MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

A recent post discussed a ‘STATE OF THE ART REVIEW’ from the BMJ. When I wrote it, I did not know that there was more to come. It seems that the BMJ is planning an entire series on the state of the art of BS! The new paper certainly looks like it:

Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind-body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs). The overall quality of the evidence for CIM in headache management is generally low and occasionally moderate. Available evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches. Spinal manipulation, chiropractic care, some supplements and botanicals, diet alteration, and hydrotherapy may also be beneficial in migraine headache. CIM has not been studied or it is not effective for cluster headache. Further research is needed to determine the most effective role for CIM in patients with headache.

My BS-detector struggled with the following statements:

  • integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM) – the fact that CIM is a nonsensical new term has been already mentioned in the previous post;
  • evidence informed modalities – another new term! evidence-BASED would be too much? because it would require using standards that do not apply to CIM? double standards promoted by the BMJ, what next?
  • CIM commonly includes the use of nutrition – yes, so does any healthcare or indeed life!
  • the overall quality of the evidence for CIM in headache management is generally low and occasionally moderate – in this case, no conclusions should be drawn from it (see below);
  • evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches – no, it doesn’t (see above)!
  • further research is needed to determine the most effective role for CIM in patients with headache – this sentence does not even make the slightest sense to me; have the reviewers of this article been asleep?

And this is just the abstract!

The full text provides enough BS to fertilise many acres of farmland!

Moreover, the article is badly researched, cherry-picked, poorly constructed, devoid of critical input, and poorly written. Is there anything good about it? You tell me – I did not find much!

My BS-detector finally broke when we came to the conclusions:

The use of CIM therapies has the potential to empower patients and help them take an active role in their care. Many CIM modalities, including mind-body therapies, are both self selected and self administered after an education period. This, coupled with patients’ increased desire to incorporate integrative medicine, should prompt healthcare providers to consider and discuss its inclusion in the overall management strategy. Low to moderate quality evidence exists for the effectiveness of some CIM therapies in the management of primary headache. The evidence for and use of CIM is continuously changing so healthcare professionals should direct their patients to reliable and updated resources, such as NCCIH.

WHAT IS HAPPENING TO THE BMJ?

IT USED TO BE A GOOD JOURNAL!

48 Responses to More BS from the BMJ

  • “The use of CIM therapies has the potential to empower patients and help them take an active role in their care”

    This type of statement is extremely common in CAIM and I’ve often wondered why these people continue to insist that ‘we should take control of our own health’ A possible answer to my question came from the transport industry – although I am not sure if it makes sense.

    People are much more likely to take a risk when they perceive to be in control of a situation. Apparently we are up to a thousand times more likely to get into a car (we are in control) vs getting into a plane (pilot is in control). So if the CAIM proponents tells us that we are in control (or we should take control) of our own health we will be much more likely to take the risk of any OTC CAIM product or modality as compared to listening to and trusting the advise of a qualified doctor/pharmacist etc. And hence people will buy more crap because they feel that they are in control of their own health and, of course, the CAIMists will use the sales figures as evidence that their crap is working. Just a thought.

    • interesting!

    • That’s how I see it too. Get the doctor out of the way so that the alternative provider can advertise and sell directly.
      However, when we say “CAIM”, we omit the really key part of this story: Supplements industry, the real money maker.

      Therefore, instead of Complementary and Integrative Medicine (CAIM), I prefer:
      Supplements, Complementary and Alternative Medicine (SCAM).

      • Indeed, the supplement industry just makes the stuff and provide the usually false big promise of eternal health for all their products and the consumer decides what they want to buy. For them important to stress the point that you are on control because then you’ll buy anything that they produce – and this is based on how they market their products.

        I have recently noticed this wonderful new project being conducted at my former Uni ““A study looking into ways of reminding people to take their health supplements is being conducted by a PhD student at Western Sydney University. An avatar- based iPad application that can verbally express reminders along with a portable pill organiser that can emit alarms at scheduled times are being tested as a part of the study.”

        Quite funny because the supplement company Blackmores donated $10 million and I guess they would like to see some return on their investment?

        Link

        • How the blazes did THAT get by the ethics committee?

          • Well, this Uni is owned by Blackmores and they are not known for their ethical principles. They are also starting a TCM ‘hospital’ (partly funded by Blackmores) in Sydney next year, because a ‘trusted’ Uni operated TCM hospital will give prospective patients a better sense of security eg more people will fall for it.

      • Maybe you are unaware that most pharmaceutical companies are also manufacturing the synthetic supplements as well as your trusted synthetic pills.

        So if the synthetic supplements don’t work and are bad for you does that mean the synthetic drugs don’t work and are bad for you?

        Get your synthetics put them in the oven heat them up and watch them melt down into a black petrochemical tar.
        That’s what your putting into your body 2-3 times a day. And you think that’s going to make you healthy, where’s the critical thinking? I commend you on your strong faith but Tomfoolery is all that is.

        • Get your synthetics put them in the oven heat them up and watch them melt down into a black petrochemical tar.

          What do non-synthetics turn into when you heat them up in the oven?

        • Goodness. Where did you get heap of burning stupidity from, MirandaT?

        • I sort of get the impression, Miranda T, you prefer natural things to synthetic. So please sample some phalloidin, hemlock, aconite, belladonna and tetrodotoxin to prove your case.

          • So how do you go from talking about supplements to animal neurotoxins. Maybe you should have tried the whole food nature based supplements and those poisons wouldn’t have eroded your brain do much.

        • Contrary to what you claim – natural supplemets do not turn into petrochemical tar, essentially they do. Additionally you do not seem to be aware that petrol is 100% bioorganic.

          Another probably new thing for you. “natural” supplements are NOT optimized for human use. A plant gives a rat’s fart on humans, as does “mother” nature. This is the reason why you take a pertrol-tar producing Aspirin if you hae a headache and you do not drink willow bark tea.

  • I agree that the article talked about in this post is nauseating. What’s next? Burnt offerings of children to the gods to empower people to cure hangnails?
    How is this even possible?
    The BMJ used to be a respectable and respected journal. Are they trying to drive people to Benny Hinn and Oprah Winfrey?

  • Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM)

    This reminds me a bit of the Soviet secret service. It started out as the Cheka, progressed though several reincarnations such as OGPU and NKVD and ended up as the KGB. Apparently as one name got a bad rep, one simply renamed.

  • I am available to have a nice chat and a cup tea with patients. Listen to their woes. Even bring biscuits. But it will cost you.

    Don’t do dancing though. That’s dangerous.

  • The most effective role for CIM in migraine and headache is: F… off.

  • Oh no! Are the BMJ now using logical fallacies!

    • they have not yet sunk as low as you

      • I may be low but at least I am not up high in some ivory tower accusing the the BMJ of writing BS.

        • accusing the the BMJ of writing BS.

          How would you go about pointing out that the BMJ is publishing bullshit without accusing them of it?

          • on top of it, the BMJ is not writing BS but publishing BS
            but ‘the better thinking’ is not thinking well enough to know the difference

          • on top of it, the BMJ is not writing BS but publishing BS
            but ‘the better thinking’ is not thinking well enough to know the difference

            That was indeed the first thing that struck me. Alternologists and quacks do not seem to be particularly good at using appropriate vocabulary and dictionaries. They remind me of the “religion classes” I got from the Jesuits.

          • WHAT DO YOU EXPECT FORM SOMEONE CALLING THEMSELVES “Theevenbetterthanthegoodthinkingsocietysociety.”?

          • Write to the editor (Dr Fiona Godlee) asking for the evidence which informed her reviewer that this article had any merit. What were the criteria for deeming it worthy?

            And ask what the BMJ means by ‘CIM’ and why it is prepared to drop CAM (or ‘camistry’ as I term the domain which uses implausible non-evidenced based treatments).

            If enough folk write in, Dr Godlee might be forced to explain.
            And revise her policy in future.

            If I get a chance, I will raise this at the BMA annual conference at the end of June.

          • WHAT DO YOU EXPECT FORM SOMEONE CALLING THEMSELVES “Theevenbetterthanthegoodthinkingsocietysociety.”?

            Good point. It is precisely why I tend to recoil from people who call themselves “expert”, “specialist”, “artist”, “honest” and other such names that they should be called by other people, not themselves.

        • Do you think the bmj is beyond reproach and should not be criticised?

  • NICE says acupuncture may be considered as second line prophylactic treatment for migraine.
    https://cks.nice.org.uk/migraine#!scenario

    Evidence for prophylactic use of acupuncture for chronic tension-type headache is of very low to low quality.
    Doctors should first address lifestyle issues including diet, sleep, exercise etc, give advice on relaxation techniques and offer CBT (mind-body?) before considering acupuncture. A holistic approach then and if that doesn’t work try acupuncture!

    https://cks.nice.org.uk/headache-tension-type#!scenario:1
    https://www.nice.org.uk/guidance/cg150/evidence/full-guideline-188258221

    As far as I am aware this is NICE’s only recommended use of acupuncture – and it is limited specifically to 10 sessions of TCM. I hope the BMJ draws the same line in the sand as NICE. Enough already.

  • Edzard: “WHAT IS HAPPENING TO THE BMJ?

    IT USED TO BE A GOOD JOURNAL!”

    Bart: “The BMJ used to be a respectable and respected journal. ”

    Personally, I’ve never viewed the BMJ with so much respect. It has always been far from a ‘typical’ scientific journal, publishing only peer-reviewed material, and much closer to a medical equivalent of something like New Scientist, with many non-peer-reviewed articles expressing opinions and views on current affairs.

    Edzard:”the overall quality of the evidence for CIM in headache management is generally low and occasionally moderate – in this case, no conclusions should be drawn from it”. I’d be even stronger: a proper, peer-reviewed, scientific publication would simply not publish this rubbish.

  • Your headline Edzard ‘More BS from the BMJ’ hardly implies that the post that follows is going to be intelligent reproach or criticism.
    Still you have strong backing from your half a dozen supporters.

    • and your comment hardly implies that you know the difference between writing and publishing [nor ‘even better thinking’].
      intelligence?
      criticism?
      you still have to demonstrate any of these!

    • Yes I’ve noticed that to, it’s always the same half a dozen people agreeing the same stuff. Hmm interesting.

      • Yes I’ve noticed that to, it’s always the same half a dozen people agreeing the same stuff. Hmm interesting.

        People interested in reality tend to agree with reality, but I agree that people who disagree with reality may be more interesting, at least for those of us who are interested in mental diseases.

  • Bart is now suggesting that anyone who doesn’t agree with his reality has mental disease.
    My critical thinking skills suggest that he is just suffering from his own logical faeces.

  • Bart is now suggesting that anyone who doesn’t agree with his reality has mental disease.
    My critical thinking skills suggest that he is just suffering from his own logical faeces.

    Bart is not suggesting that at all. Bart is merely saying that anyone who does not agree with reality, has a menal disease. It may be an easily remedied disease, such as ignorance which is easily cured by education, but it may also be something more sordid, such as the condition which Theevenbetterthanthegoodthinkingsocietysocietysociety seems to be suffering from.

    Given that psychiatry is a relatively new specialty, it may very well be incurable in the current state of our knowledge, but that doesn’t mean we should give up on herhimit.

    Get help, Theevenbetterthanthegoodthinkingsocietysocietysociety, nobody should have to live in the frightening universe you seem to think you are living in.

  • According to the Pauli exclusion principle Bart everything in the Universe is connected to everything else.
    That must mean that we are connected.
    Yes the universe is a frightening place.

  • This all seems very uncertain to me Bart. I can see the speed you are going down your logical fallacies slippery slope but I have no idea where the exact location of your slippery slope is.

    As long as our connection is only on a subatomic level we should be ok Bart. Thank Darwin that those pesky homeopaths, Chopra , wooers etc who think that we are all entangled on other levels are all wrong.

    • This all seems very uncertain to me Bart. I can see the speed you are going down your logical fallacies slippery slope but I have no idea where the exact location of your slippery slope is.

      As long as our connection is only on a subatomic level we should be ok Bart. Thank Darwin that those pesky homeopaths, Chopra , wooers etc who think that we are all entangled on other levels are all wrong.

      I think the roulette wheel used to create your word salads could use some maintenance and/or fine-tuning.

  • I think that your wave function has collapsed Bart.

    • I think that your wave function has collapsed Bart.

      I was hoping I was wrong. Nonetheless, thank you for the confirmation. I am not qualified to help you, no matter how much I may regret having to admit it. I hear that Broadmoor Hospital has excellent services. You need them. They may not be able to help you, but they are your best bet. Do yourself a favour and ask for a consultation. Run, don’t walk, to get there. They are open today: http://www.wlmht.nhs.uk/bm/broadmoor-hospital

  • Yes I might pay a visit. See you in there Bart.

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