled breath), 1 involved ovarian cancer (sensitivity 100% and specificity 97.5% using thawed frozen tumor samples), and 1 involved prostate cancer (18% of urine samples detected). One study on ovarian cancer is in progress. Early successes with canine scent detection suggest chemical analysis of exhaled breath may be a valid method for cancer detection. Tests using exhaled breath showed better sensitivity and specificity than with urine. Future research should target other tumor types, and seek to identify what exhaled compounds may signal a cancer diagnosis.
The Journal of Alternative and Complementary Medicine, 2011
Integrative Cancer Therapies, 2011
Complementary and alternative medicines are used by up to 48% of lung cancer patients but have se... more Complementary and alternative medicines are used by up to 48% of lung cancer patients but have seen little formal assessment of survival efficacy. In this 10-year retrospective survival study, the authors investigated Pan-Asian medicine + vitamins (PAM+V) therapy in a consecutive case series of all non-small-cell lung cancer patients (n = 239) presenting at a San Francisco Bay Area Chinese medicine center (Pine Street Clinic). They compared short-term treatment lasting the duration of chemotherapy/radiotherapy with long-term therapy continuing beyond conventional therapy. They also compared PAM+V plus conventional therapy with conventional therapy alone, using concurrent controls from the Kaiser Permanente Northern California and California Cancer Registries. They adjusted for confounding with Kaplan-Meier, Cox regression, and newer methods --propensity score and marginal structural models (MSMs), which when analyzing data from observational studies or clinical practice records can provide results comparable with randomized trials. Long-term use of PAM+V beyond completion of chemotherapy reduced stage IIIB deaths by 83% and stage IV by 72% compared with short-term use only for the duration of chemotherapy. Long-term PAM+V combined with conventional therapy reduced stage IIIA deaths by 46%, stage IIIB by 62%, and stage IV by 69% compared with conventional therapy alone. Survival rates for stage IV patients treated with PAM+V were 82% at 1 year, 68% at 2 years, and 14% at 5 years. PAM+V combined with conventional therapy improved survival in stages IIIA, IIIB, and IV, compared with conventional therapy alone. Prospective trials using PAM+V with conventional therapy for lung cancer patients are justified.
Integrative Cancer Therapies, 2011
Although localized colon cancer is often successfully treated with surgery, advanced disease requ... more Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference-namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified.
Integrative Cancer Therapies, 2003
European Respiratory Journal, 2012
Clinical Infectious Diseases, 2002
American Journal of Epidemiology, 2002
The American Journal of Cardiology, 2012
ment was 17.5%. Each patient was followed for Ն12 months. None of the patients received prophylac... more ment was 17.5%. Each patient was followed for Ն12 months. None of the patients received prophylactic ICDs in the first year of enrollment. Nonetheless, 40 of 41 were alive at 1 year, corresponding to an extremely low 1-year mortality rate of 2.44%. This was not an outlier, because in a similar survey 10 years ago, the 1-year mortality without ICDs of 27 newly enrolled patients with a mean LVEF of 18.3% was 0%. In contrast, the usual 1-year mortality of patients after heart failure hospitalizations ranges from 20% to 30%. 3,4 The only patient in our 2010 cohort who died within 1 year was a woman with end-stage DC and an LVEF of 5%, who was not a candidate for advanced treatments because of myeloma, was receiving home milrinone infusion, and was under hospice care. Twenty-five of the 41 patients underwent repeat echocardiography at 1 year after enrollment. In those, the mean LVEF increased from 18.8% before enrollment to 36.3% at 1 year (absolute mean increase 17.5%, relative increase 93.1%). Fifty-two percent of patients achieved LVEFs Ͼ35%, which is outside the SCD-HeFT ICD indication range. 2 The study by Zecchin et al 1 clearly demonstrated that with optimum medical management, many patients with original SCD-HeFT criteria for prophylactic ICD implantation did not maintain ICD indication at 3 to 9 months into treatment. Our data extend those observations by demonstrating that with aggressive medical management, even high-risk patients with severe symptoms and very low LVEFs at presentation can do well, have very low 1-year mortality, and have great improvement in the LVEF, in many cases moving them outside the ICD indication range.
The Permanente journal, Jan 25, 2016
Epithelioid hemangioendothelioma (EHE) is a family of blood vessel tumors originating in blood ve... more Epithelioid hemangioendothelioma (EHE) is a family of blood vessel tumors originating in blood vessels, bone, brain, kidney, liver, and lung. EHE is more common in women, and chemotherapy, radiation, and surgery have brought few successes. We present a case of a 28-year-old woman whose EHE recurred during pregnancy, suggesting hormonal involvement. We conducted a systematic review to provide analysis and interpretation of the potential significance of her disease recurring, with fatal outcome, during pregnancy. Very little research has explored the use of individual hormonal markers. Strongly positive expression of placenta growth factor (PlGF) and 17-beta estradiol receptors have been reported. Expression of PlGF is noteworthy in our case, in that our patient's disease quickly and dramatically flared in the 25th week of pregnancy, near the peak in maternal PlGF production. PlGF binds to vascular endothelial growth factor-1 (VEGF-1), and PlGF may accelerate VEGF-induced angiogen...
UroToday International Journal, 2012
The Permanente journal, 2015
A search of PubMed, EMBASE, and Google Scholar revealed 39 citations of which 7 provided reportin... more A search of PubMed, EMBASE, and Google Scholar revealed 39 citations of which 7 provided reporting quality sufficient to assess acupuncture safety in 384 anticoagulated patients (3974 treatments). Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth. The observed 0.003% complication rate is lower than the previously reported 12.3% following hip/knee replacement, and 6% following acupuncture in a prospective study of 229,230 all-type patients.
JNCI Journal of the National Cancer Institute, 2014
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Papers by Michael McCulloch, LAc MPH PhD