MD, PhD, FMedSci, FSB, FRCP, FRCPEd

alternative medicine

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As has been discussed on this blog many times before, the chiropractic profession seems to be in a bit of a crisis (my attempt at a British understatement). The Australian chiropractor, Bruce Walker, thinks that, with the adoption of his ten point plan, “the chiropractic profession has an opportunity to turn things around within a generation. Importantly, it has an obligation to the public and to successive generations of chiropractors ahead of it. By embracing this plan the profession can be set on a new path, a new beginning and a new direction. This plan should be known as the new chiropractic.”

And now you are. of course, dying to hear this 10 point plan – well, here it is [heavily abbreviated, I am afraid (the footnotes [ ] and the comments referring to them are mine)]:

  1. There is a need to improve pre professional education for chiropractors.
    Universities or private colleges?
    Chiropractic education should where possible be conducted at universities [1] and this does not mean small single purpose institutions that are deemed universities in name only. Why is this recommended? Primarily because unlike some private colleges, government funded universities insist on intellectual evidence based rigour [2] in their learning and teaching and importantly require staff to be research active. Chiropractic courses need to have an underpinning pedagogy that insists that content [3] is taught in the context of the evidence [4] and that students obtain the necessary training to question and critically appraise [5]…
    Accreditation problems
    Underpinning chiropractic education is program accreditation and this is also in need of review particularly where vitalistic subluxation [6] based courses have been legitimised by the accreditation process…
    Hospital training
    Chiropractic education should also involve specifically relevant hospital access or work experience such as hospital rounds so that students can observe patients that are truly unwell and observe the signs and symptoms taught in their theory classes. Hospital rounds would also allow chiropractic students to interact with other health providers and increase the likelihood of legitimate partnership and respect between health professions [7].
    Who should teach chiropractic students?…
  2. There is a need to establish a progressive identity.
    Chiropractors need to become solely musculoskeletal practitioners with a special emphasis on spinal pain [8]. If the profession becomes the world’s experts in this area it will command the respect deserved [9]. Importantly it will not be seen as a collective of alternative medicine practitioners with a strange belief system [10]…
  3. The profession should develop a generalised special interest.
    …Chiropractic as a profession should also develop a special interest area in the health sciences that can make a worldwide contribution to other related health sciences. This could be either research based or clinically based or indeed both. Some possibilities are: the further development and refinement of evidence based practice [11], improved posture through motor control, musculoskeletal care for the aged and elderly, improving bone density or the very important area of translating research into practice via implementation science. Whatever chosen we need to develop a special interest that sets us apart as experts in a distinctive area [12].
  4. Marginalisation of the nonsensical elements within the profession.
    As professionals chiropractors should not tolerate colleagues or leadership in the profession who demonstrate aberrant ideas. If colleagues transgress the boundaries or professionalism they should be reported to authorities and this should be followed up with action by those authorities [13]…
  5. The profession and individual practitioners should be pro public health.
    It is important to speak up openly in favour of evidence-based public health measures and to join public health associations and agencies [14]…  For example, chiropractors promoting anti-vaccination views need to be countered [15]…
  6. Support legitimate organised elements of the profession.
    Practitioners should support and become involved in chiropractic organisations that are clearly ethical and evidence based [16] and add value to them…
    …Regular collective professional advertising of the benefits of chiropractic for back pain, for example, is a worthy undertaking but the advertisements or media offerings must be evidence based [17].
  7. The profession should strive to improve clinical practice.
    Chiropractors contribute to the public health by the aggregated benefit of positive outcomes to health from their clinical practices [18]… Where restrictive practice laws relating to chiropractors prescribing medication exist the profession should seek to overturn them [19]…
  8. The profession should embrace evidence based practice.
    EBP is the amalgam of best scientific evidence plus clinical expertise plus patient values and circumstances. So what could be missing from this equation? It is clear that in the opinion of a sizable minority of the profession the elements that are missing are “practitioner ideology” and “practitioner values and circumstances”. These additional self- serving and dangerous notions should not be entertained. The adoption of evidence based practice is critical to the future of chiropractic and yet there is resistance by elements within the profession. Soft resistance occurs with attempts to change the name of “Evidence-based practice” (EBP) to “Evidence-informed practice” (EIP). It is worth noting that currently there are over 13,000 articles listed in PUBMED on EBP but less than 100 listed on EIP. So why are some of our profession so keen to use this alternate and weaker term?
    Hard resistance against EBP occurs where it is stated that the best evidence is that based on practice experience and not research. This apparently is known as Practice Based Evidence (PBE) and has a band of followers [20]…
  9. The profession must support research.Research needs to become the number one aspiration of the profession. Research informs both practice and teaching. Without research the profession will not progress. Sadly, the research contribution by the chiropractic profession can only be described as seed like. Figure 1 is a comparison of articles published in the past 45 years by decade using the key words “Physiotherapy” or “Physical Therapy” versus “Chiropractic” (source PUBMED). The Y axis is the number of articles published and the X axis is the decade, the red represents physiotherapy articles, the blue chiropractic. The difference is stark and needs urgent change [21].If the profession at large ignores research whether in its conduct, administration or its results the profession will wither on the vine [22]…
  10. Individual chiropractors need to show personal leadership to effect change.
    Change within the profession will likely only occur if individual chiropractors show personal leadership….
    As part of this personal leadership it will be critical to speak out within the profession. Speak out and become a mentor to less experienced colleagues [23]…
[1] I do wonder whether the ambition to be university-based is not more the hope for recognition than anything else.

[2] The lack of ‘intellectual evidence based rigor’ in chiropractic might prevent from being accepted by universities.

[3] What content?

[4] What evidence?

[5] If one critically assesses chiropractic, it very quickly falls apart.

[6] Subluxation does not need to be reviewed, it needs to be scrapped once and for all.

[7] Again I wonder whether this ambition is about anything else than gaining acceptance and recognition.

[8] In what way would they then differ from physiotherapists?

[9] Same point as in 1 and 7.

[10] The strangest belief system must be that of chiropractic!

[11] This is almost comical! Chiropractic is clearly much further away from evidence practice than chiropractors are aware. In my view, this statement reveals an embarrassing degree of delusion.

[12] To me, this sounds embarrassingly naïve.

[13] If such transgressions were reported in all instances, there would be only very few chiropractors left with a clean slate, I fear.

[14] The profession has a very poor track when it comes to public health measures; as back pain specialists they also would not be in a key position for such a task.

[15] I fear there are far too many anti-vaccination chiros for this to be a realistic prospect.

[16] There is plenty of evidence to show that chiropractic is often neither ethical nor evidence-based.

[17] Advertising is ethically problematic; responsible physicians are extremely cautious and restricted in this respect.

[18] What is this supposed to mean? It sounds politically correct but seems to be little more than a platitude.

[19] So, the future of chiropractic lies in prescribing medicines?

[20] These ‘followers’ are people who want to introduce double standards in healthcare – hardly anything worthy of consideration, I think.

[21] To understand this figure better, we need to know that physiotherapy is, compared to most other areas of healthcare, also not a very research-active field.

[22] But that’s precisely what chiropractors have been doing for the last 100 years!

[23] If you want to know how chiropractors receive a colleague who ‘speaks out’, you only need to read some of the comments Preston Long attracted with his guest post on this blog.

Anyone you thinks that with such a strategy “the chiropractic profession has an opportunity to turn things around within a generation” is, in my view, naïve and deluded. The 10 points are not realistic and woefully incomplete. The most embarrassing omission is a clear statement that chiropractors are fully dedicated to making sure that they serve the best interest of their patients by doing more good than harm.

If you are free on 17 – 19 November, why not pop over to Vienna and attend the European Congress for Homeopathy? The programme looks exciting (and full of humour); here are eight of my favourite lectures:

  1. R G Hahn ‘Homeopathy from a scientific and sceptic point of view’
  2. L Ellinger ‘Homeopathy as a replacement of antibiotics and in epidemics’
  3. T Farrington ‘Homeopathic treatment of farm animals’
  4. M M Montoya ‘Evidence based medicine in veterinary homeopathy’
  5. S Kruse ‘Homeopathy in neonatology’
  6. J Wurster ‘Homeopathic treatment and healing of cancer’
  7. P Knafl ‘The homeopathic treatment of cancer in cats and dogs’
  8. E Scherr ‘The homeopathic treatment of cancer in horses’

Other presenters at this meeting include two members of my ALT MED HALL OF FAME: Dr Fisher and Prof Frass. Their contributions alone would make the journey to Vienna a memorable event, I am sure.

And why are the presentations selected above amongst my favourites?

I am glad you asked! Here are some of my reasons:

  • Prof Hahn as been mentioned on this blog before. He published what some homeopaths consider a biting criticism of one of my papers. I find his arguments utterly bonkers and I tried to explain this here. In the comments section of this post, one commentator wrote: “Dr. Hahn has an interesting take on the relationship of reason and science. Perhaps the best illustration of his confused views is illustrated in a comment-dialog (in english) following a blog post by Michael Eriksson, a Swedish computer scientist living in Germany. There, the two exchange views on this matter: https://michaeleriksson.wordpress.com/2011/01/16/science-and-reason/
    The following quote from Dr. Hahn’s comments in this thread I find illustrative:

    The question is – should we believe in scientific data or should we believe is them only if you can accept them by reason? I claim that you should trust the data, in particular if “reason” is provided by a complete outsider. The risk is very great that reason provided by an outsider is completely wrong.

    Dr. Hahn reveals his denial of homeopathy’s implausibility and motivates this view by rejecting reason itself. He seems to be totally blind to the meaning of the term “reason” and presumably therefore blind to his own lack of it.
    As I said, quite a curious case. Perhaps a variant of the Nobel disease?

     

    END OF QUOTE

    These considerations render the title of Hahn’s lecture more than a little humorous, in my view.

  • Homeopathy as a preplacement of antibiotics could to be a special type of very dark humour. If anyone really did implement such a strategy, there would be millions of fatalities worldwide within just a few months.
  • Homeopathy for animals has also been debated on this blog before. The long and short of it is that there is no good evidence that it works.
  • What follows for ‘evidence-based veterinary homeopathy is simple: it is a contradiction in terms.
  • Homeopathy for children is not much different; in fact, it is worse: arguably, this is child abuse.
  • The last there of my selected lectures are all on cancer, a subject that we too on this blog are familiar with (see here, here, here, here and here, for instance). Where does the homeopathic obsession with cancer cone from? Have homeopaths somehow decided that, as they are so very useless at curing trivial conditions, they must now go for the life-threatening diseases?

In any case, this conference promises to be a hilarious event – full of comedy gold, hubris, and wishful thinking. I think it’s a ‘must event’ for sceptics – so hurry and book soon!

Would you like to see a much broader range of approaches such as nutrition, mindfulness, complementary therapies and connecting people to green spaces become part of mainstream healthcare?

No?

Well, let me tell you about this exciting new venture anyway!

It is being promoted by Dr Dixon’s ‘College of Medicine’ and claims to be “the only accredited Integrative Medicine diploma currently available in the UK… [It] will provide you with an accredited qualification as an integrative medicine practitioner. The Diploma is certified by Crossfields Institute and supported by the College of Medicine and is the only one currently available in the UK. IM is a holistic, evidence-based approach which makes intelligent use of all available therapeutic choices to achieve optimal health and resilience for our patients. The model embraces conventional approaches as well as other modalities centred on lifestyle and mind-body techniques like mindfulness and nutrition.”

Dr Dixon? Yes, this Dr Michael Dixon.

College of Medicine? Yes, this College of Medicine.

Integrative medicine? Yes, this cunning plan to adopt quackery into real medicine which I have repeatedly written about, for instance here, here and here.

Crossfields Institute? Yes this Crossfields Institute which promotes the Steiner/’Waldorf quackery and has Simon Fielding as the chair of trustees.

Simon Fielding? Yes, the Simon Fielding who “devoted much of his professional life to securing the recognition of osteopathy as an independent primary contact healthcare profession and this culminated in the passing of the Osteopaths Act in 1993. He was appointed by ministers as the first chair of the General Osteopathic Council responsible for bringing the Osteopaths Act into force… He is currently vice-chair of the board of trustees of The College of Medicine… In addition Simon has… served as a long term trustee on the boards of The Prince of Wales’s Foundation for Integrated Health… and was the founder chair of the Council for Anthroposophical Health and Social Care.”

You must admit, this IS exciting!
Now you want to know what modules are within the Diploma? Here they are:

  • The Modern Context of IM: Philosophy, History and Changing Times in Medicine
  • IM Approaches and Management of Conditions (part 1)
  • Holistic Assessment: The Therapeutic Relationship, Motivational Interviewing & Clinical Decision Making in    Integrative Medicine
  • Critical Appraisal of Medicine and IM Research
  • Holistic assessment: Social prescribing, a Community Approach in Integrative Medicine
  • Managing a Dynamic IM Practice and Developing Leadership Skills
  • IM Approaches and Management of Conditions (part 2)
  • Independent Study on Innovation in Integrative Medicine

Sounds terrific, and it reminds me a lot of another course Michael Dixon tried to set up 13 years ago in Exeter. As it concerned me intimately, I wrote about this extraordinary experience in my memoir; here is a short excerpt:

…in July 2003… I saw an announcement published in the newsletter of the Prince of Wales’ Foundation for Integrated Health:

“The Peninsula Medical School aims to become the UK’s first medical school to include integrated medicine at postgraduate level. The school also plans to extend the current range and depth of programmes offered by including healthcare ethics and legislation. Professor John Tooke, dean of the Peninsula Medical School, said: ‘The inclusion of integrated medicine is a patient driven development. Increasingly the public is turning to the medical profession for information about complementary medicines. This programme will play an important role in developing critical understanding of a wide range of therapies’.”

When I stumbled on this announcement I was taken aback. Is Tooke envisaging a course for me to run? Has he forgotten to tell me about it? When I inquired, Tooke informed me that the medical school planned to offer a postgraduate “Pathway in Integrated Health” which had been initiated by Dr Michael Dixon, a general practitioner who had at that stage become one of the UK’s most outspoken proponents of spiritual healing and other dubious forms of alternative medicine, and for this reason was apparently very well regarded by Prince Charles.

A few days after I received this amazing news, Dr Dixon arrived at my office and explained with visible embarrassment that Prince Charles had expressed his desire to establish such a course in Exeter. His Royal Highness had already facilitated its funding which, in fact, came from Nelson’s, the manufacturer of homoeopathic remedies. The day-to-day running of the course was to be put into the hands of the ex-director of the Centre for Complementary Health Studies (CCHS), the very unit I had struggled – and even paid – to be separated from almost a decade ago because of its overtly anti-scientific agenda. The whole thing had been in the planning for several months. I was, it seemed, the last to know – but now that I had learnt about it, Dixon and Tooke urged me to contribute to this course by giving a few lectures.

I could no more comply with this request than fly. Apart from anything else, I was opposed in principle to the concept of “integration.” As I saw it, “integrating” quackery with genuine, science-based medicine was nothing less than a profound betrayal of the ethical basis of medical practice. By putting its imprimatur on this course, and by offering it under the auspices of a mainstream medical school, my institution would be encouraging the dangerous idea of equivalence – i.e., the notion that alternative and mainstream medicine were merely two parallel but equally valid and effective methods of treating illness.

To add insult to injury, the course was to be sponsored by a major manufacturer of homoeopathic remedies. In all conscience, this seemed to me to be the last straw. Study after study carried out by my unit had found homoeopathy to be not only conceptually absurd but also therapeutically worthless. If we did not take a stand on this issue, we might just as well all give up and go home…

END OF QUOTE FROM MY MEMOIR

Dixon’s Exeter course was not a brilliant success; I think it folded soon after it was started. Well, better luck up the road in Bristol, Michael – I am sure there must be a market for quackery somewhere!

The Subject of the German ‘Heilpraktiker’ has recently been the topic of one of my blog-posts. In Germany, it has been a taboo for decades, but now the ‘Frankfurter Allgemeine Zeitung’ (FAZ) have courageously addressed the problem. In today’s article, the FAZ reports that, Josef Hecken, the chair of the an organisation called ‘Selbstverwaltung im Gesundheitswesen’ (self-administration in healthcare), demands that “health-insurers should be forbidden to pay for treatments that are not supported by evidence.” Hecken, is also the chair of the Gemeinsamen Bundesausschusses, an umbrella organisation of doctors, insurers and hospitals which determines which services are paid for and which not. He stated that even paying for homeopathy out of your own pocket when treating diseases like cancer must be forbidden and stressed that “this is not about well-being but human lives.”

Hecken’s views are partly supported by Rudolf Henke, the chair of both a German doctor’s union and of the Marburger Bund, a union of hospitals: “the regulations regarding the Heilpraktiker have to be re-considered entirely… I do not believe it to be acceptable that Heilpraktiker are able to treat cancer patients.”

These remarks relate to the deaths that recently occurred in a clinic led by a Heilpraktiker. About two thirds of all German health insurers seem to pay for consultations with a Heilpraktiker. Vis a vis the fact that most of their treatments are not evidence-based, this situation seems intolerable and deeply unethical.

Hecken’s stance seems clear, rational and, in view of the popularity of homeopathy in Germany, even courageous: “The government should charge the ‘Gemeinsamen Bundesausschuss’ or another organisation with the task of conducting a meta-analysis on the evidence of homeopathy and then draw the appropriate conclusions… We have reached a point where we need a public discussion, and I am prepared to take the flack.”

On the website of THE CENTRE FOR HOMEOPATHIC EDUCATION (CHE), an organisation which claims to operate ‘in partnership with’ the MIDDLESEX UNIVERSITY LONDON, we find the most amazing promotion of quackery. Under the title of ’10 Top Homeopathic Remedies for your First Aid Kit’ they state that “we wanted to give you some top tips to put together your own remedy kit to use in first-aid situations for yourself, friends and family.”

Yes, you did read correctly: apparently, the Middlesex University is supporting a homeopathic ‘first aid’ kit. You find this unbelievable? You are not alone!

The remedies they recommend would be ideal in the 30c potency for everyday use, they claim. Here are a few of the high-lighted remedies, together with their ‘indications’:

ACONITE This remedy is great for shock…

ARNICA  This is the classic remedy for trauma… The typical arnica patient will tell you that they’re fine and avoid attention, but may well still be in shock…

ARSENICUM This is your go-to remedy for food-poisoning…

BELLADONNA …This is a great remedy for fever, sunstroke, and for a skin condition such as boils.

HEPAR SULPH Very painful and infected wounds and abscesses respond well to this remedy.

RHUS TOX …used to treat skin rashes like chicken pox and shingles.

There are many more remedies to choose from, but hopefully this will give you a good little starter kit. Also it is possible to buy a comprehensive homeopathic first-aid kit from any of the reputable homeopathic suppliers. These kits will come with instructions on how to use the remedies too.

END OF 1st QUOTE

The CHE run all sorts of courses. It’s a shame that we all missed the recent lecture Evidence based homeopathy – with Dana Ullman. But if you are in London, you might want to attend on 7/9/2016 entitled Homeopathy, Detox and Cancer – with Dr Robin Murphy ND. It will cover subjects like these:

  • The Cancer Diseases –  the cancer disease is an umbrella term for a range of conditions which primarily affects the cells and immune system first.There are many causes of this condition such as emotional shocks, toxins, drugs, trauma, radiation and severe stress, etc. In some cases the cause is genetic or not known. Aging is another factor in the development and treatment of the cancer diseases.
  • Homeopathic remedies: Cancer remedies, cancer pains, chemotherapy and radiation side effects, socks, trauma, sleep, surgery, remedies for prevention and recovery.
  • Detox therapy: Detox principles and methods, heavy metals, chemo drugs, radiation, chemicals, etc. Detox diet, superfoods, herbal tonics and natural remedies.

END OF 2nd QUOTE

Yes, not just first aid but also cancer! This is sensational (or is the term scandalous better suited?) ! Cancer, they claim, can be caused by emotional shock (they do seem to like this term!) and there are homeopathic cancer remedies (the English cancer act prohibits claims, I think). This course must be a bargain at just £30! Perhaps some London sceptics should attend?

It would be ever so easy to make fun at this – but let’s try to keep a straight face because, in fact, this is not funny at all. It seems clear to me that it would be possible to kill quite a few emergency patients following the instructions of the homeopathic first aid kit, and one would most likely hasten the death of many cancer patients following Murphy’s cancer course.

Why is the Middlesex University a ‘partner’ in such monstrosities? Presumably they get some money for it, and officials would probably claim that their ‘partnership’ does not amount to an endorsement of such dangerous quackery (interestingly, when I searched their site for ‘homeopathy’, I got “no results found”). Yet they must be aware that they are lending credibility to indefensible charlatanry and thereby risking their own reputation.

If I were the Vice Chancellor of Middlesex, I would quickly sever all links to THE CENTRE FOR HOMEOPATHIC EDUCATION and publish an apology for having been involved in such mind-boggling quackery.

It has been reported that the ‘American Society of Complimentary and Alternative Medicine’ (A SCAM) has published a list of the top 10 achievements in medical history. The spelling of ‘complimentary’ and the acronym might be hints suggesting that none of the below is meant too seriously – but it could be good fun. Here is the top 10 list unabbreviated and unaltered:

Tumeric – The miracle spice that can cure everything from athletes foot to cancer.

Homeopathy – The discovery that water has memory and that you can charge people for sugar pills revolutionized alternative medicine.

Cupping – Around a lot longer than Michael Phelps, cupping took hickies to a whole new level.

Aromatherapy – Smelly things can help calm nerves and cure various diseases based on who you buy it from.

Detoxing – From getting rid of heavy metals from vaccines to cleansing the body of harmful chemtrails, detoxing was one of the most influential and revolutionary practices of the last 100 years.

Coffee Enemas – Autism “advocates” discovered that shoving coffee up your rectum can cure you of autism, vaccine-injuries and several other conditions.

Black Salve – Somewhat controversial to those who understand science, black salve has been shown to burn off cancerous tumors and various parts of the body.

The Paleo Diet – The greatest diet ever discovered. The Paleo Diet and by extension the Paleo Lifestyle has proven to improve health outcomes and the pocket books of diet gurus.

Chiropractic Manipulation – Not surprisingly, chiropractic manipulation is one of the best and most lucrative of all the SCAM practices. Recently, more and more chiropractors are discovering that parents are also willing to let you manipulate the spine of their newborn infants (make sure you get them to sign a waiver first).

Cannabis – Last but certainly not least in Cannabis. The miracle plant which is KNOWN to cure every disease known to man yet remains illegal in several countries due to the influence of Big Pharma. Remember: if someone you know uses cannabis to fight their cancer and they still die, it was because they didn’t use it early enough, possibly did some kind of conventional therapy first, or simply used the wrong kind of plant.

END OF QUOTE

I am sure that readers of this blog appreciate the list – especially as all of these treatment have previously been discussed on this very blog (just put the term in the search box, and you will find plenty od posts) –  but they might also feel the need to add more of their favourites to it. Therefore, I have a few suggestions of my own (in no particular order) which I think are well worth considering, if only for the fun of it (I put in the links to some previous posts where the therapy in question has been discussed in a less satirical manner):

Bach Flower Remedies – not as good as Mozart Balls, but almost.

Cranio-sacral therapy – the brain pulsates and the cash-register rings.

Gerson diet – the alternative way to enjoy coffee.

Urine therapy – making your very own medicine saves you going to the pharmacy and spending money.

Laetrile – apricots so good, they are worth a little plagiary.

Chelation therapy – taking out the calcium from your blood so that you can spend more on calcium supplements later.

Colloidal silver – only gold is better.

Gua sha – no pain without gain [for the TCM-practitioner].

Pranic-healing – or should this be ‘panic-healing’?

Weight-loss supplements – guaranteed to reduce the weight of your wallet.

Naturopathy – the art of turning the fallacy of ‘natural = good’ into a thriving business.

Integrative medicine – the art of mixing cow pie and apple pie and make it look attractive to gullible gourmets.

Anthroposophic medicine – East or West, Steiner knew best.

Biopuncture – the annoying obsession of puncturing holes into other people’s CVs.

Applied Kinesiology – best not to apply when you are ill.

Ear candles – candles in the shape of an ear are attractive presents not just for ENT surgeons.

Mistletoe – an inevitable complementary asset for Christmas.

Iridology – the study of Iridaceae, a family of plants in the order of Asparagales.

Holism – the bane of the proctologist.

In case my readers wanted to add to the list, I would be delighted – just put your suggestions into the comments section below.

Cranio-sacral therapy has been a subject on this blog before, for instance here, here and here. The authors of this single-blind, randomized trial explain in the introduction of their paper that “cranio-sacral therapy is an alternative and complementary therapy based on the theory that restricted movement at the cranial sutures of the skull negatively affect rhythmic impulses conveyed through the cerebral spinal fluid from the cranium to the sacrum. Restriction within the cranio-sacral system can affect its components: the brain, spinal cord, and protective membranes. The brain is said to produce involuntary, rhythmic movements within the skull. This movement involves dilation and contraction of the ventricles of the brain,  which produce the circulation of the cerebral spinal fluid. The theory states that this fluctuation mechanism causes reciprocal tension within the membranes, transmitting motion to the cranial bones and the sacrum. Cranio-sacral therapy and cranial osteopathic manual therapy originate from the observations made by William G. Sutherland, who said that the bones of the human skeleton have mobility. These techniques are based mainly on the study of anatomic and physiologic mechanisms in the skull and their relation to the body as a whole, which includes a system of diagnostic and therapeutic techniques aimed at treatment and prevention of diseases. These techniques are  based on the so-called primary respiratory movement, which is manifested in the mobility of the cranial bones, sacrum,  dura, central nervous system, and cerebrospinal fluid. The main difference between the two therapies is that cranial osteopathy, in addition to a phase that works in the direction of the lesion (called the functional phase), also uses a phase that worsens the injury, which is called structural phase.”

With this study, the researchers wanted to evaluate the effects of cranio-sacral therapy on disability, pain intensity, quality of life, and mobility in patients with low back pain. Sixty-four patients with chronic non-specific low back pain were assigned to an experimental group receiving 10 sessions of craniosacral therapy, or to the control group receiving 10 sessions of classic massage. Craniosacral therapy took 50 minutes and was conducted as follows: With pelvic diaphragm release, palms are placed in transverse position on the superior aspect of the pubic bone, under  the L5–S1 sacrum, and finger pads are placed on spinal processes.  With respiratory diaphragm release, palms are placed transverse under T12/L1 so that the spine lies along the start of fingers and the border of palm, and the anterior hand is placed on the breastbone. For thoracic inlet release, the thumb and index finger are placed on the opposite sides of the clavicle, with the posterior hand/palm of the hand cupping C7/T1. For the hyoid release, the thumb and index finger are placed on the hyoid, with the index finger on the occiput and the cupping finger pads on the cervical vertebrae. With the sacral technique for stabilizing L5/sacrum, the fingers contact the sulcus and the palm of the hand is in contact with the distal part of the sacral bone. The non-dominant hand of the therapist rested over the pelvis, with one hand on one iliac crest and the elbow/forearm of the other side over the other iliac crest. For CV-4 still point induction, thenar pads are placed under the occipital protuberance, avoiding mastoid sutures.  Classic massage protocol was compounded by the following sequence techniques of soft tissue massage on the  low back: effleurage, petrissage, friction, and kneading. The maneuvers are performed with surface pressure, followed by deep pressure and ending with surface pressure again. The techniques took 30 minutes.

Disability (Roland Morris Disability Questionnaire RMQ, and Oswestry Disability Index) was the primary endpoint. Other outcome measures included the pain intensity (10-point numeric pain rating scale), kinesiophobia (Tampa Scale of Kinesiophobia), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion, hemoglobin oxygen saturation, systolic blood pressure, diastolic blood pressure, hemodynamic measures (cardiac index), and biochemical analyses of interstitial fluid. All outcomes were measured at baseline, after treatment, and one-month follow-up.

No statistically significant differences were seen between groups for the main outcome of the study, the RMQ. However, patients receiving craniosacral therapy experienced greater improvement in pain intensity (p ≤ 0.008), hemoglobin oxygen saturation (p ≤ 0.028), and systolic blood pressure (p ≤ 0.029) at immediate- and medium-term and serum potassium (p = 0.023) level and magnesium (p = 0.012) at short-term than those receiving classic massage.

The authors concluded that 10 sessions of cranio-sacral therapy resulted in a statistically greater improvement in pain intensity, hemoglobin oxygen saturation, systolic blood pressure, serum potassium, and magnesium level than did 10 sessions of classic massage in patients with low back pain.

Given the results of this study, the conclusion is surprising. The primary outcome measure failed to show an inter-group difference; in other words, the results of this RCT were essentially negative. To use secondary endpoints – most of which are irrelevant for the study’s aim – in order to draw a positive conclusion seems odd, if not misleading. These positive findings are most likely due to the lack of patient-blinding or to the 200 min longer attention received by the verum patients. They are thus next to meaningless.

In my view, this publication is yet another example of an attempt to turn a negative into a positive result. This phenomenon seems embarrassingly frequent in alternative medicine. It goes without saying that it is not just misleading but also dishonest and unethical.

Dengue is a viral infection spread by mosquitoes; it is common in many parts of the world. The symptoms include fever, headache, muscle/joint pain and a red rash. The infection is usually mild and lasts about a week. In rare cases it can be more serious and even life threatening. There’s no specific treatment – except for homeopathy; at least this is what many homeopaths want us to believe.

And, of course, we don’t want to listen to just any odd homeopath, we want true experts to tell us the truth – for instance, experts like Dr. R.K. Manchanda, Deputy Director(Homoeopathy), Directorate of ISM & Homoeopathy, Govt. of NCT of Delhi and Dr. Surinder Verma, Assistant Director (Homoeopathy), Directorate of ISM & Homoeopathy, Govt. of NCT of Delhi. They authored an article which states the following:

There are about 25 homoeopathic drugs available for the treatment of dengue fever. These are Aconite., Arnica, Arsenic-alb., Arum-tri., Baptisia., Belladonna., Bryonia., Cantharis., China officinalis Colocynthis., Eupatorium perfoliatum., Ferrum metallicum., Gelsemium., Hamamelis., Ipecac., Lachesis, Merc-sol, Nux vomica., Podophyllum., Rhus toxicodendron., Rhus-venenata., Sanicula., Secale cornutum and Sul-acidum. These drugs had been successfully used by various homeopaths across the globe for its treatment and management. In 1996 during the epidemic of dengue in Delhi Eupatorium perfoliatum was found most effective.

Sadly, the article does not provide any evidence. A quick Medline search located one (!) single trial on the subject. Here is the abstract:

A double-blind, placebo-controlled randomized trial of a homeopathic combination medication for dengue fever was carried out in municipal health clinics in Honduras. Sixty patients who met the case definition of dengue (fever plus two ancillary symptoms) were randomized to receive the homeopathic medication or placebo for 1 week, along with standard conventional analgesic treatment for dengue. The results showed no difference in outcomes between the two groups, including the number of days of fever and pain as well as analgesic use and complication rates. Only three subjects had laboratory confirmed dengue. An interesting sinusoidal curve in reported pain scores was seen in the verum group that might suggest a homeopathic aggravation or a proving. The small sample size makes conclusions difficult, but the results of this study do not suggest that this combination homeopathic remedy is effective for the symptoms that are characteristic of dengue fever.

This is a 2007 study by a well-known US homeopath. Its results fail to confirm that homeopathy is effective for Dengue. So, surely the homeopathic community has since stopped claiming that homeopathy is an option for this infection!

No, you guessed correctly, they continue claiming that homeopathy works for Dengue. Currently, there are about half a million websites doing exactly that. An example is this article published YESTERDAY (!):

Alopathy is no more the only solution for Dengue these days. Especially in a place like Bengaluru where doctors and medicines are both expensive, residents have now turned to a cheaper and an effective alternative-Homeopathy to combat Dengue.People have been milling Homeopathy clinics and hospitals for an antidote. Dr Sudhir Babu of Javaji Advanced Homeopathy said, “People ask for some cure to keep the disease at bay. We do in fact have medicines to help build immunity against the ailment.”The dosage is for four or five days and is taken daily. Homeopathy has now become a trusted alternative in the field of medicine, especially because of its easy acceptibility among children and adults. According to a survey by IMRB, 100% people know about this form of medicine and 92% perceive it as a reputed form of treatment. The medicines that are administered depending on the symmptoms of Dengue Fever are Aconitum Napellus, Arsenicum Album, Belladonna, Bryonia Alba, Cantharis, Cinchona Officinalis, Eupatorium Perfoliatum, Gelsemium, Ipecacuanha, Nux Vomica, Rhus Toxicodendron and Rhus Venenata.

What I found particularly impressive here is the way popularity has been used to replace evidence. This, I think, begs several questions:

  • How long will homeopaths continue treating self-limiting conditions to claim success based no nothing but their natural history?
  • How long will they continue to lie to the public?
  • How long will they refuse to learn from the evidence?
  • How long will they ignore even the most fundamental rules of medical ethics?
  • How long will we let them get away with all this?

As predicted, thanks to its high visibility in Rio, to the journalists, editors, photographers, numerous ‘experts’ crawling out of the woodwork, and last but not least the gullible public, cupping has fast become fashionable, ‘cool’ and ‘en vogue’.

Yes! Literally ‘en vogue’!

It has conquered the pages of ‘VOGUE’ (and any quackery that achieves this feast must have a bright future!) where Dr. Alex Moroz, director of the Integrative Sports Medicine program at NYU Langone Medical Center’s Rusk Rehabilitation, offers some extraordinary ‘explanations’. Dr Moroz (yes, he does exist; I looked him up) claims that he uses cupping at home on himself and his family. He believes there’s wisdom in the ancient practice, as well as common sense. Cupping’s effect, he says, is “mechanical, much like a massage,” and though Moroz has not treated professional athletes personally, he says, “It makes sense that it would work for that group of muscular skeletal injuries and problems.”

Moroz believes, furthermore, that cupping’s benefits reach far beyond sports. “For people with muscle-based pain, tightness, spasms, or chronic pain of any sort, it’s a great modality to use. Like other short-term modalities, there’s a curve where you have a small number of people who have rather dramatic results, and then you have a group of people who will not be helped at all,” he says. “Everyone else will fall somewhere in between.”

Dr Moroz has opinions but seems to be remarkably short on the ‘common sense’ he praises and a bit under-developed in the area of evidence.

This is regrettable!

Where on earth can we find some reliable information?

Surely, with all the hype about cupping, there must be someone who is just a trifle more science-based. Of course there is. The ‘London Cupping Clinic’ seems serious enough; they even employ real GPs who explain the SCIENCE OF CUPPING’ as follows:

“[Cupping]… involves, as the name suggests, a series of glass or plastic cups being placed on the recipient’s skin. The cups are heated and come into effect upon cooling; the air trapped between the cup and skin contracts, creating a suction-like effect that pulls the skin upwards, drawing blood to the surface to increase blood flow and give the resulting marks their deep crimson-purple colour. At times, vacuum pumps can be used along with the cups to aid the process of suction.”

Drawing blood to the surface to increase blood flow? Really?

In my quest to find some factual information I stumble across the website of HOLISTIC LIVING TIPS. Yes, I know, ‘holistic living’ does not sound like factual information. Yet I read on and find that…

“…along with Irritable Bowel Syndrome, which is closely linked to a stressed digestive tract, cupping has been used for stomach pains, diarrhea, gastritis and other common digestive issues. Flowing the energy to help release tension in and around the digestive tract, while aiding the abdomen with added nutrients and oxygen can help stimulate a healthier digestive tract… The most common skin issues cupping has been used for is acne, skinflammation and even herpes. Your capillaries are expanded by cupping and the addition flow of blood helps tone your skin and clear unwanted toxins from the skin to help get rid of acne. Also, wet cupping, where a small cut is made before the cup is applied can reduce acne better because with the incision the therapy can extract more of the toxins from your body. Cupping has also been used for cellulite and varicose veins. An increased flow of blood throughout the skin will help tone and tighten the skin. Also, cupping stimulates and improves the flow of blood, helping reduce varicose veins…  Mainly, cupping increases the flow of blood and lymphatic fluid throughout the body. Both of these help your body protect itself from illnesses and toxins. Additionally, cupping can help extract and remove phlegm and congestion from your body. The purpose of cupping is to enhance circulation, help relieve pain, remove heat and pull out the toxins that linger in your body’s tissues. It is not something that everyone is aware of, but just like other Chinese Medicine practices, like acupuncture, it can be an effective and most importantly a natural way, to help treat several conditions and help improve your body’s overall health and function.”

Even considering that we are in the realm of alternative medicine, the claims and explanations currently made for cupping seem impressive. With such a solid base in holistic anatomy and New Age physiology, the future of cupping ought to be delightful.

I can see all sorts of profitable options for those who want to jump on the vacuum-driven bandwagon:

  • courses for aspiring cupping therapists [a safe career, as demand is bound to soar]
  • DIY books for amateur cuppers
  • car seats that give you a love bite while you are driving home from work [very practical for the less than faithful alt med fan]
  • vacuum suckers for the dental patient [cupping kills pain and reduces anxiety, they say]
  • similar devices for Indian restaurants who offer it for customers to control the well-known digestive problems after a good Vindaloo chicken [Charles’ Dutchy Originals might already be planning the launch]
  • cupping walk-in centres for every-day emergencies
  • cupping clinics for those who fear the effects of ageing [cupping ‘tightens the skin’, you know]
  • a face mask with integrated vacuum cups for teenagers suffering from acne
  • shoes that produce a sucking action on the sole of the feet as you walk [thus ingeniously combining cupping with reflexology]
  • a 24-hours cupping helpline for the less experienced DIY-cuppers…

There really are no limits (neither to profit nor to fantasy) – the future of cupping is bright!

A new Cochrane review evaluated the effectiveness and safety of Chinese herbal medicines (CHM) in the treatment of menopausal symptoms. Its authors conducted a thorough search for randomised controlled trials (RCTs) comparing the effectiveness of CHM with placebo, hormone therapy (HT), pharmaceutical drugs, acupuncture, or another CHM formula in women suffering from menopausal symptoms.

Two review authors independently assessed 864 studies for eligibility. Data extractions were performed by them with disagreements resolved through group discussion and clarification of data or direct contact with the study authors. Data analyses were performed in accordance with Cochrane Collaboration guidelines.

In total, 22 RCTs (2902 women) could be included. When CHM was compared with placebo (8 RCTs), there was little or no evidence of a difference between the groups for the following outcomes: hot flushes per day (MD 0.00, 95% CI -0.88 to 0.89; 2 trials, 199 women; moderate quality evidence); hot flushes per day assessed by an overall hot flush score in which a difference of one point equates to one mild hot flush per day (MD -0.81 points, 95% CI -2.08 to 0.45; 3 RCTs, 263 women; low quality evidence); and overall vasomotor symptoms per month measured by the Menopause-Specific Quality of Life questionnaire (MENQOL, scale 0 to 6) (MD -0.42 points; 95% CI -1.52 to 0.68; 3 RCTs, 256 women; low quality evidence). In addition, results from individual studies suggested there was no evidence of a difference between the groups for daily hot flushes assessed by severity (MD -0.70 points, 95% CI -1.00, -0.40; 1 RCT, 108 women; moderate quality evidence); or overall monthly hot flushes scores (MD -2.80 points, 95% CI -8.93 to 3.33; 1 RCT, 84 women; very low quality evidence); or overall daily night sweats scores (MD 0.07 points, 95% CI -0.19 to 0.33, 1 RCT, 64 women; low quality evidence); or overall monthly night sweats scores (MD 1.30 points, 95% CI -1.76 to 4.36, 1 RCT, 84 women; very low quality evidence). However, one study reported that overall monthly vasomotor symptom scores were lower in the CHM group (MD -4.79 points, 95% CI -5.52 to -4.06; 1 RCT, 69 women; low quality evidence).

When CHM was compared with HT (10 RCTs), only two RCTs reported monthly vasomotor symptoms using MENQOL. It was uncertain whether CHM reduces vasomotor symptoms (MD 0.47 points, 95% CI -0.50 to 1.44; 2 RCTs, 127 women; very low quality evidence).

Adverse effects were not fully reported in the included studies. Adverse events reported by women taking CHM included mild diarrhoea, breast tenderness, gastric discomfort and an unpleasant taste. Effects were inconclusive because of imprecise estimates of effects: CHM versus placebo (RR 1.51; 95% CI 0.69 to 3.33; 7 trials, 705 women; I² = 40%); CHM versus HT (RR 0.96; 95% CI 0.66 to 1.39; 2 RCTs, 864 women; I² = 0%); and CHM versus specific conventional medications (such as Fluoxetine and Estazolam) (RR 0.20; 95% CI 0.03 to 1.17; 2 RCTs, 139 women; I² = 61%).

The authors concluded: We found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Effects on safety were inconclusive. The quality of the evidence ranged from very low to moderate; there is a need for well-designed randomised controlled studies.

This review seems well done and reports clear findings. The fact that there was insufficient evidence for CHM is probably no surprise to most readers of this blog. However, I would like to draw your attention to a finding that could easily be missed: most of the primary studies failed to mention adverse effects; to be perfectly clear: they did not state “there were no adverse effects”, but they simply did not mention the subject of adverse effects at all.

In my view, this is a breach of research ethics. I have been banging on about this phenomenon for some time now, because I think it is important. Many if not most clinical trials in this area neglect reporting adverse effects. This means that we get an entirely misleading impression about the safety of the treatments in question. Reviewers of such studies are bound to conclude that they seem to be safe, while, in fact, researchers have only been withholding crucial information from us.

The solution to this fast-growing problem would be simple: trialists must be forced to fully report adverse effects. This is less complicated that it might seem: journal editors must insist that all authors fully report adverse effects of alternative treatments. Even if there were none at all – a very unlikely proposition if you think about it – they must disclose this fact.

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