Edzard Ernst

MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

In one of my last posts, I was rather dismissive of veterinary chiropractic.

Was I too harsh?

I did ask readers who disagree with my judgment to send me their evidence.

Sadly, none arrived!

Therefore, I did several further literature searches and found a recent review of the topic. It included 14 studies; 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. . Study quality was low (n = 4), moderate (n = 7), and high (n = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. The authors concluded that it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

This, I think, can hardly be called good evidence. But I also found this more recent paper:

Chiropractic care is a common treatment modality used in equine practice to manage back pain and stiffness but has limited evidence for treating lameness. The objective of this blinded, controlled clinical trial was to evaluate the effect of chiropractic treatment on chronic lameness and concurrent axial skeleton pain and dysfunction. Two groups of horses with multiple limb lameness (polo) or isolated hind limb lameness (Quarter Horses) were enrolled. Outcome measures included subjective and objective measures of lameness, spinal pain and stiffness, epaxial muscle hypertonicity, and mechanical nociceptive thresholds collected on days 0, 14, and 28. Chiropractic treatment was applied on days 0, 7, 14, and 21. No treatment was applied to control horses. Data was analyzed by a mixed model fit separately for each response variable (p < 0.05) and was examined within each group of horses individually. Significant treatment effects were noted in subjective measures of hind limb and whole-body lameness scores and vertebral stiffness. Limited or inconsistent therapeutic effects were noted in objective lameness scores and other measures of axial skeleton pain and dysfunction. The lack of pathoanatomical diagnoses, multilimb lameness, and lack of validated outcome measures likely had negative impacts on the results.

Great! So, we finally have an RCT of chiropractic for horses. Unfortunately, the study is less than convincing:

  • It included just 20 polo horses plus 18 horses active in ridden or competitive work all suffering from lameness.
  • The authors state that ‘horses were numerically randomized to treatment and control groups’; yet I am not sure what this means.
  • Treatment consisted of high-velocity, low-amplitude, manually applied thrusts to sites of perceived pain or stiffness with the axial and appendicular articulations. Treatment was applied on days 0, 7, 14, and 21 by a single examiner. The control group received no treatment and was restrained quietly for 15 min to simulate the time required for chiropractic treatment. In other words, no placebo controls were used.
  • The validity of the many outcome measures is unknown.
  • The statistical analyses seem odd to me.
  • No correction for multiple statistical tests was done.
  • Most of the outcomes show no significant effect.
  • Overall, there were some small positive treatment effects based on subjective assessment of lameness, but no measurable treatment effects on objective measures of limb lameness.
  • The polo horses began their competition season at the beginning of the study which would have confounded the outcomes.

What does all this tell us about veterinary chiropractic?

Not a lot.

All we can safely say, I think, is that veterinary chiropractic is not evidence-based and that claims to the contrary are certainly ill-informed and most probably of a promotional nature.

Konjac glucomannan (KGM), also just called ‘glucomannan’, is a dietary fiber hydro colloidal polysaccharide isolated from the tubers of Amorphophallus konjac. It is used as a food, a food additive, as well as a dietary supplement in many countries. KGM is claimed to reduce the levels of glucose, cholesterol, triglycerides, and blood pressure.

The objective of this study was to evaluate the effect of the consumption of gummy candy enriched with KGM on appetite and to evaluate anthropometric data, biochemical, and oxidative stress markers in overweight individuals. Forty-two participants aged 18 to 45 years completed this randomized, double-blind, placebo-controlled clinical trial. Participants were randomly assigned to consume for 14 days, 2 candies per day, containing 250 mg of KGM or identical-looking placebo candy with 250 mg of flaxseed meal, shortly after breakfast and dinner. As a result, we observed that there was a reduction in waist circumference and in the intensity of hunger of the participants who consumed KGM. The authors believe that a longer consumption time as well as an increased dose of KGM would contribute to even more satisfactory body results.

These findings seem promising, yet somehow I am not convinced. The study was small and short-term; moreover, the authors seem uncritical and, instead of a conclusion, they offer speculations.

Our own review of 2014 included 9 clinical studies. There was a variation in the reporting quality of the included RCTs. A meta-analysis (random effect model) of 8 RCTs revealed no significant difference in weight loss between glucomannan and placebo (mean difference [MD]: -0.22 kg; 95% confidence interval [CI], -0.62, 0.19; I(2) = 65%). Adverse events included abdominal discomfort, diarrhea, and constipation. We concluded that the evidence from available RCTs does not show that glucomannan intake generates statistically significant weight loss. Future trials should be more rigorous and better reported.

Rigorous trials are required to change my mind, and I am not sure that the new study falls into this category.

About 10 years ago, I published this little post about ‘MY HOLISTIC HEALTH CENTRE’:

Where I live, some of the old-fashioned, privately-owned shops that used to dominate our high streets have survived the onslaught of the supermarkets. Our bakery is such a quaint remnant from the past. Surprisingly, it also is more holistic and more therapeutic than any alternative health centre I have come across.

The first thing that strikes anyone who enters the premises is the irresistible smell. Customers’ well-being hits the ceiling, and the local aromatherapists are in danger of going out of business. The intense stimulation of the customers’ olfactory system relaxes their minds and puts them into a meditative state as they patiently wait to be served. Everyone in the queue has a little word with the baker’s wife, and progress is therefore slow – but we don’t mind: the chat is holistic counseling at its best, and our slow movements toward the counter are healthier than tai chi.

“You are looking well today,” says the baker’s wife, thereby gently arousing me from my aroma-induced meditation and indicating that she is about to focus her shaman healing energy on me. Her diagnosis is spot on; the alternative therapies I enjoyed while waiting have re-balanced my chakras and got my qi flowing nicely – no wonder I am looking well!

The whole-wheat scones are finely balanced and nutritious; so I order three—one for the walk home and two for tea later. Prices have gone up a bit but, as with all holistic therapies, the more you pay, the more it’s worth. “Here you are,” she says, handing me her dietary delights. As I pay, our hands touch ever so briefly, just long enough for me to experience the instant transfer of healing energy that is so characteristic of Therapeutic Touch.

“Take care now, and God bless”, she says. As I walk out of her aura, I contemplate her words full of empathetic spiritual guidance and ancient wisdom. “That was expensive”, my wife mutters back home. I beg to differ: not only did I get the most wholesome food for my physical body, but I received holistic and patient-centered aromatherapy, counseling, meditation, tai chi, and energy healing for my emotional, psychological, and spiritual needs.

If only our Health Secretary knew about this traditional, yet integrated and therefore cutting-edge approach to cost-effective health and holistic well-being. We could all have it for free, and it might even save the NHS from its current crisis!

Since I wrote these lines, the healthcare crises have deepened and, in some countries, privatization is considered a possible solution. If that moment arrives, it will be the day of so-called alternative medicine (SCAM) clinics. They will pop up like mushrooms and prosper like gold mines. In preparation for this glorious development, I have been trying to think of a few names that would be best for attracting needy consumers to my new alternative health clinics:

  • An establishment specializing in SCAM for grieving individuals: GOOD GRIEF
  • A clinic for traditional acupuncture: WHAT’S THE POINT?
  • A body purification center: CHUCKY’S DETOX TINCTURES
  • An institute specializing in SCAM for erectile dysfunction: SOMETHING MIGHT COME UP
  • A clinic for talking therapies: THE HOT AIR SALOON
  • Osteopathy school: STILL FOR ALL ILLS
  • An institute for veterinary homeopathy: NOTHING IS BETTER
  • A center specializing in SCAM for premature ejaculation: COMING LATER
  • SCAM diagnostic clinic: SECOND BEST OPINION
  • Chiropractic clinic: SUBLUXOURIOUS LUXATIONS
  • Energy healing institute: TOO GOOD TO BE TRUE
  • Clinic specializing in SCAM for intestinal pain: GONE WITH A WIND
  • Essential oils clinic: I CAN’T BELIEVE IT’S NOT BUTTER
  • Coffee enema clinic: STARBUCKS
  • Spiritual healing: CREED AND GREED
  • Clinic for Oriental medicine: EAST OF EDEN
  • Body reshaping center: WASTE WATCHERS
  • Leech therapy clinic: BORN TO SUCK
  • Mind-body institute: NEVER MIND
  • Alternative computer skills: NEUROLINGUISTIC PROGRAMMING
  • Vibrational medicine clinic: SATISFACTION GUARANTEED
  • Homeopathic health clinic: A LOT TO DO ABOUT NOTHING
  • Clinic specializing in SCAM for Benign Prostate Hypertrophy: TO PEE OR NOT TO PEE

I am sure many of you have much better ideas than I can think of – please, do not hesitate to let me know.

The concept of ultra-processed food (UPF) was initially developed and the term coined by the Brazilian nutrition researcher Carlos Monteiro, with his team at the Center for Epidemiological Research in Nutrition and Health (NUPENS) at the University of São Paulo, Brazil. They argue that “the issue is not food, nor nutrients, so much as processing,” and “from the point of view of human health, at present, the most salient division of food and drinks is in terms of their type, degree, and purpose of processing.”

Examples of UPF include:

Ultra-processed food is bad for our health! This message is clear and has been voiced so many times – not least by proponents of so-called alternative medicine (SCAM) – that most people should now understand it.

But how bad?

And what diseases does UPF promote?

How strong is the evidence?

I did a quick Medline search and was overwhelmed by the amount of research on this subject. In 2022 alone, there were more than 2000 publications! Here are the conclusions from just a few recent studies on the subject:

Don’t get me wrong: this is not a systematic review of the subject. I am merely trying to give a rough impression of the research that is emerging. A few thoughts seem nonetheless appropriate.

  1. The research on this subject is intense.
  2. Even though most studies disclose associations and not causal links, there is in my view no question that UPF aggravates many diseases.
  3. The findings of the current research are highly consistent and point to harm done to most organs.
  4. Even though this is a subject on which advocates of SCAM are exceedingly keen, none of the research I saw was conducted by SCAM researchers.
  5. The view of many SCAM proponents that conventional medicine does not care about nutrition is clearly not correct.
  6. Considering how unhealthy UPF is, there seems to be a lack of effective education and action aimed at preventing the harm UPF does to us.

Drip IV is “Australia’s first and leading mobile healthcare company specialising in assisting with nutritional deficiencies”. They claim to provide a mobile IV service that is prescribed and tailored individually to your nutritional needs. Treatment plans and customised infusions are determined by a medical team to suit individual requirements. They deliver vitamins, minerals and amino acids directly to the body via the bloodstream, a method they state allows for optimal bioavailability.

These claims are a little puzzling to me, not least because vitamins, minerals and amino acids tailored individually to the nutritional needs of the vast majority of people would mean administering nothing at all. But I guess that virtually every person who consults the service will get an infusion [and pay dearly for it].

The Australian Therapeutic Goods Administration (TGA) seems to have a similarly dim view on Drip IV. The TGA has just issued 20 infringement notices totalling $159,840 to the company and to one of its executive officers. The reason: unlawful advertising of intravenous infusion products to Australian consumers on a company website and social media. Ten notices totalling $133,200 were issued to the company and ten notices totalling $26,640 were issued to an executive officer. The TGA considers the intravenous infusion products to be therapeutic goods because of the claims made about them, and the advertising to be unlawful because the advertisements allegedly:

  • contained prohibited representations, such as claims regarding cancer.
  • contained restricted representations such as that the products would alleviate fatigue caused by COVID-19, assist in the treatment of Graves’ Disease and Alzheimer’s Disease, and support the treatment of autoimmune diseases such as Multiple Sclerosis. No TGA approval had been given to make such claims.
  • referred to ingredients that are prescription only, such as glutathione. Prescription medicines cannot be advertised directly to the public in Australia.
  • contained a statement or picture suggesting or implying the products were ‘TGA Approved’. Advertising of therapeutic goods cannot include a government endorsement.
  • contained a statement or picture expressing that the goods were ‘miraculous’.

Vitamin infusions have become very popular around the globe. There are now thousands of clinics offering this service, and many of them advertise aggressively with claims that are questionable. Here is just one example from the UK:

Modern life is hectic. If you are looking to boost your wellbeing, increase your energy levels, lift your mood and hydrate your body, Vitamin IV Infusions are ideal. Favoured by celebrities such as Madonna, Simon Cowell and Rihanna, Vitamin IV Infusions are an easy, effective way of delivering vitamins, minerals and amino acids directly into your bloodstream via an IV (intravenous) drip. Vitamins are essential for normal growth and staying healthy – but our bodies can’t produce all of the nutrients we need to function and thrive. That’s why more than one in three people take daily vitamin supplements – often without realising that only 15% of the active nutrients consumed orally actually find their way into their bloodstream. With Vitamin IV Infusions, the nutrients enter your bloodstream directly and immediately, and are delivered straight to your cells. We offer four different Vitamin IV Infusions, so you can choose the best combination for your personal needs, while boosting your general health, energy and wellbeing.

My advice to consumers is a little different and considerably less costly:

  1. to ensure you get enough vitamins, minerals, and amino acids, eat a balanced diet;
  2. to boost your well-being, sit down and calculate the savings you made by NOT using such a service;
  3. to increase your energy levels, take a nap;
  4. to lift your mood, recount the money you saved and think of what nice things you might buy with it;
  5. to hydrate your body drink a glass of water.

Perhaps it is time the authorities in all countries had a look at what these clinics are offering and what health claims they are making. Perhaps it is time they act as the TGA just did.

 

The UK medical doctor, Sarah Myhill, has a website where she tells us:

Everyone should follow the general approach to maintaining and restoring good health, which involves eating a paleo ketogenic diet, taking a basic package of nutritional supplements, ensuring a good night’s sleep on a regular basis and getting the right balance between work, exercise and rest. Because we live in an increasingly polluted world, we should probably all be doing some sort of detox regime.

She also happens to sell dietary supplements of all kinds which must surely be handy for all who want to follow her advice. Dr. Myhill boosted her income even further by putting false claims about Covid-19 treatments online. And that got her banned from practicing for nine months after a medical tribunal.

She posted videos and articles advocating taking vitamins and other substances in high doses, without evidence they worked. The General Medical Council (GMC) found her recommendations “undermined public health” and found some of her recommendations had the potential to cause “serious harm” and “potentially fatal toxicity”. The tribunal was told she uploaded a series of videos and articles between March and May 2020, describing substances as “safe nutritional interventions” which she said meant vaccinations were “rendered irrelevant”. But the substances she promoted were not universally safe and have potentially serious health risks associated with them, the panel was told. The tribunal found Dr. Myhill “does not practice evidence-based medicine and may encourage false reassurance in her patients who may believe that they will not catch Covid-19 or other infections if they follow her advice”.

Dr. Myhill previously had a year-long ban lifted after a General Medical Council investigation into her claims of being a “pioneer” in the treatment of chronic fatigue syndrome. In fact, the hearing was told there had been 30 previous GMC investigations into Dr. Myhill, but none had resulted in findings of misconduct.

Dr. Myhill is also a vocal critic of the PACE trial and biopsychosocial model of ME/CFS. Dr. Myhill’s GMC complaint regarding a number of PACE trial authors was first rejected without investigation by the GMC, after Dr. Myhill appealed the GMC stated they would reconsider. Dr. Myhill’s action against the GMC for failing to provide reasoning for not investigating the PACE trial authors is still continuing and began a number of months before the most recent GMC instigation of her practice started.

The recent tribunal concluded: “Given the circumstances of this case, it is necessary to protect members of the public and in the public interest to make an order suspending Dr. Myhill’s registration with immediate effect, to uphold and maintain professional standards and maintain public confidence in the profession.”

I remember being a student in Munich – that was about half a century ago! – protesting against some new regulations that my University (LMU) was trying to implement. We were in the street and some placards read: “TRAUE NIEMAND UEBER 30!” (DON’T TRUST ANYONE BEYOND THE AGE OF 30!).

And now I am 75!

Do I still trust myself?

Not with everything, of course.

For instance, I would not trust myself to ski down neck-breaking slopes; nor would I trust myself to pass the medical exams again; nor to drum 3 times per week in jazz clubs.

But, generally speaking, I do manage not that badly. In particular, I think I am capable of providing (hopefully constructive) criticism and reliable information on so-called alternative medicine (SCAM), the subject that became my hobby horse in the late 1970s and subsequently my job in the early 1990s.

At my age, people often ask me about regrets.

Do I have regrets?

I used to answer this question with a straight NO.

Lately, I am realizing that this is not entirely true.

I have quite a few regrets – mostly, they are relatively trivial. But some go deeper.

Those who know my CV well often wonder “Do you not regret having left your position in Vienna?” It’s a legitimate question: in Vienna, I had a position for life, a large and well-funded department of high reputation. In Exeter, I initially had as good as nothing followed by 20 years of fighting for ever more scarce funding.

Despite all this, the positives of the last 30 years more than outweighed the negatives, in my view: I was soon able to build up a productive team of researchers; together we managed to publish some exciting and important research; and eventually, we even managed to get a reputation – depending on who you ask, a good or a bad one.

But more important for me was just being in England. I loved it! No, not the food, not the weather, but the British openness, tolerance, understatement, politeness, integrity, gentleness, and decency. Sadly, since the Brexit vote, much of this has started to slowly disappear.

So, regrets?

Yes, several!

Would I do it all again?

Yes!

I am an incorrigible optimist convinced that the UK is presently going through a bit of a rough patch that soon will end. It’s just that, at the age of 75, I feel they better hurry up.

PS

The birthday cake just came from Natalie Grams – thanks Natalie

If you think that scanning through dozens of new scientific articles every week is a dry and often somewhat tedious exercise, you are probably correct. But every now and then, this task is turned into prime entertainment by some pseudoscientists trying to pretend to be scientists. Take, for instance, the latest homeopathy study by Indian researchers with no less than 9 seemingly impressive affiliations:

  • 1Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Salt Lake, Kolkata, West Bengal, India.
  • 2Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Block GE, Sector III, Salt Lake, Kolkata, West Bengal, India.
  • 3Department of Homoeopathy, State Homoeopathic Dispensary, Karaila, Pratapgarh, Uttar Pradesh, India.
  • 4Department of Homoeopathy, State Homoeopathic Dispensary, Tulsipur, Shrawasti, Uttar Pradesh, India.
  • 5Department of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Salt Lake, Kolkata, West Bengal, India.
  • 6State Homoeopathic Dispensary, Mangalbari Rural Hospital, Matiali Block, Jalpaiguri, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, India.
  • 7Department of Repertory, The Calcutta Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, West Bengal, India.
  • 8Department of Homoeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Village and Post Office: Gouripur (South), Police Station Bishnupur, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, India.
  • 9Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Tangra, Kolkata, West Bengal, India.

Now that I have whetted your appetite, here is their study:

Lumbar spondylosis (LS) is a degenerative disorder of the lumbar spine. Despite substantial research efforts, no gold-standard treatment for LS has been identified. The efficacy of individualized homeopathic medicines (IHMs) in lumbar spondylosis (LS) is unknown. In this double-blind, randomized, placebo-controlled trial, the efficacy of IHMs was compared with identical-looking placebos in the treatment of low back pain associated with LS. It was conducted at the National Institute of Homoeopathy, West Bengal, India.

Patients were randomized to receive IHMs or placebos; standardized concomitant care was administered in both groups. The Oswestry low back pain and disability questionnaire (ODQ) was used as the primary outcome measure; the Roland-Morris questionnaire (RMQ) and the short form of the McGill pain questionnaire (SF-MPQ) served as secondary outcome measures. They were measured at baseline and every month for 3 months. Intention-to-treat analyses (ITT) were used to detect any inter-group differences using two-way repeated measures analysis of variance models overall and by unpaired t-tests at different time points.

Enrolment was stopped prematurely because of time restrictions; 55 patients had been randomized (verum: 28; control: 27); 49 could be analyzed by ITT (verum: 26; control: 23).

The results are as follows:

  • Inter-group differences in ODQ (F 1, 47 = 0.001, p = 0.977), RMQ (F 1, 47 = 0.190, p = 0.665) and SF-MPQ total score (F 1, 47 = 3.183, p = 0.081) at 3 months were not statistically significant.
  • SF-MPQ total score after 2 months (p = 0.030) revealed an inter-group statistical significance, favoring IHMs against placebos.
  • Some of the SF-MPQ sub-scales at different time points were also statistically significant: e.g., the SF-MPQ average pain score after 2 months (p = 0.002) and 3 months (p = 0.007).
  • Rhus Toxicodendron, Sulphur, and Pulsatilla nigricans were the most frequently indicated medicines.

The authors concluded that owing to failure in detecting a statistically significant effect for the primary outcome and in recruiting a sufficient number of participants, our trial remained inconclusive.

Now that I (and hopefully you too) have recovered from laughing out loud, let me point out why this paper had me in stitches:

  • The trial was aborted not because of a “time limit” but because of slow recruitment, I presume. The question is why were not more patients volunteering? Low back pain with LS is extremely common. Could it be that patients know only too well that homeopathy does not help with low back pain?
  • If a trial gets aborted because of very low patient numbers, it is probably best not to publish it or at least not to evaluate its results at all.
  • If the researchers insist on publishing it, their paper should focus on the reason why it did not succeed so that others can learn from their experience by avoiding their mistakes.
  • However, once the researchers do run statistical tests, they should be honest and conclude clearly that, because the primary outcome measure showed no inter-group difference, the study failed to demonstrate that the treatment is effective.
  • The trial did not “remain inconclusive”; it was squarely negative.
  • The editor of the journal HOMEOPATHY should know better than to publish such nonsense.

A final thought: is it perhaps the ultimate proof of homeopathy’s ‘like cures like’ assumption to use sound science (i.e. an RCT), submit it to the homeopathic process of endless dilutions and succussions, and – BINGO – generate utter nonsense?

This prospective study aimed to identify an optimal lifestyle profile to protect against memory loss in older individuals from areas representative of the north, south, and west of China. Individuals aged 60 years or older who had normal cognition and underwent apolipoprotein E (APOE) genotyping at baseline in 2009 were included. Participants were followed up until death, discontinuation, or 26 December 2019.

Six lifestyle factors were assessed:

  • a healthy diet (adherence to the recommended intake of at least 7 of 12 eligible food items),
  • regular physical exercise (≥150 min of moderate intensity or ≥75 min of vigorous intensity, per week),
  • active social contact (≥twice per week),
  • active cognitive activity (≥twice per week),
  • never or previously smoked,
  • never drinking alcohol.

Participants were categorised into the favourable group if they had 4-6 healthy lifestyle factors, into the average group for two to three factors, and into the unfavourable group for zero to one factor.

Memory function was assessed using the World Health Organization/University of California-Los Angeles Auditory Verbal Learning Test, and global cognition was assessed via the Mini-Mental State Examination. Linear mixed models were used to explore the impact of lifestyle factors on memory in the study sample.

A total of 29 072 participants were included (mean age of 72.23 years; 48.54% (n=14 113) were women; and 20.43% (n=5939) were APOE ε4 carriers). Over the 10-year follow-up period (2009-19), participants in the favourable group had slower memory decline than those in the unfavourable group (by 0.028 points/year, 95% confidence interval 0.023 to 0.032, P<0.001). APOE ε4 carriers with favourable (0.027, 95% confidence interval 0.023 to 0.031) and average (0.014, 0.010 to 0.019) lifestyles exhibited a slower memory decline than those with unfavourable lifestyles. Among people who were not carriers of APOE ε4, similar results were observed among participants in the favourable (0.029 points/year, 95% confidence interval 0.019 to 0.039) and average (0.019, 0.011 to 0.027) groups compared with those in the unfavourable group. APOE ε4 status and lifestyle profiles did not show a significant interaction effect on memory decline (P=0.52).

The authors concluded that a healthy lifestyle is associated with slower memory decline, even in the presence of the APOE ε4 allele. This study might offer important information to protect older adults against memory decline.

This is an important and meticulously reported study. It is the first large-scale investigation that assesses the effects of different lifestyle profiles, APOE ε4 status, and their interactions on longitudinal memory trajectories over a 10-year follow-up period. The results show that lifestyle is associated with the rate of memory decline in cognitively normal older individuals, including in people who are genetically susceptible to memory decline. The authors are rightly careful to avoid causal inferences between lifestyle and memory decline. To demonstrate causality beyond doubt, we would need different study designs.

The authors also discuss several weaknesses of the study:

  • Firstly, the assessments of lifestyle factors were based on self-reports and are, therefore, prone to measurement errors.
  • Secondly, several participants were excluded due to missing data or not returning for follow-up evaluations, which might have led to selection bias.
  • Thirdly, the proportion of individuals with an unhealthy lifestyle might have been underestimated in the study because people with poor health were less likely to have participated in the study.
  • Fourthly, given the nature of the study design, it could not assess whether maintaining a healthy lifestyle had already started influencing memory by the time of enrolment in the study.
  • Fifthly, the evaluation of memory using a single neuropsychological test that does not comprehensively reflect overall memory function. However, the Auditory Verbal Learning Test is an effective instrument for memory assessment, and a composite score was used based on four Auditory Verbal Learning Test subscales to represent memory conditions to the greatest extent possible.
  • Sixthly, as participants might become familiar with repeated cognitive testing, a learning effect could have influenced the results.
  • Finally, memory decline was studied solely among older adults; however, memory problems commonly affect young individuals as well.

The authors, therefore, state that further studies should be conducted to facilitate a more extensive investigation into the effects of a healthy lifestyle on memory decline across the lifespan. This approach would help to elucidate the crucial age window during which a healthy lifestyle can exert the most favourable effect.

The UK mainstream media have so far failed to report on this new and highly worrying development: in a rare show of unity, the UK practitioners of so-called alternative medicine (SCAM) have formed the ‘SCAM Union’ (SCAMU) – pronounced ‘scam you’ – and decided to go on strike. Their demands are straightforward:

  1. increase pay in line with inflation;
  2. full recognition of their profession;
  3. right to regular 15 min tai chi breaks.

Already last week, they staged a two-day nationwide walkout.

  • Homeopaths stopped seeing patients and some had to start taking remedies at the C 2000 potency to keep calm but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Chiropractors did not adjust a single subluxation and started cracking jokes instead but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Naturopaths failed to detox a single patient but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Crystal healers kept their crystals under wraps but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Osteopath mobilized not a single joint but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Acupuncturists failed to insert a single needle but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Vaginal steamers only steamed the odd dim sum for lunch but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Ear candlers did not light a single candle and instead aligned them in a visual picket line but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Aromatherapists refused to open any bottles with essential oil but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Herbalists simply said ‘Thyme will tell’ but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Bach flower therapists had to consume their own Rescue Remedies in large quantities but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.
  • Holistic practitioners claimed to be wholly distraught but NOBODY NOTICED AND THE EFFECT ON THE NATIONS HEALTH WAS NOT NOTICABLE.

Perhaps the most outrageous thing about these events is that the UK press studiously ignored the all-out strike (one broadsheet editor commented: “if it’s not about Megan, we are not interested). Merely King Charles seemed alarmed and was overheard privately mumbling to Camilla: “What next?”

 

 

PS

I have been told that some of my readers have difficulties knowing when I am pulling their legs. So, let me confirm: every word here is uninvented – or was that uninventive?

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