MD, PhD, FMedSci, FSB, FRCP, FRCPEd

alternative medicine

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“Dr” Brian Moravec is a chiropractor from the US; he has a website where he describes himself and his skills as follows: I attended Chiropractic College and I am a graduate of Palmer College of Chiropractic in Davenport Iowa. I earned a Bachelor of Science degree as well as my Doctor of Chiropractic degree from Palmer College, which is the first chiropractic college in the world and the origin of our profession. I also attend continuing education seminars designed to keep doctors current with regard to clinical chiropractic, technique and nutrition.

The key to overall health and wellness is to have a healthy nervous system and that is what I do as a chiropractor – I make sure that your spine is functioning at its best so that your nervous system functions at its best. When the nervous system is functioning at 100%, you are a healthier individual that experiences a higher quality of life and health. I know this to be true in myself, my family and my patients.

I go to great lengths to provide my patients with the best chiropractic care I can give. I work with my patients to design a treatment plan that will be effective for their particular condition and specific to their needs. We utilize manual and low force techniques (safe and effective for newborns to seniors), to correct sublaxations in the spine. Chiropractic adjustments remove nerve interference, which allows the body to perform at its best again. I also am available for consultations on nutrition and diet, dietary supplementation and how to minimize the wear and tear on your spine.

[Emphases are mine]

What he does not state is the fact that he also is a nifty e-mail writer!

To my great surprise, I received an e-mail from him which is far too good to be kept for myself. So I decided to share it with my readers; here it is in its full and unabbreviated beauty:

its interesting to see someone with your education, and is a self proclaimed “expert” on alternative medicine, promote so much misinformation with regard to chiropractic care.   fortunately you look old.  and soon will be gone.  I always refer to the few of you anti chiropractic fools left here as “dinosaurs”.   the proof is in the pudding my “friend”.  chiropractic works and will continue to be here for centuries more.   you and others with much much more power than you (the AMA for example) have tried to perpetuate lies and squash chiropractic.  you fail, and they failed, because whatever better serves mankind will stand the test of time.   you’re a dying breed edzard.  thank God.
yours in health,

brian moravec d.c.

I am encouraged to see that he recognises my education but do wonder why his upbringing obviously failed so dismally teach him even a minimum of politeness, tact, or critical thinking. It is disappointing, I think, that he does not even mention what he perceives as my lies about his beloved chiropractic. So sad, I am sure it would have been fun to debate with him.

One of the problems regularly encountered when evaluating the effectiveness of chiropractic spinal manipulation is that there are numerous chiropractic spinal manipulative techniques and clinical trials rarely provide an exact means of differentiating between them. Faced with a negative studies, chiropractors might therefore argue that the result was negative because the wrong techniques were used; therefore they might insist that it does not reflect chiropractic in a wider sense. Others claim that even a substantial body of negative evidence does not apply to chiropractic as a whole because there is a multitude of techniques that have not yet been properly tested. It seems as though the chiropractic profession wants the cake and eat it.

Amongst the most commonly used is the ‘DIVERSIFIED TECHNIQUE’ (DT) which has been described as follows: Like many chiropractic and osteopathic manipulative techniques, Diversified is characterized by a high velocity low amplitude thrust. Diversified is considered the most generic chiropractic manipulative technique and is differentiated from other techniques in that its objective is to restore proper movement and alignment of spine and joint dysfunction.

Also widely used is a technique called ‘FLEXION DISTRACTION’ (FD) which involves the use of a specialized table that gently distracts or stretches the spine and which allows the chiropractor to isolate the area of disc involvement while slightly flexing the spine in a pumping rhythm.

The ‘ACTIVATOR TECHNIQUE’ (AT) seems a little less popular; it involves having the patient lie in a prone position and comparing the functional leg lengths. Often one leg will seem to be shorter than the other. The chiropractor then carries out a series of muscle tests such as having the patient move their arms in a certain position in order to activate the muscles attached to specific vertebrae. If the leg lengths are not the same, that is taken as a sign that the problem is located at that vertebra. The chiropractor treats problems found in this way moving progressively along the spine in the direction from the feet towards the head. The activator is a small handheld spring-loaded instrument which delivers a small impulse to the spine. It was found to give off no more than 0.3 J of kinetic energy in a 3-millisecond pulse. The aim is to produce enough force to move the vertebrae but not enough to cause injury.

There is limited research comparing the effectiveness of these and the many other techniques used by chiropractors, and the few studies that are available are usually less than rigorous and their findings are thus unreliable. A first step in researching this rather messy area would be to determine which techniques are most frequently employed.

The aim of this new investigation was to do just that, namely to provide insight into which treatment approaches are used most frequently by Australian chiropractors to treat spinal musculoskeletal conditions.

A questionnaire was sent online to the members of the two main Australian chiropractic associations in 2013. The participants were asked to provide information on treatment choices for specific spinal musculoskeletal conditions.

A total of 280 responses were received. DT was the first choice of treatment for most of the included conditions. DT was used significantly less in 4 conditions: cervical disc syndrome with radiculopathy and cervical central stenosis were more likely to be treated with AT. FD was used almost as much as DT in the treatment of lumbar disc syndrome with radiculopathy and lumbar central stenosis. More experienced Australian chiropractors use more AT and soft tissue therapy and less DT compared to their less experienced chiropractors. The majority of the responding chiropractors also used ancillary procedures such as soft tissue techniques and exercise prescription in the treatment of spinal musculoskeletal conditions.

The authors concluded that this survey provides information on commonly used treatment choices to the chiropractic profession. Treatment choices changed based on the region of disorder and whether neurological symptoms were present rather than with specific diagnoses. Diversified technique was the most commonly used spinal manipulative therapy, however, ancillary procedures such as soft tissue techniques and exercise prescription were also commonly utilised. This information may help direct future studies into the efficacy of chiropractic treatment for spinal musculoskeletal disorders.

I am a little less optimistic that this information will help to direct future research. Critical readers might have noticed that the above definitions of two commonly used techniques are rather vague, particularly that of DT.

Why is that so? The answer seems to be that even chiropractors are at a loss coming up with a good definition of their most-used therapeutic techniques. I looked hard for a more precise definition but the best I could find was this: Diversified is characterized by the manual delivery of a high velocity low amplitude thrust to restricted joints of the spine and the extremities. This is known as an adjustment and is performed by hand. Virtually all joints of the body can be adjusted to help restore proper range of motion and function. Initially a functional and manual assessment of each joint’s range and quality of motion will establish the location and degree of joint dysfunction. The patient will then be positioned depending on the region being adjusted when a specific, quick impulse will be delivered through the line of the joint in question. The direction, speed, depth and angles that are used are the product of years of experience, practice and a thorough understanding of spinal mechanics. Often a characteristic ‘crack’ or ‘pop’ may be heard during the process. This is perfectly normal and is nothing to worry about. It is also not a guide as to the value or effectiveness of the adjustment.

This means that the DT is not a single method but a hotchpotch of techniques; this assumption is also confirmed by the following quote: The diversified technique is a technique used by chiropractors that is composed of all other techniques. It is the most commonly used technique and primarily focuses on spinal adjustments to restore function to vertebral and spinal problems.

What does that mean for research into chiropractic spinal manipulation? It means, I think, that even if we manage to define that a study was to test the effectiveness of one named chiropractic technique, such as DT, the chiropractors doing the treatments would most likely do what they believe is required for each individual patient.

There is, of course, nothing wrong with that approach; it is used in many other area of health care as well. In such cases, we need to view the treatment as something like a ‘black box'; we test the effectiveness of the black box without attempting to define its exact contents, and we trust that the clinicians in the trial are well-trained to use the optimal mix of techniques as needed for each individual patient.

I would assume that, in most studies available to date, this is precisely what already has been implemented. It is simply not reasonable to assume that a trial the trialists regularly instructed the chiropractors not to use the optimal treatments.

What does that mean for the interpretation of the existing trial evidence? It means, I think, that we should interpret it on face value. The clinical evidence for chiropractic treatment of most conditions fails to be convincingly positive. Chiropractors often counter that such negative findings fail to take into account that chiropractors use numerous different techniques. This argument is not valid because we must assume that in each trial the optimal techniques were administered.

In other words, the chiropractic attempt to have the cake and eat it has failed.

Influenza kills thousands of people every year. Immunisation could prevent many of these deaths. Those at particularly high risk, e.g. young children, individuals aged 65 and older and people with severe diseases in their medical history, are therefore encouraged to get immunised. Nova Scotia health officials have just started their annual flu shot campaign. Now they are warning about some anti-flu vaccine literature being distributed by a chiropractor.

The leaflets from local chiropractic clinics suggest that flu shots increase the risk of a child ending up in hospital and link Alzheimer’s disease to flu shots. When questioned about this, the chair of the Nova Scotia College of Chiropractors defended this misinformation and claimed the author of the pamphlet did his homework. “Chiropractic is really pro information. Look at the positive, look at the negative, look at both sides, get your information and make the appropriate decision that’s right for you,” he said.

However, Dr. Robert Strang, Nova Scotia’s chief public health officer, said the message is wrong and added that the pamphlet is not based on medicine and is confusing to the public. “It’s discouraging, but unfortunately there are a range of what I call alternative-medicine practitioners who espouse a whole bunch of views which aren’t evidence based,” he said.

The stance of many chiropractors against immunisations is well known and has long historical roots. Campbell and colleagues expressed this clearly: Although there is overwhelming evidence to show that vaccination is a highly effective method of controlling infectious diseases, a vocal element of the chiropractic profession maintains a strongly antivaccination bias… The basis seems to lie in early chiropractic philosophy, which, eschewing both the germ theory of infectious disease and vaccination, considered disease the result of spinal nerve dysfunction caused by misplaced (subluxated) vertebrae. Although rejected by medical science, this concept is still accepted by a minority of chiropractors. Although more progressive, evidence-based chiropractors have embraced the concept of vaccination, the rejection of it by conservative chiropractors continues to have a negative influence on both public acceptance of vaccination and acceptance of the chiropractic profession by orthodox medicine.

No doubt, there will be comments following this post claiming that many chiropractors have now learnt their lesson and have considerably revised their stance on vaccination. This may well be true. But far too many chiropractors still post hair-raising nonsense about vaccination. Take this guy, for instance, who concludes his article (just one example of many) on the subject with this revealing paragraph: Our original blood was good enough. What a thing to say about one of the most sublime substances in the universe. Our original professional philosophy was also good enough. What a thing to say about the most evolved healing concept since we crawled out of the ocean. Perhaps we can arrive at a position of profound gratitude if we could finally appreciate the identity, the oneness, the nobility of an uncontaminated unrestricted nervous system and an inviolate bloodstream. In such a place, is not the chiropractic position on vaccines self-evident, crystal clear, and as plain as the sun in the sky? 

As long as dangerous cranks are tolerated by the vast majority of chiropractors and their professional organisations to mislead the public, I have to agree with Dr Strang: “It’s discouraging, but unfortunately there are a range of what I call alternative-medicine practitioners who espouse a whole bunch of views which aren’t evidence based.”

A reader of this blog recently sent me the following message: “Looks like this group followed you recent post about how to perform a CAM RCT!” A link directed me to a new trial of ear-acupressure. Today is ‘national acupuncture and oriental medicine day’ in the US, a good occasion perhaps to have a critical look at it.

The aim of this study was to assess the effectiveness of ear acupressure and massage vs. control in the improvement of pain, anxiety and depression in persons diagnosed with dementia.

For this purpose, the researchers recruited a total of 120 elderly dementia patients institutionalized in residential homes. The participants were randomly allocated, to three groups:

  • Control group – they continued with their routine activities;
  • Ear acupressure intervention group – they received ear acupressure treatment (pressure was applied to acupressure points on the ear);
  • Massage therapy intervention group – they received relaxing massage therapy.

Pain, anxiety and depression were assessed with the Doloplus2, Cornell and Campbell scales. The study was carried out during 5 months; three months of experimental treatment and two months with no treatment. The assessments were done at baseline, each month during the treatment and at one and two months of follow-up.

A total of 111 participants completed the study. The ear acupressure intervention group showed better improvements than the two other groups in relation to pain and depression during the treatment period and at one month of follow-up. The best improvement in pain was achieved in the last (3rd) month of ear acupressure treatment. The best results regarding anxiety were also observed in the last month of treatment.

The authors concluded that ear acupressure and massage therapy showed better results than the control group in relation to pain, anxiety and depression. However, ear acupressure achieved more improvements.

The question is: IS THIS A RIGOROUS TRIAL?

My answer would be NO.

Now I better explain why, don’t I?

If we look at them critically, the results of this trial might merely prove that spending some time with a patient, being nice to her, administering a treatment that involves time and touch, etc. yields positive changes in subjective experiences of pain, anxiety and depression. Thus the results of this study might have nothing to do with the therapies per se.

And why would acupressure be more successful than massage therapy? Massage therapy is an ‘old hat’ for many patients; by contrast, acupressure is exotic and relates to mystical life forces etc. Features like that have the potential to maximise the placebo-response. Therefore it is conceivable that they have contributed to the superiority of acupressure over massage.

What I am saying is that the results of this trial can be interpreted in not just one but several ways. The main reason for that is the fact that the control group were not given an acceptable placebo, one that was indistinguishable from the real treatment. Patients were fully aware of what type of intervention they were getting. Therefore their expectations, possibly heightened by the therapists, determined the outcomes. Consequently there were factors at work which were totally beyond the control of the researchers and a clear causal link between the therapy and the outcome cannot be established.

An RCT that is aimed to test the effectiveness of a therapy but fails to establish such a causal link beyond reasonable doubt cannot be characterised as a rigorous study, I am afraid.

Sorry! Did I spoil your ‘national acupuncture and oriental medicine day’?

Some time ago, my wife and I had the visit of a French couple. They came from Britany by ferry, and when we picked them up in Plymouth we saw two very pale, sick individuals staggering from the boat. It had been a rough crossing, and they had been sea-sick for 7 hours – enough to lose the will to live! “Why did you not take something against it?” we asked. “But we did”, they replied, “we even went especially to a pharmacy at home to get professional advice. They sold us this medication, but it just did not work.” To my amazement they showed me a homeopathic remedy marketed against sea-sickness in France.

I am sure most readers would have similar, perhaps even better stories to tell. But what do you do with people who happily sell you bogus treatments? Most of us do very little – and that is wrong, I think, very wrong. We need to protest in the sharpest terms each and every time this happens. I would even suggest we do like Mark Twain.

In 1905, Mark Twain sent the following letter to J. H. Todd, a salesman who had just attempted to flog a bogus medicine to the author by way of a letter and leaflet delivered to his home. According to the literature Twain received, the “medicine” in question — called “The Elixir of Life” — could cure such ailments as meningitis (which had previously killed Twain’s daughter in 1896) and diphtheria (which killed his 19-month-old son). Twain, himself of ill-health at the time and recently widowed after his wife suffered heart failure, was furious and dictated this reply.

Dear Sir,

Your letter is an insoluble puzzle to me. The handwriting is good and exhibits considerable character, and there are even traces of intelligence in what you say, yet the letter and the accompanying advertisements profess to be the work of the same hand. The person who wrote the advertisements is without doubt the most ignorant person now alive on the planet; also without doubt he is an idiot, an idiot of the 33rd degree, and scion of an ancestral procession of idiots stretching back to the Missing Link. It puzzles me to make out how the same hand could have constructed your letter and your advertisements. Puzzles fret me, puzzles annoy me, puzzles exasperate me; and always, for a moment, they arouse in me an unkind state of mind toward the person who has puzzled me. A few moments from now my resentment will have faded and passed and I shall probably even be praying for you; but while there is yet time I hasten to wish that you may take a dose of your own poison by mistake, and enter swiftly into the damnation which you and all other patent medicine assassins have so remorselessly earned and do so richly deserve.

Adieu, adieu, adieu!

Mark Twain

(Source: Berry Hill & Sturgeon)

Whenever I give a public lecture about homeopathy, I explain what it is, briefly go in to its history, explain what its assumptions are, and what the evidence tells us about its efficacy and safety. When I am finished, there usually is a discussion with the audience. This is the part I like best; in fact, it is the main reason why I made the effort to do the lecture in the first place.

The questions vary, of course, but you can bet your last shirt that someone asks: “We know it works for animals; animals cannot experience a placebo-response, and therefore your claim that homeopathy relies on nothing but the placebo-effect must be wrong!” At this stage I often despair a little, I must admit. Not because the question is too daft, but because I did address it during my lecture. Thus I feel that I have failed to get the right message across – I despair with my obviously poor skills of giving an informative lecture!

Yet I need to answer the above question, of course. So I reiterate that the perceived effectiveness of homeopathy relies not just on the placebo-effect but also on phenomena such as regression towards the mean, natural history of the condition etc. I also usually mention that it is erroneous to assume that animals cannot benefit from placebo-effects; they can be conditioned, and pets can react to the expectations of their owners.

Finally, I need to mention the veterinary clinical evidence which – just like in the case of human patients – fails to show that homeopathic remedies are better than placebos for treating animals. Until recently, this was not an easy task because no systematic review of randomised placebo-controlled trials (RCTs) of veterinary homeopathy was available. Now, I am happy to announce, this situation has changed.

Using Cochrane methods, a brand-new review aimed to assess risk of bias and to quantify the effect size of homeopathic interventions compared with placebo for each eligible peer-reviewed trial. Judgement in 7 assessment domains enabled a trial’s risk of bias to be designated as low, unclear or high. A trial was judged to comprise reliable evidence, if its risk of bias was low or was unclear in specified domains. A trial was considered to be free of vested interest, if it was not funded by a homeopathic pharmacy.

The 18 RCTs found by the researchers were disparate in nature, representing 4 species and 11 different medical conditions. Reliable evidence, free from vested interest, was identified in only two trials:

  1. homeopathic Coli had a prophylactic effect on porcine diarrhoea (odds ratio 3.89, 95 per cent confidence interval [CI], 1.19 to 12.68, P=0.02);
  2. individualised homeopathic treatment did not have a more beneficial effect on bovine mastitis than placebo intervention (standardised mean difference -0.31, 95 per cent CI, -0.97 to 0.34, P=0.35).

The authors conclusions are clear: Mixed findings from the only two placebo-controlled RCTs that had suitably reliable evidence precluded generalisable conclusions about the efficacy of any particular homeopathic medicine or the impact of individualised homeopathic intervention on any given medical condition in animals.

My task when lecturing about homeopathy has thus become a great deal easier. But homeopathy-fans are not best pleased with this new article, I guess. They will try to claim that it was a biased piece of research conducted, most likely, by notorious anti-homeopaths who cannot be trusted. So who are the authors of this new publication?

They are RT Mathie from the British Homeopathic Association and J Clausen from one of Germany’s most pro-homeopathic institution, the ‘Karl und Veronica Carstens-Stiftung’.

DOES ANYONE BELIEVE THAT THIS ARTICLE IS BIASED AGAINST HOMEOPATHY?

I know, I have written about this guy before – and I am likely to do so again – he is just too outstanding to pass by!

A few days ago, he was in the headlines again:  the Conservative health committee member David Tredinnick insisted that herbal medicine and even astrology should be given to patients in order to plug a growing hole in the NHS-budget: “I have referred to the fact that in some cultures astrology is part of healthcare because they need to have a voice and I’ve got up and said that,” he told Channel Four News. “But I also think we can reduce the bill by using a whole range of alternative medicine including herbal medicine, acupuncture, homeopathy…We could probably save five per cent of the [NHS] budget.”

Unbelievably, a man with such views is a member of the science and technology committee! This really does instil trust in politics!!!

His track record regarding the promotion of quackery might even dwarf that of Prince Charles; earlier this year he told MPs that astrology should be used to replace some “conventional” medicines on the NHS: “I am absolutely convinced that those who look at the map of the sky for the day that they were born and receive some professional guidance will find out a lot about themselves and it will make their lives easier,” he told the Commons. “I hope that in future we stop looking just at increasing the supply of drugs and consider the way that complementary and alternative medicine can reduce the demand for drugs, reduce pressures on the health service, increase patient satisfaction, and make everyone in this country happier.”

Speaking recently while thousands of NHS workers were on strike, he defended their pay freeze, stating that NHS’s budget was “finite”. However, asked whether he planned to take his own upcoming 9% pay rise, he refused to answer: “I’m not getting drawn on MPs pay… I’m not answering that question on this programme because we’re dealing with the health service.” Pushed further, he suggested that the rise was necessary in order to make MPs “good public servants… All members of parliament will be given a pay rise which is been set by an independent authority. Most of those members of parliament will take that pay rise because that is what is deemed necessary to have good public servants,” he insisted.

But is he really a “good public servant” ???

Addressing parliament about its ‘evidence check’ on homeopathy which came out squarely against it, Tredinnick once stated: “It is my belief that the advice the Clerks provided to the Science and Technology Committee Chairman was inadequate, in that the evidence taken by the Committee in its evidence check on homeopathy was biased, as they did not call representatives of the homeopathic profession and instead chose a professor who did not represent the alternative medicine world. They chose the one person who would give an answer that suited those who were in opposition.”  The professor he refers to is Edzard Ernst, I think! When I was invited to give evidence to the committee, Tredinnick was in the audience; I saw him as we were waiting to go in and even had a chat with him. So, he must remember that sitting next to me were several defenders of homeopathy, amongst them the Queen’s homeopath himself.

Perhaps Tredinnick just forgot!

He couldn’t be lying, could he?

No, a good public servant wouldn’t do that!

I just came across this hilarious yet revealing article by Italian authors defending homeopathy. It is far too remarkable to keep it for myself, and I therefore decided to quote its abstract here in full:

Throughout its over 200-year history, homeopathy has been proven effective in treating diseases for which conventional medicine has little to offer. However, given its low cost, homeopathy has always represented a serious challenge and a constant threat to the profits of drug companies. Moreover, since drug companies represent the most relevant source of funding for biomedical research worldwide, they are in a privileged position to finance detractive campaigns against homeopathy by manipulating the media as well as academic institutions and the medical establishment. The basic argument against homeopathy is that in some controlled clinical trials (CCTs), comparison with conventional treatments shows that its effects are not superior to those of placebo. Against this thesis we argue that a) CCT methodology cannot be applied to homeopathy, b) misconduct and fraud are common in CCTs, c) adverse drug reactions and side effects show that CCT methodology is deeply flawed, d) an accurate testing of homeopathic remedies requires more sophisticated techniques, e) the placebo effect is no more “plausible” than homeopathy, and its real nature is still unexplained, and f) the placebo effect is nevertheless a “cure” and, as such, worthy of further investigation and analysis. It is concluded that no arguments presently exist against homeopathy and that the recurrent campaigns against it represent the specific interests of the pharmaceutical industry which, in this way, strives to protect its profits from the “threat” of a safer, more effective, and much less expensive treatment modality.

Despite (or is it because?) of such nonsense, homeopathy seems to be very popular, especially in the treatment of small children, and particularly for conditions where conventional medicine has no effective treatment. Teething problems are thus an ideal target for the homeopathic industry.

A survey of British GPs found that the most frequently prescribed homeopathic remedies were for common self-limiting infantile conditions such as colic, cuts and bruises, and teething. Similarly, the Avon-study suggested that homeopathic Chamomillia is popular to alleviate the pain of teething. And prominent homeopaths recommend that “teething often responds to Chamomilla.

One website also recommends Chamomilla as well as several other homeopathic remedies leaving little doubt about their efficacy:

Chamomilla 6c: When teething is very painful and the child becomes quite cranky, satisfied with nothing and pacified only by being carried, then Chamomilla may help. Sometimes, the child seeking some relief from the discomfort will demand one thing after another, rejecting each one when it does not give relief. Children who could benefit from this remedy are very irritable, with a cry that sounds as if they are in pain. Chamomilla 6c can be taken every thirty minutes, up to six times per day, while symptoms persist.

Mercurius sol 6c: This remedy may be of help in cases where teething is accompanied by excessive salivation and drooling. In addition, the gums are likely to be red and sore, and the child may have diarrhea with a foul smell to it. Mercurius sol 6c can be taken four to six times per day for two to three days; its use should be discontinued when the symptoms diminish.

>Belladonna 30c: For children who tend to develop a fever with a flushed, red face when they are cutting teeth, Belladonna may be a good choice. Often the eyes have a glassy look due to the dilation of the pupils. The child may be irritable and crying as if angry. Belladonna 30c can be taken every thirty minutes up to four times per day, while symptoms continue.

Aconite napellus 30c: When the symptoms come on quickly and include physical and mental restlessness, this remedy may be useful. The affected gums will be hot, swollen, and inflamed and there may also be an earache with aversion to loud noises. The condition may come on following exposure to cold, dry winds. Try Aconite napellus 30c every hour for up to six times per day.

Calcarea carbonica 6c: When children are finally cutting teeth that have been late in erupting, Calcarea carbonica could be helpful. This remedy is often helpful with “late bloomers,” babies who develop a little more slowly, crawling, walking, and cutting teeth on their own schedule, weeks or months later than some other babies or toddlers. Children likely to benefit from Calcarea carbonica often have sweaty heads and feet and may have a tendency to develop cradle cap or yeast infections. With teething, they often do not show the extreme irritability that calls for Chamomilla, or the fever that indicates Belladonna, but they may have teeth that seem permanently on the verge of breaking through the surface. Calcarea carbonica 6c can be taken three times per day, for up to ten days; its use should be discontinued when symptoms improve.

Given this level of assurance, it not really surprising that manufacturers of homeopathic remedies want to profit from all this. Anxious mothers must seem like sitting ducks to the homeopathic industry.

Camilia, a homeopathic teething remedy that contains Chamomillia in the 9c potency from Boiron, the world’s largest producer of homeopathic products, will be launched shortly in the UK. The PR-agency in charge of the UK campaign to promote camilia announced that they will focus on a “national awareness drive through earned and paid-for media along with influencer engagement.” The agency is also responsible for re-building the brand’s website and implementing a strategy to drive discovery online. Amanda Meyrick of Clarion Communications, said: “Launching a product into a new market gives us the opportunity to work in partnership from the beginning to establish Camilia in the UK, and we are looking forward to seeing the results of our planning and creativity.” Remarkably, nobody seems to mention efficacy as a factor in the promotion of camilia.

However, the product is already available in the US, and from the US website we learn that this remedy “temporarily relieves symptoms of teething, including painful gums and irritability.” So, there are clear claims of efficacy after all!

Boiron is not the only firm who aim to profit from the vast market of teething problems. Nelson’s Teetha, for instance, is already available in the UK. Each 300mg sachet of TEETHA contains “the active ingredient of Chamomilla 6c.” Even Boots, the UK’s ‘trusted’ high street pharmacy, sell a product called ‘TEETHING PAIN RELIEF’ which also contains Chamomilla 6c, its only ‘active’ ingredient. Even the name of their product carries a therapeutic claim for efficacy, in my view.

But hold on! A 6c dilution equals one ml of plant extract diluted in 1 000 000 000 litres of water (add 6 zeros to that figure for the Boiron product)!!! Is that really going to alleviate teething problems?

Of course not!, you will say. Dilutions of this nature will do nothing whatsoever.

But they are not just dilutions, they are potentiations! would the homeopaths counter; they have been succussed at each dilution step, and this process transfers a vital force from the Chamomilla extract to the remedy. Yes, of course, how could I forget – it’s homeopathy where LIKE CURES LIKE and people believe in the tooth fairy.

But this does not make any sense either!

Chamomillia is nothing other than chamomile, a plant known to sooth through its anti-inflammatory actions. So, in highly diluted homeopathic products, the actions of this plant should be reversed according to the ‘like cures like’ principle. That means that these teething products, according to homeopathic ‘logic’, is not for treating inflamed gums but for treating the absence of inflammation.

My mind boggles because nothing seems to make sense any more:

  • according to real science (or just common sense), the dilutions are far to high to have any effect at all,
  • according to homeopathic ‘logic’, these products should, if anything, produce inflammation and not alleviate it,
  • according to the best clinical evidence, homeopathic remedies are not effective for teething; I am not aware of a single rigorous trial that would show its efficacy, and current reviews do not recommend homeopathy for teething problems,
  • regardless of all this and despite of regulations prohibiting it, therapeutic claims are being made for these over-priced placebos.

Puzzled?

Don’t be!

IT’S HOMEOPATHY STUPID!

Here and elsewhere, I have repeatedly written about the many things that can go wrong with acupuncture. This invariably annoys acupuncture fans who usually counter by accusing me of being alarmist. Despite their opposition, I continue to think it is important to regularly point out that acupuncture – contrary to what many acupuncturists would tell us – can result in serious injury. I will therefore carry on reporting new evidence about the harm caused by acupuncture. Here is a very brief review of new (2014) articles on this important topic.

A recent study found that the incidence of any adverse events per patient was 42.4% with traditional acupuncture, 40.7% with minimal acupuncture and 16.7% with non-invasive sham acupuncture. These figures are much higher than those around 10% previously reported.

Other authors described the case of a broken off acupuncture needle in a patient’s abdomen. A very long needle was used which happily is unusual in routine practice.

Pneumothorax has been often noted as a complication of acupuncture – it is by far the most frequently reported serious complication caused by acupuncture; well over 100 instances have been described in the medical literature which, of course, reflects only the tip of an iceberg – new cases are being reported almost on a monthly basis.

Cardiac tamponade is even more dangerous but fortunately also much rarer. A case of life-threatening cardiac tamponade due to penetration of an acupuncture needle directly into the right ventricle was recently published. Cardiac tamponade can happen when the patient is unfortunate enough to have a sternal foramen, an congenital abnormality that is not normally detected by simple inspection or palpation. An investigation found that the frequency of a sternal foramen is approximately 10.5%. The authors concluded that sternal acupuncture should be planned in the region of corpus-previous CT should be done to rule out this variation. Furthermore, we strongly recommend the acupuncture technique which prescribes a safe superficial-oblique approach to the sternum.

A review from Egypt noted that acupuncture presented a significant risks for acquiring hepatitis C infections.

Other types of infections can also be transmitted by acupuncture needles, if the therapist fails to adhere to proper procedures of sterility. One report described the diagnosis, treatment and >1 year follow-up of 30 patients presenting with acupuncture-induced primary inoculation tuberculosis.

Similarly, Chinese authors reported the case of a 54-year-old woman who presented with progressive low back pain and fever. She underwent surgical decompression, with an immediate improvement of her pain. A culture of the epidural abscess grew Serratia marcescens. One year postoperatively, magnetic resonance imaging revealed the almost complete eradication of the abscess. This case is the first case of Serratia marcescens-associated spinal epidural abscess formation secondary to acupuncture.

Other authors reported a rare case of isolated unilateral hypoglossal nerve injury following ipsilateral acupuncture for migraines in a 53-year-old lady.

Finally, Greek authors published a case of severe rhabdomyolysis and acute kidney injury after acupuncture sessions. Rhabdomyolysis is a rare condition that can be caused by muscle injury and presents with muscle weakness and pain. It is characterized by myoglobinuria which, in turn, may cause acute kidney injury.

I can hear the world of acupuncture arguing that all of these events are extreme rarities and that conventional treatments are much more dangerous. This may well be true but it also ignores the following facts:

  • The frequency of such events is essentially unknown. Contrary to conventional medicine, alternative medicine has no functioning systems to monitor adverse events. Therefore the true incidence figures of acupuncture-related complications are anyone’s guess.
  • Most conventional treatments in common use are backed up by good evidence for efficacy and therefore demonstrably do more good than harm, even if they regularly cause adverse effects. This is not the case for acupuncture. In the absence of solid evidence for efficacy, even relatively rare or minor adverse effects would mean that the risk/benefit profile of acupuncture is not positive.

For these reasons, it is an ethical imperative, I think, to keep a keen eye on the harm caused by acupuncture and to inform the public about the fact that it is undeniably not free of risks.

There are few concepts in medicine which are more often abused than that of ‘holistic medicine’. Professor Baum and many other well-reasoned observers have pointed out that true “holism in medicine is an open-ended and exquisitely complex understanding of human biology that over time has led to spectacular improvements in the length and quality of life of patients with cancer and that this approach encourages us to consider the transcendental as much as the cell and molecular biology of the human organism. ‘Alternative’ versions of holism are arid and closed belief systems, locked in a time warp, incapable of making progress yet quick to deny it in the field of scientific medicine.”

Holism does not belong to any type of health care, it is an essential characteristic of any type of good medicine; without it, health care is defective, almost by definition. This is not my personal opinion, it is and always has been the generally accepted view: it is a common misconception that holistic medicine is just ‘alternative’ or ‘complementary’ medicine. Clinical holistic medicine actually dates as far back as Hippocrates. An holistic approach to patient care was also suggested by Percival in his book – the first textbook of medical ethics – first published in 1803. Percival stated: “The feeling and emotions of the patients require to be known and to be attended to, no less than the symptoms of their diseases.” More recently, John Macleod in his book ‘Clinical Examination’, first published in 1964, also commented that “we should aim to be holistic in our care”. Also, the seminal work by Michael Balint, ‘The Doctor, the Patient and his Illness’, first published in 1957, represents an important landmark in seeing the patient as a whole rather than as isolated pathology… An holistic approach is good practice and has been strongly advocated by the Royal College of General Practitioners for many years. 

Proponents of alternative medicine, however, tend to see this very differently. They have jumped on the ‘holistic band-wagon’ and frequently claim that they now own it: they pretend or imply to be the only clinicians who practice holistically. Thus a most effective straw man has been created, and conventional medicine is attacked by these ‘new-born holists’ for not being holistic.

One website may serve as an example for many: Holistic medicine (or holistic health) is a section of alternative medicine where practitioners believe that in order to successfully treat an illness or health problem, it is necessary to focus on the many components that make up an individual, including the mental and emotional aspects, rather than focusing exclusively on the physical symptoms or just the illness itself. Holistic medicine looks at the “whole package” in order to determine an appropriate path to healing.

More often than not, the ‘alternative path to healing’ turns out to consist of a series of bogus alternative treatments some of which may be directly harmful, while others are just useless but nevertheless detrimental because they replace effective therapies that would alleviate patients’ suffering.

In case you doubt this statement, I recommend searching the Internet for ‘holistic healing centres’. Just one website will have to stand for virtually thousands of others; this is the list of treatments offered in one UK holistic healing centre:

aromatherapy
bodytalk
bio resonance
bowen technique
clinical psychology
cognitive hypnotherapy
counselling
cranial osteopathy
crystal healing
deep tissue massage
dr hauschka rhythmic treatments
emotional freedom technique
food allergy testing
homeopathy
hypnotherapy
indian head massage
kinesiology
la stone massage therapy
metamorphic technique
mindfulness
naturopathy
neuro-linguisitc programming
nutritional therapy
osteopathy
pilates
pregnancy massage
psychotherapy
reflexology
reiki
remedial massage
shiatsu
sports therapy
swedish massage
yoga

I think it is important to realise what has happened here and what charlatans have made of holism which is (I repeat) a central and essential element of conventional health care. They have hijacked it, claimed they have a monopoly on it, used it to create a straw man misleading the public, and perverted it into a tool for attracting and financially exploiting the often all too gullible public.

And the reaction of conventional medicine to all this? Hardly any! Many conventional health care professionals seem now resigned to delegating holism to quacks. Some organisations, like the infamous COLLEGE OF MEDICINE, run by Prince Charles’ sycophants, have even taken an active role in supporting this shameful take-over.

I strongly feel that this regressive development will, in the end, render all of medicine less effective, less humane and will thus turn out to be a great disservice to patients.

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