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Anyone who has looked into the discussions around homeopathy for more than 10 minutes will have come across Dana Ullman (DU). Some 15 years ago, I had the pleasure to meet him in person during a conference in Boston. After the brief chat, I asked a UK homeopath who this bizarre person was. “Oh Dana!” he replied “Dana is alright.”

But is he? Let’s have a look at the evidence.

There are very few papers by DU listed in Medline, and most of these articles are simply opinion pieces. The opinions DU expresses there (or anywhere else) are usually not supported by good evidence; some of them are even outright dangerous. Here are a few quotes:

“…homeopathic care is cost effective…”

“…homeopathic medicines are effective…”

“…homeopathic medicine may play a useful role as an adjunctive and/or alternative therapy [for HIV infections]”

“[There are]…significant effects of homeopathic treatment in allergic patients.”

Occasionally, DU writes little essays full of utter nonsense, logical fallacies and falsehoods for HUFFPOST where he is nevertheless characterised in glowing terms: Dana Ullman, M.P.H. (Masters in Public Health, U.C. Berkeley), CCH (Certification in Classical Homeopathy) is “” and is widely recognized as the foremost spokesperson for homeopathic medicine in the U.S.

Wikipedia, however, is more critical and cites the opinion of a judge who was presiding over a class action against a US homeopathic producer in which DU had been called as an expert witness: The Defendant presented the testimony of Gregory Dana Ullman who is a homeopathic practitioner. He outlined the theory of homeopathic treatment and presented his opinion as to the value and effectiveness of homeopathic remedies. The Court found Mr. Ullman’s testimony to be not credible. Mr. Ullman’s bias in favor of homeopathy and against conventional medicine was readily apparent from his testimony. He admitted that he was not an impartial expert but rather is a passionate advocate of homeopathy. He posted on Twitter that he views conventional medicine as witchcraft. He opined that conventional medical science cannot be trusted…Mr. Ullman’s testimony was unhelpful in understanding the purported efficacy of the ingredients of SnoreStop to reduce the symptoms of snoring. Although he is familiar with the theory of homeopathic treatment, his opinions regarding its effectiveness was unsupported and biased. The Court gave no weight to his testimony.

The Encyclopedia of Americam Loons is even more poignant and describes DU as: A master of cognitive dissonance and memory bias, Ullman seems clinically unable to grasp the possibility that he may be wrong. Combined with a lack of understanding of science or medicine – and the possession of certain marketing skills – what we end up with is rather insidious.

Anyone who has debated with DU will have to concur with the claim that he fails to understand science or medicine. If you don’t believe me, please read his recent comments on the post about Prof Frass on this blog where he excels in producing one fallacy after the next (if he were on a mission to give homeopathy a bad name, he would be doing a sterling job!).

Despite all this abysmal ignorance, DU has one undisputed and outstanding talent: the knack of getting on people’s nerves and thus driving rational thinkers to distraction. In this way he even managed to be headlined as an ‘idiot‘!

I find it tempting to agree with the many experts who have called him an idiot, a moron or a laughing stock but, for now, I will resist that temptation. On the contrary, I want point out that he is much more cunning and clever than we give him credit for: after all, he runs a thriving business and lives off the nonsense he produces. To my mind, this is not idiotic; devious and unethical surely, but not idiotic nor laughable!

Not long ago, Peter Fisher fired me from the editorial board of ‘his’ journal ‘HOMEOPATHY’. I thought that this was a surprisingly daft move, particularly as we used to have respect for each other and even published together as co-authors (for instance here). But perhaps I should not have been surprised because, already in 2007, he published an important, potentially libellous falsehood about me.

In this article which he published as Dr. Peter Fisher, Homeopath to Her Majesty, the Queen, he wrote: There is a serious threat to the future of the Royal London Homoeopathic Hospital (RLHH), and we need your help…Lurking behind all this is an orchestrated campaign, including the ’13 doctors letter’, the front page lead in The Times of 23 May 2006, Ernst’s leak of the Smallwood report (also front page lead in The Times, August 2005), and the deeply flawed, but much publicised Lancet meta-analysis of Shang et al…

If you have read my memoir, you will know that even the hostile 13-months investigation by my own university did not find me guilty of the ‘leak’. The Times journalist who interviewed me about the Smallwood report already had the document on his desk when we spoke, and I did not disclose any contents of the report to him. But the truth in homeopathy seems often highly diluted.

More recently, Peter Fisher could be heard on UK radio and TV (for instance here) making further claims which, in my view, are false. Specifically, I am thinking of two of his statements which would mislead the public, if they stood uncorrected:

  1. He said that the studies unanimously show that integrating homeopathy into conventional medicine improves outcomes and saves money.
  2. He also claimed that most of the homeopathic remedies available in the high street still contain small amounts of active ingredients.


It seems obvious that adding homeopathy with its lengthy, compassionate encounters to conventional care can easily generate positive outcomes. But costs? I don’t see unanimously positive evidence here at all.

Dr Fisher must know the literature on homeopathy very well. Therefore I assume that he is aware of the most up-to-date systematic review of economic evaluations of this subject. Its authors from the ‘School of Health and Related Research’, University of Sheffield concluded that “it is… not possible to draw firm conclusions based on existing economic evaluations of homeopathy“.

Fisher knows and likes to quote Claudia Witt’s work on homeopathy. Why does he not cite this recent paper then?


The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group).


Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache).


Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29]) than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.


Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.

To speak about unanimously positive evidence is simply not true! And Fisher, I suspect, must know it.


This point is even clearer, I think. The most commonly used homeopathic potency is surely a ’30C’ – it was already Hahnemann’s favourite. A small statistic proves my point: of the 24 products listed on the Nelson site, 21 are ’30C’ and just three are ‘6C’. For Ainsworths, all 33 of their listed standard products are ’30C’. Helios have 70 ’30C’ products and 27 ‘200C’ products

The likelihood that a ’30C’ contains a single molecule of what it says on the bottle is precisely zero. In fact, this applies already to all remedies beyond ’12C’. Fisher knows that, of course, I assume; if not he should not be a homeopath.


I do not take any pleasure in calling anyone a liar – and it is, of course, far from me to use this word in connection with the Queen’s homeopath. Therefore, in the interest of the scientific truth, medical ethics and honesty, I would like to give Dr Fisher the opportunity to comment on the above issues and herewith invite him to correct the three errors/falsehoods/inaccuracies/misunderstandings mentioned above by supplying the evidence for his statements or by withdrawing them. Then we won’t have to call him names which he might feel are hurtful.

I am probably more used to nonsensical statements by promoters of alternative medicine than the average person. But the ‘ALTERNATIVE MEDICINE ZONE’ just broke my BS-meter. Here are a few samples from their most remarkable website, all relating to homeopathy:

There has always been a debate whether allopathic treatment methods of the modern age are more beneficial or are the natural homeopathic treatment ways more reliable. The goal of healing the sick is the same in both these groups of treatment, but there is a strong contrast in the methods use, the ideology behind the treatment and the detailed theories. The following is a detailed comparison between homeopathy and Allopathy for those who wish to pick between the two:


Allopathic practitioners aim to target that part of the body that has been affected by a problem or disease and they do so by identifying the causing agent. On the other hand, in Homeopathy, doctors believe that emotional stress or psychological reasons make the body more susceptible to diseases and use more of a holistic approach of treatment.


Allopathic doctors make use of those medications which are produced by pharma companies or are man-made. On the other hand, Homeopathy uses natural supplements and cures such as herbs, dietary changes and other such ways to cure a disease. Allopathic doctors use an aggressive approach whereas homeopathic doctors consider one dose enough to treat a disease.


While on one hand, allopathic doctors consider surgeries to be very important for removal of tumors etc. or correcting problems inside the body, Homeopathic doctors almost never use surgery as a treatment method. Only when certain tissue in the body has become seriously damaged they practice this technique.

Allopathic surgeons heavily rely on surgical procedures in case of serious diseases which cannot be cured by medicines or any other approach. Homeopathic doctors try to treat each and every condition with a natural method or by recommending strong dietary changes.


Homeopathy is basically based on beliefs of German Physician Samuel Hahnemann whereas Allopathic system of treatment or cure of diseases is based on the principles of the ancient Greeks, for example Hippocrates. Allopathic is considered to be regular medicine in many countries such as US but Homeopathy is argued to be a natural and holistic way of cure.


Both these schools of medicine consider the other to be non-beneficial. Homeopathy thinks that allopathic medicines tend to make people even sicker in the long run whereas Allopathy doctors believe that Homeopathy only uses Placebo as its mechanism to cure people. Supporters of both schools are often seen defending their preferred method of treatment.

The ‘ALTERNATIVE MEDICINE ZONE’ also does not shy away from giving concrete medical advice on their website. Two examples will have to suffice:


Compare to anti-viral medicines, homeopathy has proved more effective for shingles and chicken pox. It offers rapid and successful approach in treating this infection. People with weak immune system are more prone to get shingles. Homeopathy medicines influence the immune system efficiently from within and improve body’s healing capacity. The homeopathy medicines are also capable of defusing pain, discomfort in body due to shingle. It also refrain shingles from spreading.


The homeopathic treatment is considered much better than surgery because it corrects the problem from the root which is not the case in surgery. Homeopathy is considered very useful in the early cases of piles and can help in complete healing. However as the problem becomes complex, it can only help in the healing of the symptoms.

Both articles finish by giving a list of homeopathic remedies that are recommended for the two conditions.

So there we have it!

My BS-meter has just broken.

Who can I sue?

On this blog, we have already discussed the good news that the US Federal Trade Commission (FTC) is considering whether advertisements for homeopathic products have any evidence to back the numerous claims that are being made for them. A meeting took place on 21 September, and now the first details are emerging.

Michelle Rusk, senior staff attorney in the FTC advertising practices division, said in this public hearing on over-the-counter homeopathic products that advertisements lauding the health benefits of medical products need to be based on competent, reliable, and rigorous scientific support.

“As a general rule, for treatment claims, we expect randomized, double-blind, placebo-controlled human clinical studies—not in vitro studies, not animal studies, not anecdotal evidence, no matter how compelling it is,” she said. “Second, we expect the studies to be internally valid. That means well-designed, reliably conducted, using procedures accepted in the field of research. It also means that results are not just statistically significant but also strong enough to be clinically meaningful. Third, the evidence has to match the product and the specific claim.”

In the context of any form of health care, such statements would amount to mere platitudes: the fact that we cannot possibly tolerate double standards in medicine is almost too obvious to mention. In the realm of homeopathy, however, these words amount to a revolution!

Could it be that the days of bogus claims for homeopathic products are counted?

Could it be that consumers might soon be protected from unscrupulous entrepreneurs exploiting the vulnerable?

Could it be that, one day, we will have one standard only?

Don’t get me wrong, I have nothing against systematic reviews. Quite to the contrary, I am sure they are an important source of information for patients, doctors, scientists, policy makers and others – after all, I have published more than 300 of such papers!

Having said that, I do dislike a certain type of systematic review, namely systematic reviews by Chinese authors evaluating TCM therapies and arriving at misleading conclusions. Such papers are currently swamping the marked.

At first glance, they look fine. On closer scrutiny, however, most turn out to be stereotypically useless, boring and promotional. The type of article I mean starts by stating its objective which usually is to evaluate the evidence for a traditional Chinese therapy as a treatment of a condition which few people in their right mind would treat with any form of TCM. It continues with details about the methodologies employed and then, in the results section, informs the reader that x studies were included in the review which mostly reported encouraging results but were wide open to bias. And then comes the crucial bit: THE CONCLUSIONS.

They are as predictable as they are misleading. let me give you two examples only published in the last few days.

The first review drew the following conclusions: This systematic review suggests that Chinese Herbal Medicine as an adjunctive therapy can improve cognitive impairment and enhance immediate response and quality of life in Senile Vascular Dementia patients. However, because of limitations of methodological quality in the included studies, further research of rigorous design is needed.

The second review concluded that the evidence that external application of traditional Chinese medicine is an effective treatment for venous ulcers is encouraging, but not conclusive due to the low methodological quality of the RCTs. Therefore, more high-quality RCTs with larger sample sizes are required.

Why does that sort of thing frustrate me so much? Because it is utterly meaningless and potentially harmful:

  • I don’t know what treatments the authors are talking about.
  • Even if I managed to dig deeper, I cannot get the information because practically all the primary studies are published in obscure journals in Chinese language.
  • Even if I  did read Chinese, I do not feel motivated to assess the primary studies because we know they are all of very poor quality – too flimsy to bother.
  • Even if they were formally of good quality, I would have my doubts about their reliability; remember: 100% of these trials report positive findings!
  • Most crucially, I am frustrated because conclusions of this nature are deeply misleading and potentially harmful. They give the impression that there might be ‘something in it’, and that it (whatever ‘it’ might be) could be well worth trying. This may give false hope to patients and can send the rest of us on a wild goose chase.

So, to ease the task of future authors of such papers, I decided give them a text for a proper EVIDENCE-BASED conclusion which they can adapt to fit every review. This will save them time and, more importantly perhaps, it will save everyone who might be tempted to read such futile articles the effort to study them in detail. Here is my suggestion for a conclusion soundly based on the evidence, not matter what TCM subject the review is about:


On the website of the Bristol University Hospital, it was just revealed that UK homeopathy seems to have suffered another blow:

“Homeopathic medicine has been available in Bristol since 1852, when Dr Black first started dispensing from premises in the Triangle. During the next 69 years the service developed and expanded culminating in the commissioning in 1921 of a new hospital in the grounds of Cotham House. The Bristol Homeopathic Hospital continued to provide a full range of services until 1986 when the in-patient facilities were transferred to the Bristol Eye Hospital, where they continue to be provided, and outpatient services were moved to the ground floor of the Cotham Hill site. In 1994, following the sale of the main building to the University by the Bristol and District Health Authority, a new purpose built Department was provided in the Annexe buildings of the main building, adjoining the original Cotham House. The NHS Homeopathic Service is now being delivered on behalf of University Hospital Bristol by the Portland Centre for Integrative Medicine (PCIM), a Community Interest Company.”

The Portland Centre for Integrative Medicine has joined Litfield House offering medical homeopathy with Dr Elizabeth Thompson. And this is how the new service is described [I have added references in the following unabridged quote in bold which refer to my comments below]:

Medical Homeopathy is a holistic [1] approach delivered by registered health care professionals that uses a low dose of an activated [2] natural [3] substance [4] to stimulate a self-healing response in the body [5]. At the first appointment the doctor will take time to understand problem symptoms that might be physical, emotional or psychological and then a treatment plan will be discussed between the patient and the doctor [6], with homeopathic medicines chosen for you or your child on an individual basis.

Homeopathy can be safely [7] used to improve symptoms and well-being across a wide range of long term conditions: from childhood eczema [8] and ADHD [9]; to adults with medically unexplained conditions [10]; inflammatory bowel disease [11], cancer [12] or chronic fatigue syndrome [13]; and other medical conditions, including obesity [14] and depression [15]. Some people use homeopathy to stay well [16] and others use it to help difficult symptoms and/ or the side effects of conventional treatments [17].

This looks like a fairly bland and innocent little advertisement at first glance. If we analyse it closer, however, we find plenty of misleading claims. Here are the ones that caught my eye:

  1. Homeopaths claim that their approach is holistic and thus aim at differentiating it from conventional health care. This is misleading because ALL good medicine is by definition holistic.
  2. Nothing is ‘activated’; homeopaths believe that succession releases the ‘vital force’ in a remedy – but this is little more than hocus-pocus from the dark ages of medicine.
  3. Nothing is natural about endlessly diluting and shaking a medicine, while pretending that this ritual renders it more active and effective. And nothing is natural about remedies such as ‘Berlin Wall’.
  4. It is misleading to speak about ‘substance’ in relation to homeopathic remedies, because they can be manufactured also from non-material stuff too; examples are remedies such as X-ray, sol [sun light] or lunar [moonlight].
  5. The claim that homeopathic remedies stimulate the self-healing properties of the body is pure phantasy.
  6. “The doctor will take time to understand problem symptoms that might be physical, emotional or psychological and then a treatment plan will be discussed between the patient and the doctor” – this also applies to any consultation with any health care practitioner.
  7. Homeopathy is not as safe as homeopaths try to make us believe; several posts on this blog have dealt with this issue.
  8. There is no good evidence to support this claim.
  9. There is no good evidence to support this claim.
  10. There is no good evidence to support this claim.
  11. There is no good evidence to support this claim.
  12. There is no good evidence to support this claim.
  13. There is no good evidence to support this claim.
  14. There is no good evidence to support this claim.
  15. There is no good evidence to support this claim.
  16. True, some people use anything for anything; but there is no sound evidence to show that homeopathy is an effective prophylactic intervention for any disease.
  17. Nor is there good evidence that it is effective to “help difficult symptoms and/ or the side effects of conventional treatments”.

So, what we have here is a short paragraph which, on closer inspection, turns out to be full of misleading statements, bogus claims and dangerous lies. Not a good start for a new episode in the life of the now dramatically down-sized homeopathic clinic in Bristol, I’d say. And neither is it a publication of which the Bristol University Hospital can be proud. I suggest they correct it as a matter of urgency; otherwise they risk a barrage of complaints to the appropriate regulators by people who treasure the truth a little more than they seem to do themselves.

Recently an interesting article caught my eye. It was published in the official journal of the ‘Deutscher Zentralverein Homoeopathischer Aerzte’ (the professional body of German doctor homeopath which mostly acts as a lobby group). Unfortunately it is in German – but I will try to take you through what I believe to be the most important issue.

The article seems to have the aim to defame Natalie Grams, the homeopath who had the courage to change her mind about homeopathy and to even write a book about her transformation. This book impressed me so much that I wrote a post about it when it was first published. The book did, however, not impress her ex-colleagues. Consequently the book review by the German lobbyists is full of personal attacks and almost devoid of credible facts.

A central claim of the defamatory piece is that, contrary to what she claims in her book, homeopathy is supported by sound evidence. Here is the crucial quote: Meta-Analysen von Kleijnen (1991), Linde (1997), Cucherat (2000) und Mathie (2014) [liefern] allesamt positive Ergebnisse zur Wirksamkeit der Homöopathie… This translates as follows: meta-analyses of Kleijnen, Linde, Cucherat and Matie all provide positive results regarding the effectiveness of homeopathy. As this is a claim, we hear ad nauseam whenever we discuss the issue with homeopathy (in the UK, most homeopathic bodies and even the Queen’s homeopath, P Fisher, have issued very similar statements), it may be worth addressing it once and for all.


This paper was the result of an EU-funded project in which I was involved as well; I therefore know about it first hand. The meta-analysis itself is quite odd in that it simply averages the p-values of all the included studies and thus provides a new overall p-value across all trials. As far as I know, this is not an accepted meta-analytic method and seems rather a lazy way of doing the job. The man on our EU committee was its senior author, professor Boissel, who did certainly not present it to us as a positive result for homeopathy (even Peter Fisher who also was a panel member should be able to confirm this). What is more, the published conclusions are not nearly as positive as out lobbyists seem to think: ‘There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results.’

Anybody who claims this is a proof for homeopathy’s efficacy should be sent back to school to learn how to read and understand English, in my view.

The meta-analysis by Linde et al seems to be the flag-ship in the homeopathic fleet. For those who don’t know it, here is its abstract in full:

BACKGROUND: Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo.

METHODS: We sought studies from computerised bibliographies and contracts with researchers, institutions, manufacturers, individual collectors, homeopathic conference proceedings, and books. We included all languages. Double-blind and/or randomised placebo-controlled trials of clinical conditions were considered. Our review of 185 trials identified 119 that met the inclusion criteria. 89 had adequate data for meta-analysis, and two sets of trial were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data for information on clinical condition, homeopathy type, dilution, “remedy”, population, and outcomes.

FINDINGS: The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of homeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03 (1.51, 2.74). Five studies on postoperative ileus had a pooled mean effect-size-difference of -0.22 standard deviations (95% CI -0.36, -0.09) for flatus, and -0.18 SDs (-0.33, -0.03) for stool (both p < 0.05).

INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

Again, the conclusions are not nearly as strongly in favour of homeopaths as the German lobby group assumes. Moreover, this paper has been extensively criticised for a wide range of reasons which I shall not have to repeat here. However, one point is often over-looked: this is not an assessment of RCTs, it is an analysis of studies which were double-blind and/or randomised and placebo-controlled. This means that it includes trials that were not randomised and studies that were not double-blind.

But this is just by the way. What seems much more important is the fact that, in response to the plethora of criticism to their article, the same authors published a re-analysis of exactly the same data-set two years later. Having considered the caveats and limitations more carefully, they now concluded that ‘in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results.’

It is most intriguing to see how homeopaths cite their ‘flagship’ on virtually every possible occasion, while forgetting that a quasi correction has been published which puts the prior conclusions in a very different light !


The much-cited article by Kleijnen is now far too old to be truly relevant. It includes not even half of the trials available today. But, for what it’s worth, here are Kleijnen’s conclusions: At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.

If the homeopathy lobby today proclaims that this paper constitutes proof of efficacy, they are in my view deliberately misleading the public.


The Mathie meta-analysis has been extensively discussed on this blog (see here and here). It is not an overall meta-analysis but merely evaluates the subset of those trials that employed individualised homeopathy. Crucially, it omits the two most rigorous studies which happen to be negative. Its conclusions are as follows: ‘Medicines prescribed in individualised homeopathy may have small, specific treatment effects. Findings are consistent with sub-group data available in a previous ‘global’ systematic review. The low or unclear overall quality of the evidence prompts caution in interpreting the findings. New high-quality RCT research is necessary to enable more decisive interpretation.’

Again, I would suggest that anyone who interprets this as stating that this provides ‘positive results regarding the effectiveness of homeopathy’ is not telling the truth.


  1.  Some systematic reviews and meta-analyses do indeed suggest that the trial data are positive. However, they all caution that such a result might be false-positive.
  2. None of these papers provide anything near a proof for the effectiveness of homeopathy.
  3. Homeopathy has not been shown to be more than a placebo therapy.
  4. To issue statements to the contrary is dishonest.

Today the GUARDIAN published an article promoting acupuncture on the NHS. The article is offensively misleading, I think, and therefore deserves a comment. I write these comments with a heavy heart, I should add, because the GUARDIAN is by far my favourite UK daily. In the following, I will cite key passages from the article in question and add my comments in bold.

Every woman needing pain relief while giving birth at University College London hospital (UCLH) is offered acupuncture, with around half of the hospital’s midwives specially trained to give the treatment. UCLH is far from typical in this respect, though: acupuncture is not standard throughout the UK and many health practitioners claim patients are often denied access to it through the NHS because of entrenched scepticism from sections of the medical establishment.

Entrenched scepticism? I would say that it could be perhaps be related to the evidence. The conclusions of the current Cochrane review on acupuncture for labour pain are cautious and do not seem strong enough to issue a general recommendation for general use in childbirth: “acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.”

“There are conditions for which acupuncture works and others where it doesn’t. It is not a cure-all, and should be open to scrutiny. But the focus of my work is for acupuncture to become a standard part of midwifery training, and at the same time change perceptions among clinicians about its appropriate use for a whole range of other conditions.”

Open to scrutiny indeed! And if we scrutinise the evidence critically – rather than engaging in uncritical and arguably irresponsible promotion – we find that the evidence is not nearly as convincing as acupuncture fans try to make us believe.

The UK lags behind many other European countries in its support for acupuncture. Just 2,500 medical professionals here are qualified to practice it, compared with 45,000 in Germany. The National Institute for Clinical Excellence (Nice) recommends WMA specifically for the treatment of only two conditions – lower back pain (which costs the NHS £1bn a year) and headaches.

Yes, the UK also lags behind Germany in the use of leeches and other quackery. The ‘ad populum’ fallacy is certainly popular in alternative medicine – but surely, it is still a fallacy!

A growing body of healthcare practitioners believe it should be offered routinely for a variety of conditions, including pain in labour, cancer, musculoskeletal conditions and even irritable bowel syndrome (IBS).

Here we go, belief as a substitute for evidence and fallacies as a replacement of logical arguments. I had thought the GUARDIAN was better than this!

At a time of NHS cuts the use of needles at 8p per unit look attractive. In St Albans, where a group of nurse-led clinics have been using acupuncture since 2008 for patients with knee osteoarthritis, economics have been put under scrutiny. WMA was offered to 114 patients rather than a knee replacement costing £5,000, and 79% accepted. Two years later a third of them had not required a knee transplant, representing an annual saving of £100,000, as estimated by researchers to the St Albans local commissioning group.

This looks a bit like a ‘back of an envelope’ analysis. I would like to see this published in a reputable journal and see it scrutinised by a competent health economist.

So why is acupuncture not being used more widely? The difficulty of proving its efficacy is clearly one of the biggest stumbling blocks. An analysis of 29 studies of almost 18,000 patients found acupuncture effective in treating chronic pain compared with sham acupuncture.

This passage refers to an analysis by Vickers et al. It was severely and repeatedly criticised for being too optimistic and, more importantly, it is not nearly as positive as implied here. Its conclusions are in fact quite cautious: “acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”

But even treatment proponents question whether a randomised controlled trial – the gold standard of medical research – works, given that faking treatment is nearly impossible.

What do you mean ‘even treatment proponents’? It is only proponents who question these sham needles! The reason: they frequently do not generate the results acupuncture fans had hoped for.


The article is clearly not the GUARDIAN’s finest hour. It lacks even a tinge of critical assessment. This is regrettable, I think, particularly as the truth about acupuncture is not that difficult to transmit to the public:

  • Much of the research is of woefully poor quality.
  • Its effectiveness is not proven beyond doubt for a single condition.
  • Serious adverse effects have been reported.
  • Because it requires substantial amounts of therapist time, it also is not cheap.

If you start reading the literature on chiropractic, you are bound to have surprises. The paucity of rigorous and meaningful research is one of them. I am constantly on the look-out for such papers but am regularly frustrated. Over the years, I got the impression that chiropractors tend to view research as an exercise in promotion – that is promotion of their very own trade.

Take this article, for instance. It seems to be a systematic review of chiropractic for breastfeeding. This is an interesting indication; remember: in 1998, Simon Singh wrote in the Guardian this comment “The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.” As a consequence, he got sued for libel; he won, of course, but ever since, chiropractors across the world are trying to pretend that there is some evidence for their treatments after all.

The authors of the new review searched Pubmed [1966-2013], Manual, Alternative and Natural Therapy Index System (MANTIS) [1964-2013] and Index to Chiropractic Literature [1984-2013] for the relevant literature. The search terms utilized “breastfeeding”, “breast feeding”, “breastfeeding difficulties”, “breastfeeding difficulty”, “TMJ dysfunction”, “temporomandibular joint”, “birth trauma” and “infants”, in the appropriate Boolean combinations. They also examined non-peer-reviewed articles as revealed by Index to Chiropractic Literature and conducted a secondary analysis of references. Inclusion criteria for their review included all papers on breastfeeding difficulties regardless of peer-review. Articles were excluded if they were not written in the English language.

The following articles met the inclusion criteria: 8 case reports, 2 case series, 3 cohort studies and 6 manuscripts (5 case reports and a case series) that involved breastfeeding difficulties as a secondary complaint. The findings revealed a “theoretical and clinical framework based on the detection of spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex and assessment of the infant while breastfeeding.”

Based on these results, the authors concluded that chiropractors care of infants with breastfeeding difficulties by addressing spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex.

Have I promised too much?

I had thought that chiropractors had abandoned the subluxation nonsense! Not really, it seems.

I had thought that systematic reviews are about evidence of therapeutic effectiveness! Not in the weird world of chiropractic.

I would have thought that we all knew that ‘chiropractors care of infants with breastfeeding difficulties’ and do not need a review to confirm it! Yes, but what is good for business deserves another meaningless paper.

I would have thought that the conclusions of scientific articles need to be appropriate and based on the data provided! It seems that, in the realm of chiropractic, these rules do not apply.

An appropriate conclusion should have stated something like THERE IS NO GOOD EVIDENCE THAT CHIROPRACTIC CARE AIDS BREASTFEEDING. But that would have been entirely inappropriate from the chiropractic point of view because it is not a conclusion that promotes the sort of quackery most chiropractors rely upon for a living. And the concern over income is surely more important than telling the truth!

This study created a media storm when it was first published. Several articles in the lay press seemed to advertise it as though a true breakthrough had been made in the treatment of hypertension. I would not be surprised, if many patients consequently threw their anti-hypertensives over board and queued up at their local acupuncturist.

Good for business, no doubt – but would this be a wise decision?

The aim of this clinical trial was to examine effectiveness of electroacupuncture (EA) for reducing systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients. Sixty-five hypertensive patients not receiving medication were assigned randomly to one of two acupuncture intervention. Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated by 4 acupuncturists with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 (control group) once weekly for 8 weeks. Primary outcomes measuring effectiveness of EA were peak and average SBP and DBP. Secondary outcomes examined underlying mechanisms of acupuncture with plasma norepinephrine, renin, and aldosterone before and after 8 weeks of treatment. Outcomes were obtained by blinded evaluators.

After 8 weeks, 33 patients treated with EA at PC 5-6+ST 36-37 had decreased peak and average SBP and DBP, compared with 32 patients treated with EA at LI 6-7+GB 37-39 control acupoints. Changes in blood pressures significantly differed between the two patient groups. In 14 patients, a long-lasting blood pressure–lowering acupuncture effect was observed for an additional 4 weeks of EA at PC 5-6+ST 36-37. After treatment, the plasma concentration of norepinephrine, which was initially elevated, was decreased by 41%; likewise, renin was decreased by 67% and aldosterone by 22%.

The authors concluded that EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.

These results are baffling, to say the least; and they contradict a recent meta-analysis which did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

So, who is right and who is wrong here?

Or shall we just look for alternative explanations of the effects observed in the new study?

There could be dozens of reasons for these findings that are unrelated to the alleged effects of acupuncture. For instance, they could be due to life-style changes suggested to the experimental but not the control group, or they might be caused by some other undisclosed bias or confounding. At the very minimum, we should insist on an independent replication of this trial.

It would be silly, I think, to trust these results and now recommend acupuncture to the millions of hypertensive patients worldwide, particularly as dozens of safe, cheap and very effective treatments for hypertension do already exist.

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