MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Monthly Archives: November 2016

WHAT DOCTORS DON’T TELL YOU (WDDTY) is probably the most vile publication I know. It systematically misleads its readers by alarming news about this or that conventional treatment, while relentlessly promoting pseudoscientific non-sense. This article , entitled “MMR can cause skin problems and ulcers if your immune system is compromised” is a good example (one of a multitude):

The MMR vaccine can cause serious adverse reactions, researchers have admitted this week. The rubella (German measles) component of the jab increases the risk of infection from the rubella virus itself, and can cause serious skin inflammation and ulcers in anyone whose immune system is compromised.

The risk is highest among people with primary immunodeficiency diseases (PIDD), chronic genetic disorders that cause the immune system to malfunction.

Although the risk for people with compromised immune systems has been known, and is even included in the package inserts supplied with the vaccine, it was theoretical, say researchers from the Children’s Hospital of Philadelphia, who say they have uncovered “genuine evidence of harm.”

The researchers analysed the health profile of 14 people—four adults and 10 children—who suffered some form of a PIDD. Seven of them still had the rubella virus in their tissues, suggesting that their immune systems were too weak to get rid of the virus in the vaccine. The virus can damage skin cells and cause ulcers, and makes the person more susceptible to the actual rubella virus, the researchers say.

People with a poor immune system already have compromised T-cells—which are responsible for clearing viral infections—and the MMR makes the problem worse.

END OF QUOTE

And what is wrong with this article?

The answer is quite a lot:

  1. The research seems to be about a very specific and rare condition, yet WDDTY seem to want to draw much more general conclusions.
  2. The research itself is not described in a way that it would be possible to evaluate.
  3. The sample size of what seems to have been a case-control study was tiny.
  4. The study is not properly cited for the reader to verify and check; for all we know, it might not even exist.
  5. I was not able to find the publication on Medline, based on the information given.

Collectively, these points render the article not just useless, in my view, but make it a prime example of unethical, unhelpful and irresponsible scaremongering.

 

On this blog, we have repeatedly discussed the issues around para-normal or spiritual healing practices. In one of these posts I concluded that these treatments are:

  1. utterly implausible
  2. not supported by good clinical evidence.

What follows seems as simple as it is indisputable: energy healing is nonsense and does not merit further research.

Yet both research and – more importantly – the practice of spiritual healing continue, not only in the developed world but even more so in poor and under-developed countries.

Traditional healers, known in Rwanda as Abarangi or Abacwezi claim to use their spiritual powers to heal sick patients. Recently, they urged their government to acknowledge them through proper regulation. Jean-Bosco Kajongi, the leader of the healers in Rwanda, said Abahereza are like doctors who have been selected by angels. “Umuhereza is someone who gets power from God to treat different diseases but particularly demonic possession such as ‘Amahembe’ and ‘Imandwa’. Sometimes, doctors detect something in the body, do surgery but find nothing. But Abarangi can identify the disease beforehand and heal it. Thus, we want to have legal personality and work with modern doctors because what we cure, they cannot even see it. Therefore, mortality rate would decrease.”

Abahereza claim to have God-given powers to heal any disease, provided that the patient has belief in their powers. Claudine Uwamahoro, a resident of Rulindo district is one of them. “Last year, I was transferred to Kanombe Military Hospital to have my leg cut off after they diagnosed me with cancer. Abarangi told me it was not cancer but rather ‘Imandwa.’ They treated me but I didn’t get healed immediately because I had not yet heeded God’s commandment because they do not use any medicines but only requires you to obey God and respect his commandments.  Now my leg has been healed… Like Jesus came to save us so that we don’t perish, Umurangi also came so that we do not die of diseases that normal medicines cannot treat.”

Another patient agrees: “In 1983, I played football but later, Imandwa disabled me and my legs were paralyzed. I went to various hospitals and was given an assortment of medicines but they could not help. I always had fever; Doctors treated me but could not identify what kind of disease it really was. I even went to traditional healers but they didn’t have a solution. Pastors and priests prayed for me but in vain. Sorcerers also tried but failed. I was possessed by Imandwa and I was cured by Umurangi from Kirehe District. I believe that they have the power from God and when you respect their conditions, they treat and cure you completely.”

According to Alexia Mukahirwa, another witness, Umurangi is very powerful. “I was sick for 16 years. I went to different places and met many doctors. Some told me I had blood infection, others said it was stomach and intestinal infections. I consumed numberless medicines that never helped until I saw the power of Abarangi and believed them. Some people said that I had HIV/AIDS but it was not true. I only weighed 42 kilograms but now I have 68. Abarangi are powerful and may God bless them.”

James Mugabo, who is an “Umuhereza” or priest, said: “Before colonialism, people had their way of treating illness. But we have abandoned everything yet we should not.” The Director General of clinical services in the Ministry of Health responded by stating: “The law and policy are being drafted and will help us to know who does what kind of medicine and their identity. From that, we will know where to localize Abarangi in traditional or alternative.”

Hearing such things, we might smile and think ‘that’s Rwanda – this would not happen in developed countries’. But sadly, it does! These things happen everywhere. I know of healing ceremonies in the UK and the US that are embarrassingly similar to the ones in Rwanda – remember, for instance, the scenes seen on TV where Donald Trump was blessed by some evangelicals to receive the ability to win the election? And now they will probably claim that it worked!

Nothing to do with alternative medicine, you say? Perhaps this website on ‘spiritual homeopathy’ is more relevant then:

START OF QUOTE

What is spiritual homeopathy? It is based on the principle that “like cures like” and “wounds heal wounds” — the underlying wisdom of support groups. A Biblical story which illustrates this principle takes place on the ancient shepherding people’s journey through the desert. When they grew impatient and complained bitterly to Moses, God sent venomous snakes to bite the people. Many died. When the people confessed their sin, God told Moses to put a bronze snake on a pole. Those who were bitten and focused on the bronze snake did not die; they looked and lived.

Many years later Jesus said of his mission, “As Moses lifted up the serpent in the desert, so the Chosen One must be lifted up, so that everyone who believes on the Chosen One might have eternal life.” Jesus’ disciple Peter wrote, “By Christ’s wounds you are healed.” In “The Angel that Troubled the Waters,” Thornton Wilder wrote: “Without your wound where would your power be? … In love’s service only the wounded can serve.”

As the Thanksgiving and Christmas season approaches, spiritual homeopathy offers healing to all – because the Babe in the Manger is also the Wounded Healer

END OF QUOTE

I think I rest my case.

 

 

A press-release from a company based in Germany recently caught my attention. I here present only the most relevant sections from this document:

Natural remedies like medicinal mushrooms also called vitality mushrooms haven proven helpful in prevention and as a support in the therapy, of diabetes type 2. This could be shown by long-time observational studies in naturopathy, for example by MykoTroph – Institute for Medicinal Mushrooms. Medicinal mushroom Coprinus has regenerating effects on the pancreas; it also helps the sensitization of the receptors responsible for the absorption of insulin and claims to have a blood sugar lowering effect.

Medicinal mushroom Maitake has positive effects on the fat metabolism and the sensitivity of insulin receptors. Diabetes type 2 is often linked to circulation problems, vascular diseases and hypertension. Therefore, regular monitoring of the blood pressure, blood lipids, triglycerides and body weight is highly important. The intake of Maitake can help ‒ even in a preliminary stage ‒ to get a grip on these determining factors.

Within the scope of a holistic therapy of diabetes type 2 with metabolic syndrome, the combined intake of medicinal mushrooms and Nopal juice (prickly pear) can be very reasonable. Nopal juice has a lowering effect on the glycemic index of ingested food. The consequence is a slower release of carbohydrates in the intestines and is therefore favorable for a healthy level of blood sugar…

Medicinal mushrooms are available as mushroom powder capsules. According to observational studies of MykoTroph – Institute for Medicinal Mushrooms, especially mushroom powder derived from the whole mushroom has proven effective. Only if the mushroom powder is derived from the whole mushroom, the powder will contain all of the effective ingredients of medicinal mushrooms. It should also be taken care that the mushrooms are from certified organic production. For further information, please visit us on http://www.mykotroph.com
a Japanese study participants comprised 726 Japanese T2DM outpatients free of history of CVD. Life styles were analyzed using self-reported questionnaires. The relationship between dietary patterns, identified by factor analysis, and potential risk factors for CVD was investigated by linear and logistic regression analyses….The “Seaweeds, Vegetables, Soy products and Mushrooms” pattern, characterized by high consumption of seaweeds, soy products and mushrooms, was associated with lower use of diabetes medication and healthier lifestyles.

END OF QUOTE

These are claims that could be relevant to millions of diabetic patients worldwide – but are they true?

The study cited above did indeed show an association; but an association is not necessarily a causal relationship! So what evidence is there fore a causal relationship between mushroom-consumption and diabetes? The answer is: frustratingly little.

A Cochrane review concluded that “evidence from a small number of randomised controlled trials does not support the use of G lucidum [Ganoderma lucidum (also known as lingzhi or reishi)] for treatment of cardiovascular risk factors in people with type 2 diabetes mellitus. Future research into the efficacy of G lucidum should be placebo-controlled and adhere to clinical trial reporting standards.”

The authors of another Cochrane review concluded that “our review did not find sufficient evidence to justify the use of G. lucidum as a first-line treatment for cancer. It remains uncertain whether G. lucidum helps prolong long-term cancer survival. However, G. lucidum could be administered as an alternative adjunct to conventional treatment in consideration of its potential of enhancing tumour response and stimulating host immunity. G. lucidum was generally well tolerated by most participants with only a scattered number of minor adverse events. No major toxicity was observed across the studies. Although there were few reports of harmful effect of G. lucidum, the use of its extract should be judicious, especially after thorough consideration of cost-benefit and patient preference. Future studies should put emphasis on the improvement in methodological quality and further clinical research on the effect of G. lucidum on cancer long-term survival are needed. An update to this review will be performed every two years.”

A further study determined whether a supplement of Agaricus blazei Murill extract improves insulin resistance in type 2 diabetes. It was designed as a clinical randomized, double-blind, placebo-controlled trial. Diabetic patients were randomly assigned to either receiving supplement of Agaricus blazei Murill (ABM) extract or placebo (cellulose) 1500 mg daily for 12 weeks. At the end of the study, the subjects who received supplement of ABM extract (n = 29) showed significantly lower HOMA-IR index than the control group (n = 31). The plasma adiponectin concentration increased by 20% in the ABM group after 12 weeks of treatment, but decreased 20% among those taking the placebo. The authors concluded that “ABM extract improves insulin resistance among subjects with type 2 diabetes. The increase in adiponectin concentration after taking AMB extract for 12 weeks might be the mechanism that brings the beneficial effect. Studies with longer periods of follow-up should be conducted in the future.”

On the basis of all this evidence, it seems fair to conclude that mushrooms have little or no effect on diabetes.

And what about the above press-release?

Diabetes is a serious condition that can be well-controlled with diet, exercise and drugs. Many diabetics are nevertheless fed up with taking drugs throughout their entire life and would only be too happy to exchange them for ‘something natural’. Therefore patients might try mushrooms or other natural ‘cures’, if they are promoted in this way. However, this decision could prove fatal (examples of such tragedies abound).

In view of these considerations, I find such promotion irresponsible, unethical and outright dangerous.

Which illnesses can be treated with homeopathy?

The answer to this question could not be more simple: none!

This is not my opinion but the general consensus amongst critical thinkers and people who adhere to the principles of evidence-based medicine – a group that evidently does not include homeopaths. Take this website, for instance; it advocates homeopathy for almost every conceivable condition:

START OF QUOTE

Homeopathic medicines can be used for numerous illnesses, both acute and chronic. In an acute illness such as the flu or gastroenteritis, for example, the homeopath will choose the homeopathic medicine by taking into consideration and assessing the signs and symptoms exhibited by the patient from the beginning of the illness.

This is the medication or medications that will be administered to the patient with the aim of quickly reversing the pathological process and restoring optimal health.

In the case of a chronic illness such as asthma, rheumatoid arthritis or chronic gastroenteritis, the homeopathic physician will, in addition to assessing the current clinical symptoms of the illness, also take into consideration other general signs in the patient.

He will give equal importance to the person’s pathological background, their build, character, personality, attitude towards life etc.

All of this information will enable the homeopathic physician to identify the best medicine or medicines needed for the patient’s recovery.

Homeopathic treatment can space out the relapses that occur in chronic conditions, until they eventually disappear.

Numerous illnesses can be treated with homeopathy – in many cases the treatment is curative and in some cases it is palliative, when the illness is irreversible.

Some of the illnesses that respond best to homeopathic treatment are as highlighted below:

ENT and bronchial problems

  • Ear infections,
  • rhinitis,
  • sinusitis,
  • pharyngitis,
  • tonsillitis,
  • tracheitis,
  • bronchitis,
  • asthma.

Digestive problems

  • Stomach complaints
  • acidity,
  • heartburn,
  • fullness,
  • poor digestion,
  • flatulence,
  • duodenal ulcer,
  • diarrhoea,
  • constipation,
  • nausea,
  • vomiting,
  • canker sores.

Cardiovascular problems

Osteoarticular complaints

All types of muscle and/or joint pain due to arthrosis or arthritis:

  • neck pain,
  • shoulder pain,
  • elbow pain,
  • wrist pain,
  • Back pain,
  • sciatica,
  • knee pain,
  • ankle pain,
  • Sprains,
  • contractures etc.

Traumas

Urological disorders

Gynaecological problems

Dermatological problems

  • Eczema, hives,
  • Acne vulgaris, acne rosacea,
  • Recurrent boils, verucas, plantar warts,
  • Molluscum contagiosum,
  • Herpes simple and zoster
  • Psoriasis

Neurological disorders

  • Headaches and migraines.
  • Eye problems
  • Conjunctivitis,
  • blepharitis,
  • styes, dacryocistitis,
  • uveitis.

Behavioural and psychiatric disorders

  • Anxiety,
  • depression,
  • stress,
  • mental fatigue,
  • Pediatric problems,
  • Ear infections,
  • tonsillitis,
  • bronchitis,
  • asthma,
  • diarrhoea,
  • vomiting,
  • skin complaints,
  • canker sores,
  • teething problems,
  • sleep disorders,
  • educational attainment issues,
  • behavioural issues.

Endocrine disorders

  • Obesity,
  • hypothyroidism,
  • hyperthyroidism,
  • Depleted immune defences,
  • Recurrent infections affecting the throat,
  • sinuses, nose, ears,
  • connective tissue, larynx,
  • bronchial tubes,
  • lungs,
  • skin,
  • bladder etc.

Palliative care

For the treatment of the diverse symptoms that appear over the course of the illness. Homeopathy can improve the patient’s general wellbeing and counteract the side effects of other treatments.

These are just a few examples, but the list could be endless – it is important to stress that homeopathy is very effective in pathologies that are difficult to establish or those with contradictory or paradoxical symptoms.

In recurrent illnesses, homeopathic medicines can boost the defences and help to regulate the sufferer’s body in order to prevent further relapses.

Homeopathy is an excellent preventive medicine.

END OF QUOTE

Some of us wonder why homeopathy continues to be popular in many parts of the world. The answer seems obvious: homeopathy is popular mostly because consumers fail to understand what it really is and therefore fall for the uncounted lies published by homeopaths and other interested parties.

If this is so, we urgently need factual and easy to understand information for consumers – and guess what: this is precisely the aim of the book I have just published – for the 1st review of this book, see here.

Dietary and herbal supplements (DHS) are currently popular. They are being promoted as being natural and therefore safe – an assumption that is clearly wrong: some DHS can contain toxic substances or they might cause interactions with drugs or other DHS.

This study explored whether adverse events were actually associated with such interactions and examined specific characteristics among inpatient DHS users prone to such adverse events. It was designed as a cross-sectional survey of 947 patients hospitalized in 12 departments of a tertiary academic medical centre in Haifa, Israel. It evaluated the rate of DHS use among inpatients, the potential for interactions, and actual adverse events during hospitalization associated with DHS use. It also assessed whether DHS consumption was documented in patients’ medical files. Statistical analysis was used to delineate DHS users at risk for adverse events associated with interactions with conventional drugs or other DHS.

The results show that about half of all patients took DHS. In 17 (3.7%) of the 458 DHS users, an adverse event may have been caused by DHS-drug-DHS interactions. According to the Drug Interaction Probability Scale, 14 interactions “probably” caused the adverse events, and 11 “possibly” caused them. Interactions occurred more frequently in older patients (p = 0.025, 95% CI: 2.26-19.7), patients born outside Israel (p = 0.025, 95% CI: 0.03-0.42), those with ophthalmologic (p = 0.032, 95% CI: 0.02-0.37) or gastrointestinal (p = 0.008, 95% CI: 0.05-0.46) comorbidities, and those using higher numbers of DHS (p < 0.0001, 95% CI: 0.52-2.48) or drugs (p = 0.027, 95% CI: 0.23-3.77).

The authors concluded that approximately one in 55 hospitalizations in this study may have been caused by adverse events associated with DHS-drug-DHS interactions. To minimize the actual occurrence of adverse events, medical staff education regarding DHS should be improved.

This seems to be a good study and it generated interesting findings on an important topic.

Why do I have nevertheless a problem with it?

The answer is simple but not pleasant: very similar results have been published almost simultaneously in more than one journal. The link above is to an article in the BR J CLIN PHARMACOL of October this year. The following text is from the abstract of an article in INTERN EMERG MED also of October this year:

Of 927 patients who agreed to answer the questionnaire, 458 (49.4 %) reported the use of 89 different DHS. Potential DHS-DHS interactions were identified in 12.9 % of DHS users. Three interactions were associated with the actual occurrence of adverse events. Patients at risk of DHS-DHS interactions included females (p = 0.026) and patients with greater numbers of concomitant medications (p < 0.0001) and of consumed DHS (p < 0.0001). In 88.9 % of DHS users, DHS use was not reported in medical files and only 18 % of the DHS involved in interactions were documented. Potential DHS-DHS interactions are common in inpatients, and may lead to hospitalization or worsen existing medical conditions. The causal relationship between potential interactions and actual adverse events requires further study.

END OF QUOTE

And to my surprise, I also found a third article also from the October issue of INTERN EMERG MED reporting on this survey. Here is part of its abstract:

DHS users were determined via a questionnaire. The Natural Medicine database was used to search for potential DHS-drug interactions for identified DHS, and the clinical significance was evaluated using Lexi-interact online interaction analysis. Medical files were assessed for documentation of DHS use. Univariate and multivariate logistic regression analyses were used to characterize potential risk factors for DHS-drug interactions. Of 927 patients consenting to answer the questionnaire, 458 (49 %) reported DHS use. Of these, 215 (47 %) had at least one potential interaction during hospitalization (759 interactions). Of these interactions, 116 (15 %) were potentially clinically significant. Older age [OR = 1.02 (1.01-1.04), p = 0.002], males [OR = 2.11 (1.35-3.29), p = 0.001] and increased number of used DHS [OR = 4.28 (2.28-8.03), p < 0.001] or drugs [OR = 1.95 (1.17-3.26), p = 0.011] were associated with potential interactions in DHS users. Physicians documented only 16.5 % of DHS involved in these interactions in patients’ medical files. In conclusion, a substantial number of inpatients use DHS with potential interactions with concomitant medications. Medical staff should be aware of this, question patients on DHS usage and check for such interactions.

END OF QUOTE

What is the difference between the three articles? The first one in INTERN EMERG MED authored by Levy I, Attias S, Ben Arye E, Goldstein L, Schiff E evaluated “potential DHS-DHS interactions among inpatients”. The second one in INTERN EMERG MED also authored by Levy I, Attias S, Ben Arye E, Goldstein L, Schiff E evaluated “potentially dangerous interactions of DHS with prescribed medications among inpatients”. Finally the one in BR J CLIN PHARMACOL also authored by Levy I, Attias S, Ben-Arye E, Goldstein L, Schiff E  assessed in addition the interactions between DHS and prescription drugs.

Dual publications are usually considered to be a violation of research ethics. Publication of different aspects of one single data-set in multiple articles is called ‘salami-slicing’ and is often considered to be poor form.

My question to you, the reader of this post, is: What type of scientific misconduct do we have here?

Homeopathic remedies are being marketed and sold as though they are medicines, yet highly diluted preparations contain nothing and do nothing. This means consumers are constantly mislead into believing that they are drugs. This situation seems to be changing dramatically in the US, and hopefully – led by the American example – elsewhere as well.

It has been reported that the US Federal Trade Commission issued a statement which said that, in future, homeopathic remedies have to be held to the same standard as other medicinal products. In other words, American companies must now have reliable scientific evidence for health-related claims that their products can treat specific conditions and illnesses.

The ‘Enforcement Policy Statement on Marketing Claims for Over-the-Counter (OTC) Homeopathic Drugs’ makes it clear that “the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product’s efficacy.”

However, an [over-the-counter] homeopathic drug claim that is not substantiated by competent and reliable scientific evidence might not be deceptive if the advertisement or label where it appears effectively communicates that: 1) there is no scientific evidence that the product works; and 2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts. In other words, if no evidence for efficacy exists, companies must advertise this fact clearly on their labelling, and also disclose that claims are today rejected by the majority of the scientific community. Failure to do this will be considered a violation of the FTC Act.

“This is a real victory for reason, science, and the health of the American people,” said Michael De Dora, public policy director for The Center for Inquiry in a statement issued in response to the new act. “The FTC has made the right decision to hold manufacturers accountable for the absolutely baseless assertions they make about homeopathic products.”

The new regulation will make sure that customers are informed explicitly about whether the product they purchase at a pharmacy has any scientific basis. This is important because homeopathic remedies aren’t just ineffective, but they can be dangerous too. The FDA is currently investigating the deaths of 10 babies who were given homeopathic teething tablets that contained deadly nightshade.

“Consumers can’t help but be confused when snake oil is placed on the same pharmacy shelves as real science-based medicine, and they throw away billions of dollars every year on homeopathy based on its false promises,” said De Dora. “The dangers of homeopathy are very real, for when people choose these deceptive, useless products over proven, effective medicine, they risk their health and the health of their families.”

These are clear words indeed; the new regulation is bound to make a dramatic change for homeopathy in the US. The winner will undoubtedly the consumer who can no longer be so openly and shamelessly misled as before. The FTC has set an example for other national regulators who will hopefully follow suit.

Acupuncture for hot flushes?

What next?

I know, to rational thinkers this sounds bizarre – but, actually, there are quite a few studies on the subject. Enough evidence for me to have published not one but four different systematic reviews on the subject.

The first (2009) concluded that “the evidence is not convincing to suggest acupuncture is an effective treatment of hot flash in patients with breast cancer. Further research is required to investigate whether there are specific effects of acupuncture for treating hot flash in patients with breast cancer.”

The second (also 2009) concluded that “sham-controlled RCTs fail to show specific effects of acupuncture for control of menopausal hot flushes. More rigorous research seems warranted.”

The third (again 2009) concluded that “the evidence is not convincing to suggest acupuncture is an effective treatment for hot flush in patients with prostate cancer. Further research is required to investigate whether acupuncture has hot-flush-specific effects.”

The fourth (2013), a Cochrane review, “found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms. When we compared acupuncture with sham acupuncture, there was no evidence of a significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than HT. These findings should be treated with great caution as the evidence was low or very low quality and the studies comparing acupuncture versus no treatment or HT were not controlled with sham acupuncture or placebo HT. Data on adverse effects were lacking.”

And now, there is a new systematic review; its aim was to evaluate the effectiveness of acupuncture for treatment of hot flash in women with breast cancer. The searches identified 12 relevant articles for inclusion. The meta-analysis without any subgroup or moderator failed to show favorable effects of acupuncture on reducing the frequency of hot flashes after intervention (n = 680, SMD = − 0.478, 95 % CI −0.397 to 0.241, P = 0.632) but exhibited marked heterogeneity of the results (Q value = 83.200, P = 0.000, I^2 = 83.17, τ^2 = 0.310). The authors concluded that “the meta-analysis used had contradictory results and yielded no convincing evidence to suggest that acupuncture was an effective treatment of hot flash in patients with breast cancer. Multi-central studies including large sample size are required to investigate the efficiency of acupuncture for treating hot flash in patients with breast cancer.”

What follows from all this?

  • The collective evidence does NOT seem to suggest that acupuncture is a promising treatment for hot flushes of any aetiology.
  • The new paper is unimpressive, in my view. I don’t see the necessity for it, particularly as it fails to include a formal assessment of the methodological quality of the primary studies (contrary to what the authors state in the abstract) and because it merely includes articles published in English (with a therapy like acupuncture, such a strategy seems ridiculous, in my view).
  • I predict that future studies will suggest an effect – as long as they are designed such that they are open to bias.
  • Rigorous trials are likely to show an effect beyond placebo.
  • My own reviews typically state that MORE RESEARCH IS NEEDED. I regret such statements and would today no longer issue them.

The global Homeopathy Product Market has recently been projected to increase by 18.2% during the forecast period 2016-2024. Considering that highly diluted homeopathic remedies are pure placebos, this is remarkable, I think.

But why? Why are consumers spending their money on ineffective treatments?

The answer is probably complex, and there are many factors to explain this puzzling phenomenon. One of them is the constant and clever marketing of homeopathy. This website, for instance, claims that homeopathy can be used for first aid. Below I have copied the remedy in question, the potency best suited, and the conditions to be treated.

START OF QUOTE

1. ARNICA MONT. 30 – bruises, contusions, injuries, shock.

2. HYPERICUM 200 – injuries to parts rich in nerve-supply, laceration, also preventive for tetanus.

3. LEDUM PAL 30-punctured wounds, black eye. Also preventive for tetanus.

4. RHUS TOX 30 – sprains and strains, muscular pains.

5. RUT A GRA V. 30 – bruised periosteum, bones and injury to ligaments.

6. CANTHARIS 30 } for burns

7. URTICA URENS 6 } for burns

8 HEPAR SULPH 200 – septic wounds extremely painful and tender.

9. SILICIA 30 – sepsis.

FEVER, HEADACHE, COLD-DRUGS

1. ACONITE NAP. 30 – sudden high fever with chill, bad effects of fear, shock.

2. ARSENIC ALB 30 – colds, food poisoning.

3. BELLADONNA 30 – high fever, sunstroke, earache,

4. BRYONIA ALB. 30 – fever with cold, biliousness and constipation.

5. GELSEMIUM 30•-high fever with chill, influenza, cold.

6. PULSATILLA 30 – for cold, indigestion, after fatty food.

OTHER DRUGS

1 CARBO VEG. 30 – flatulence and indigestion.

2. CHAMOMILLA 30 – teething children with various troubles.

3. CINA 30 – worms

4. COFFF A 30 – sleeplessness 5. GLONOINE 6 – sunstroke, headache, high b16dd-pressure.

6. H AMAMELLIS 30 – bleeding from veins-dark blood.

7. IPECACUANHA 30– nausea vomiting, also for haemorrhages.

8. NUX VOMICA 30- biliousness, constipation, dysentery.

9. PODOPHYLLUM 30 – diarrhoea

10. PHOSPHORUS 30 – haemorrhage with bright red blood.

EXTERNAL APPLICATIONS

1. ARNICA OINT } for injuries where skin not broken

2. HYPERICUM OINT }for injuries where skin not broken

3. CALENDULA OINT. – for open wounds.

4. MULLIEN OIL – for earache

5. PLANTAGO MAJ. for toothache

BESIDES THE ABOVE DRUGS THE TWELVE TISSUE WILL ALSO BE USEFUL AS FIRST-AID DRUGS WHEN

PER INDICATIONS.

HOMEOPATHIC PROPHYLACTICS

Diseases or Condition Preventive medicine
Chicken Pox Ant.tart and Malandrinum
Cholera Ars.alb and Ver.alb.
Diphtheria Diphtherinum
Measles Morbilinum
Herpes Variolinum
Influenza Influenzinum
Whooping Cough Drosera, Pertussin
Mumps Pilocarpine and Parotidinum
Poliomyelitis Lathyrus Sativus and Plumbum
Small Pox Variolinum and Malandrinum
Tetanus Ledum, Hypericum
Typhoid Baptisia Q, Typhoidinum
Vaccination Ill effects Thuja
Rabies Hydrophobinum
Tuberculosis Tuberculinum Bov.

END OF QUOTE

You must admit that this is impressive. Imagine someone reading this – is it not understandable that consumers try homeopathy?

If this website were an exception or an extreme case – but it is not! Information like this is available on the Internet and elsewhere a million times over. And there is no doubt that such information is a risk factor for public health.

What is needed is factual information presented such that consumers can understand it. In my view, this would be an important contribution to public health – so important, in fact, that I have just published a book with exactly this aim. I hope that many consumers will learn about it.

Price Charles celebrates his 68th birthday today. Time to update the tribute which I dedicated to him on this occasion three years ago. Charles is, of course, one of the world’s most outspoken and influential proponent of alternative medicine and a notorious attacker of science. This is why he has featured on this blog with some regularity. His love affair with all things alternative started early in his life.

As a youngster, Charles went on a journey of ‘spiritual discovery’ into the wilderness of northern Kenya. His guru and guide was Laurens van der Post (later discovered to be a fraud and compulsive fantasist and to have fathered a child with a 14-year old girl entrusted to him during a sea voyage). Van der Post wanted to awake Charles’ mind and attune it to the ideas of Carl Jung’s ‘collective unconscious’ which allegedly unites us all through a common vital force. It is this belief in vitalism that provides the crucial link to alternative medicine: virtually every form of the otherwise highly diverse range of alternative therapies is based on the assumption that some sort of vital force or energy exists. Charles was so taken by van der Post that, after his death, he established an annual lecture in his honour.

Throughout the 1980s, Charles lobbied for the statutory regulation of chiropractors and osteopaths in the UK. In 1993, it finally became reality.

Osteopathy has strong Royal links: Prince Charles is the President of the GOsC; Princess Diana was the President of the GCRO; and Princess Anne is the patron of the British School of Osteopathy (statement dated 2011).

In 1982, Prince Charles was elected as President of the British Medical Association (BMA) and promptly challenged the medical orthodoxy by advocating alternative medicine. In a speech at his inaugural dinner as President, the Prince lectured the medics: ‘Through the centuries healing has been practised by folk healers who are guided by traditional wisdom which sees illness as a disorder of the whole person, involving not only the patient’s body, but his mind, his self-image, his dependence on the physical and social environment, as well as his relation to the cosmos.’ The BMA-officials were impressed – so much so that they ordered a full report on alternative medicine which promptly condemned this area as nonsense.

In 1993, Charles founded his lobby group that ended up being called the ‘Foundation for Integrated Health’ (FIH). It was closed down in 2010 amidst allegations of money laundering and fraud. Its chief executive, George Gray, was later convicted and went to jail. The FIH had repeatedly been economical with the truth.

In 2000, Charles wrote an open letter to The Times stating that…It makes good sense to evaluate complementary and alternative therapies. For one thing, since an estimated £1.6 billion is spent each year on them, then we want value for our money. The very popularity of the non-conventional approaches suggests that people are either dissatisfied with their orthodox treatment, or they find genuine relief in such therapies. Whatever the case, if they are proved to work, they should be made more widely available on the NHS…But there remains the cry from the medical establishment of “where’s the proof?” — and clinical trials of the calibre that science demands cost money…The truth is that funding in the UK for research into complementary medicine is pitiful…So where can funding come from?…Figures from the department of complementary medicine at the University of Exeter show that less than 8p out of every £100 of NHS funds for medical research was spent on complementary medicine. In 1998-99 the Medical Research Council spent no money on it at all, and in 1999 only 0.05 per cent of the total research budget of UK medical charities went to this area…

In 2001, Charles worked on plans to help build a model hospital of integrated medicine. It was to train doctors to combine conventional medicine and alternative treatments, such as homeopathy, Ayurvedic medicine and acupuncture, and was to have have up to 100 beds. The prince’s intervention marked the culmination of years of campaigning by him for the NHS to assign a greater role to alternative medicine. Teresa Hale, founder of the Hale Clinic in London, said: “Twenty-five years ago people said we were quacks. Now several branches, including homeopathy, acupuncture and osteopathy, have gained official recognition.” The proposed hospital, which was due to open in London in 2003 or early 2004, was to be overseen by Mosaraf Ali, who runs the Integrated Medical Centre (IMC) in London. But the hospital never materialised. This might be due to Mosaraf Ali falling in disrepute: Raj Bathija, 69 and from India, went for a massage at the clinic of Dr Mosaraf Ali and his brother Imran in 2005 after suffering from two strokes. However, he claims that shortly after the treatment, his legs became pale and discoloured. Four days afterwards, Mr Bathija was admitted to hospital, where he had to have both legs amputated below the knee due to a shortage of blood. According to Mr Bathija, Dr Ali and his brother were negligent in that they failed to diagnose his condition and neglected to advise him to go to hospital. His daughter Shibani said: “My father was in a wheelchair but was making progress with his walking. He hoped he might become a bit more independent. With the amputations, that’s all gone.”

In 2002, the The Royal London Homeopathic Hospital (today called the Royal London Hospital for Integrated Medicine (RLHIM)) received £18.5 million of NHS funds to pay for an extensive refurbishment and restoration of the grand Victorian building. It seems likely that Royal protection facilitated this action.

In 2003, Prince Charles’ FIH launched a five-year plan which outlined how to improve access to alternative therapies.

In 2004, Charles publicly supported the Gerson diet as a treatment for cancer and Prof Baum, one of the UK’s most eminent oncologists, was invited to respond in an open letter to the British Medical Journal: …Over the past 20 years I have treated thousands of patients with cancer and lost some dear friends and relatives to this dreaded disease…The power of my authority comes with knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth. I don’t begrudge you that authority but I do beg you to exercise your power with extreme caution when advising patients with life-threatening diseases to embrace unproven therapies.

In 2005, the ‘Smallwood-Report’ was published; it had been commissioned by Charles and paid for by Dame Shirley Porter to inform health ministers. It stated that up to 480 million pounds could be saved, if one in 10 family doctors offered homeopathy as an alternative to standard drugs for asthma. Savings of up to 3.5 billion pounds could be achieved by offering spinal manipulation rather than drugs to people with back pain. Because I had commented on this report, Prince Charles’ first private secretary asked my vice chancellor to investigate my activities; even though I was found to be not guilty of any wrong-doing, all local support stopped which eventually led to my early retirement. ITV later used this incident in a film entitled THE MEDDLING PRINCE.

In a 2006 speechPrince Charles told the World Health Organisation in Geneva that alternative medicine should have a more prominent place in health care and urged every country to come up with a plan to integrate conventional and alternative medicine into the mainstream. But British science struck back. Anticipating Prince Charles’s sermon in Geneva, 13 of Britain’s most eminent physicians and scientists wrote an “Open Letter” which expressed concern over “ways in which unproven or disproved treatments are being encouraged for general use in Britain’s National Health Service.” The signatories argued that “it would be highly irresponsible to embrace any medicine as though it were a matter of principle.”

In 2008The Times published my letter asking the FIH to withdraw two guides promoting “alternative medicine”, saying: “the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous.” A speaker for the FIH countered the criticism by stating: “We entirely reject the accusation that our online publication Complementary Healthcare: A Guide contains any misleading or inaccurate claims about the benefits of complementary therapies. On the contrary, it treats people as adults and takes a responsible approach by encouraging people to look at reliable sources of information… so that they can make informed decisions. The foundation does not promote complementary therapies.”

In 2009, the Prince held talks with the health Secretary to persuade him to introduce safeguards amid a crackdown by the EU that could prevent anyone who is not a registered health practitioner from selling remedies. This, it seems, was yet another example of Charles’ disregard of his constitutional role.

In the same year, Charles urged the government to protect alternative medicine because “we fear that we will see a black market in herbal products”, as Dr Michael Dixon, then medical director of Charles’ FIH, put it.

In 2009, the health secretary wrote to the prince suggesting a meeting on the possibility of a study on integrating complementary and conventional healthcare approaches in England. The prince had written to Burnham’s predecessor, Alan Johnson, to demand greater access to complementary therapies in the NHS alongside conventional medicine. The prince told him that “despite waves of invective over the years from parts of the medical and scientific establishment” he continued to lobby “because I cannot bear people suffering unnecessarily when a complementary approach could make a real difference”. He opposed “large and threatened cuts” in the funding of homeopathic hospitals and their possible closure. He complained that referrals to the Royal London homeopathic hospital were increasing “until what seems to amount to a recent ‘anti-homeopathic campaign’”. He warned against cuts despite “the fact that these homeopathic hospitals deal with many patients with real health problems who otherwise would require treatment elsewhere, often at greater expense”.

In 2009, the ‘College of Integrated Medicine’ (the name was only later changed to ‘College of Medicine’, see below) was to have a second base in India. An Indian spokesman commented: “The second campus of the Royal College will be in Bangalore. We have already proposed the setting up of an All India Institute of Integrated Medicine to the Union health ministry. At a meeting in London last week with Prince Charles, we finalized the project which will kick off in July 2010”.

In 2010, Charles publicly stated that he was proud to be perceived as ‘an enemy of the enlightenment’.

In 2010, ‘Republic’ filed an official complaint about FIH alleging that its trustees allowed the foundation’s staff to pursue a public “vendetta” against a prominent critic of the prince’s support for complementary medicines. It also suggested that the imminent closure of Ernst’s department may be partly down to the charity’s official complaint about him after he publicly attacked its draft guide to complementary medicines as “outrageous and deeply flawed”.

In 2010, former fellows of Charles’ disgraced FIH launched a new organisation, The College of Medicine’ supporting the use of integrated treatments in the NHS. One director of the college is Michael Dixon, a GP in Cullompton, formerly medical director of the Foundation for Integrated Health. My own analysis of the activities of the new college leaves little doubt that it is promoting quackery.

In 2010, Charles published his book HARMONY which is full of praise for even the most absurd forms of alternative therapies and even bogus diagnostic tests used by alternative practitioners.

In 2011, after the launch of Charles’ range of herbal tinctures, I had the audacity to publicly criticise Charles for selling the Duchy Herbals detox tincture.

In 2011, Charles forged a link between ‘The College of Medicine’ and an Indian holistic health centre (see also above). The collaboration was reported to include clinical training to European and Western doctors in ayurveda and homoeopathy and traditional forms of medicine to integrate them in their practice. The foundation stone for the extended campus of the Royal College known as the International Institution for Holistic and Integrated Medicine was laid by Dr Michael Dixon in collaboration with the Royal College of Medicine.

In 2012, Charles was nominated for ‘THE GOLDEN DUCK AWARD’ for his achievements in promoting quackery. However, Andrew Wakefield beat him to it; Charles certainly was a deserving runner-up.

In 2013, Charles called for society to embrace a broader and more complex concept of health. In his article he described a vision of health that includes the physical and social environment, education, agriculture and architecture.

In 2013, Charles’ Highgrove enterprise offered ‘baby-hampers’ for sale at £195 a piece and made a range of medicinal claims for the products it contained. As these claims were not supported by evidence, there is no way to classify them other than quackery.

By 2013, the ‘Association of Osteomyologists’ were seeking to become regulated by statute, with the help of Prince Charles as their patron. The chairman and founder of this organisation was knighted for services to alternative medicine.  Osteomyologists encourage the use of techniques including cranio-sacral therapy and claim that “we all know that Colleges, Institutions, and Medical Practitioners, are brain washed from the very outset into believing that their discipline is the only way to go.”

In November 2013, Charles invited alternative medicine proponents from across the world, including Dean Ornish, Michael Dixon, chair of College of Medicine, UK and Issac Mathai of Soukya Foundation, Bangalore, to India for a ‘brain storm’ and a subsequent conference on alternative medicine. The prince wanted the experts to collaborate and explore the possibilities of integrating different systems of medicines and to better the healthcare delivery globally, one of the organisers said.

In June 2014, BBC NEWS published the following text about a BBC4 broadcast entitled ‘THE ROYAL ACTIVIST’ aired on the same day: Prince Charles has been a well-known supporter of complementary medicine. According to a… former Labour cabinet minister, Peter Hain, it was a topic they shared an interest in. He had been constantly frustrated at his inability to persuade any health ministers anywhere that that was a good idea, and so he, as he once described it to me, found me unique from this point of view, in being somebody that actually agreed with him on this, and might want to deliver it. Mr Hain added: “When I was Secretary of State for Northern Ireland in 2005-7, he was delighted when I told him that since I was running the place I could more or less do what I wanted to do.*** I was able to introduce a trial for complementary medicine on the NHS, and it had spectacularly good results, that people’s well-being and health was vastly improved. And when he learnt about this he was really enthusiastic and tried to persuade the Welsh government to do the same thing and the government in Whitehall to do the same thing for England, but not successfully,” added Mr Hain. On this blog, I have pointed out that the research in question was fatally flawed and that Charles, once again, overstepped the boundaries of his constitutional role.

In 2015, two books were published which are relevant in this context. My memoir A SCIENTIST IN WONDERLAND recounts most of my dealings with Charles and his sycophants, including how an intervention from his first private secretary eventually led to the closure of my department. The book by Catherine Meyer CHARLES, THE HEART OF A KING is far less critical about our heir to the throne; it nevertheless severely criticises his stance on alternative medicine.

In October 2015, the Guardian obtained the infamous “black spider memos” which revealed that Charles had repeatedly lobbied politicians in favour of alternative medicine (see also above).

In 2016, speaking at a global leaders summit on antimicrobial resistance, Prince Charles warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”

CONCLUSIONS

It seems that, in recent years (and perhaps in view of soon becoming our King), the Prince has tried to keep a low profile in controversial areas such as alternative medicine. But, every now and then, his passion for quackery seems to get the better of him. The late Christopher Hitchens repeatedly wrote about this passion, and his comments are, in my view, unsurpassable:

We have known for a long time that Prince Charles’ empty sails are so rigged as to be swelled by any passing waft or breeze of crankiness and cant. He fell for the fake anthropologist Laurens van der Post. He was bowled over by the charms of homeopathic medicine. He has been believably reported as saying that plants do better if you talk to them in a soothing and encouraging way… The heir to the throne seems to possess the ability to surround himself—perhaps by some mysterious ultramagnetic force?—with every moon-faced spoon-bender, shrub-flatterer, and water-diviner within range.

HAPPY BIRTHDAY YOUR ROYAL HIGHNESS

We live in interesting, if they were not so frightening, one could almost say amusing times!

Politicians who previously have criticised Trump for his unacceptable deeds, behaviour and statements can now be seen to bend over backwards to join his band-waggon. They don’t know where the waggon is heading but they don’t want to be left behind. A prime example is UK’s Boris Johnson who now even criticises other politicians for having more back-bone than himself and therefore being less enthusiastic about America’s future leader.

But this is not a political blog, and I will therefore try to focus on matters related to alternative medicine.

The first band-waggon jumpers were, as far as I can see, the guys from NATURAL NEWS; I reported about them in a previous blog and therefore will not go over this again.

More indicative of the things to come is the article by John Weeks, the recently appointed editor of JACM. John also featured on this blog before, and now he has published an article in Huffpo entitled  “Trumpism and the Bigotry of the Antagonists to Integrative Medicine and Health”. In it he takes a very different approach to the matter of Trump and alt med; he states that:

The group, from Australia, USA and Great Britain – the 3 last two named Gorski and Ernst – each used Trumpian tactics. One pre-emptively names the report as “one of the most blatant examples of quackacademic confabulation I have seen in ages.” Another’s label is “tooth fairy science.” Like the Florida judge deemed mistrustful to Trump by his heritage, the study is questioned based on the professional background of two members of the team: “If you want to know why NCCIH supports so much pseudoscience, look no further than it having chiropractors and naturopaths in high ranking positions.” Never mind that each of these NIH employees has a separate research doctorate along with a clinical doctorate.

The study is then blasted for coming from the NIH National Center for Complementary and Integrative Health – once again de-faming the work based on origin rather than substance. The study is “worthless.” The NIH team “actively misleading” the public. These scientists’ tools apparently “exaggerations, sloppy research and misleading conclusions.” The NIH scientists are “”sincerely deluded cranks.” Such name-calling—and particularly the routine attributions of quackery—recall Trump’s epithets placed on each of his opponents, for example “Crooked Hillary.”

(I discussed the paper in question here)

Isn’t that hilarious?

In the Trump-era, one no longer seems to need good evidence, critical thinking or even just plain logic; words suffice, even if they are nonsensical.

The principle is adorably simple and effective:

  • you are faced with some criticism,
  • you find it hard to argue against it,
  • therefore you elect to attack your critic personally,
  • you claim that the criticism is insulting,
  • you re-name any criticism ‘TRUMPISM’,
  • and all is forgiven!

Weeks is not even original; others have used this method before him. In fact, advocates of alternative medicine thrive on ad hominem attacks, and without them they would go nowhere.

What they fail to realise in this particular case is that, in the final analysis, Donald Trump is one of theirs.

You don’t follow me?

Let me explain:

White middle-class American males are desperate; they see themselves close to bankruptcy. To remedy the problem, they had to elect someone who knows all about bankruptcies, someone who has been bankrupted several times before – because LIKE CURES LIKE!

Get it now?

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