Edzard Ernst

MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The title of the press-release was impressive: ‘Columbia and Harvard Researchers Find Yoga and Controlled Breathing Reduce Depressive Symptoms’. It certainly awoke my interest and I looked up the original article. Sadly, it also awoke the interest of many journalists, and the study was reported widely – and, as we shall see, mostly wrongly.

According to its authors, the aims of this study were “to assess the effects of an intervention of Iyengar yoga and coherent breathing at five breaths per minute on depressive symptoms and to determine optimal intervention yoga dosing for future studies in individuals with major depressive disorder (MDD)”.

Thirty two subjects were randomized to either the high-dose group (HDG) or low-dose group (LDG) for a 12-week intervention of three or two intervention classes per week, respectively. Eligible subjects were 18–64 years old with MDD, had baseline Beck Depression Inventory-II (BDI-II) scores ≥14, and were either on no antidepressant medications or on a stable dose of antidepressants for ≥3 months. The intervention included 90-min classes plus homework. Outcome measures were BDI-II scores and intervention compliance.

Fifteen HDG and 15 LDG subjects completed the intervention. BDI-II scores at screening and compliance did not differ between groups. BDI-II scores declined significantly from screening (24.6 ± 1.7) to week 12 (6.0 ± 3.8) for the HDG (–18.6 ± 6.6; p < 0.001), and from screening (27.7 ± 2.1) to week 12 (10.1 ± 7.9) in the LDG. There were no significant differences between groups, based on response (i.e., >50% decrease in BDI-II scores; p = 0.65) for the HDG (13/15 subjects) and LDG (11/15 subjects) or remission (i.e., number of subjects with BDI-II scores <14; p = 1.00) for the HDG (14/15 subjects) and LDG (13/15 subjects) after the 12-week intervention, although a greater number of subjects in the HDG had 12-week BDI-II scores ≤10 (p = 0.04).

The authors concluded that this dosing study provides evidence that participation in an intervention composed of Iyengar yoga and coherent breathing is associated with a significant reduction in depressive symptoms for individuals with MDD, both on and off antidepressant medications. The HDG and LDG showed no significant differences in compliance or in rates of response or remission. Although the HDG had significantly more subjects with BDI-II scores ≤10 at week 12, twice weekly classes (plus home practice) may rates of response or remission. Although the HDG, thrice weekly classes (plus home practice) had significantly more subjects with BDI-II scores ≤10 at week 12, the LDG, twice weekly classes (plus home practice) may constitute a less burdensome but still effective way to gain the mood benefits from the intervention. This study supports the use of an Iyengar yoga and coherent breathing intervention as a treatment to alleviate depressive symptoms in MDD.

The authors also warn that this study must be interpreted with caution and point out several limitations:

  • the small sample size,
  • the lack of an active non-yoga control (both groups received Iyengar yoga plus coherent breathing),
  • the supportive group environment and multiple subject interactions with research staff each week could have contributed to the reduction in depressive symptoms,
  • the results cannot be generalized to MDD with more acute suicidality or more severe symptoms.

In the press-release, we are told that “The practical findings for this integrative health intervention are that it worked for participants who were both on and off antidepressant medications, and for those time-pressed, the two times per week dose also performed well,” says The Journal of Alternative and Complementary Medicine Editor-in-Chief John Weeks

At the end of the paper, we learn that the authors, Dr. Brown and Dr. Gerbarg, teach and have published Breath∼Body∼Mind©, a technique that uses coherent breathing. Dr. Streeter is certified to teach Breath∼Body∼Mind©. No competing financial interests exist for the remaining authors.

Taking all of these issues into account, my take on this study is different and a little more critical:

  • The observed effects might have nothing at all to do with the specific intervention tested.
  • The trial was poorly designed.
  • The aims of the study are not within reach of its methodology.
  • The trial lacked a proper control group.
  • It was published in a journal that has no credibility.
  • The limitations outlined by the authors are merely the tip of an entire iceberg of fatal flaws.
  • The press-release is irresponsibly exaggerated.
  • The authors have little incentive to truly test their therapy and seem to use research as a means of promoting their business.

George Lewith has died on 17 March, aged 67. He was one of the most productive researchers of alternative medicine in the UK; specifically he was interested in acupuncture. If you search this blog, you find several posts that mention him or are entirely dedicated to his work. Undeniably, my own views and research were often very much at odds with those of Lewith.

Wikipedia informs us that Lewith graduated from Trinity College, Cambridge in medicine and biochemistry.  He then went on to Westminster Medical School to complete his clinical studies and began working clinically in 1974. In 1977 Lewith became a member of the Royal College of Physicians. Then, in 1980, he became a member of the Royal College of General Practitioners and, later in 1999, was elected a fellow of the Royal College of Physicians.

He was a Professor of Health Research in the Department of Primary Care at the University of Southampton and a director of the International Society for Complementary Medicine Research. Lewith has obtained a significant number of institutional peer reviewed fellowships at doctoral and post-doctoral level and has been principal investigator or collaborator in research grants totally over £5 million during the last decade.

Between 1980 and 2010, Lewith was a partner at the Centre for Complementary and Integrated Medicine, a private practice providing complementary treatments with clinics in London and Southampton.

A tribute by the British Acupuncture Council is poignant, in my view: “George was a friend not only to all of the acupuncture profession, be it traditional, medical or physiotherapist – he was a member of all three professional bodies – but to the whole of complementary medicine. As well as being a research leader he was also politically savvy, working tirelessly up front and behind the scenes to try to bring acupuncture and CAM further into the mainstream. Nobody did more.”

I find it poignant because it hints at the many differences I (and many others) had with Lewith during the last 25 years that I knew him. George was foremost a proponent of acupuncture. His 1985 book – the first of many – advocated treating many internal diseases with acupuncture!

George did not strike me as someone who had the ability or even the ambition to use science for finding the truth and for falsifying hypotheses; in my view, he employed it to confirm his almost evangelic belief. In the pursuit of this all-important aim he did indeed spend a lot of time and energy pulling strings, including on the political level. George was undoubtedly successful but the question has to be asked to what extent this was due to his tireless work ‘behind the scenes’.

In my view, George was a typical example of someone who first and foremost was an advocate and a researcher second. During my time in Exeter, I have met numerous co-workers who had the same problem. Almost without exception, I found that it is impossible to turn such a person into a decent scientist. The advocacy of alternative medicine always got in the way of objectivity and rationality, qualities that are, of course, essential for good science.

George’s very first publication on acupuncture was a ‘letter to the editor’ published in the BMJ. In it, he announced that he is planning to conduct a trial of acupuncture and stated that “acupuncture will be compared to an equally magical placebo”. Yes, George always had the ability to make me laugh; and this is why I will miss him.

The love-affair of many nurses with complementary medicine is well-known. We have discussed it many times on this blog – see for instance here, here and here. Yet the reasons for it remain somewhat mysterious, I find. Therefore I was interested to see a new paper on the subject.

The aim of this ‘meta-synthesis‘ was to review, critically, appraise and synthesize the existing qualitative research to develop a new, more substantial interpretation of nurses’ attitudes regarding the, use of complementary therapies by patients. Fifteen articles were included in the review.

Five themes emerged from the data relating to nurses’ attitude towards complementary therapies:

  1. the strengths and weaknesses of conventional medicine;
  2. complementary therapies as a way to enhance nursing practice;
  3. patient empowerment and patient-centeredness;
  4. cultural barriers and enablers to integration;
  5. structural barriers and enablers to integration.

Nurses’ support for complementary therapies, the authors of this article claim, is not an attempt to challenge mainstream medicine but rather an endeavour to improve the quality of care available to patients. There are, however, a number of barriers to nurses’ support including institutional culture and clinical context, as well as time and knowledge limitations.

The authors concluded that some nurses promote complementary therapies as an opportunity to personalise care and practice in a humanistic way. Yet, nurses have very limited education in this field and a lack of professional frameworks to assist them. The nursing profession needs to consider how to address current deficiencies in meeting the growing use of complementary therapies by patients.

In my view, there are two most remarkable misunderstandings here:

  1. While it is undoubtedly laudable that nurses “endeavour to improve the quality of care available to patients”, it has to be said that such an endeavour does not require complementary medicine. Are they implying that with conventional medicine the quality of care cannot be improved?
  2. I fail to understand why the lack of good evidential support for most complementary therapies did not emerge as a prominent theme. Are nurses not concerned about the (lack of) evidence that underpins their actions?

On their website, ‘CBC News’ just published an article that is relevant to much what we have been discussing here. I therefore take the liberty of showing you a few excerpts:

START OF QUOTES

…A CBC News analysis of company websites and Facebook pages of every registered chiropractor in Manitoba found several dozen examples of statements, claims and social media content at odds with many public health policies or medical research.

Examples include:

  • Offers of treatments for autism, Tourette’s syndrome, Alzheimer’s disease, colic, infections and cancer.
  • Anti-vaccination literature and recently published letters to the editor from chiropractors that discourage vaccination.
  • An article claiming vaccines have caused a 200 to 600 per cent increase in autism rates.
  • A statement that claims the education and training of a chiropractor is “virtually identical” to that of a medical doctor.
  • Discouraging people from getting diagnostic tests such as CT scans, colonoscopies and mammograms.
  • An informational video discouraging the use of sunscreen.

…”It misleads the public in two areas. Firstly, those who choose to go for chiropractic care, particularly for things like infection and autism and things that we know they’re not going to be beneficial for, it misleads those individuals and gives them false hope for treatment that will not be effective,” he [Dr. Alan Katz, director of the Manitoba Centre for Health Policy] said. “Putting these things up on their website also puts the doubt in the minds of others about what we do know works, and as a result those people may not seek the right type of care for conditions that could deteriorate if they don’t seek that care.”

The Manitoba Chiropractors Association declined an interview request but did say it would review the content.

health-care-lies

This image disparaging medical treatments and physicians appeared on a chiropractor’s clinic Facebook page.

…The Manitoba Chiropractors Association has previously addressed certain issues with its membership through an internal communication. “In Manitoba, the administration of ‘vaccination and immunization’ currently falls outside the scope of chiropractic practice,” the communication said. It also cautioned members that:

  • “Chiropractors may be liable for opinions they provide to patients/public in circumstances where it would be reasonably foreseeable that the individual receiving the opinion would rely on it.
  • “Providing professional opinions on the issue of vaccination and immunization would likely be found by a court to be outside the scope of practice of a chiropractor.”

The association also said, “The degree to which a chiropractor can or cannot discuss ‘vaccination and immunization’ or other health-care procedures that are outside the scope of practice with a patient is currently being reviewed by the board of directors.”…

fluoride-hitler

A local chiropractor shared this message on their company Facebook page. Health Canada says fluoride concentrations in drinking water do not pose a risk to human health and are endorsed by over 90 national and international professional health organizations. (Facebook)

The fact that members of a regulated health profession are actively disseminating questionable medical information while benefiting from public funds is cause for concern, Katz said. “Should we as a society be paying for the services of professionals, and I use that word loosely, that are advocating care that is contrary to the official public policy?”

 

fever-baby-ad

Information on fevers posted online by a Manitoba chiropractor. The College of Family Physicians of Canada says that if a infant has a temperature of 100.4°F (38°C) or higher to call the doctor or immediately go to an emergency room.

…A letter by Winnipeg chiropractor Henri Marcoux was published last February in Manitoba’s francophone weekly newspaper La Liberté, in response to an article in which a regional health authority expert was interviewed about influenza immunizations.

Marcoux wrote that he does not recommend flu vaccines, calling them “toxic.” He further stated that the flu virus actually “purifies our systems” and said that he believes flu vaccines are “driven by a vast operation orchestrated by pharmaceutical companies.” People should instead focus on general wellness — which includes chiropractic treatment — to stave off the flu, he wrote.

treating-chiro…Now-retired chiropractor and long-time anti-vaccination advocate Gérald Bohémier wrote a later letter in support of Marcoux that also appeared in La Liberté.

Letters then poured in from members of the community, including a resident and two physicians who took exception to these statements. Marcoux told the CBC’s French service, Radio-Canada, that he does not believe his views are at odds with public health. He stands by his letter, he said, adding if society as a whole took health and wellness more seriously — rather than trying to treat symptoms — the need for vaccines would dissipate or never would have existed in the first place…

END OF QUOTES

Some chiropractors will respond that this is Canada and that elsewhere the situation is much better. I fear that this is not necessarily true – and if it is better in the UK, it is not because of the efforts of chiropractors or their professional organisations. In the UK, the situation has improved because of the work of organisations such as the Nightingale Collaboration and The Good Thinking Society. Likewise, in other countries, progress is being generated not by chiropractors but by critical thinkers and critics of quackery.

THE HINKLEY TIMES is quickly becoming my favourite newspaper. Yesterday they published an article about my old friend Tredinnick. I cannot resist showing you a few excerpts from it:

START OF EXCERPTS

Alternative therapy advocate, David Tredinnick has called for greater self reliance as a way of reducing pressures on the NHS. Speaking on the BBC’s regional Sunday Politics Show he suggested people should take more responsibility for their own health, rather than relying on struggling services. He highlighted homeopathy as a way of treating ailments at home and said self-help could cut unnecessary trips to the GP. He also said people could avoid illness by not being overweight and taking exercise…During debate on the show about the current ‘crisis’ in health and social care he said: “There are systems such as homeopathic remedies. Try it yourself before going to the doctor.”

Mr Tredinnick has always stood by his personal preferences for traditional therapies despite others disparaging his views. His recent remarks have sparked a response from Lib Dem Parliamentary spokesman Michael Mullaney. He said in the wake of the NHS facing cuts and closures, Mr Tredinnick was yet again showing he was out of touch. He added: “It’s dangerous for Mr Tredinnick, who is not properly medically trained, to use his platform as an MP to tell ill people to treat themselves with homeopathy, a treatment for which there is no medical proof that it works. He should stop talking about his quack theories and do his job representing the people of Hinckley and Bosworth, or otherwise he should resign as MP for he is totally failing to do his job of representing local people.”

END OF EXCERPTS

Yes, there is no doubt in my mind: if the public would ever take Tredinnick seriously when he talks about quackery, our health would be in danger. Therefore, it must be seen as most fortunate that hardly anyone does take him seriously. And here are a few reasons why this is so:

David Tredinnick: not again! Alternative medicine saves lives?!?

Tory MP David Tredinnick: “perhaps the worst example of scientific illiteracy in government.” But is he also a liar?

David Tredinnick: perhaps the worst example of scientific illiteracy in government?

Personally, I would very much regret if he resigned – there would be so much less to laugh about in the realm of alternative medicine!

Homeopaths have, as I reported previously, claimed to be able to ‘cure’ homosexuality. This is why I was less amazed than you might be when I came across a comment about a woman who tried a homeopathic solution called Dr. Reckeweg R20 Glandular Drops for Women. Nonetheless, the story is so remarkable that I cannot resist sharing it with you.

The solution promises to fix pituitary dysfunction, goiters, obesity, Grave’s diseases, Addison’s disease, and “lesbian tendencies.” The product also brags that it is “derived and potentised from fetal tissues.”

A much more detailed description of the remedy in question can be found here:

Dr. Reckeweg R20 Glandular drops for women, goitre, endocrine dysfunction, Graves disease, addisons disease, Adiposity (Overweight)

Dr Reckeweg R20 Glandular drops are indicated for frigidity in women. Dr.Reckeweg R20 drops treats endocrine dysfunction in women through individual remedies like Glandulae suprarenaises, Hypophysis that is derived and potentised from fetal tissues based on Arndt-Schulz principle. Also indicated for growth disturbances, obesity due to pituitary dysfunction, Goiter (swelling in neck due to thyroid enlargement), Grave’s diseases (auto immune disease from hyperthyroidism), Addison’s disease (due to deficient hormones from adrenal cortex), myxoedema (swelling due to under active thyroid glands), etc.

Introduction The disorders of glands in the human body can affect the physiological functions due to excess or deficient hormones. This occurs when glands like the adrenal or pituitary do not function properly resulting in too much or too little hormones being released. This includes important HORMONEs like cortisol aldosterone and sex hormones produced by adrenal gland and Growth hormone, Prolactin, Adrenocorticotropin (ACTH), Thyroid-stimulating hormone (TSH). For example too much aldosterone increases blood pressure whereas Adrenal insufficiency results in fatigue, muscle weakness, decreased appetite, and weight loss. Pituitary glandtumor is another manifestation of The disorders of glands in the human body and is fairly common in adults.

About Dr.Reckeweg R 20 drops is a popular homeopathic medicine to treat disorders of glands in human body and acts through a proprietary blend of several homeopathic herbs (available in drops). It has key Ingredients like hypophysis, pancreas etc that act on endocrine dysfunction, obesity that is caused due to pituitary dysfunction, growth disturbances. It is also indicated for swelling of the neck resulting from enlargement of the thyroid gland (goiter), swelling of the neck and protrusion of the eyes resulting from an overactive thyroid gland (Graves disease), disease characterized by progressive anemia, low blood pressure, great weakness, and bronze discoloration of the skin (Addisons disease) and swelling of the skin and underlying tissues giving a waxy consistency (myxoedema).

Indicated for following medical conditions Adiposity (Overweight), Disturbances of endocrive gland, Disturbances of gland,Obesity (Overweight)

INGREDIENTS: Dr.Reckeweg R 20 drops for women contains: Glandulae Thymi D12, Thyreoidinum D12, Hypophysis D12, Pancreas D12, Glandulae Supratenales D12, Ovaria D12 In R 20.

How the ingredients in Dr.Reckeweg R 20 drop work? The key properties in Dr.Reckeweg R 20 drops are derived from the following ingredients to treat disorders of glands in women

Glandulae suprarenales – treats abnormal physical weakness (asthenia), reduction of weight and condition causing abnormal weakness of certain muscles (myasthenia). It also treats asthma, allergic conditions, deficiency of glucose in the bloodstream (hypoglycaemia) and abnormal increase in muscle tension and a reduced ability of a muscle to stretch (hypertonia).

Hypophysis – it helps to control internal secretion, contents of the lactic acid in blood, mineralization and fluidic content of body.

Pancreas – treats pancreatic diabetes and stimulates production of the digestive secretions.

Testes (male) or Ovaria (female) – treats disorders of glands in human body such as senility (condition of being senile i.e. old age), inclining potency (male’s ability to achieve an erection or to reach orgasm), faulty memory, functional disturbances of glands. It also treats depression, inferiority complex, and condition in which one or both of the testes fail to descend from the abdomen (cryptorchidism), nocturnal involuntary urination (enuresis) and sexual dysfunction to maintain an erection of the penis (impotency).

Treats the failure of a female to respond to sexual stimulus (frigidity), lesbian tendencies, congestion and faulty circulation

It also reduces the hyperactivity of pituitary (hypophysis).

Glandulae thyme – treats exhaustion and congenital disorder arising from a chromosome defect, causing intellectual impairment and physical abnormalities (mongolism).

Thyreoidinum – it regulates thyroid gland, myxoedema, and interrupted development of the thyroid gland. It also treats condition of having low body temperature (hypothermy), excess of cholesterol in the bloodstream (hypercholesterolaemia) and retarded intellectual development.

DOSAGE: Generally 3 times daily 10 to 15 drops of Dr.Reckeweg R 20 in some water.

Complimentary medicines to R20: R26 drops (to increase reactivity after debilitating illness), R59 (in obesity)

SIZE:. 22 ML sealed Bottle

Encouraged by such scientific-sounding words, the women in question gives the remedy a try. By day four of the treatment, she writes, “At 3 AM, I find myself singing along to ‘You wanna see cunt, you wanna see pussy’ with someone else’s lipstick on my face.”

The conclusion of the author of the article is this: “So it looks like homeopathic fetus water does not in fact cure lesbianism. Still, as far as gay conversion therapy treatments go, it’s pretty tame — there’s no exorcism or electrocution, at least.”

I am sure by now you wonder about the Reckeweg remedy line. Here are two short paragraphs from my book to explain:

Dr. Reckeweg was a German homeopathic physician who practised complex homeopathy and developed homotoxicology as well as homaccorde, i. e. the administration of multiple potencies of the same remedies in one single preparation. He started a commercially successful line of combination remedies. The remedies are recommended for conventional diagnostic indications, but treated with homeopathically manufactured mixtures. According to proponents, they therefore built a bridge between conventional and homeopathic medicine. In the early 1970s, Reckeweg sold 50% of his company to the Delton Group and moved to the US.

Homotoxicology is a method inspired by homeopathy which was developed by Hans Heinrich Reckeweg (1905 – 1985). He believed that all or most illness is caused by an overload of toxins in the body. The toxins originate, according to Reckeweg, both from the environment and from the malfunction of physiological processes within the body. His treatment consists mainly in applying homeopathic remedies which usually consist of combinations of single remedies, because health cannot be achieved without ridding the body of toxins. The largest manufacturer and promoter of remedies used in homotoxicology is the German firm Heel.

And to put some icing on this cake: Heel was, of course, one of the firms who financed a journalist for systematically defaming me (more here, here and here).

Aromatherapy is popular and pleasant – but does it have real health effects? The last time I tried to find an answer to this question was in 2012. At that time, our systematic review concluded that “the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition.” But 5 years can be a long time in research, and more up-to-date information would perhaps be helpful.

This systematic review of 2017 aimed to provide an analysis of the clinical evidence on the efficacy of aromatherapy specifically for depressive symptoms on any type of patients. The authors searched 5 databases for relevant studies Outcome measures included scales measuring depressive symptoms levels. Twelve randomized controlled trials (RCTs) were included. Aromatherapy was administered by inhalation (5 studies) or massage (7 studies). Seven RCTs showed improvement in depressive symptoms. The quality of half of the studies was low, and the administration protocols varied considerably among the studies. Different assessment tools were employed in the studies. In 6 of the RCTs, aromatherapy was compared to no intervention.

Despite these caveats, the authors concluded that aromatherapy showed potential to be used as an effective therapeutic option for the relief of depressive symptoms in a wide variety of subjects. Particularly, aromatherapy massage showed to have more beneficial effects than inhalation aromatherapy.

Apart from the poor English, this paper is irritating because of the almost total lack of critical input. Given that half of the trials were of poor quality (only one was given the full points on the quality scale) and many totally failed to control for placebo-effects, I think that calling aromatherapy an effective therapeutic option for the relief of depressive symptoms is simply not warranted. In fact, it is highly misleading and, given the fact that depression is a life-threatening condition, it seems unethical and dangerous.

Considering these facts, my conclusion remains that “the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition, including depression.”

The British Chiropractic Association (BCA) has lost all credibility after suing Simon Singh for drawing the public’s attention to the fact that they were ‘happily promoting bogus treatments’. Now, it seems, they are trying to re-establish themselves with regular, often bogus or dubious pronouncements about back pain. It looks as though they have learnt nothing. A recent article in THE INDEPENDENT is a good example of this ambition, I think:

START OF QUOTE

Skinny jeans and coats with big fluffy hoods can contribute to painful back problems, chiropractors have warned.

Nearly three-quarters of women have experienced back pain, according to a survey by the British Chiropractic Association (BCA), who said fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame.

Wearing very tight jeans can restrict mobility and force other muscles to strain as they try to compensate for the resulting change in posture, chiropractor Rishi Loatey told The Independent.

“If they’re incredibly tight, you won’t be able to walk as you normally would,” he said.

“You’ve got a natural gait, or stride, that you would take, and the knee, hip and lower back all move to minimise the pressure coming up through the joints.

“However, if one of those areas isn’t moving as it should be, it’s going to cause more pressure elsewhere.”

While 73 per cent of women from a sample of more than 2,000 said they have had back pain, more than a quarter – 28 per cent – said they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.

Lower back pain is the most common cause of disability worldwide, with 9.4 per cent of people suffering from it, according to a previous study.

High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.

A number of high-profile campaigns against “sexist” dress codes requiring women to wear high heels at work have made reference to this fact.

But backless shoes, flimsy ballet pumps and some soft boots can also damage your back if they are worn too often, said Mr Loatey.

“If you imagine the back of a shoe, the bit that goes round the back is supposed to be quite firm, so it grips the rear foot,” he said. “If you don’t have that, then your foot is more mobile in the shoe.”

“If they’re not the right size, they’re a bit loose or they don’t have the bit at the back, you’re almost gripping the shoe as you walk, which again changes the way you walk,” said Mr Loatey, adding that ideally shoes should be laced up at the front to make sure the foot is held firmly.

A third of women surveyed by the BCA were unaware that their clothing choices could harm their backs and necks.

Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.

They should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead, he said.

END OF QUOTE

This piece strikes me as pure promotion of chiropractic – health journalism at its worse, I’d say. What is more objectionable than the promotion, it is full of half truths, ‘alternative facts’ and pure invention. Let me list a few statements that I find particularly doggy:

  1. “Skinny jeans and coats with big fluffy hoods can contribute to painful back problems.” Do they have any evidence for this? I don’t know of any!
  2. “…fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame [for back problems].” Idem!
  3. “Wearing very tight jeans can restrict mobility and force other muscles to strain…” Idem!
  4. “…it’s going to cause more pressure elsewhere.” Idem!
  5. 28% of women said “they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.” To make the findings from a survey look like scientific evidence for cause and effect is at best misleading, at worst dishonest.
  6. “…according to a previous study“. It turns out that this previous study was of occupational back pain which has nothing to do with tight jeans etc.
  7. “High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.” A link to the evidence would be nice – if there is any.
  8. “But backless shoes, flimsy ballet pumps and some soft boots can also damage your back – if they are worn too often…” Evidence needed – if there is any.
  9. “Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.” Concrete recommendations require concrete evidence or a link to it.
  10. Women “should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead.” Idem.

At this point congratulations are in order, I feel.

Firstly to THE INDEPENDENT for publishing one of the most inadequate health-related article which I have seen in recent months.

Secondly to the BCA for their stubborn determination to ‘happily promoting bogus’ notions. Instead of getting their act together when found out to advertise quackery in 2008, they sued Simon Singh (unsuccessfully, I hasten to add). Instead of cutting out the nonsense once and for all, they now promote populist ‘alternative facts’ about the causes of back pain. Instead of behaving like a professional organisation that promotes high standards and solid evidence, they continue to do the opposite.

One cannot but be impressed with so much intransigence.

On 13 March, the UK Charity Commission published the following announcement:

This consultation is about the Commission’s approach to deciding whether an organisation which uses or promotes CAM therapies is a charity. For an organisation to be charitable, its purposes must be exclusively charitable. Some purposes relate to health and to relieve the needs of the elderly and disabled.

We are seeking views on:

  • the level and nature of evidence to support CAM
  • conflicting and inconsistent evidence
  • alternative therapies and the risk of harm
  • palliative alternative therapy

Last year, lawyers wrote to the Charity Commission on behalf of the Good Thinking Society suggesting that, if the commission refused to revoke the charitable status of organisations that promote homeopathy, it could be subject to a judicial review. The commission responded by announcing their review which will be completed by 1 July 2017.

Charities must meet a “public benefit test”. This means that they must be able to provide evidence that the work they do benefits the public as a whole. Therefore the consultation will have to determine what nature of evidence is required to demonstrate that a CAM-promoting charity provides this benefit.

In a press release, the Charity Commission stated that it will consider what to do in the face of “conflicting or inconsistent” evidence of a treatment’s effectiveness, and whether it should approach “complementary” treatments, intended to work alongside conventional medicine, differently from “alternative” treatments intended to replace it. In my view, however, this distinction is problematic and often impossible. Depending on the clinical situation, almost any given alternative therapy can be used both as a complementary and as an alternative treatment. Some advocates seem to cleverly promote their therapy as complementary (because this is seen as more acceptable), but clearly employ it as an alternative. The dividing line is often far too blurred for this distinction to be practical, and I have therefore long given up making it.

John Maton, the commission’s head of charitable status, said “Our consultation is not about whether complementary and alternative therapies and medicines are ‘good’ or ‘bad’, but about what level of evidence we should require when making assessments about an organisation’s charitable status.” Personally, I am not sure what this means. It sounds suspiciously soft and opens all sorts of escape routes for even the most outright quackery, I fear.

Michael Marshall of the Good Thinking Society said “We are pleased to see the Charity Commission making progress on their review. Too often we have seen little effective action to protect the public from charities whose very purpose is the promotion of potentially dangerous quackery. However, the real progress will come when the commission considers the clear evidence that complementary and alternative medicine organisations currently afforded charitable status often offer therapies that are completely ineffective or even potentially harm the public. We hope that this review leads to a policy to remove such misleading charities from the register.”

On this blog, I have occasionally reported about charities promoting quackery (for instance here, here and here) and pointed out that such activities cannot ever benefit the public. On the contrary, they are a danger to public health and bring many good charities into disrepute. I would therefore encourage everyone to use this unique occasion to write to the Charity Commission and make their views felt.

 

The notorious tendency of pharmacist to behave like shop-keepers when it comes to the sale of bogus remedies has been the subject of this blog many times before. In my view, this is an important subject, and I will therefore continue to report about it.

On the website of the AUSTRALIAN JOURNAL OF PHARMACY (AJP), we find interesting new data on Australian pharmacists’ love affair with bogus alternative medicine. The AJP recently ran a poll asking readers: “Do you stock Complementary Medicines (CMs) in your pharmacy?” The results of this little survey so far show that 54% of all participating pharmacists say they stock CMs, including homeopathic products. About a quarter (28%) of respondents stock CMs but not homeopathic products. And 9% said they “only stock evidence-based CMs”. Three percent completely refuse to stock CMs, while 2% stock them but with clear in-store labels saying that they may not work. One person stated they stock CMs but have recently decided to no longer do so.

The President of the Pharmaceutical Society of Australia (PSA) Joe Demarte commented on these findings: “The latest survey results, showing over 40% of pharmacists are adhering to PSA’s Code of Ethics on complementary medicines, are very encouraging… However it’s disappointing that some pharmacists are still stocking homeopathy products, which are not supported by PSA’s Code of Ethics or our Position Statement on Complementary Medicines… Irrespective of the products stocked in a pharmacy, the important thing is when discussing the use of complementary medicines with consumers, pharmacists must ensure that consumers are provided with the best available information about the current evidence for efficacy, as well as information on any potential side effects, drug interactions and risks of harm… It’s important for pharmacists to provide a fair, honest and balanced view of the current evidence available on all complementary medicines,” Demarte added.

NSW pharmacist Ian Carr, who is a member of the Friends of Science in Medicine group, commented that many pharmacists may not have much choice when it comes to stocking complementary and alternative medicines. “CMs policy is not being filtered through the professional assessment of the pharmacist… It’s basically a business deal with the franchise, and as a pharmacist taking on a franchise you’ve basically got to sign those rights away about what you get to sell. Some of the chains offer basically everything that is available, no questions asked. As an independent pharmacist I am able to make my own decisions about what to stock… We’ve got a ‘de-facto’ corporatisation happening with marketing groups and franchises, and I’m concerned the government will look at this trend and ask, why are we not deregulating the industry to reflect the apparent reality of pharmacy today? We’re only playing into the hands of people who want deregulation… We should be telling people in no uncertain terms that if something is on the shelf it doesn’t mean it’s been assessed or approved by the TGA… There is no doubt that there has been a long-term relationship between the supplement industry and pharmacy. But it was also a few decades ago that researchers started applying the concept of evidence-based medicine to healthcare generally. That should have been the point where we said, ‘we’re not just going to be a conduit for your products without questioning their basis in evidence’. That’s where we lost the plot. The question now is: where do we draw that line? I’m really trying to say to my fellow pharmacists: Please let us reassess the unquestioning support of the CM industry, or we’ll all be tarred with the same brush. I and many others are concerned about – and fighting for – the reputation of the pharmacy profession.”

A BMC Complementary and Alternative Medicine survey by researchers from Alfred Hospital in Melbourne found that 92% thought pharmacists should provide safety information about CMs, while 93% thought it important for pharmacists to be knowledgeable about CMs. This shows a huge divide between what is happening in Australian pharmacy on the one side and ethical demands or public opinion on the other side. What is more, there is little reason to believe that the situation in other countries is fundamentally different.

And did you notice this little gem in the comments above?  “…over 40% of pharmacists are adhering to PSA’s Code of Ethics…” – the PSA president finds this ‘VERY ENCOURAGING’.

When I saw this, I almost fell off my chair!

Does the president know that this means that 60% of his members are violating their own code of ethics?

Is that truly VERY ENCOURAGING, I ask myself.

My answer is no, this is VERY WORRYING.

 

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