MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Bach flower remedies (BFR) are amazingly popular. They have been the subject of posts on this blog before (see here and here, for instance). They are as dilute as most homeopathic remedies and just as implausible. All the rigorous trials that have tested BFR have so far been squarely negative. Here is a truly surprising new study where BFR was administered externally which would seem to make an effect not more but less likely.

A randomized, placebo-controlled clinical trial was conducted with the aim of evaluating the effectiveness of a cream based on BFR for symptoms of carpal tunnel syndrome. Forty-three patients with mild to moderate carpal tunnel syndrome during their “waiting” time for surgical option were randomized into 3 parallel groups: Placebo (n = 14), blinded BFR (n = 16), and non-blinded BFR (n = 13). These groups were treated during 21 days with topical placebo or a cream based on BFR.

Significant improvements were observed on self-reported symptom severity and pain intensity favorable to BFR groups with large effect sizes. In addition, all signs observed during the clinical exam showed significant improvements among the groups as well as symptoms of pain, night pain, and tingling, also with large effect sizes (φ > 0.5). Finally, there were significant differences between the blinded and non-blinded BFR groups for signs and pain registered in clinical exam but not in self-reports.

The Cuban authors of this study concluded that the proposed BFR cream could be an effective intervention in the management of mild and moderate carpal tunnel syndrome, reducing the severity symptoms and providing pain relief.

This is truly amazing, not least because there is not much that we can offer such patients except for surgery which usually is very successful. The current Cochrane review of non-surgical interventions for carpal tunnel syndrome shows significant short-term benefit from oral steroids, splinting, ultrasound, yoga and carpal bone mobilisation. Other non-surgical treatments do not produce significant benefit. More trials are needed to compare treatments and ascertain the duration of benefit.

What then should we make of the new study?

I have to admit, I am not sure. It was published in one of the worst journals I know which has attracted our attention on this blog before. It was published by authors from Cuba who I know nothing about. More importantly, its findings sound far too good to be true.

If I had been the editor in charge, I would have asked for the original data and had them re-analysed by an independent statistician. As we cannot do that, our only option is to apply common sense and wait for an independent replication before conceding that BFR are effective.

31 Responses to Bach flower remedies – too good to be true?

  • I do agree that more studies need to be done.

    Turning Ranch, LLC, our organic, grass-fed meat producing Ranch uses the Bach Rescue remedy with great success. Here are some studies to consider….http://www.bachcentre.com/centre/research.pdf
    http://www.flowersociety.org/depression-study.pdf and much more if you search for them.

    RCT’s are okay but their effectiveness is being questioned in many scholarly journals and papers. I personally have issues with them because they are not always the correct way of doing medicine. An example, when I tried to do new Cardiac surgical procedures, did I open up some patients and not put the shunt in place or a placebo shunt to see if the shunt I did was tested by RCT rules? HECK NO! that is malpractice and an unnecessary patient risk… now we did compare with those who had different techniques and patients with no shunts at all but RCT’s are only valid some of the time. I propose that working with energy medicine is NOT ALWAYS proper with an RCT protocol.

    Many of the studies are not done by folks or teams that are qualified conventional medicine and complementary (like homeopathy) trained to make an “honest” trial that is not slanted. One of the missions of Turning Ranch. LLC is to do such trials with a team that is MD, PHD, DVM, DC and Homeopathic Qualified CCH, RSHOM etc.

    Lets get back to true science with open mind and not come to a study with preconceived ideas (prejudice).

    • Do you mean stent where you say “shunt”? I’m very happy you are not my cardiologist!

      Please direct me to the “scholarly journals” that are questioning RCT’s.

      • You are correct, it is “shunt”. haha … got me… Medical school never taught we to write (look at my scripts if you want to see poor penmanship).

        “Medical Proofs, Social Experiments: Clinical Trials in Shifting Contexts” edited by Tiago Moreira, Dr Catherine Will is a start… Chapter 5 .. “When trials are not enough”..

        Most of the talk is over the “water cooler’ but if you would, do A search on “RCT questioned”.

    • @Ted Maines

      Tell us please. Do you know anything about science at all? Have you ever been in a classroom where they teach things like statistics, research methodology or epidemiology?
      You write in first person as if you were a cardiothoracic surgeon with experience in research and you drop abbreviations and names of sciency sounding things as if you knew what you were talking about, yet there are clear indications that you do not know even the first thing about the science or methodology involved.

      Please note that you are here in the company of people, many of whom have extended, formal education in life sciences and have published real, peer reviewed science many times.
      We all know very well that you would not want to or even need to do a randomised trial that was paramount to testing the safety of jumping out of an airplane with vs. without a parachute. Of course RCT’s are not always appropriate but in the context we are talking about here, they are the only way to find out the truth.
      You absolutely do not have to tell the regulars here anything about honest trials, fake science or qualified education.
      If you did not realise it, scientific looking research can be done on the most stupid subjects, like on the question whether there is a man in the moon or if the tooth fairy exists. It will even turn out some pretty significant looking results, especially if you repeat it often enough, like was demonstrated here. It is the same as throwing a die… six will come up once in a while.
      The basic trick to real science is to ascertain beforehand that there is at least a modicum of probability that what you wish to find out really can exist. This you have to do before you set up a trial or an experiment. If you omit that essential first step, you will turn up make-believe science like in the nonsense listed in the two references you gave. This step rules out homeopathy, flower drops and most other “alternative” nostrums and measures.

      It is great to have ambitions and plans but it would help to know a little bit about what you are doing first. At least the basic science of what you want to do. In your case it is evident that you need at least to finish courses in basic physics and chemistry to learn about the relatively simple mathematics and physical phenomena that tell us what happens in solutions when you dilute them ‘ad absurdum’.
      Then you need to learn and understand how you find out about the true effect of an health intervention without letting the confounding effects of wishful thinking, philosophical belief and misinterpretation of perceptual findings fool you.
       
      Come back to us when you have learned enough to understand that there is no way that shaken water or water that has had little sweet flowers swimming in it under the sunlight will have any good (or bad) effect on your grass, shrubbery or livestock. Even if it is fortified by belief in fairies and elves and a little brandy.

      • @Björn Geir – Yes, I know a little about science, maybe not as much as you do for I get the impression from this post that you know so much. I have been in the classroom both as a student and teacher in schools you may have not heard of (MIT, Standford, CMU, UT Austin, and Harvard Medical) but am open to learn from those more learned than I. I am an old soldier (Vietnam Era – Combat Medical Officer) and sometimes am hard of hearing so please speak clearly.

        I am honored to be in the presence of such an esteemed group of folks. I was of the impression that we were here to learn, share and explore. If you have arrived, then please excuse me for interrupting the Divine and i will return to my Ranch research and share with others who are not as “educated” as this group.

        [quote]The basic trick to real science is to ascertain beforehand that there is at least a modicum of probability that what you wish to find out really can exist. This you have to do before you set up a trial or an experiment. If you omit that essential first step, you will turn up make-believe science like in the nonsense listed in the two references you gave. This step rules out homeopathy, flower drops and most other “alternative” nostrums and measures.[End Quote]

        As for science on “stupid” subjects, well my heroes, Galileo, Copernicus, Kepler, Curie, Hahnemann, Tesla (to name a few), all were opposed for “stupid science”. My problem is when we are dealing with issues that we know so little about (Quantum Biology), it is hard to know what has a probability and what does not. I guess I could ask you and then I would know…. Right???

        Thank for you comments…. Helps keep me humble….

        • This is not about stupid science, you missed the point (and tell me why in the world should “Galileo, Copernicus, Kepler, Curie, Hahnemann, Tesla” be opposed to stupid science ?), it’s about prior plausibility. This one thing alone, that most of the alt med forgot very quick, shut down stupid thing like homeopathy.

          Yeah, homeopathy is stupid science. Why ? Because we know exactely how physics and chemistry behave in this case, and homeopathy just say ‘f—‘ to all this (with no biological effect either). All the people you cited before discovered thing based on what we knew at this time, completing and correcting work of the past scientist (and they also bring clear and measurable evidence), not burning every knwoledge and building stupid theory defying common sense and refusing every proof of their wrongness.

          And please, do not try to hide behind the ‘quantum biology’, we know enough to say that it won’t save homeopathy. The quantum world is not something that is contradictory with macroscopic physics, it’s just a matter of scale. It’s not some ‘magic energy’ or whatever non sense.

          ” it is hard to know what has a probability and what does not.”

          -> Clearly you have bad with plausibility and probability.

          • @quark:
            [quote] The quantum world is not something that is contradictory with macroscopic physics, it’s just a matter of scale. It’s not some ‘magic energy’ or whatever non sense. [unquote]

            Do not agree that quantum world (mechanics, physics) is the same as “macroscopic physics”. It explains special cases of the macro world that do not fit our know paradigms.

            Lets start with Michael H.F. Wilkinson ( , Centre for High Performance Computing, University of Groningen paper (http://www.cs.rug.nl/~michael/qthair.pdf). Let us explore this world of quantum physics.

            [quote]All the people you cited before discovered thing based on what we knew at this time, completing and correcting work of the past scientist (and they also bring clear and measurable evidence), not burning every knwoledge and building stupid theory defying common sense and refusing every proof of their wrongness. [unquote]

            I too use the knowledge of others (The metaphor of dwarfs standing on the shoulders of giants), as I heard from Richard Stallman, MIT, and Torvalds (Linus) would later put it: “I had hoisted myself up on the shoulders of giants.”. But then as a thinking and learning Human being I moved past the basics and have looked on into “dark areas” of unknown.

            I realize that you are far more educated than I , as you say, and instinctively know the answer before the question, but please show me the way through this “quantum muddle” that you are so well versed in. Please start with Wilkinson issues. Thanks.

          • Ted Maines, please put some effort. I said :

            “The quantum world is not something that is contradictory with macroscopic physics” note ‘NOT CONTRADICTORY’ you tell me that is said ‘Do not agree that quantum world (mechanics, physics) is the same as “macroscopic physics”’ note ‘THE SAME AS’. No, ‘NOT CONTRADICTORY’ is not the same as ‘the same as’, hint, this is not even the same word.

            Of course not it’s not the same, quantum physics describe how particle behave when they are in the most isolated state. Macroscopic physics, obivously, look at how particle behave when they interact. Now, tell me how a biological system is an isolated system. Tell me about decoherence. Then, tell me again how quantum physics could be implicated in a biological system. (Living biological system, not some frozen system to absolute 0)

            Now, EVEN if there is some quantic effect in biology at ground state, lets go back to homeopathy. You dilute something in water, you dilute again, and again, so statistically you have less and less of what is diluted, right ? We can measure this, it’s easy, it’s known. Then, tell me how quantum physics can allow you to say that the contrary is logic ? (that diluting will render your compound more efficient). Then, tell me why his effect is impossible to detect on a living body ?

            Now, about the cure-like principle of homeopathy. Tell me how in the world (in macro or quantum physcis) this makes any sense ? How in the world take oscillo (a bacteria that don’t exist and give no symptom – it does not exist -) will help you to cure the flu if you dilute it ? You can take for exemple any other homeopathic remedie.

            So, stop hiding behind big name. Stop looking in ‘dark are of the unknown’ and tell me about what you know. Surely you have to know something that i don’t know to claim that quantum physics have anything to do with all this. Or maybe, you should start you learn about the basics.

          • @Ted Maines:

            Lets start with Michael H.F. Wilkinson ( , Centre for High Performance Computing, University of Groningen paper (http://www.cs.rug.nl/~michael/qthair.pdf). Let us explore this world of quantum physics.

            Note the journal to which it was submitted.

          • wonderful !!!

          • Are we now journal bigots? Give me a break. Is this some kind of elite group snobbery? What happened to searching for TRUTH wherever it may be?

          • @Ted Maines
            I never belittled your possible formal educational merits, I only said you were not demonstrating them. You may have had quite some education and you may even have taught at learned institutions as you say. But your latest blunder, referring to a joke paper, only confirms the impression I described before, that if you ever had any scholarly education, you seem to have lost your ability to apply it.
            Please note that I am not deriding your person, I am only pointing out that your engagement in this discussion about physically impossible pseudo-medical remedies sadly reveals a severe lack of intellectual and scientific competence.

  • No, RCTs are not perfect, but I am not clear what Ted means by his phase ‘not correct’.
    RCTs are the best method yet devised for establishing the value of a health intervention.
    What better method does Ted have?

    In the Cuban ‘trial’, were there enough numbers treated to provide valid statistics?

    • First, I would like to know, how many doctors observed these patients; then, how many doctors had been treating each of them before, whether they were selected in one clinic or in several, who observed them during the treatment – this e.g. could have influenced wellbeing (delayed diagnosis and telling that patient exaggerates vs. timely diagnosis and real treatment) of the patient and chance of the bias. Time spent waiting for operation before the study (could be years, could be days) and closeness of the operation also could influence results, if selection had not done been correctly (patient who is told he will have to wait for a year and patient who has been waiting for a year and is going to have operation straight after the study is not the same). Previous treatments, the allowed treatments during the research etc.

    • It was the way the RCT’s are done that I question (as many other scholars do). We are in a field of Quantum Energy here with Homeopathy and our understanding of the Physics is limited at this time. Research with nanotechnology and energy transfer in the quantum fields is still on going. This is all I was saying. Let us be more open minded in the what we do not know vs what we “think” we know.

      As for Cuba, I have dealt with the Finlay Institute with vaccinations and HomoProphylaxis (another can of worms) but can not give a knowledgeable comment this study.

      • @Ted Maines:

        It was the way the RCT’s are done that I question (as many other scholars do). We are in a field of Quantum Energy here with Homeopathy and our understanding of the Physics is limited at this time. Research with nanotechnology and energy transfer in the quantum fields is still on going. This is all I was saying.

        All an RCT does is measure the difference in outcome between the groups. Our “understanding of the Physics” doesn’t matter; if homoeopathy made a difference it would be detectable in RCTs. Bandying around terms like “quantum”, “energy” and “nanotechnology” doesn’t change this.

        • [quote} “Quantum Energy”, “Quantum Biology”. “Research with nanotechnology and energy transfer in the quantum fields is still on going.”, I think you’d get on with Deepak Chopra*. *That is not a compliment [unquote]

          Not looking for compliments nor opinions, just science. Have not seen any scientific evidence to refute these theories.

          • Not looking for compliments nor opinions, just science. Have not seen any scientific evidence to refute these theories.

            Science does not work by „refuting“ (=disproving) something. Science tries to prove theories and either fails or succeeds. To illustrate why disproving the effect or workings of shaken water would not work, simply try to devise a method of disproving the existence of Santa Claus. Just like with shaken water, the prior probability of Santa’s existence is extremely low. But like homeopathy, his existence is quite real, in the fictive imagination of millions of humans. You can find a lot of seemingly real “evidence” for his existence and a lot of anecdotes about his intercourse with humans but they all fail, mainly because of the lack of this principal requirement of scientific proof, the question of prior probability.
            It is quite well established that Santa Claus does not exist for real, right? But has it been ‘disproven’? No. Try to devise a method of ‘disproving’ Santa’s existence. It cannot be done. One can only to ‘prove’ it and succeed or fail. That is how science works. If an experiment or trial happens to show positive evidence, it may be due to chance and it will have to be repeatedly tested, especially if prior probability is lacking.
            Homeopathy and Flower remedies not only have exceedingly low prior probability. Homeopathy has had more than two centuries to prove itself but failed consistently. If it was worth anything, it would be in general use within the health care system. It is not. That millions believe in it and it is widely used by believers proves nothing other than ignorance and popularity, just like with Santa Claus.

          • Björn Geir:

            [quote] Science tries to prove theories and either fails or succeeds. To illustrate why disproving the effect or workings of shaken water would not work, simply try to devise a method of disproving the existence of Santa Claus.[unquote]

            I see no connection between homeopathy and Santa Claus – sorry must be an Icelandic or European “thang”.

            [quote]That is how science works. If an experiment or trial happens to show positive evidence, it may be due to chance and it will have to be repeatedly tested, especially if prior probability is lacking.[unquote]. This is so true and for over 200 years homeopathy has worked and will work again. Everyday, I see it work in our clients and we see the body heal itself. You can test it yourself. Contact a homeopathic clinic, set up a trial and watch it work.

            [quote]If it was worth anything, it would be in general use within the health care system. It is not.[unquote] Think this is your believe or shall I say your “religion of science”.

            Thousands (or more) of doctors, vets and practitioners in India, Germany, France, UK, USA and world wide have used homeopathy successfully for over 200 years. Looking at the history of medicine, it is more political and profit motive. Big Pharma and Academia. No profit in Homeopathy and much of Academia (begging for grants) toe the party line or lose the “MONEY”. Try doing your PHD on Homeopathy and watch your academic advisers run as Big Pharma puts pressure on department heads to squash funding (been there, done that).

            [quote]That millions believe in it and it is widely used by believers proves nothing other than ignorance and popularity, just like with Santa Claus.[unquote] So we are ignorant now for using the science of Homeopathy to heal.

            I would invite you to clinics in Africa to see for your self. Peter Chappell (http://www.arhf.nl/pc-technology) says it best [quote]The best verification for PC Remedies is whether they cure patients or not. This is the era of evidence-based medicine. The main question important to the AIDS patients in Africa is… does it work? The thousands of them who recover with such certainty that never did I record a failure gives the answer. That is a small miracle in itself and a strong realisation for me. For the first time in my life I realised that a remedy always works, and if it does not seem to, then there is always an explanation like wrong diagnosis, starvation or continuous reïnfection. [unquote]

            Homeopathy works. I have seen it, I use it. I am a good old boy from Texas who does not let my Formal Education interfere with my Education. Call me ignorant that’s okay, I prefer to help folks heal themselves over the praise of some of the pompous Academia Fellows I have been scorned by that do not heal the masses. It is a choice and a road I have taken. Call me the Fool.

            Since I have seen homeopathy work and initially it “should not” (Avogadro’s number and that) obviously our theory is “wrong” so lets look elsewhere like quantum theory, etc to see why it works.

          • Therein lies the problem. You are unable to understand simple logic. Your fath in homeoparhy is blinding.
            Let’s try to put it in words a five year old would understand.
            If I had taken homeopathic remedies for the backache I felt coming on last thursday, I would also have thought I had “seen” the effect of it. Now I didn’t take any homeoremedies and the backache got better anyway. What does that mean?

          • too complicated question for this person, I fear.

          • Björn Geir:

            [quote] If I had taken homeopathic remedies for the backache I felt coming on last thursday, I would also have thought I had “seen” the effect of it. Now I didn’t take any homeoremedies and the backache got better anyway. What does that mean?[unquote].

            Obviously you did not need a remedy if it healed itself without intervention. Your ache could have been due to poor posture or some minor issue. Homeopathy is a serious form of Medicine, not to be taken for minor issues. Take an aspirin and hope for the best. But had you been in an auto wreck, the ache most probable would not have correct itself without assistance. Then the use of different modalities would come into play.

            I deal with “Never been well since” (NBWS) and accidents mostly. In NBWS, issues are usual chronic and long term. Patients have been going to Conventional Medical practitioners for months or years, had many therapies and conventional medicine has said, “No hope of cure, just use pain killers to ease the pain”. In Accidents, we have better healing and less scaring and pain (see trial http://archfaci.jamanetwork.com/article.aspx?articleid=48092) for Arnica.

            As for Faith in Homeopathy, I am a simple Texan, If it works, use it. not a matter of faith, just knowledge.

            In 1614 John Woodall, Surgeon General of the East India Company, published “The Surgion’s Mate” as a handbook for apprentice surgeons aboard the company’s ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds

            BUT

            . It wasn’t until the 1930’s that Albert Szent-Györgyi discovered the chemical ascorbic acid—also known as vitamin C—that enables the body to efficiently use carbohydrates, fats, and protein.

            Just because I can not understand the mechanism totally, does not mean it does not work.

          • @Ted Maines:

            Homeopathy works. I have seen it…

            Given the paper you cited above, perhaps your powers of observation are not entirely reliable

          • Björn Geir:

            [quote] But your latest blunder, referring to a joke paper, only confirms the impression I described before, that if you ever had any scholarly education, you seem to have lost your ability to apply it. Please note that I am not deriding your person, I am only pointing out that your engagement in this discussion about physically impossible pseudo-medical remedies sadly reveals a severe lack of intellectual and scientific competence. [unquote]

            I guess, my Texas humor is not understood. What i am saying is that I spend over 25 years of higher education, academia and scholarly work to find out many of my colleagues were “Horses Behinds” and worried more about “jots and tittles” than healing the patient. Trying to argue “how many angels can dance on the head of a pin” is a total waste of effort in my book. As for “intellectual competence” who is to say. I turned my back on those pompous ivory tower folks and started practicing County Medicine.

            If this group is more interested in Pontificating its collective beliefs and not examining the world we live in, then I guess I should take my leave of this group and continue on with others who want to heal the world.

            Thank you for your time.

          • Ted Maines, you nicely avoided every question. But you go again on it :

            “Since I have seen homeopathy work and initially it “should not” (Avogadro’s number and that) obviously our theory is “wrong” so lets look elsewhere like quantum theory, etc to see why it works.”

            Why do you think quantum physics have anything to do with it ? (Beside that the word ‘quantum’ is cool, and it seems that this is the only reason why you are using it). It’s not only about Avogadro’s number, the like-cure-like principle is absurd too.

            “Obviously you did not need a remedy if it healed itself without intervention. Your ache could have been due to poor posture or some minor issue.”

            Like every case when homeopathy is taken, such a coincidence. Pain is subjectied to placebo effect, nothing new.
            ‘Serious medicine’ ? Report about homeopathy healing trauma or cancer ?

            “As for Faith in Homeopathy, I am a simple Texan, If it works, use it. not a matter of faith, just knowledge. ”

            -> Knowledge ? You aren’t able to explain anything, how this is knowledge ? You believe that it work, this is faith. Everything said that it don’t work, but you still believe it, this is blind faith.

          • @Ted Maines:

            Obviously you did not need a remedy if it healed itself without intervention.

            That’s the precise reason RCTs are needed to support claims of efficacy. You just have it backwards.

          • As for Faith in Homeopathy, I am a simple Texan, If it works, use it. not a matter of faith, just knowledge.

            Yes, ‘simple’ seems to be a rather well selected term.

  • “Quantum Energy”
    “Quantum Biology”
    “Research with nanotechnology and energy transfer in the quantum fields is still on going.”

    I think you’d get on with Deepak Chopra*.

    *That is not a compliment

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