MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Monthly Archives: March 2016

The Swiss interior ministry has yesterday announced its intention to elevate quackery to the same level as conventional medicine.

The 5 therapies were named as

  • homeopathy,
  • holistic medicine,
  • herbal medicine,
  • acupuncture,
  • traditional Chinese medicine

No, this is not an early April fools joke! It might merely a sign that this country is in dire need of some critical thinking.

The 5 therapies will acquire the same status as conventional medicine by May 2017. After being rejected in 2005 by the authorities for lack of scientific proof of their efficacy, complementary and alternative medicines made a comeback in 2009 when two-thirds of Swiss backed their inclusion on the constitutional list of paid health services. As a result of the vote, these treatments are covered by basic compulsory insurance as part of six-year trial period from 2012-2017, during which their efficacy would be examined. The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. It has therefore opted to accept them on par with other medical disciplines. It plans to continue allowing reimbursements of treatment costs by compulsory health insurance, provided they are administered by certified medical professionals. However, as is the practice for conventional medicine, certain controversial practices under these complementary therapies will be subjected to further scrutiny. The ministry has initiated a consultation process – open until June 30, 2016 – on the proposed modification of the regulations.

There are a few interesting things here:

  1. What on earth is ‘holistic medicine’? It seems to be an umbrella term under which any type of quackery can be included.
  2. The lack of proof of efficacy – which since 20015 has only increased – is over-ruled by a popular vote.
  3. The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. What does that mean? From a scientific point of view, it means science cannot show that these treatment work, BECAUSE THEY DON’T! But I suspect they did not want to say that. What did they want to say then?
Personally, I wonder what the Swiss will vote into their health service next. Here are a few suggestions – but I am sure my readers have better ones:
  • holidays for citizens who feel ‘under the weather’,
  • clairvoyance,
  • distance healing,
  • botox therapy for wrinkled faces,
  • hair transplants,
  • pet ownership,
  • free champagne for low blood pressure,

Sorry, I just realized that all of the above are already included in the category of HOLISTIC MEDICINE.

I must have stated this a thousand times – but I will do it again: A HOMEOPATHIC REMEDY MIGHT BE HARMLESS, BUT MANY HOMEOPATHS AREN’T!

As to prove my point, US homeopaths are about to host a conference where it is made quite obvious. The National Center for Homeopathy (NHC) is a non-profit organization in the US dedicated to “promoting health through homeopathy by advancing the use and practice of homeopathy.” The NCH is also the host organization for the Joint American Homeopathic Conference (JAHC). This event offers an afternoon of homeopathic learning for those interested in understanding more about the use of homeopathy on 9 April this year.

“We host a conference every year for practitioners and serious students but we also know there are a lot of people who’d like to learn more about homeopathy. So we created this special afternoon for interested beginners called Homeopathy Academy for Moms Live! Though we find moms and dads increasingly interested in using homeopathic remedies for their families, we created this event for all novice users,” explains NCH Executive Director Alison Teitelbaum. “People are interested in homeopathy because it’s safe, has no side effects, is inexpensive and, best of all, natural.”

Interested attendees to the introductory workshop receive:

1. Two 2-hour workshops taught by renowned homeopathic instructors that are guaranteed to increase your understanding, skill level, and confidence in using homeopathy at home for yourself and your family
2. Access to our one-of-a-kind holistic Marketplace – where close to 40 exhibitors and vendors will be showcasing and selling their natural, holistic, and homeopathic products and services.

Pre-registration rate of $35 is available until March 23 and then $50 thereafter.

A few clicks away, I found a NHC website which might disclose more clearly what the moms are about to be taught. Here are a few highlights:

Based on a thorough review of the literature, I believe strongly that the decreased incidence of these serious diseases is linked to improved sanitation and hygiene as well as to the introduction of vaccinations.  However, I am deeply concerned about the catastrophic rise of chronic diseases like asthma, autism, and behavioral disorders. Much more research into the possible relationship between vaccinations and these epidemic problems needs to be done.

At present, there is little data to support or reject any such association.

If your state permits exemption to vaccination, you may decide to withhold vaccinations from your child based on the simple philosophical decision that you do not wish to inject foreign bacterial/viral matter into your healthy child. Given that the infectious diseases for which people get vaccinated are exceedingly rare in the U.S., it is unlikely that your child would suffer the consequences of one of them. Be aware, however, that in some cities it is becoming routine to remove unvaccinated children from schools whenever there is a child with an infectious disease for which the majority are vaccinated. In the case of chickenpox, this could result in a child being removed from school two or four weeks a year, without recourse….

Do not accept the bland reassurances of health professionals or public health authorities that your child will be safe if vaccinated. There is no question that vaccines have the potential to undermine immune function in some children who receive them. Many vaccine investigators agree that the increase in asthma, diabetes, autism, and some autoimmune diseases is directly attributed to vaccine use in children. Educate yourself about disease incidence, vaccine effectiveness, and vaccine adverse effects before you agree to any vaccinations…

Don’t be bullied by the medical profession. Do make a decision and try not to let it plague you–move on and enjoy your baby! Also, don’t forget that if you are breastfeeding, your baby will get a lot of immunity from you and it would be unnecessary to vaccinate quite so early in their life…

All vaccines are artificial disease products, accompanied with preservatives of varying potential toxicity. Their introduction into the body is a serious proposition…

NOW, WHO FEELS LIKE PERPETUATING THE MYTH OF HOMEOPATHY BEING HARMLESS?

On this blog, I have repeatedly pleaded for a change of the 2010 NICE guidelines for low back pain (LBP). My reason was that it had become quite clear that their recommendation to use spinal manipulation and acupuncture for recurrent LBP was no longer supported by sound evidence.

Two years ago, a systematic review (authored by a chiropractor and published in a chiro-journal) concluded that “there is no conclusive evidence that clearly favours spinal manipulation or exercise as more effective in treatment of CLBP.” A the time, I wrote a blog explaining that “whenever two treatments are equally effective (or, in this case, perhaps equally ineffective?), we must consider other important criteria such as safety and cost. Regular chiropractic care (chiropractors use spinal manipulation on almost every patient, while osteopaths and physiotherapists employ it less frequently)  is neither cheap nor free of serious adverse effects such as strokes; regular exercise has none of these disadvantages. In view of these undeniable facts, it is hard not to come up with anything other than the following recommendation: until new and compelling evidence becomes available, exercise ought to be preferred over spinal manipulation as a treatment of chronic LBP – and consequently consulting a chiropractor should not be the first choice for chronic LBP patients.”

Three years ago, a systematic review of acupuncture for LBP (published in a TCM-journal) concluded that the effect of acupuncture “is likely to be produced by the nonspecific effects of manipulation.” At that time I concluded my blog-post with this question: Should NICE be recommending placebo-treatments and have the tax payer foot the bill? Now NICE have provided an answer.

The new draft guideline by NICE recommends various forms of exercise as the first step in managing low back pain. Massage and manipulation by a physiotherapist should only be used alongside exercise; there is not enough evidence to show they are of benefit when used alone. Moreover, patients should be encouraged to continue with normal activities as far as possible. Crucially, the draft guideline no longer recommends acupuncture for treating low back pain.

NICE concluded that the evidence shows that acupuncture is not better than sham treatment. Paracetamol on its own is no longer recommended either, instead non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Talking therapies are recommended in combination with physical therapies for patients who had no improvement on previous treatments or who have significant psychological and social barriers to recovery.

Professor Mark Baker, clinical practice director for NICE, was quoted stating “Regrettably there is a lack of convincing evidence of effectiveness for some widely used treatments. For example acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.”

Good news for us all, I would say:

  • good news for patients who now hear from an accepted authority what to do when they suffer from LBP,
  • good news for society who does no longer need to spend vast amounts of money on questionable therapies,
  • good news for responsible clinicians who now have clear guidance which they can show and explain to their patients.

Not so good news, I admit, for acupuncturists, chiropractors and osteopaths who just had a major source of their income scrapped. I have tried to find some first reactions from these groups but, for the moment, they seemed to be stunned into silence – nobody seems to have yet objected to the new guideline. Instead, I found a very recent website where chiropractic is not just recommended for LBP therapy but where patients are instructed that, even in the absence of pain, they need to see their chiropractor regularly: “Maintenance chiropractic care is well supported in studies for controlling chronic LBP.”

NEVER LET THE TRUTH GET IN THE WAY OF YOUR CASH-FLOW…they seem to conclude.

This sad story was reported across the world. It is tragic and, at the same time, it makes me VERY angry. A women lost her life after giving birth due to the incompetence of her midwife. On this website, we learn the following gruesome details:

Many question the culpability of Australian midwife Gaye Demanuele in the wake of the investigations into the death of Caroline Lovell during her home birth in 2012. And while Demanuele played a major role in Lovell’s passing, a closer look may show the real culprit: homeopathy. In January 2012, Demanuele, an outspoken home birth advocate, served as senior midwife in Lovell’s home birth. After giving birth, Lovell experienced severe blood loss and begged to call an ambulance. According to the investigating coroner, Demanuele refused several times, never checking her patient’s blood pressure or effectively monitoring her blood loss. Demanuele instead tried a homeopathic “remedy” to relieve Lovell’s anxiety. Only after Lovell fainted in a pool of her own blood and went into cardiac arrest was she taken to a hospital, where she died 12 hours later…

We know that many midwifes are besotted with alternative medicine. Their love-affair with quackery had to lead to serious harm sooner or later. This story is thus tragic and awful – but it is not surprising.

What makes me angry, is the complete lack of critical comment from homeopaths and their professional organisations. Where are the homeopaths who state clearly and categorically that the use of homeopathic remedies in the situation described above (and indeed in midwifery generally) is not based on sound evidence? In fact, it is criminal charlatanry!

Homeopaths are usually not lost for words.

Where is the homeopathic organisation stating that a bleeding patient does not need homeopathy?

How should we interpret this deafening silence?

Does it mean that those homeopaths who quietly tolerate charlatanry are themselves charlatans?

If so, would this not be 100% of them?

Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated as a treatment of chronic low back pain. According to its authors, this RCT was aimed at evaluating “the effectiveness for chronic low back pain of MBSR vs cognitive behavioural therapy (CBT) or usual care.”

The investigators randomly assigned patients to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113). CBT meant training to change pain-related thoughts and behaviours and MBSR meant training in mindfulness meditation and yoga. Both were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received.

Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks.

There were 342 randomized participants with a mean duration of back pain of 7.3 years. They attended 6 or more of the 8 sessions, 294 patients completed the study at 26 weeks, and 290 completed it at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%), and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group, and RR for CBT vs usual care was 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

The authors concluded that among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.

At first glance, this seems like a well-conducted study. It was conducted by one of the leading back pain research team and was published in a top-journal. It will therefore have considerable impact. However, on closer examination, I have serious doubts about certain aspects of this trial. In my view, both the aims and the conclusions of this RCT are quite simply wrong.

The authors state that they aimed at evaluating “the effectiveness for chronic low back pain of MBSR vs cognitive behavioural therapy (CBT) or usual care.” This is not just misleading, it is wrong! The correct aim should have been to evaluate “the effectiveness for chronic low back pain of MBSR plus usual care vs cognitive behavioural therapy plus usual care or usual care alone.” One has to go into the method section to find the crucial statement: “All participants received any medical care they would normally receive.”

Consequently, the conclusions are equally wrong. They should have read as follows: Among adults with chronic low back pain, treatment with MBSR plus usual care or CBT plus usual care, compared with usual care alone, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT.

In other words, this is yet another trial with the dreaded ‘A+B vs B’ design. Because A+B is always more than B (even if A is just a placebo), such a study will never generate a negative result (even if A is just a placebo). The results are therefore entirely compatible with the notion that the two tested treatments are pure placebos. Add to this the disappointment many patients in the ‘usual care group’ might have felt for not receiving an additional therapy for their pain, and you have a most plausible explanation for the observed outcomes.

I am totally puzzled why the authors failed to discuss these possibilities and limitations in full, and I am equally bewildered that JAMA published such questionable research.

 

Lots of people are puzzled how healthcare professionals – some with sound medical training – can become convinced homeopaths. Having done part of this journey myself, I think I know one possible answer to this question. So, let me try to explain it to you in the form of a ‘story’ of a young doctor who goes through this development. As you may have guessed, some elements of this story are autobiographical but others are entirely fictional.

Here is the story:

After he had finished medical school, our young and enthusiastic doctor wanted nothing more than to help and assist needy patients. A chain of coincidences made him take a post in a homeopathic hospital where he worked as a junior clinician alongside 10 experienced homeopaths. What he saw impressed him: despite of what he had learnt at med school, homeopathy seemed to work quite well: patients with all sorts of symptoms improved. This was not his or anybody else’s imagination, it was an undeniable fact.

As his confidence and his ability to think clearly grew, the young physician began to wonder nevertheless: were his patients’ improvements really due to the homeopathic remedies, or were these outcomes caused by the kind and compassionate care he and the other staff provided?

To cut a long story short, when he left the hospital to establish his own practice, he certainly knew how to prescribe homeopathics but he was not what one might call a convinced homeopath. He decided to employ homeopathy in parallel with conventional medicine and it turned out that he made less and less use of homeopathy as the months went by.

One day, a young women consulted him; she had been unsuccessfully trying to have a baby for two years and was now getting very frustrated, even depressed, with her childlessness. All tests on her and her husband had not revealed any abnormalities. A friend had told her that homeopathy might help, and see had therefore made this appointment to consult a doctor who had trained as a homeopath.

Our young physician was not convinced that he could help his patient but, in the end, he was persuaded to give it a try. As he had been taught by his fellow homeopaths, he conducted a full homeopathic history to find the optimal remedy for his patient, gave her an individualised prescription and explained that any effect might take a while. The patient was delighted that someone had given her so much time, felt well-cared for by her homeopaths, and seemed full of optimism.

Months passed and she returned for several further consultations. But sadly she failed to become pregnant. About a year later, when everyone involved had all but given up hope, her periods stopped and the test confirmed: she was expecting!

Everyone was surprised, not least our doctor. This outcome, he reasoned, could not possibly be due to placebo, or the good therapeutic relationship he had been able to establish with his patient. Perhaps it was just a coincidence?

In the small town where they lived, news spread quickly that he was able to treat infertility with homeopathy. Several other women with the same problem liked the idea of having an effective yet risk-free therapy for their infertility problem. The doctor thus treated several infertile women, about 10, during the next months. Amazingly most of them got pregnant within a year or so. The doctor was baffled, such a series of pregnancies could not be a coincidence, he reasoned.

Naturally, the cases that were talked about were the women who had become pregnant. And naturally, these were the patients our doctor liked to remember. Slowly he became convinced that he was indeed able to treat infertility homeopathically – so much so that he published a case series in a homeopathic journal about his successes.

In a way, he had hoped that, perhaps, someone would challenge him and explain where he had gone wrong. But the article was greeted nationally with much applause by his fellow homeopaths, and he was even invited to speak at several conferences. In short, within a few years, he made himself a name for his ability to help infertile women.

Patients now travelled from across the country to see him, and some even came from abroad. Our physician had become a minor celebrity in the realm of homeopathy. He also, one has to admit, had started to make very good money; most of his patients were private patients. Life was good. It almost goes without saying that all his former doubts about the effectiveness of homeopathic remedies gradually vanished into thin air.

Whenever now someone challenged his findings with arguments like ‘homeopathics are just placebos’, he surprised himself by getting quite angry. How do they dare doubt my data, he thought. The babies are there, to deny their existence means calling me a liar!

OUR DOCTOR HAD BECOME AN EVANGELICALLY CONVINCED HOMEOPATH, AND NO RATIONAL ARGUMENT COULD DISSUADE HIM.

And what arguments might that be? Isn’t he entirely correct? Can dozens of pregnancies be the result of a placebo effect, the therapeutic relationship or coincidence?

The answer is NO! The babies are real, very real.

But there are other, even simpler and much more plausible explanations for our doctor’s apparent success rate: otherwise healthy women who don’t get pregnant within months of trying do very often succeed eventually, even without any treatment whatsoever. Our doctor struck lucky when this happened a few times after the first patient had consulted him. Had he prescribed non-homeopathic placebos, his success rate would have been exactly the same.

As a clinician, it is all too easy and extremely tempting not to adequately rationalise such ‘success’. If the ‘success’ then happens repeatedly, one can be in danger of becoming deluded, and then one almost automatically ‘forgets’ one’s failures. Over time, this confirmation bias will create an entirely false impression and often even a deeply felt conviction.

I am sure that this sort of thing happens often, very often. And it happens not just to homeopaths. It happens to all types of quacks. And, I am afraid, it also happens to many conventional doctors.

This is how ineffective treatments survive for often very long periods. This is how blood-letting survived for centuries. This is how millions of patients get harmed following the advice of their trusted physicians to employ a useless or even dangerous therapy.

HOW CAN THIS SORT OF THING BE STOPPED?

The answer to this most important question is very simple: health care professionals need to systematically learn critical thinking early on in their education. The answer may be simple but its realisation is unfortunately not.

Even today, courses in critical thinking are rarely part of the medical curriculum. In my view, they would be as important as anatomy, physiology or any of the other core subjects in medicine.

Recently, I came across the ‘Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer’ published by the ‘Society for Integrative Oncology (SIO) Guidelines Working Group’. The mission of the SIO is to “advance evidence-based, comprehensive, integrative healthcare to improve the lives of people affected by cancer. The SIO has consistently encouraged rigorous scientific evaluation of both pre-clinical and clinical science, while advocating for the transformation of oncology care to integrate evidence-based complementary approaches. The vision of SIO is to have research inform the true integration of complementary modalities into oncology care, so that evidence-based complementary care is accessible and part of standard cancer care for all patients across the cancer continuum. As an interdisciplinary and inter-professional society, SIO is uniquely poised to lead the “bench to bedside” efforts in integrative cancer care.”

The aim of the ‘Clinical Practice Guidelines’ was to “inform clinicians and patients about the evidence supporting or discouraging the use of specific complementary and integrative therapies for defined outcomes during and beyond breast cancer treatment, including symptom management.”

This sounds like a most laudable aim. Therefore I studied the document carefully and was surprised to read their conclusions: “Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment.”

How can this be? On this blog, we have repeatedly seen evidence to suggest that integrative medicine is little more than the admission of quackery into evidence-based healthcare. This got me wondering how their conclusion had been reached, and I checked the document even closer.

On the surface, it seemed well-made. A team of researchers first defined the treatments they wanted to look at, then they searched for RCTs, evaluated their quality, extracted their results, combined them into an overall verdict and wrote the whole thing up. In a word, they conducted what seems a proper systematic review.

Based on the findings of their review, they then issued recommendations which I thought were baffling in several respects. Let me just focus on three of the SIO’s recommendations dealing with acupuncture:

  1. “Acupuncture can be considered for treating anxiety concurrent with ongoing fatigue…” [only RCT (1) cited in support]
  2. “Acupuncture can be considered for improving depressive symptoms in women suffering from hot flashes…” [RCTs (1 and 2) cited in support] 
  3. “Acupuncture can be considered for treating anxiety concurrent with ongoing fatigue…” [only RCT (1) cited in support]
One or two studies as a basis for far-reaching guidelines? Yes, that would normally be a concern! But, at closer scrutiny, my worries about these recommendation turn out to be much more serious than this.

The actual RCT (1) cited in support of all three recommendations stated that the authors “randomly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care…” As we have discussed often before on this blog and elsewhere, such a ‘A+B versus B study design’ will never generate a negative result, does not control for placebo-effects and is certainly not a valid test for the effectiveness of the treatment in question. Nevertheless, the authors of this study concluded that: “Acupuncture is an effective intervention for managing the symptom of cancer-related fatigue and improving patients’ quality of life.”

RCT (2) cited in support of recommendation number 2 seems to be a citation error; the study in question is not an acupuncture-trial and does not back the statement in question. I suspect they meant to cite their reference number 87 (instead of 88). This trial is an equivalence study where 50 patients were randomly assigned to receive 12 weeks of acupuncture (n = 25) or venlafaxine (n = 25) treatment for cancer-related hot flushes. Its results indicate that the two treatments generated the similar results. As the two therapies could also have been equally ineffective, it is impossible, in my view, to conclude that acupuncture is effective.

Finally, RCT (1) does in no way support recommendation number two. Yet RCT (1) and RCT (2) were both cited in support of this recommendation.

I have not systematically checked any other claims made in this document, but I get the impression that many other recommendations made here are based on similarly ‘liberal’ interpretations of the evidence. How can the ‘Society for Integrative Oncology’ use such dodgy pseudo-science for formulating potentially far-reaching guidelines?

I know none of the authors (Heather Greenlee, Lynda G. Balneaves, Linda E. Carlson, Misha Cohen, Gary Deng, Dawn Hershman, Matthew Mumber, Jane Perlmutter, Dugald Seely, Ananda Sen, Suzanna M. Zick, Debu Tripathy) of the document personally. They made the following collective statement about their conflicts of interest: “There are no financial conflicts of interest to disclose. We note that some authors have conducted/authored some of the studies included in the review.” I am a little puzzled to hear that they have no financial conflicts of interest (do not most of them earn their living by practising integrative medicine? Yes they do! The article informs us that: “A multidisciplinary panel of experts in oncology and integrative medicine was assembled to prepare these clinical practice guidelines. Panel members have expertise in medical oncology, radiation oncology, nursing, psychology, naturopathic medicine, traditional Chinese medicine, acupuncture, epidemiology, biostatistics, and patient advocacy.”). I also suspect they have other, potentially much stronger conflicts of interest. They belong to a group of people who seem to religiously believe in the largely nonsensical concept of integrative medicine. Integrating unproven treatments into healthcare must affect its quality in much the same way as the integration of cow pie into apple pie would affect the taste of the latter.

After considering all this carefully, I cannot help wondering whether these ‘Clinical Practice Guidelines’ by the ‘Society for Integrative Oncology’ are just full of honest errors or whether they amount to fraud and scientific misconduct.

WHATEVER THE ANSWER, THE GUIDELINES MUST BE RETRACTED, IF THIS SOCIETY WANTS TO AVOID LOSING ALL CREDIBILITY.

I do not seem to agree on much these days with doctor Perter Fisher, the Queen’s homeopath (see for instance here, here and here), but I might share his view on vaccinations. This became clear to me through reading a recent comment made by a homeopath, and not just any old homeopath. The author is Rudi Verspoor, the Dean and Chair Department of Philosophy Hahnemann College for Heilkunst, Ottawa. He was Director of the British Institute of Homeopathy Canada from 1993 to early 2001. Part of his time is spent advising the Canadian government on health-care policy and in working for greater acceptance of and access to homeopathy. I take the liberty to reproducing his comments here:

Dr. Peter Fisher, in an interview published in The American Homeopath 2015 edition (p. 39), made some comments related to vaccination. Dr. Fisher supported the validity of vaccination as a health promoting measure. I disagree, but that is not why I’m writing. Dr. Fisher then claimed that Hahnemann himself supported them.

“Some homeopaths attack vaccination unaware that in the 6th edition of the Organon, Hahnemann has said that vaccination is a wonderful thing and it has saved the lives of children. Do see the footnote under paragraph 46. Hahnemann seems to have considered that the Jennerian method of vaccination – scratching cowpox pus under the skin – was both preventative in epidemics and curative when it was used against similar disease states. Both homeopathy and Jenner’s cowpox vaccine came around in the late 1700s and Hahnemann saw the benefits of cowpox vaccination.

In the present day and age, we have been able to eradicate polio, smallpox, diptheria and even tetanus by judicious use of vaccination. I see cervical cancer being wiped out by the use of the HPV immunization program. We have to wake up to the benefit of vaccination. There can be some adverse effects, no doubt, but vaccination has done a lot of good. Homeopaths would be able to do a lot by staying out of the vaccine controversy.”

Presumably because of the ‘fact’ that the very founder of homeopathy himself supported vaccination comes the advice for homeopaths to stay out of the “vaccine controversy.” I can understand, while not agreeing, with the view that getting involved in this controversy might damage the advance of homeopathy. However, I cannot understand nor agree with the claims made about Hahnemann’s views on vaccination.

In the comments that follow I have taken Dr. Fisher’s wise advice “to stick to core knowledge” using the Organon as “our foundation.” As for the advice that “all homeopaths must study it,” I take this to mean a careful and considered study, as presumably all homeopaths have studied it to some degree. In my defence, I offer 30 years of careful study, the fruits of which are available to anyone who cares to examine them, in various articles for homeopathic journals, in particular detailed articles in Homeopathy-On-Line (www.hpathy.com), and most particularly in a comprehensive analysis of all of Hahnemann’s writings, freely available at www.homeopathiceducation.com.

All this to say that I feel I have met the conditions set down by Dr. Fisher, and offer my considered response to his claims regarding Hahnemann and vaccination based on my detailed assessment of the relevant provisions of the Organon, in particular the footnote to Aphorism 46, which Dr. Fisher specifically references.

These are the claims made by Dr. Fisher in respect of Hahnemann and vaccination. I have simply quoted from the text of the interview and in the order they were made:

  1. “in the 6th edition of the Organon, Hahnemann has said that vaccination is a wonderful thing and it has saved the lives of children.”
  2. “Hahnemann seems to have considered that the Jennerian method of vaccination – scratching cowpox pus under the skin – was both preventative in epidemics and curative when it was used against similar disease states.”
  3. “Hahnemann saw the benefits of cowpox vaccination.”

To start, we need to be clear on the term ‘vaccination’. Historically, it refers to ‘the Jennerian method of vaccination’, the cow pox also being referred to as ‘the vaccine disease’ (OED), and then extended by Pasteur to refer to all subsequent inoculations of disease agents to act as a prevention of that disease when encountered naturally.

Next, to assess the three claims against the footnote to Aphorism 46, to which we are specifically referred, we need the context within which each is situated.

In Aphorism 46, the context for the footnote Dr. Fisher refers us to, Hahnemann gives various examples from nature where a stronger similar disease removes a weaker one. This itself follows from the preceding Aphorisms 43-45, wherein Hahnemann sets out the important principle of the law of similar, that in Nature the stronger similar disease annihilates the weaker similar disease. Hahnemann follows this with examples to be found in Nature herself.

Hahnemann first notes that smallpox disease, his most prominent example, has been found to have lifted and cured numerous maladies with similar symptoms and then gives various examples involving a reported cure by smallpox of a similar existing disease in a person. One of these examples involves the natural smallpox disease lifting the cowpox due to similarity and the greater strength of smallpox.

Hahnemann then goes on to comment on the other side of the equation, namely the impact on the stronger smallpox disease from its encounter with the weaker cowpox disease. Though this is not directly concerning the principle of the law of similars he is illustrating, it is nonetheless a valuable observation: “the ensuing outbreak of smallpox is at least greatly diminished (homoeopathically) and made more benign by the cowpox which has already neared its maturity.”

Thus, while the stronger smallpox disease is not, or course, destroyed, it is “at least greatly diminished and made more benign.” The conclusion is that the weaker similar disease (cowpox) does not act preventatively against the incoming disease, but lessens its impact. We also learn that the weaker disease is removed “at once entirely”, consistent with his principle that the stronger similar disease annihilates the weaker one.

At this point, we get the footnote Dr. Fisher is referring to:

This appears to be the reason for the beneficent, remarkable event that, since the general dispersal of Jenner’s cowpox inoculation, smallpox has never again appeared among us either so epidemically or so virulently as 40-50 years ago when a city seized therewith would lose at least half and often three-quarters of its children by the most wretched plague death.

What I understand Dr. Hahnemann to be noting here tangentially, following from his previously mentioned observation regarding the impact of an existing cowpox disease in a person on contracting smallpox, is a possible reason for the reduced severity of smallpox, since Jenner’s deliberate inoculation of people with cowpox disease (as opposed to the more random act of nature in infecting some people with cowpox, such as milk maids).

END OF QUOTE

Fascinating, isn’t it? The minds of some homeopaths seem to work differently from that of a responsible healthcare professional. I am tempted to say WHO CARES WHAT HAHNEMANN WROTE ABOUT IMMUNISATIONS 200 YEARS AGO? IN VIEW OF THE CURRENT EVIDENCE, ONLY A COMPLETELY DELUDED AND DANGEROUS QUACK CAN ARGUE AGAINST THEIR BENEFITS.

In recent blogs, I have written much about acupuncture and particularly about the unscientific notions of traditional acupuncturists. I was therefore surprised to see that a UK charity is teaming up with traditional acupuncturists in an exercise that looks as though it is designed to mislead the public.

The website of ‘Anxiety UK’ informs us that this charity and the British Acupuncture Council (BAcC) have launched a ‘pilot project’ which will see members of Anxiety UK being able to access traditional acupuncture through this new partnership. Throughout the pilot project, they proudly proclaim, data will be collected to “determine the effectiveness of traditional acupuncture for treating those living with anxiety and anxiety based depression.”

This, they believe, will enable both parties to continue to build a body of evidence to measure the success rate of this type of treatment. Anxiety UK’s Chief Executive Nicky Lidbetter said: “This is an exciting project and will provide us with valuable data and outcomes for those members who take part in the pilot and allow us to assess the benefits of extending the pilot to a regular service for those living with anxiety. “We know anecdotally that many people find complementary therapies used to support conventional care can provide enormous benefit, although it should be remembered they are used in addition to and not instead of seeking medical advice from a doctor or taking prescribed medication. This supports our strategic aim to ensure that we continue to make therapies and services that are of benefit to those with anxiety and anxiety based depression, accessible.”

And what is wrong with that, you might ask.

What is NOT wrong with it, would be my response.

To start with, traditional acupuncture relies of obsolete assumptions like yin and yang, meridians, energy flow, acupuncture points etc. They have one thing in common: they fly in the face of science and evidence. But this might just be a triviality. More important is, I believe, the fact that a pilot project cannot determine the effectiveness of a therapy. Therefore the whole exercise smells very much like a promotional activity for pure quackery.

And what about the hint in the direction of anecdotal evidence in support of the study? Are they not able to do a simple Medline search? Because, if they had done one, they would have found a plethora of articles on the subject. Most of them show that there are plenty of studies but their majority is too flawed to draw firm conclusions.

A review by someone who certainly cannot be accused of being biased against alternative medicine, for instance, informs us that “trials in depression, anxiety disorders and short-term acute anxiety have been conducted but acupuncture interventions employed in trials vary as do the controls against which these are compared. Many trials also suffer from small sample sizes. Consequently, it has not proved possible to accurately assess the effectiveness of acupuncture for these conditions or the relative effectiveness of different treatment regimens. The results of studies showing similar effects of needling at specific and non-specific points have further complicated the interpretation of results. In addition to measuring clinical response, several clinical studies have assessed changes in levels of neurotransmitters and other biological response modifiers in an attempt to elucidate the specific biological actions of acupuncture. The findings offer some preliminary data requiring further investigation.”

Elsewhere, the same author, together with other pro-acupuncture researchers, wrote this: “Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.”

What does this mean in the context of the charity’s project?

I think, it tells us that acupuncture for anxiety is not exactly the most promising approach to further investigate. Even in the realm of alternative medicine, there are several interventions which are supported by more encouraging evidence. And even if one disagrees with this statement, one cannot possibly disagree with the fact that more flimsy research is not required. If we do need more studies, they must be rigorous and not promotion thinly disguised as science.

I guess the ultimate question here is one of ethics. Do charities not have an ethical and moral duty to spend our donations wisely and productively? When does such ill-conceived pseudo-research cross the line to become offensive or even fraudulent?

As we all know, homeopathy was invented in Germany, and the Germans have always been very fond of it. Perhaps this is the explanation why there has been so little criticism of homeopathy in this country.

But this situation seems to be changing as we speak. Our initiative ‘INFORMATIONS NETZWERK HOMOEOPATHIE’ had an unprecedented response, for instance, in the German press. Even the German ‘Heilpraktiker’ (German alternative practitioner) have deemed it necessary to defend their favourite therapy against our arguments.

On their website they published a press release in response to our activities. Here they recycled an argument which is as old as it is fallacious. Nevertheless, it is surprisingly popular and therefore it is perhaps worth having a closer look at it. The fallacy goes something like this:

  • conventional medicine is also largely unproven;
  • but this does not bother anyone;
  • only if an alternative medicine lacks evidence, the ‘ideologists’ of medicine kick a fuzz;
  • nobody knows, for instance, how analgesics work;
  • another example is Aspirin which was used much before, in the 1970s, scientists found out how it works;
  • the list of such examples could be extended ad lib,
  • so, insisting on sound evidence for homeopathy merely displays the double standards of a few weird ‘ideologists’.

(For those who read German, here is their original text: “Schulmedizinischen Methoden dagegen hat man mangelnde wissenschaftliche Belegbarkeit zum wiederholten Mal nachgesehen… Aber niemand weiß bis heute wie ein Betäubungsmittel wirklich funktioniert… Aspirin wurde über Jahrzehnte angewendet, obwohl erst im Jahr 1970 der Wirkmechanismus vollständig geklärt werden konnte. Die Liste der Beispiele ließe sich noch beliebig fortsetzen.)

Sounds convincing?

Yes, many lay people (such as Heilpraktiker) are convinced by such nonsense.

I did say ‘nonsense’, so I better explain. Perhaps I can make this brief, merely using a few bullet points:

  • true, not everything is proven in medicine, but we are working very hard on it, and we have made huge progress, both in terms of increasing our knowledge and (much more importantly) improving patient care;
  • in homeopathy, we have made no progress whatsoever;
  • critical thinkers kick a fuzz wherever the evidence is flimsy, regardless whether this is in alt med or in real med;
  • we do know how analgesics work (perhaps Heilpraktiker don’t but that’s their problem);
  • true, we did use Aspirin before its mode of action had been discovered (and a Nobel Prize was awarded for it);
  • we would use any therapy without knowing how it works, regardless of its label;
  • all that matters is whether it works;
  • Aspirin was and is used because it works;
  • homeopathy should NOT be used because it does not work.

SIMPLE, REALLY!

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