MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

alternative medicine

You may remember my post entitled “How turn a negative trial into a positive one? Simple, just cheat!

No?

Let me remind you by copying the relevant parts of my original post of 20/2/2018:

…The purpose of their study was to examine the feasibility of Sipjeondaebo-tang (Juzen-taiho-to, Shi-Quan-Da-Bu-Tang) for cancer-related anorexia. A total of 32 participants with cancer anorexia were randomized to either Sipjeondaebo-tang group or placebo group. Participants were given 3 g of Sipjeondaebo-tang or placebo 3 times a day for 4 weeks. The primary outcome was a change in the Anorexia/Cachexia Subscale of Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The secondary outcomes included Visual Analogue Scale (VAS) of anorexia, FAACT scale, and laboratory tests.

The results showed that anorexia and quality of life measured by FAACT and VAS were improved after 4 weeks of Sipjeondaebo-tang treatment. However, there was no significant difference between changes of Sipjeondaebo-tang group and placebo group.

From this, the authors of the study concluded that sipjeondaebo-tang appears to have potential benefit for anorexia management in patients with cancer. Further large-scale studies are needed to ensure the efficacy.

Well, isn’t this just great? Faced with a squarely negative result, one simply ignores it and draws a positive conclusion!

As we all know – and as trialists certainly must know – controlled trials are designed to compare the outcomes of two groups. Changes within one of the groups can be caused by several factors unrelated to the therapy and are therefore largely irrelevant. This means that “no significant difference between changes of Sipjeondaebo-tang group and placebo group” indicates that the herbal mixture had no effect. In turn this means that a conclusion stating that “sipjeondaebo-tang appears to have potential benefit for anorexia” is just fraudulent.

This level of scientific misconduct is remarkable, even for the notoriously poor ..

END OF QUOTE

This article prompted me to do something I have only done once before: I filed an official complaint with the journal. I received a reply that they would look into it. Then there was silence; then came 2 or 3 emails that they are still considering my complaint. Yesterday, I finally received the following response:

Dear Dr. Ernst,

With reference to our correspondence below, thank you again for raising this matter, we appreciate your careful attention to the reporting of this article.  The authors have apologized for the error and said they did not check the abstract carefully enough when revising the article. The board decided that this may be addressed by publishing a corrigendum; please find the notice attached to this email.  Please let us know if you would like to be acknowledged in the notice for raising this issue, e.g. as follows: “This error in the reporting was brought to the attention of the journal by Prof. Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter.”

I look forward to hearing from you.

Kind regards…

And the attachment reads as follows:

Corrigendum to “Efficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial”
Dear Dr. Ernst,

With reference to our correspondence below, thank you again for raising this matter, we appreciate your careful attention to the reporting of this article. The authors have apologized for the error and said they did not check the abstract carefully enough when revising the article. The board decided that this may be addressed by publishing a corrigendum; please find the notice attached to this email. Please let us know if you would like to be acknowledged in the notice for raising this issue, e.g. as follows: “This error in the reporting was brought to the attention of the journal by Prof. Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter.”

I look forward to hearing from you.

Kind regards…
Chunhoo Cheon,1 Jeong-Eun Yoo,2 Hwa-Seung Yoo,2 Chong-Kwan Cho,2 Sohyeon Kang,1 Mia Kim,3 Bo-Hyoung Jang,1 Yong-Cheol Shin,1 and Seong-Gyu Ko1

1Department of Preventive Medicine, Korean Medical College, Kyung Hee University, Seoul, Republic of Korea 2Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea 3Department of Cardiovascular and Neurologic Disease (Stroke Center), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea

In the article titled “Efficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial” [1], there was an error in the conclusion of the Abstract where the text reading “Sipjeondaebo-tang appears to have potential benefit for anorexia management in patients with cancer. Further large-scale studies are needed to ensure the efficacy” should be corrected to “In the present study, Sipjeondaebo-tang did not show a significant effect on anorexia in patients with cancer. Further large-scale studies which compensate for the limitations of this study are needed to assess the efficacy”.

References

1. Chunhoo Cheon, Jeong-Eun Yoo, Hwa-Seung Yoo, et al., “Efficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial,” Evidence-Based Complementary and Alternative Medicine, vol. 2017, Article ID 8780325, 9 pages, 2017. doi:10.1155/2017/8780325


So, what should we make of all this?

On the one hand, it is laudable that the Journal does correct the mistake. Bravo!!!

On the other hand, I find it odd that only the authors seem to be found guilty of an ‘error’. Even if it was just a error – and I am happy to give them the benefit of the doubt – there are other parties involved. The reviewers have a responsibility and so does the editor! Should they not own up to it?

In the end, this sorry tale does not restore my confidence in this Journal, quite the opposite. In view of all this, I have to repeat what I stated in my previous post:

I strongly suggest that:

  1. The journal is de-listed from Medline because similarly misleading nonsense has been coming out of this rag for some time.
  2. The paper is withdrawn because it can only mislead vulnerable patients.

PS

Needless to say that my reply to the above-cited email was to uphold my complaint and urge the Journal to publish an adequate response that includes and explains the failures of the reviewers and the editor. So: watch this space!

In Germany, homeopathy had been an undisputed favourite for a very long time. Doctors prescribed it, Heilpraktiker recommended it, patients took it and consumers, politicians, journalists, etc. hardly ever questioned it. But recently, this has changed; thanks not least to the INH and the ‘Muensteraner Kreis‘, some Germans are finally objecting to paying for the homeopathic follies of others. Remarkably, this might even have led to a dent in the sizable profits of homeopathy producers: while in 2016 the industry sold about 55 million units of homeopathic preparations, the figure had decreased to ‘just’ ~53 million in 2017.

Enough reason, it seems, for some manufacturers to panic. The largest one is the DHU (Deutsche Homoeopathische Union), and they recently decided to go on the counter attack by investing into a large PR campaign. This article (in German, I’m afraid) explains:

…Unter dem Hashtag #MachAuchDuMit lädt die Initiative Anwenderinnen und Anwender ein, ihre guten Erfahrungen in Sachen Homöopathie zu teilen. “Über 30 Millionen zufriedene Menschen setzen für ihre Gesundheit auf Homöopathie und vertrauen ihr. Mit unserer Initiative wollen wir das Selbstbewusstsein der Menschen stärken, sich für die Homöopathie zu entscheiden oder mindestens für eine freie Wahl einzustehen,” so Peter Braun, Geschäftsführer der DHU…

“Die Therapiefreiheit, die in unserem Slogan mit “Meine Entscheidung!” zum Ausdruck kommt, ist uns das wichtigste in dieser Initiative”, unterstreicht Peter Braun. Und dafür lohnt es sich aktiv zu werden, wie der Schweizer weiß. 2017 haben sich die Menschen in der Schweiz per Volksabstimmung für das Konzept einer integrativen Medizin entschieden. Neben der Schulmedizin können dort auch weitere Therapieverfahren wie Homöopathie oder Naturmedizin zum Einsatz kommen.

In Deutschland will die DHU mit ihrer Initiative Transparenz schaffen und die Homöopathie hinsichtlich Fakten und Erfolge realistisch darstellen. Dafür besteht offensichtlich Bedarf: “Wir als DHU haben in der jüngsten Vergangenheit dutzende spontane Anfragen bekommen, für die Homöopathie Flagge zu zeigen”.

Was die Inhalte der Initiative angeht betont Peter Braun, dass es dabei nie um ein “Entweder-Oder” zwischen Schulmedizin und anderen Therapieverfahren gehen soll: “Die Kombination der jeweils am besten für den Patienten passenden Methode im Sinne von “Hand-in-Hand” ist das Ziel der modernen integrativen Medizin. In keiner Art und Weise ist eine Entscheidung für die Homöopathie eine Entscheidung gegen die Schulmedizin. Beides hat seine Berechtigung und ergänzt sich in vielen Fällen.”

——————————————————————————————————————

For those who do not read German, I will pick out a few central themes from the text.

Amongst other things, the DHU proclaim that:

  1. Homeopathy has millions of satisfied customers in Germany.
  2. The campaign aims at defending customers’ choice.
  3. The campaign declares to present the facts realistically.
  4. The decision is “never an ‘either or’ between conventional medicine (Schulmedizin) and other methods”; combining those therapies that suit the patient best is the aim of modern Integrative Medicine.

It is clear to anyone who is capable of critical thinking tha
t these 4 points are fallacious to the extreme. For those to whom it isn’t so clear, let me briefly explain:

  1. The ‘appeal to popularity’ is a classical fallacy.
  2. Nobody wants to curtail patients’ freedom to chose the therapy they want. The discussion is about who should pay for ineffective remedies. Even if homeopathy will, one day, be no longer reimbursable in Germany, consumers will still be able to buy it with their own money.
  3. The campaign has so far not presented the facts about homeopathy (i. e. the remedies contain nothing, homeopathy relies on implausible assumptions, the evidence fails to show that highly diluted homeopathic remedies are effective beyond placebo).
  4. Hahnemann called all homeopaths who combined his remedies with conventional treatments ‘traitors’ (‘Verraeter’) and coined the term ‘Schulmedizin’ to defame mainstream medicine.

The DHU campaign has only started recently, but already it seems to backfire big way. Social media are full with comments pointing out how pathetic it truly is, and many Germans have taken to making fun at it on social media. Personally, I cannot say I blame them – not least because the latest DHU campaign reminds me of the 2012 DHU-sponsored PR campaign. At the time, quackometer reported:

A consortium of pharmaceutical companies in Germany have been paying a journalist €43,000 to run a set of web sites that denigrates an academic who has published research into  their products.

These companies, who make homeopathic sugar pills, were exposed in the German newspaper Süddeutsche Zeitung in an article, Schmutzige Methoden der sanften Medizin (The Dirty Tricks of Alternative Medicine.)

This story has not appeared in the UK media. And it should. Because it is a scandal that directly involves the UK’s most prominent academic in Complementary and Alternative Medicine.

The newspaper accuses the companies of funding the journalist, Claus Fritzsche, to denigrate critics of homeopathy. In particular, the accusation is that Fritzsche wrote about UK academic Professor Edzard Ernst on several web sites and then linked them together in order to raise their Google ranking. Fritzsche continually attacks Ernst of being frivolous, incompetent and partisan…

This story ended tragically; Fritzsche committed suicide.

My impression is that the PR-campaigns of homeopaths in general and the DHU in particular are rather ill-fated. Perhaps they should just forget about PR and do what responsible manufacturers should aim at doing: inform the public according to the best evidence currently available, even if this might make a tiny dent in their huge profits.

Regular readers of this blog will find plenty of things that are familiar to them in my new book ‘SCAM’. Many of the thoughts in there were originally conceived on this blog; and quite a few ideas might even be inspired by your comments. In this way, SCAM can be seen as a big ‘thank you’ to all of my readers.

SCAM, of course, stands for ‘So-Called Alternative Medicine’ which might be the name best suited to my field of research. In the book, I explain why I chose this terminology:

Why do I call it SCAM? Why not just ‘alternative medicine’ or one of the many other possible names for it? … Mainly because, whatever it is, it is it is not an alternative:

  • if a therapy does not work, it cannot be an alternative to medicine;
  • if a therapy does work, it does not belong to alternative medicine but to medicine.

Therefore, I think, that so-called alternative medicine or SCAM is not a bad term to use.

I would be lying to you, if I said I did not want you all to buy my new book – which author does not want people to purchase his product? So, to entice you to do exactly that (and while you are at it, get one for your sister, cousin, grandma, etc. as well), here are two tiny snippets from ‘SCAM’, the preface and the postscript:

PREFACE

I should perhaps start with a warning: this book might unsettle you. If you are a true believer in so-called alternative medicine (SCAM), you may find the things I am about to tell you disturbing. My book was not written for true believers. In my experience, they often are emotionally or intellectually unable to rationalise and to change their minds. Any attempt at opening their eyes and making them think critically might therefore be a waste of time.

This book was written for everyone who has an interest in SCAM and is open to consider the evidence. Yet it is not a guide-book that tells you which SCAM can be employed what condition. It is a compilation of 50 essays about SCAM in more general terms. I ordered them loosely under seven headings and have tried to write them in such a way that they can be read independently. This necessitated a certain amount of repetition of crucial themes which, I hope, is forgivable. My main aim in publishing this book is to stimulate your ability to think critically about healthcare in general and, of course, about SCAM in particular.

The book is based on my 25 years of research in SCAM. It quotes numerous investigations by my team and by other researchers. It also discusses many recently published examples of pseudo-science, misleading information and unethical SCAM-promotion. The text avoids technical language and should be easily understood by anyone. The ‘glossary’ at the end of the book provides additional explanations of more complex issues and terminology. Throughout the book, I use hints of irony, touches of sarcasm, and sometimes even a degree of exaggeration. This makes certain points clearer and might even make you smile from time to time…

POSTSCRIPT

Some people say that I am fighting a losing battle and insist that SCAM cannot be defeated. It will be around for ever, they say.

I quite agree with the latter parts of this statement. Humans seem to need some degree of irrationality in their lives, and SCAM certainly offers plenty of that. Moreover, conventional medicine is never going be totally perfect. Therefore, disgruntled consumers will always search elsewhere, and many of them will then find SCAM.

However, I disagree with the first part of the above assumption: I did not write this book with the aim of fighting a battle against SCAM. I can even see several positive sides of SCAM. For instance, the current SCAM-boom might finally force conventional healthcare professionals to remember that time, compassion and empathy are some of their core values which cannot be delegated to others. Whatever the current popularity signifies, it is a poignant criticism of what is going on in conventional healthcare – and we would be ill-advised to ignore this criticism.

In the preface, I stated that my main aim in publishing this book was to stimulate my readers’ ability to think critically about SCAM and healthcare generally. My book is therefore not a text against but as a plea for something. If reading it has, in fact, made some of my readers a little less gullible, it … could improve both their health and their bank balance.

The above advertisement, apparently from the German woman’s magazine ‘Brigitte’, came to me via Twitter. Naturally, I thought someone had made a joke. Just to be sure, I quickly conducted a simple search for ‘astro-homeopathy’ and found numerous articles which collectively made my theory most unlikely.

Yes, there are people out there who advocate astro-homeopathy. This website, for instance informs us that:

Astro homeopathy is based on a very unique idea of relating homeopathy with astrology. Many people follow the astrohomeopathy principles and lead a healthy life. You can also try astro homeopathy healing methods so that you can lead a life free from health hazards and fitness problems.

Astrology and homeopathy are bridged in astro homeopathy. An astrohomeopathy reading for you finds out your sun sign and the body parts related to your sign of the zodiac, and tells you the health problems you have the possibility to suffer from (if, of course, there is any). In addition, you also come to know the homeopathic remedies for the health problems.

Being aware of the possible health problems is an advantage. If you want to know your astrohomeopathy profile, you can get an astrology homeopathy test. You can plan your diet, habits and lifestyle according to your astro homeopathy report. You can also use the astro homeopathy remedies, if anything is suggested in your astrology homeopathy test…

Another website is even more revealing:

… In Astrohomoeopathy, which is a beautiful blend of Astrology and Homoeopathy, the horoscope serves as an invaluable diagnostic tool to provide a unique insight into the patient’s mental, emotional and physical makeup, which is indicated by the placement of planets in various signs and houses at the time of birth.

Each planet and its sign have certain characteristics, which may be weak or strong, depending on their placement in the horoscope. By matching these characteristics of the planets and their signs with the symptoms of Homoeopathic remedies, it is possible to connect them in order to select the right medicine.

By knowing the characteristic of houses and planets in ones horoscope, one can determine the key features and disposition of patient, the most important characteristics/features in the chart and the remedies to be covered.

After a complete case study, the physician comes to a group of remedies with the Horoscope which helps to distinguish these medicines by considering the key points.

From a Horoscope one can also understand how strong is the constitution by knowing the condition of his Ascendant and its Lord which will explained further with examples.The main keys to health are the state of Ascendant, its Lord and strength of malefic in the chart. I wouldn’t go in detail with regard to Astrology basics as one can learn the basic principals from a range of Astrology books available.

My outlook would be as to how to correlate Homoeopathy and Astrology and use it as a important diagnostic tool to differentiate various remedies when indicated in a patient so to come close to constitutional similitude to cure the patient in shortest possible time…

A third article concluded: Homeopathy, astrology and psychology are two of the most fascinating humanistic disciplines. They can be an invaluable combination. For finding the simillimum, astrology is not needed every time, yet it remains in our toolbox for when needed and as a constant support.

It seems that Einstein (as reported by my late friend Gustav Born) was wrong when he stated that: “If one were to lock up 10 very clever people in a room and told them they were only allowed out once they had come up with the most stupid idea conceivable, they would soon come up with homeopathy.”

The 10 very clever people would have had to come up with astro-homeopathy!

As you know, my ambition is to cover all (or at least most) alternative methods on this blog _ by no means an easy task because there is a sheer endless list of treatments and a sizable one of diagnostic techniques. One intervention that we have not yet discussed is ZERO BALANCING.

What is it?

This website explains it fairly well:

Developed by Fritz Smith, MD in the early 1970s, Zero Balancing is a powerful body-mind therapy that uses skilled touch to address the relationship between energy and structures of the body. Following a protocol that typically lasts 30 to 45 minutes,  the practitioner uses finger pressure and gentle traction on areas of tension in the bones, joints and soft tissue to create fulcrums, or points of balance, around which the body can relax and reorganize. Zero Balancing focuses primarily on key joints of our skeleton that conduct and balance forces of gravity, posture and movement. By addressing the deepest and densest tissues of the body along with soft tissue and energy fields, Zero Balancing helps to clear blocks in the body’s energy flow, amplify vitality and contribute to better postural alignment. A Zero Balancing session leaves you with a wonderful feeling of inner harmony and organization.

Did I just say ‘fairly well’? I retract this statement. Zero Balancing turns out to be one of the more nebulous alternative treatments.

The therapy might be defined by lots of nonsensical terminology, but that does not necessarily mean it is rubbish. Judging from the claims made for Zero Balancing, it might even be a most useful therapy. Here are just some of the claims frequently made for zero balancing:

  • Increases feelings of health and well-being
  • Releases stress and improves the flow of energy in our bodies
  • Reduces pain and discomfort
  • Enhances stability, balance and freedom
  • Amplifies the sense of connection, peace and happiness
  • Releases mental, emotional and physical tension
  • Supports us through transitions and transformations
  • Improves quality of life and increases capacity for enjoyment

These claims are testable, and we must, of course, ask by what evidence they are being supported. I did a quick Medline-search to find out.

And the result?

Zero!

… now the rather odd name of the treatment begins to make sense: ZERO BALANCING, ZERO EVIDENCE.

On this blog, we have seen more than enough evidence of how some proponents of alternative medicine can react when they feel cornered by critics. They often direct vitriol in their direction. Ad hominem attacks are far from being rarities. A more forceful option is to sue them for libel. In my own case, Prince Charles went one decisive step further and made sure that my entire department was closed down. In China, they have recently and dramatically gone even further.

This article in Nature tells the full story:

A Chinese doctor who was arrested after he criticized a best-selling traditional Chinese remedy has been released, after more than three months in detention. Tan Qindong had been held at the Liangcheng county detention centre since January, when police said a post Tan had made on social media damaged the reputation of the traditional medicine and the company that makes it.

On 17 April, a provincial court found the police evidence for the case insufficient. Tan, a former anaesthesiologist who has founded several biomedical companies, was released on bail on that day. Tan, who lives in Guangzhou in southern China, is now awaiting trial. Lawyers familiar with Chinese criminal law told Nature that police have a year to collect more evidence or the case will be dismissed. They say the trial is unlikely to go ahead…

The episode highlights the sensitivities over traditional Chinese medicines (TCMs) in China. Although most of these therapies have not been tested for efficacy in randomized clinical trials — and serious side effects have been reported in some1TCM has support from the highest levels of government. Criticism of remedies is often blocked on the Internet in China. Some lawyers and physicians worry that Tan’s arrest will make people even more hesitant to criticize traditional therapies…

Tan’s post about a medicine called Hongmao liquor was published on the Chinese social-media app Meipian on 19 December…Three days later, the liquor’s maker, Hongmao Pharmaceuticals in Liangcheng county of Inner Mongolia autonomous region, told local police that Tan had defamed the company. Liangcheng police hired an accountant who estimated that the damage to the company’s reputation was 1.4 million Chinese yuan (US$220,000), according to official state media, the Beijing Youth Daily. In January, Liangcheng police travelled to Guangzhou to arrest Tan and escort him back to Liangcheng, according to a police statement.

Sales of Hongmao liquor reached 1.63 billion yuan in 2016, making it the second best-selling TCM in China that year. It was approved to be sold by licensed TCM shops and physicians in 1992 and approved for sale over the counter in 2003. Hongmao Pharmaceuticals says that the liquor can treat dozens of different disorders, including problems with the spleen, stomach and kidney, as well as backaches…

Hongmao Pharmaceuticals did not respond to Nature’s request for an interview. However, Wang Shengwang, general manager of the production center of Hongmao Liquor, and Han Jun, assistant to the general manager, gave an interview to The Paper on 16 April. The pair said the company did not need not publicize clinical trial data because Hongmao liquor is a “protected TCM composition”. Wang denied allegations in Chinese media that the company pressured the police to pursue Tan or that it dispatched staff to accompany the police…

Xia is worried that the case could further silence public criticism of TCMs, environmental degredation, and other fields where comment from experts is crucial. The Tan arrest “could cause fear among scientists” and dissuade them from posting scientific comments, he says.

END OF QUOTE

On this blog, we have repeatedly discussed concerns over the validity of TCM data/material that comes out of China (see for instance here, here and here). This chilling case, I am afraid, is not prone to increase our confidence.

Amongst all the implausible treatments to be found under the umbrella of ‘alternative medicine’, Reiki might be one of the worst, i. e. least plausible and outright bizarre (see for instance here, here and here). But this has never stopped enthusiasts from playing scientists and conducting some more pseudo-science.

This new study examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical centre. It was designed as a retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. Hospitalized patients requesting or referred to the healing arts team received either a massage or reiki session and completed pre- and post-therapy symptom questionnaires. Differences between pre- and post-sessions in pain, nausea, fatigue, anxiety, depression, and overall well-being were recorded using an 11-point Likert scale.

Patients reported symptom relief with both reiki and massage therapy. Reiki improved fatigue and anxiety  more than massage. Pain, nausea, depression, and well being changes were not different between reiki and massage encounters. Immediate symptom relief was similar for cancer and non-cancer patients for both reiki and massage therapy and did not vary based on age, gender, length of session, and baseline symptoms.

The authors concluded that reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to validate the data.

Don’t I just adore this little addendum to the conclusions, “controlled trials should be considered to validate the data” ?

The thing is, there is nothing to validate here!

The outcomes are not due to the specific effects of Reiki or massage; they are almost certainly caused by:

  • the extra attention,
  • the expectation of patients,
  • the verbal or non-verbal suggestions of the therapists,
  • the regression towards the mean,
  • the natural history of the condition,
  • the concomitant therapies administered in parallel,
  • the placebo effect,
  • social desirability.

Such pseudo-research only can only serve one purpose: to mislead (some of) us into thinking that treatments such as Reiki might work.

What journal would be so utterly devoid of critical analysis to publish such unethical nonsense?

Ahh … it’s our old friend the Journal of Alternative and Complementary Medicine

Say no more!

Most diabetics need life-long medication. Understandably, this makes many fed-up, and some think that perhaps natural remedies might be a less harmful, less intrusive way to control their condition. They don’t have to look far to find an impressively large choice.

This article in the Canadian Journal of Diabetes was aimed at reviewing CAM, including natural health products (NHP) and others, such as yoga, acupuncture, tai chi and reflexology, that have been studied for the prevention and treatment of diabetes and its complications. It claims that, in adults with type 2 diabetes, the following NHP have been shown to lower glycated hemoglobin (A1C) by at least 0.5% in randomized controlled trials lasting at least 3 months:

Ayurveda polyherbal formulation

Citrullus colocynthis

Coccinia cordifolia

Eicosapentaenoic acid

Ganoderma lucidum

Ginger (Zingiber officinale)

Gynostemma pentaphyllum

Hintonia latiflora

Lichen genus Cladonia BAFS “Yagel-Detox”

Marine collagen peptides

Nettle (Urtica dioica)

Oral aloe vera

Pterocarpus marsupium (vijayasar)

Salacia reticulate

Scoparia dulcis porridge

Silymarin

Soybean-derived pinitol extract

Touchi soybean extract

Traditional Chinese medicine herbs:

Berberine

Fructus Mume

Gegen Qinlian Decoction (GQD)

Jianyutangkang (JYTK) with metformin

Jinlida with metformin

Sancaijiangtang

Shen-Qi-Formula (SQF) with insulin

Tang-Min-Ling-Wan (TM81)

Xiaoke (contains glyburide)

Zishentongluo (ZSTL)

Trigonella foenum-graecum (fenugreek)

Even though the authors caution that these remedies should not be recommended for routine use, I fear that such lists do motivate diabetics to give them a try. If they do, the outcome could be that:

  • Nothing at all happens other than the patient wasting some money on useless remedies. The clinical trials on which the above list is based are usually so flimsy that their findings are next to meaningless and quite possibly false-positive.
  • The patient might, if the remedy does affect blood sugar levels, develop hypoglycaemia. If severe, this could be life-threatening.
  • The patient might trust in a natural remedy and thus discontinue the prescribed anti-diabetic medication. In this case, she could develop hyperglycaemia. If severe, this could be life-threatening.

It seems obvious that none of the possible outcomes are in the patients’ interest. I fear that it is dangerous to tempt diabetics with the possibility that a natural remedy. Even if such treatments did work, they are not well-researched, unreliable and do not have sufficiently large effects (a 0.5% decrease of glycated haemoglobin is hardly impressive) to represent realistic options.

I hear this argument so regularly that it might be worth analysing it (yet again) a bit closer.

It is used with the deepest of convictions by proponents of all sorts of quackery who point out that science does not know or explain everything – and certainly not their (very special) therapy. Science is just not sophisticated enough, they say; in fact, a few years ago, it could not even explain how Aspirin works. And just like Aspirin, their very special therapy – let’s call it energy healing (EH) for the sake of this post – does definitely and evidently work. There even is ample proof:

  • Patients get better after using EH, and surely patients don’t lie.
  • Patients pay for EH, and who would pay for something that does not work?
  • EH has survived hundreds of years, and ineffective therapies don’t.
  • EH practitioners have tons of experience and therefore know best.
  • They are respected by very important people and organisations.
  • EH is even reimbursed by some insurance companies.

You have all heard the argument, I’m sure.

How to respond?

The ‘proofs’ listed above are simply fallacies; as such they do not need more detailed discussions, I hope.

But how can we refute the notion that science is not yet sufficiently advanced to explain EH?

The simplest approach might be to explain that science has already tested EH and found it to be ineffective. There really is nothing more to say. And the often-quoted example of Aspirin does clearly not wash. True, a few decades ago, we did not know how it worked. But we always knew that it worked because we conducted clinical trials, and they generated positive results. These findings we the main reasons why scientists wanted to find out how it works, and eventually they did (and even got a Nobel Prize for it). Had the clinical trials not shown effectiveness, nobody would have been interested in alleged mechanisms of action.

With EH, things are different. Rigorous clinical trials of EH have been conducted, and the totality of this evidence fails to show that EH works. Therefore, chasing after a mechanism of action would be silly and wasteful. It’s true, science cannot explain EH, but this is not because it is not yet sophisticated enough; it is because there is nothing to explain. EH has been disproven, and waffling about ‘science is not yet able to explain it’ is either a deliberate lie or a serious delusion.

So far so good. But what if EH had not been submitted to clinical trials?

In such cases, the above line of argument would not work very well.

For instance, as far as I know, there is not a single rigorous clinical trial of crystal healing (CH). Does that mean that perhaps CH-proponents are correct when claiming that it does evidently work and science simply cannot yet understand how?

No, I don’t think so.

Like most of the untested alternative therapies, CH is not based on plausible assumptions. In fact, the implausibility of the underlying assumptions is the reason why such treatments have not and probably never will be submitted to rigorous clinical trials. Why should anyone waste his time and our money running expensive tests on something that is so extremely unlikely? Arguably doing so would even be unethical.

With highly implausible therapies we need no trials, and we do not need to fear that science is not yet sufficiently advance to explain them. In fact, science is sufficiently advanced to be certain that there can be no explanation that is in line with the known laws of nature.

Sadly, some truly deluded fans of CH might still not be satisfied and respond to our reasoning that we need a ‘paradigm shift’. They might say that science cannot explain CH because it is stuck in the straightjacket of an obsolete paradigm which does not cater for phenomena like CH.

Yet this last and desperate attempt of the fanatics is not a logical refuge. Paradigm shifts are not required because some quack thinks so, they are needed only if data have been emerging that cannot possibly be explained within the current paradigm. But this is never the case in alternative medicine. We can explain all the experience of advocates, positive results of researchers and ‘miracle’ cures of patients that are being reported. We know that the experiences are real, but are sure that their explanations of the experience are false. They are not due to the treatment per se but to other phenomena such as placebo effects, natural history, regression towards the mean, spontaneous recovery, etc.

So, whichever way we turn things, and whichever way enthusiasts of alternative therapies twist them, their argument that ‘SCIENCE IS NOT YET ABLE TO EXPLAIN’ is simply wrong.

Generally speaking, Cochrane reviews provide the best (most rigorous, transparent and independent) evidence on the effectiveness of medical or surgical interventions. It is therefore important to ask what they tell us about homeopathy. In 2010, I did exactly that and published it as an overview of the current best evidence. At the time, there were 6 relevant Cochrane reviews. They covered the following conditions: cancer, attention-deficit hyperactivity disorder, asthma, dementia, influenza and induction of labour. And their results were clear: they did not show that homeopathic medicines have effects beyond placebo.

Now a further Cochrane review has been published.

Does it change this situation?

This systematic review assessed the effectiveness and safety of oral homeopathic medicinal products compared with placebo or conventional therapy to prevent and treat acute respiratory tract infections (ARTIs) in children. The researchers conducted extensive literature searches, checked references, and contacted study authors to identify additional studies. They included all double-blind, randomised controlled trials (RCTs) or double-blind cluster-RCTs comparing oral homeopathy medicinal products with identical placebo or self selected conventional treatments to prevent or treat ARTIs in children aged 0 to 16 years.

Eight RCTs of 1562 children receiving oral homeopathic medicinal products or a control treatment (placebo or conventional treatment) for upper respiratory tract infections (URTIs). Four treatment studies examined the effect on recovery from URTIs, and four studies investigated the effect on preventing URTIs after one to three months of treatment and followed up for the remainder of the year. Two treatment and two prevention studies involved homeopaths individualising treatment for children. The other studies used predetermined, non-individualised treatments. All studies involved highly diluted homeopathic medicinal products.

Several key limitations to the included studies were identified, in particular methodological inconsistencies and high attrition rates, failure to conduct intention-to-treat analysis, selective reporting, and apparent protocol deviations. The authors deemed three studies to be at high risk of bias in at least one domain, and many had additional domains with unclear risk of bias. Three studies received funding from homeopathy manufacturers; one reported support from a non-government organisation; two received government support; one was co-sponsored by a university; and one did not report funding support.

Methodological inconsistencies and significant clinical and statistical heterogeneity precluded robust quantitative meta-analysis. Only four outcomes were common to more than one study and could be combined for analysis. Odds ratios (OR) were generally small with wide confidence intervals (CI), and the contributing studies found conflicting effects, so there was little certainty that the efficacy of the intervention could be ascertained.

All studies assessed as at low risk of bias showed no benefit from oral homeopathic medicinal products; trials at uncertain and high risk of bias reported beneficial effects. The authors found low-quality evidence that non-individualised homeopathic medicinal products confer little preventive effect on ARTIs (OR 1.14, 95% CI 0.83 to 1.57). They also found low-quality evidence from two individualised prevention studies that homeopathy has little impact on the need for antibiotic usage (N = 369) (OR 0.79, 95% CI 0.35 to 1.76).

The authors also assessed adverse events, hospitalisation rates and length of stay, days off school (or work for parents), and quality of life, but were not able to pool data from any of these secondary outcomes. There is insufficient evidence from two pooled individualised treatment studies (N = 155) to determine the effect of homeopathy on short-term cure (OR 1.31, 95% CI 0.09 to 19.54; very low-quality evidence) and long-term cure rates (OR 1.01, 95% CI 0.10 to 9.96; very low-quality evidence). Adverse events were reported inconsistently; however, serious events were not reported. One study found an increase in the occurrence of non-severe adverse events in the treatment group.

The authors concluded that pooling of two prevention and two treatment studies did not show any benefit of homeopathic medicinal products compared to placebo on recurrence of ARTI or cure rates in children. We found no evidence to support the efficacy of homeopathic medicinal products for ARTIs in children. Adverse events were poorly reported, so conclusions about safety could not be drawn.

In their paper, the authors state that “there are no established explanatory models for how highly diluted homeopathic medicinal products might work. For this reason, homeopathy remains highly controversial because the key concepts governing this form of medicine are not consistent with the established laws of conventional therapeutics.” In other words, there is no reason why highly diluted homeopathic remedies should work. Yet, remarkably, when asked what conditions responds best to homeopathy, most homeopaths would probably include ARTI of children.

The authors also point out that “The results of this review are consistent with all previous systematic reviews on homeopathy. Funders and study investigators contemplating any further research in this area need to consider whether further research will advance our knowledge, given the uncertain mechanism of action and debate about how the lack of a measurable dose can make them effective. The studies we identified did not use a uniform approach to choosing and measuring outcomes or assigning appropriate time points for outcome measurement. The use of validated symptom scales would facilitate future meta-analyses. It is unclear if there is any benefit from individualised (classical) homeopathy over the use of commercially available products.”

Even though I agree with the authors on most of their views and comment their excellent work, I would be more outspoken regarding the need of further research. In my view, it would be a foolish, wasteful and therefore unethical activity to fund, plan or conduct further research in this area.

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