Monthly Archives: December 2017
The Society of Homeopaths (SoH) has launched a campaign to inform the public that, despite everything non-homeopaths may say and despite the undeniable facts about homeopathy, their remedies are highly effective. This article provides a detailed account of their incompetence.
I saw the image below first on Twitter. It is part of their current campaign and summarises ‘POSITIVE MESSAGES ABOUT HOMEOPATHY’ as the SoH proclaim them. Presumably, they did this piece of work to help their members finding the right arguments when defending the indefensible.
I am not usually prone to laughing fits, but this had me in stiches! It is hilarious, I think; a true masterpiece of comedy.
The masterpiece is almost too perfect to tarnish with my comments; however, I cannot resist. Sorry!
I will take the arguments in turn going clockwise and starting with
‘HOMEOPATHY MEDICINES ARE TESTED SAFELY AND EFFECTIVELY ON HEALTHY HUMANS’
Should this not be ‘homeopathic medicines’? In any case, the remedies (medicines seems too strong a word) are tested in so-called ‘provings’ – yes, safely because they normally contain no active ingredient… and effectively? I cannot see why provings might be ‘effective’; they are pure fantasy.
HOMEOPATHY MAKES A POSITIVE CONTRIBUTION TO INTEGRATED HEALTHCARE
No, as we have discussed often on this blog, adding cow pie to apple pie is not a positive contribution to anything.
HOMEOPATHY HAS BEEN AVAILABLE ON THE NHS SINCE 1948
Appeal to tradition = fallacy.
Appeal to authority = fallacy.
HOMEOPATHY PUTS THE PATIENT AT THE CENTRE OF THEIR HEALTHCARE
This too is false logic, because all good medicine puts the patient at the centre; in addition it is grammatically false English (if I as a non-native speaker may be so bold).
HOMEOPATHY IS USED BY 15% OF UK CITIZENS
I doubt it. But even if this figure is correct, an appeal to popularity is a fallacy and not a logical argument.
HOMEOPATHY IS USED BY 450 MILLION PEOPLE WORLDWIDE
I doubt it. But even if this figure is correct, an appeal to popularity is a fallacy and not a logical argument.
HOMEOPATHY IS A SYSTEM OF NATURAL HEALTHCARE THAT HAS BEEN USED WORLDWIDE FOR 200 YEARS
What is ‘natural’ in endlessly diluting things like ‘Berlin Wall’ and pretending it is a medicine? In any case, the appeal to tradition is yet another fallacy.
HOMEOPATHY DOES NOT CONTRADICT SCIENTIFIC PROGRESS, IT IS PART OF IT
This is where I almost fell off my chair; homeopathy is the opposite of progress, it is a dogma and a belief-system.
HOMEOPATHY IS HOLISTIC
All good medicine is holistic; arguably, homeopathy is not holistic.
HOMEOPATHY IS EFFECTIVE IN BOTH ACUTE AND CHRONIC ILLNESS
Yes, this is what homeopaths believe, but it is not true.
To conclude what better than quoting the person who, a long time ago, said: “HOMEOPATHS ARE THE CLOWNS AMONGST THE HEALTHCARE PROFESSIONALS” ?
This overview by researchers from that Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, UK, was aimed at summarising the current best evidence on treatment options for 5 common musculoskeletal pain presentations: back, neck, shoulder, knee and multi-site pain. Reviews and studies of treatments were considered of the following therapeutic options: self-management advice and education, exercise therapy, manual therapy, pharmacological interventions (oral and topical analgesics, local injections), aids and devices, other treatments (ultrasound, TENS, laser, acupuncture, ice / hot packs) and psychosocial interventions (such as cognitive-behavioural therapy and pain-coping skills).
Here are the findings for those treatments most relevant in alternative medicine (it is interesting that most alternative medicines were not even considered because of lack of evidence and that the team of researchers can hardly be accused of an anti-alternative medicine bias, since its senior author has a track record of publishing results favourable to alternative medicine):
Current evidence shows significant positive effects in favour of exercise on pain, function, quality of life and work related outcomes in the short and long-term for all the musculoskeletal pain presentations (compared to no exercise or other control) but the evidence regarding optimal content or delivery of exercise in each case is inconclusive.
The evidence from a good quality individual patient data meta-analysis suggests that acupuncture may be effective for short-term relief of back pain and knee pain with medium summary effect sizes respectively compared with usual care or no acupuncture. However, effects on function were reported to be minimal and not maintained at longer-term follow-up. Similarly for neck and shoulder pain, acupuncture was only found to be effective for short-term (immediately post-treatment and at short-term follow-up) symptom relief compared to placebo.
Current evidence regarding manual therapy is beset by heterogeneity. Due to paucity of high quality evidence, it is uncertain whether the efficacy of manual therapy might be different for different patient subgroups or influenced by the type and experience of professional delivering the therapy. On the whole, the available evidence suggests that manual therapy may offer some beneficial effects on pain and function, but it may not be superior to other non-pharmacological treatments (e.g. exercise) for patients with acute or chronic musculoskeletal pain.
Overall. the authors concluded that the best available evidence shows that patients with musculoskeletal pain problems in primary care can be managed effectively with non-pharmacological treatments such as self-management advice, exercise therapy, and psychosocial interventions. Pharmacological interventions such as corticosteroid injections (for knee and shoulder pain) were shown to be effective treatment options for the short-term relief of musculoskeletal pain and may be used in addition to non-pharmacological treatments. NSAIDs and opioids also offer short-term benefit for musculoskeletal pain, but the potential for adverse effects must be considered. Furthermore, the optimal treatment intensity, methods of application, amount of clinical contact, and type of provider or setting, are unclear for most treatment options.
These findings confirm what we have pointed out many times before on this blog. There is very little that alternative therapies have to offer for musculoskeletal pain. Whenever it is possible, I would recommend exercise therapy initiated by a physiotherapist; it is inexpensive, safe, and at least as effective as acupuncture or chiropractic or osteopathy.
Practitioners of alternative medicine will, of course, not like this solution.
Acupuncturists may not be that bothered by such evidence: their focus is not necessarily on musculoskeletal but on a range of other conditions (with usually little evidence, I hasten to add).
But for chiropractors and osteopaths, this is much more serious, in my view. Of course, some of them also claim to be able to treat a plethora of non-musculoskeletal conditions (but there the evidence is even worse than for musculoskeletal pain, and therefore this type of practice is clearly unethical). And those who see themselves as musculoskeletal specialists have to either accept the evidence that shows little benefit and considerable risk of spinal manipulation, or go in a state of denial.
In the former case, the logical conclusion is to look for another job.
In the latter case, the only conclusion is that their practice is not ethical.
Who could resist reading an article entitled “Is Dead Vagina Syndrome Real? Plus, 4 Ways To Boost Your Libido“?
Well I couldn’t, particularly as it came from a site promisingly called ‘ALTERNATIVE DAILY’!
And I did not regret it. Here are some excerpts:
…“Dead vagina syndrome” or DVS is used to describe a woman’s over-sensitized vagina. Some people believe that regularly using a strong vibrator can cause a woman to lose feeling in her private parts. What’s worse, it’s thought that this desensitization of the nether regions makes it almost impossible for a woman to get aroused with an actual human partner. Thus, DVS is born. The theory behind the condition suggests that using a strong vibrator regularly will ultimately damage sensitive nerves around the clitoris and in the vagina…”[Luckily, there is help – help from all natural, herbal remedies, no less. The article recommends the following cures]
Saffron, a culinary delicacy, has a powerful libido-boosting effect. In fact, research suggests that saffron has been used traditionally as an aphrodisiac. And a little goes a long way. All you need is one or two strands to do the trick.
Used for centuries in Asian countries, maca root has traditionally been used for male sexuality. But a study from the Department of Psychiatry, Massachusetts General Hospital has found that it may also be helpful for women in need of a sexual boost.
In animal studies, nutmeg has been found to increase sexual activity in male rats. Interestingly, nutmeg has also been used traditionally as an aphrodisiac by African women and is still used today by women of all cultures. So, what’s good for men is obviously good for women too…
END OF QUOTE
Before you get all excited and start planting your own physic garden or hurry to the next health food shop, let me tell you this: I have looked into the evidence, and to call it flimsy would be the understatement of the year. There is no good reason to believe that these herbal remedies (or any other alternative therapy) can help women increase their libido.
Thankfully, the article ends on a truthful and reassuringly positive note: “most experts agree that DVS is not a real medical concern for women.”
… nor for men, I hasten to add.
A comprehensive review of the evidence relating to acupuncture entitled “The Acupuncture Evidence Project: A Comparative Literature Review” has just been published. The document aims to provide “an updated review of the literature with greater rigour than was possible in the past.” That sounds great! Let’s see just how rigorous the assessment is.
The review was conducted by John McDonald who no stranger to this blog; we have mentioned him here, for instance. To call him an unbiased, experienced, or expert researcher would, in my view, be more than a little optimistic.
The review was financed by the ‘Australian Acupuncture and Chinese Medicine Association Ltd.’ – call me a pessimist, but I do wonder whether this bodes well for the objectivity of the findings.
The research seems to have been assisted by a range of experts: Professor Caroline Smith, National Institute of Complementary Medicine, Western Sydney University, provided advice regarding evidence levels for assisted reproduction trials; Associate Professor Zhen Zheng, RMIT University identified the evidence levels for postoperative nausea and vomiting and post-operative pain; Dr Suzanne Cochrane, Western Sydney University; Associate Professor Chris Zaslawski, University of Technology Sydney; and Associate Professor Zhen Zheng, RMIT University provided prepublication commentary and advice. I fail to see anyone in this list who is an expert in EBM or who is even mildly critical of acupuncture and the many claims that are being made for it.
The review has not been published in a journal. This means, it has not been peer-reviewed. As we will see shortly, there is reason to doubt that it could pass the peer-review process of any serious journal.
There is an intriguing declaration of conflicts of interest: “Dr John McDonald was a co-author of three of the research papers referenced in this review. Professor Caroline Smith was a co-author of six of the research papers referenced in this review, and Associate Professor Zhen Zheng was co-author of one of the research papers in this review. There were no other conflicts of interest.” Did they all forget to mention that they earn their livelihoods through acupuncture? Or is that not a conflict?
I do love the disclaimer: “The authors and the Australian Acupuncture and Chinese Medicine Association Ltd (AACMA) give no warranty that the information contained in this publication and within any online updates available on the AACMA website are correct or complete.” I think they have a point here.
But let’s not be petty, let’s look at the actual review and how well it was done!
Systematic reviews must first formulate a precise research question, then disclose the exact methodology, reveal the results and finally discuss them critically. I am afraid, I miss almost all of these essential elements in the document in question.
The methods section includes statements which puzzle me (my comments are in bold):
- A total of 136 systematic reviews, including 27 Cochrane systematic reviews were included in this review, along with three network meta-analyses, nine reviews of reviews and 20 other reviews. Does that indicate that non-systematic reviews were included too? Yes, it does – but only, if they reported a positive result, I presume.
- Some of the included systematic reviews included studies which were not randomised controlled trials. In this case, they should have not been included at all, in my view.
- … evidence from individual randomised controlled trials has been included occasionally where new high quality randomised trials may have changed the conclusions from the most recent systematic review. ‘Occasionally’ is the antithesis of systematic. This discloses the present review as being non-systematic and therefore worthless.
- Some systematic reviews have not reported an assessment of quality of evidence of included trials, and due to time constraints, this review has not attempted to make such an assessment. Say no more!
It is almost needless to mention that the findings (presented in a host of hardly understandable tables) suggest that acupuncture is of proven or possible effectiveness/efficacy for a very wide array of conditions. It also goes without saying that there is no critical discussion, for instance, of the fact that most of the included evidence originated from China, and that it has been shown over and over again that Chinese acupuncture research never seems to produce negative results.
So, what might we conclude from all this?
I don’t know about you, but for me this new review is nothing but an orgy in deceit and wishful thinking!
Sorry, but something I stated in my last post was not entirely correct!
I wrote that “I could not find a single study on Schuessler Salts“.
Yet, I do know of a ‘study’ of Schuessler Salts after all; I hesitate to write about it because it is an exceedingly ugly story that goes back to the ‘Third Reich’, and some people do not seem to appreciate me reporting about my research on this period.
The truth, however, is that I already did mention the Schuessler salts before on this blog: “…in 1941 a research unit was established in ‘block 5’ [of the Dachau Concetration Camp] which, according to Rascher’s biographer, Sigfried Baer, contained his department and a homeopathic research unit led by Hanno von Weyherns and Rudolf Brachtel (1909-1988). I found the following relevant comment about von Weyherns: “Zu Jahresbeginn 1941 wurde in der Krankenabteilung eine Versuchsstation eingerichtet, in der 114 registrierte Tuberkulosekranke homöopathisch behandelt wurden. Leitender Arzt war von Weyherns. Er erprobte im Februar biochemische Mittel an Häftlingen.” My translation: At the beginning of 1941, an experimental unit was established in the sick-quarters in which 114 patients with TB were treated homeopathically. The chief physician was von Weyherns. In February, he tested Schuessler Salts [a derivative of homeopathy still popular in Germany today] on prisoners.”
Wikipedia provides further details: [Im Dritten Reich] konnten erstmals mit staatlicher Billigung und Förderung Untersuchungen durchgeführt werden, in denen die behauptete Wirksamkeit „biochemischer“ Arzneimittel überprüft wurde. Solche Versuche fanden auch in den Konzentrationslagern Dachau und Auschwitz statt, unter Leitung des Reichsarztes SS Ernst-Robert Grawitz. Dabei wurden unter anderem künstlich herbeigeführte Fälle von Blutvergiftung und Malaria weitgehend erfolglos behandelt. Für die Häftlinge nahmen diese Experimente in den meisten Fällen einen tödlichen Ausgang.
My translation: During the Third Reich, it became possible for the first time possible to conduct with governmental support investigations into the alleged effectiveness of ‘biochemical’ Schuessler Salts. Such tests were carried out in the concentration camps of Dachau and Auschwitz under the leadership of Reichsarzt SS Ernst-Robert Grawitz. They involved infecting prisoners with sepsis and malaria and treating them – largely without success. Most of the prisoners used for these experiments died.
I also found several further sources on the Internet. They confirm what was stated above and also mention the treatment of TB with Schuessler Salts. Furthermore, they state that the victims were mostly Polish priests:
- Versuchsstation im Krankenrevier des KZ Dachau, in der Tuberkulosekranke mit homöopathischen Mitteln behandelt werden. Leitender Arzt ist Dr. von Weyherns, 114 Versuchspersonen sind registriert.
- Zu Jahresbeginn 1941 wurde in der Krankenabteilung eine Versuchsstation eingerichtet, in der 114 registrierte Tuberkulosekranke homöopathisch behandelt wurden. Leitender Arzt war von Weyherns.
- Dr. Rudolph Kießwetter, (andere Schreibweise: Kiesewetter), Biochemiker aus Magdeburg, spritzte 10 Häftlingen Eiter in die Oberschenkel bzw. in die Venen, 7 starben. (Experimente mit Entzündungen: vgl. Sulfonamid-Experimente von Karl Gebhardt)
- Mitte Juni 1942 wurde Heinrich Schütz Leiter der Biochemischen Versuchsstation im Krankenrevier des Konzentrationslagers Dachau. Dort erprobte er biochemische Heilmittel an Häftlingen, die er mit bakteriellen Eitererregern infiziert hatte. Die Opfer waren vor allem polnische Priester im Pfarrerblock (KZ Dachau). Hintergrund war die These, dass Krankheiten auf einer Störung der Gewebesalze in den Körperzellen beruhen und durch Mineralzufuhr in homöopathischer Verdünnung geheilt werden könnten. Obwohl die meisten Versuche mit dem Tod der Erkrankten endeten, wurden die biochemischen Mittel weiter erprobt, ungeachtet der Tatsache, dass mit den Sulfonamiden wirksame Medikamente zur Verfügung standen. Bei diesen Versuchen halfen ihm unter anderem Waldemar Wolter und Karl Babor.
- Ab Mitte Juni 1942 waren Babor und Waldemar Wolter Assistenzärzte in der „Biochemischen Versuchsstation“ im KZ Dachau. Dort wurden unter der Leitung von Heinrich Schütz an Häftlingen Sepsisversuche durchgeführt, um die Wirksamkeit von biochemischen Heilmethoden gegenüber Sulfonamiden bei Infektionen zu testen. Insgesamt wurden zwischen Mitte und Ende 1942 vier Versuchsreihen durchgeführt. Bei den äußerst schmerzhaften und inhumanen Versuchen, bei denen Häftlingen auch der eigene Eiter injiziert wurde, starben mindestens 28 Häftlinge.
The last source claims that at least 28 prisoners died as a result of these unspeakably cruel experiments.
The most detailed account (and even there, it is just 2 or 3 pages) about these experiments that I could find is in the superb and extremely well-researched book ‘AUSCHWITZ, DIE NS MEDIZIN UND IHRE OPFER’ by Ernst Klee. In it (p 146), Klee cites Grawitz’s correspondence with Himmler where Grawitz discloses that, prior to the Dachau ‘Schuessler experiments’, there were also some in Auschwitz where all three victims had died. Apparently Grawitz tried to persuade Himmler to stop these futile and (even for his standards) exceedingly cruel tests; the prisoners suffered unimaginable pain before their deaths. However, Himmler reprimanded him sharply and instructed him to continue. Dr Kiesswetter was subsequently recruited to the team because he was considered to be an expert on the clinical use of Schuessler Salts.[Another book entitled ‘Der Deutsche Zentralverein homöopathischer Ärzte im Nationalsozialismus‘ also mentions these experiments. Its author claims that Weyherns was not a doctor but a Heilpraktiker (all other sources agree that he was a medic). In general, the book seems to down-play this deplorable story and reads like an attempt to white-wash German homeopathy during the Third Reich] .
Klee concludes his chapter by reporting the post-war fate of all the doctors involved in the ‘Schuessler experiments’:
Dr Waldemar Wolter was sentenced to death and executed.
Dr Hermann Pape disappeared.
Dr Rudolf Kiesswetter disappeared.
Dr Babor fled to Addis Abeba.
Dr Laue died.
Dr Heinrich Schuetz managed to become a successful consultant in Essen. Only in 1972, he was charged and tried by a German court to 10 years of jail. Several of his colleagues, however, certify that he was too ill to be imprisoned, and Schuetz thus escaped his sentence.
Why do I dwell on this most unpleasant subject?
Surely, this has nothing to do with today’s use of Schuessler Salts!
Do I do it to “smear homeopathy and other forms of complementary medicine with a ‘guilt by association’ argument, associating them with the Nazis“, as Peter Fisher once so stupidly put it?
I have other, more important reasons:
- I do not think that the evidence regarding Schuessler Salts is complete without these details.
- I believe that these are important historical facts.
- I feel that the history of alternative medicine during the Third Reich is under-researched and almost unknown (contrary to that of conventional medicine for which a very large body of published evidence is now available).
- I feel it should be known and ought to be much better documented than it is today.
- I fear that we live in times where the memory of such atrocities might serve as a preventative for a resurgence of fascism in all its forms.
When I started this blog, I promised to discuss all major alternative modalities. This is a big task, and I am not nearly there yet. For instance, I have so far written hardly anything about ‘Schuessler Salts’, a derivative of homeopathy that is hugely popular in Germany and is slowly spreading also to other countries. According to ‘Homeopathy Plus’, Schuessler’s Tissue Salts are ‘a medicine chest for the whole family’. Specifically, his is what they say:
… Tissue Salts were first developed by the German doctor, Wilhelm Schuessler, who said ill-health was caused by an imbalance in the bodies twelve vital cell salts. Schuessler believed that these imbalances could be corrected by easily absorbed and homeopathically-prepared, micro-doses of each salt.
Schuessler’s Tissue Salts (also known as biochemic or cell salts) are potentised micro-doses of the 12 essential minerals your body needs to repair and maintain itself. They are prepared in homeopathic 6X potencies that are gentle enough to be used by the youngest to the eldest member of your family. They can even be used with pets.
Schuessler introduced his homeopathically-prepared Tissue Salts more than 100 years ago but today, they have spread to most parts of the world where families and individuals rely on them as simple home treatments for a wide range of problems.
Tissue Salts, as either individual remedies or in combination, are an ideal addition to the home medicine cabinet for simple health complaints. They are:
- Absorbed rapidly
- Pleasant tasting
- Lactose free
- Convenient to carry
- Non-toxic and non-addictive
- Safe to use with prescription medicines
- Suitable for broad, general health complaints (unlike standard homeopathy that requires more precise symptom matching).
END OF QUOTE
Other websites offer much more concrete recommendations for the 12 specific remedies; for instance this one:
1. KALI PHOS (Kali Phosphoricum; Potassium Phosphate)
a. mental/emotional symptoms predominate
b. Feel as if “I’m too tired to rest.”
c. Anxiety, brain fatigue, irritability, temper-tantrums, sleeplessness, dizziness,
d. easily bleeding gums
2. KALI MUR (Kali Muriaticum; Potassium Chloride)
a. white mucus, swollen glands
b. white or gray coated tongue, glandular swellings, discharge of white, thick
mucus from nose or eyes
c. indigestion from rich food
3. KALI SULPH (Kali Sulphuricum; Potassium Sulphate)
a. yellow mucus, later stages of illness, congestion and cough worse in evening
b. dandruff, yellow coated tongue, yellow crusts on eyelids
c. gas, poor digestion
4. CALC PHOS (Calcarea Phosphorica; Calcium Phosphate)
a. teething remedy
b. upset stomach, post-nasal drip, chronic cold feet, poor dentition
5. CALC SULPH (Calcarea Sulphurica; Calcium Sulphate)
a. sores that heal poorly, herpes blisters
b. pain in forehead, vertigo, pimples on the face
6. CALC FLUOR (Calcarea Fluorica; Calcium Fluoride)
a. poor tooth enamel, cracks in palms of hands, lips
7. NAT MUR (Natrum Muriate; Sodium Chloride)
a. dryness of body openings, clear thin mucus
b. effects of excess overheating; itching of hair at nape of neck
c. early stage of common colds with clear, running discharge
d. insect bites (applied locally)
8. NAT SULPH (Natrum Sulphuricum; Sodium Sulphate)
a. rarely needed
b. green stools and other excess bile symptoms
c. Sensitive scalp, greenish-gray or greenish-brown coating on tongue, influenza
9. NAT PHOS (Natrum Phosphoricum; Sodium Phosphate)
a. simple morning sickness; acid rising in throat
b. Headache on crown of head, eyelids glued together in morning,
c. grinding of teeth in sleep; pain and sour risings from stomach after eating
10. MAG PHOS (Magnesia Phosphorica; Magnesium Phosphate)
a. Muscle spasms, cramps and menstrual cramps, if always better with heat
b. hiccups; trembling of hands
c. teeth sensitive to cold
11. FERRUM PHOS ( Ferrum Phosphate; Ferrum Phosphate)
a. first stages of inflammation, redness, swelling, early fever
b. congestive headache, earache, sore throat
c. loss of voice from overuse
12. SILICEA (Silica)
a. white pus forming conditions, boils (“homeopathic lancet”), stony-hard glands
b. Sty in eye area, tonsillitis, brittle nails
END OF QUOTE
All these promotional websites are guilty of two remarkable omissions:
- these remedies are biologically implausible,
- there is not a jot of evidence to suggest they are more than pure placebos.
Even if the ingredients named on the bottles were effective, the salts are far too dilute (6X signifies a dilution of 1: 1000000) to have any meaningful health effects. Unsurprisingly, there is no evidence whatsoever that these remedies work. I could not find a single study on Schuessler Salts – but if anyone knows of one, I would be ready to change my view. However, I did find this quote from the ‘Government Gazette of Western Australia’ 1946:
THE following report is issued under section 210 of the Health Act, 1911-1944:- It is claimed that the above “remedy” [Dr. Schuessler’s Cell Salts, Kali Phos. 3X] is “indicated in loss of mental power, brain fog, paralysis of any part, nervous headaches, neuralgic pains, general disability and exhaustion and sleeplessness from nervous disorders.” The “remedy” has been analysed and been found to contain potassium dihydrogen phosphate and lactose. The actual quantity of potassium dihydrogen phosphate in the “adult dose” is so minute that over 9,000 tablets would be necessary to give the minimum medicinal dose of this drug. Lactose is a sugar which is of no value in the treatment of any of the above-mentioned maladies. Dr. Schuessler’s Cell Salts can therefore have no curative value. They will bring about no improvement in any of the illnesses for which they are said to be indicated. Any expenditure on the purchase of these salts will be money wasted.
A new acupuncture study puzzles me a great deal. It is a “randomized, double-blind, placebo-controlled pilot trial” evaluating acupuncture for cancer-related fatigue (CRF) in lung cancer patients. Twenty-eight patients presenting with CRF were randomly assigned to active acupuncture or placebo acupuncture groups to receive acupoint stimulation at LI-4, Ren-6, St-36, KI-3, and Sp-6 twice weekly for 4 weeks, followed by 2 weeks of follow-up. The primary outcome measure was the change in intensity of CFR based on the Chinese version of the Brief Fatigue Inventory (BFI-C). The secondary endpoint was the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS). Adverse events were monitored throughout the trial.
A significant reduction in the BFI-C score was observed at 2 weeks in the 14 participants who received active acupuncture compared with those receiving the placebo. At week 6, symptoms further improved. There were no significant differences in the incidence of adverse events of the two group.
The authors, researchers from Shanghai, concluded that fatigue is a common symptom experienced by lung cancer patients. Acupuncture may be a safe and feasible optional method for adjunctive treatment in cancer palliative care, and appropriately powered trials are warranted to evaluate the effects of acupuncture.
And why would this be puzzling?
There are several minor oddities here, I think:
- The first sentence of the conclusion is not based on the data presented.
- The notion that acupuncture ‘may be safe’ is not warranted from the study of 14 patients.
- The authors call their trial a ‘pilot study’ in the abstract, but refer to it as an ‘efficacy study’ in the text of the article.
But let’s not be nit-picking; these are minor concerns compared to the fact that, even in the title of the paper, the authors call their trial ‘double-blind’.
How can an acupuncture-trial be double-blind?
The authors used the non-penetrating Park needle, developed by my team, as a placebo. We have shown that, indeed, patients can be properly blinded, i. e. they don’t know whether they receive real or placebo acupuncture. But the acupuncturist clearly cannot be blinded. So, the study is clearly NOT double-blind!
As though this were not puzzling enough, there is something even more odd here. In the methods section of the paper the authors explain that they used our placebo-needle (without referencing our research on the needle development) which is depicted below.
Then they state that “the device is placed on the skin. The needle is then gently tapped to insert approximately 5 mm, and the guide tube is then removed to allow sufficient exposure of the handle for needle manipulation.” No further explanations are offered thereafter as to the procedure used.
Removing the guide tube while using our device is only possible in the real acupuncture arm. In the placebo arm, the needle telescopes thus giving the impression it has penetrated the skin; but in fact it does not penetrate at all. If one would remove the guide tube, the non-penetrating placebo needle would simply fall off. This means that, by removing the guide tube for ease of manipulation, the researchers disclose to their patients that they are in the real acupuncture group. And this, in turn, means that the trial was not even single-blind. Patients would have seen whether they received real or placebo acupuncture.
It follows that all the outcomes noted in this trial are most likely due to patient and therapist expectations, i. e. they were caused by a placebo effect.
Now that we have solved this question, here is the next one: IS THIS A MISUNDERSTANDING, CLUMSINESS, STUPIDITY, SCIENTIFIC MISCONDUCT OR FRAUD?