The British Homeopathic Association (BHA) is a registered charity founded in 1902 which aims to promote and develop the study and practice of homeopathy and to advance education and research in the theory and practice of homeopathy. The British Homeopathic Association’s overall priority is to ensure that homeopathy is available to all…
One does not need a particularly keen sense of critical thinking to suspect that this aim is not in line with a charitable status. Homeopathy for all would not be an improvement of public health. On the contrary, the best evidence shows that this concept would lead to a deterioration of it. It would mean less money for effective treatments. Who could argue that this is a charitable aim?
Currently, the BHA seems to focus on preventing that the NHS England stops the reimbursement of homeopathic remedies. They even have initiated a petition to this effect. Here is the full text of this petition, entitled ‘Stop NHS England from removing herbal and homeopathic medicines’:
NHS England is consulting on recommendations to remove herbal and homeopathic medicines from GP prescribing. The medicines cost very little and have no suitable alternatives for many patients. Therefore we call on NHS England to continue to allow doctors to prescribe homeopathy and herbal medicine.
Many NHS patients either suffer such severe side-effects from pharmaceutical drugs they cannot take them, or have been given all other conventional medicines and interventions with no improvement to their health. These patients will continue to need treatment on the NHS and will end up costing the NHS more with conventional prescriptions. There will be no cost savings and patient health will suffer. It is clear stopping homeopathic & herbal prescriptions will not help but hurt the NHS.
I find the arguments and implications of this petition pathetic and misleading. Here is why:
- NHS England is not considering to remove homeopathy from GPs’ prescribing. To the best of my knowledge, the plan is for the NHS to stop paying for homeopathic remedies. If some patients then still want homeopathy, they can get it, but will have to pay for it themselves. That seems entirely fair and rational. Why should we, the tax payers, pay for ineffective treatments?
- Because homeopathic remedies are not effective for any condition, it seems misleading to call them ‘medicines’.
- That homeopathy costs very little is not true; and even if it were correct, it would be neither here or there. The initiative is not primarily about money, it is about the principle: either the NHS adheres to EBM and ethical standards, or not.
- Homeopathy is not a ‘suitable alternative’ for anything, and it is misleading to call it thus.
- Even if NHS England decides against the funding homeopathic remedies, GPs could still be allowed to prescribe them; the only change would be that the NHS would not pay for them.
- Patients who ‘will continue to need treatment on the NHS’ under the described circumstances will not be helped by ineffective treatments like homeopathy.
- It is simply wrong to claim with certainty that there will be no cost savings.
- If the NHS scraps ineffective treatments, patients will suffer not more but less because they might actually receive a treatment that does work.
- It is fairly obvious that stopping to pay for homeopathic remedies will bring progress, help the NHS, patients and the general public.
Nine false or misleading statements in such a short text might well be a new record, even for homeopaths. Perhaps the BHA should apply for an entry in the Guinness Book of Records.
Should we start a petition?
On this blog, we had many chiropractors commenting that their profession is changing fast and the old ‘philosophy’ is a thing of the past. But are these assertions really true? This survey might provide an answer. A questionnaire was sent to chiropractic students in all chiropractic programs in Australia and New Zealand. It explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests.
A total of 347 chiropractic students participated. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student’s chiropractic institution. Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice.
The authors concluded that chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.
Traditional chiropractic theory is, of course, all the palmereque nonsense about ‘95% of all diseases are caused by subluxations of the spine’ etc. And evidence-based practice means knowing that subluxations are a figment of the chiropractic imagination.
Imagine a physician who believes in evidence and, at the same time, in the theory of the 4 humours determining our health.
Imagine a geologist thinking that the earth is flat and also spherical.
Imagine a biologist subscribing to both creationism and evolution.
Imagine a surgeon earning his livelihood with blood-letting and key-hole surgery.
Imagine a doctor believing in vital energy after having been taught physiology.
Imagine an airline pilot considering the use of flying carpets.
Imagine a chemist engaging in alchemy.
Imagine a Brexiteer who is convinced of doing the best for the UK.
Imagine a homeopath who thinks he practices evidence-based medicine.
Imagine a plumber with a divining rod.
Imagine an expert in infectious diseases believing is the miasma theory.
Imagine a psychic hoping to use her skills for winning a fortune on the stock market.
Once you have imagined all of these situations, I fear, you might know (almost) all worth knowing about chiropractic.
Dr. Dietmar Payrhuber is not famous – no, by no means. I had never heard of him until a watched this TV discussion about homeopathy (it’s in German, and well-worth watching, if you understand the language). I found the discussion totally mesmerising: Payrhuber is allowed to come out with case after case alleging he cured cancer of various types with homeopathy. Prof Frass is also there to defend the indefensible, but hardly intervenes, other than repeatedly and pompously stating that he is a professor with 200 publications who runs a homeopathy clinic at the university hospital of Vienna and therefore he is a cut above.
There are also three very bright and eloquent sceptical disputants who do their best to oppose Payrhuber’s moronic monstrosities. One of them even alerts us (and the broadcaster!) to the fact that some cancer patients might watch this and conclude that homeopathy cues cancer. Yes, TV can be dangerous!
After watching Payrhuber, I felt the urge to learn more about this man. On TV, he mentioned repeatedly his publications, so I first of all conducted a Medline search; it turns out that Medline lists not a single article in his name. However, I did find his (self-published) book: ‘HOMOEOPATHIE UND KREBS’ (HOMEOPATHY AND CANCER). It greatly impressed me – but not in a positive sense.
The preface (in English) is by Jan Scholten (who IS quite famous in the realm of homeopathy); here is a short quote from it:[Payrhuber’s book] … is an important book for several reasons. The first reason is that it shows that homeopathy is a real healing art. Often homeopathy is seen as good for superficial, light and self-healing diseases such as colds, eczema’s, bronchitis and the like. Together with this view goes the opinion that it is not a real medicine, because it cannot treat „real diseases“. But this shows the opposite: cancer can be healed, cured with homeopathy. It shows that homeopathy can have very profound effect and can really cure deeply. Of course cancer was cured already in the past with homeopathy by famous homeopaths such as Grimmer and Resch. But Dietmar shows that it can be done in a consistent way. Homeopathy cannot be set aside as superficial anymore…
But it gets worse! Payrhuber himself is equally clear that homeopathy can cure cancer; here is a quote that I translated from his German text into English:
The book shows options to treat cancer; this is not an exclusive option of homeopathy. However, it offers an alternative for therapy-resistant and slow-responding cases treated conventionally… The question whether homeopathy is an alternative or a complementary therapy is superfluous. As the cases presented here demonstrate, homeopathy is part of medicine, a method which is more scientific than conventional medicine, because it has clear principles and laws. In certain cases or in certain phases of cancer, homeopathy is quite simply indicated! Homeopathy is holistic and puts the whole patient rather than a local symptom in the centre.
We must not keep homeopathy from cancer patients, because it offers in many cases a cure which cannot be achieved by other means.
(For those who can read German, here is the original: Das Buch zeigt Möglichkeiten auf, Krebs zu behandeln, es stellt keinen Alleinanspruch der Homöopathie dar. Es bietet allerdings alternative Möglichkeiten für therapieresistente und therapieträge Behandlungsverläufe bei konventioneller Therapie an….
Es erübrigt sich die Frage, ob Homöopathie eine alternative oder komplementäre Medizin ist. Wie die vorliegenden Fälle zeigen, ist sie ein Teil der Medizin, eine Methode, die „eher wissenschaftlicher ist als die Schulmedizin, weil die Homöopathie deutliche Prinzipien und Gesetze hat“. Die Homöopathie ist in bestimmten Fällen oder in bestimmten Phasen der Behandlung schlicht und einfach indiziert! Sie ist ganzheitlich, setzt den Menschen ins Zentrum und nicht das Lokalsymptom…
Die Homöopathie darf dem Patienten nicht vorenthalten werden, da sie in vielen Fällen Heilungsmöglichkeiten bietet, die auf andere Weise nicht erreicht werden können…)
END OF QUOTE
As I said, Payrhuber is not famous – he is infamous!
This sad story left me with three questions:
- Can someone please stop Payrhuber before he does more damage to cancer patients?
- And can someone please tell the medical faculty of the university of Vienna (my former employer) that running a homeopathy clinic for cancer patients is not ethical?
- Can someone please teach journalists that, in healthcare, giving a voice to dangerous nonsense can do serious harm?
Newsweek recently reported that a herbalist has been charged with the death of a 13-year-old diabetic boy. Allegedly, the therapist replaced the boy’s insulin with herbal remedies. Tim Morrow, 83, was charged with
- child abuse causing death
- and with practicing medicine without a license.
Morrow stated that god had guided him to use herbs rather than conventional medicine and that he successfully treated treat his own prostate cancer in this way. Marrow can be seen on multiple YouTube videos from his ‘University of Common Sense’ promoting his bizarre ideas of health and disease.
Perhaps god also guided Marrow to make lots of money? He runs regular seminars and a thriving herbal on-line business, the ‘Common Sense Herbal Products‘. There are few ailments, for which ‘Common Sense Herbal Products’ do not seem to offer a herbal cure.
One of the remedies, ‘Pancreas Reg‘, for instance, claims to “act as natural insulin”. The 270 Tablets tub of this product costs US $74.22. It is easy to see, I find, how bold claims attract gullible customers depriving them not just of their money but also of their health.
Morrow started treating the boy suffering from Type 1 diabetes after he met his mother at one of his seminars. When the boy subsequently became semi-comatose, Morrow told his parents to treat their son with his herbal remedies rather than insulin which had been prescribed by qualified medical doctors. The boy, Edgar L., died only hours later. There is little doubt that he would have survived, if he had undergone conventional treatment, the medical examiner concluded.
“The allegations in this case underscore the serious health and safety risks of taking medical advice from someone who lacks a license and the proper training that goes with it,” the medical examiner said in a statement. “No family should have to suffer the tragedy of losing a child because of irresponsible, un-credentialed medical advice.”
On this blog, during lectures etc., I often stress that by far the biggest danger of seemingly harmless alternative therapies is that they are used to replace effective treatments for serious conditions. Diabetes is such a condition, and there are numerous instances where the advice of incompetent practitioners has endangered the lives of diabetics.
Three examples will have to suffice as examples of the plethora of such unethical neglect:
- “In homeopathy, diabetes is seen as a reflection of the body’s inability to function optimally. There is an imbalance that results in the body’s incapacity to effectively utilize the insulin that it produces, or to produce sufficient insulin for its needs. While symptoms often disappear after conventional treatment, the vital force does not. Homoeopathy can be used effectively in the treatment of diabetes. Here we mainly concentrate on functioning of the pancreas in efficient insulin production. The metabolic condition of a patient suffering from diabetes requires both therapeutic and nutritional measures to correct the illness. Homeopathy can regulate sugar metabolism while helping to resolve the metabolic disturbances that lead to diabetes. Furthermore, homeopathy helps stimulate the body’s self-healing powers in order to prevent complications such as open leg sores and other dysfunctions of the blood vessel, loss of vision, kidney failure. Homeopathic treatment does not target one illness, an organ, a body part or a symptom. Remedies are prescribed based on an assembly of presenting symptoms, their stresses in life.”
- “Management of Blood sugar. The commonly used remedies are Uranium Nitricum, Phosphoric Acid, Syzygium Jambolanum, Cephalandra Indica etc. These are classical Homeopathic remedies. These are used in physiologically active doses such as Mother tincture, 3x etc. depending up on the level of the blood sugar and the requirement of the patient. Several pharmaceutical companies have also brought in propriety medicines with a combination of the few Homeopathic medicines. Biochemic remedies which is a part of Homeopathy advocates Biocombination No 7 as a specific for Diabetes. Another Biochemic medicine Natrum Phos 3x is widely used with a reasonable success in controlling the blood sugar. Scientific studies on the impact of homeopathic medicines in bringing down blood sugar are limited, but many of the above remedies have some positive effects either as a stand-alone remedy or as an adjunct along with other medications.”
- “Modern medicine has no permanent cure for diabetes but alternative medicines like yoga ,mudra,ayurveda is very useful to control and even cure diabetes.Ayurveda is an alternative medicine to cure diabetes.”
But these are very rare instances!!!
That’s what apologists usually respond.
Yet, the truth is that NOBODY knows how often such harm occurs.
There is no monitoring system anywhere that would provide such information.
START OF QUOTE
Antiretroviral Therapy (ART) is recommended for each and every case of AIDS where CD4 count goes less than 350. Aura Homeopathy does not offer cure for AIDS. However, several research and clinical studies done by various Research centre including few from CCRH (Central Council for Research in Homeopathy, Govt. of India), have prove the supportive role of homeopathic medicines. Homeopathy medicine only relief symptoms but also reduced frequency of opportunistic infections, increase appetite, weight, and sense of well being, etc. At Aura Homeopathy, we apply classical homeopathy protocols on HIV/AIDS patients, as a part of our Clinical trial and Research projects. The results were very encouraging.
At Aura Homeopathy, we have seen an increase in the CD4 count in number of patients, after using Aura homeopathy medicines. Dr.Abhishek recommend’s Homeopathy as supporting line of therapy for all HIV patients.
END OF QUOTE
When I read this I wanted to be sick; but instead I did something a little more sensible: I conducted a quick Medline search for ‘homeopathy, AIDS’.
It returned 30 articles. Of these, there were just 4 that presented anything remotely resembling data. Here are their abstracts:
Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine and homeopathy (TIMH), which is used by up to two-thirds of its population to help meet primary health care needs, particularly in rural areas. India has an estimated 2.5 million HIV infected persons. However, little is known about TIMH use, safety or efficacy in HIV/AIDS management in India, which has one of the largest indigenous medical systems in the world. The purpose of this review was to assess the quality of peer-reviewed, published literature on TIMH for HIV/AIDS care and treatment.
Of 206 original articles reviewed, 21 laboratory studies, 17 clinical studies, and 6 previous reviews of the literature were identified that covered at least one system of TIMH, which includes Ayurveda, Unani medicine, Siddha medicine, homeopathy, yoga and naturopathy. Most studies examined either Ayurvedic or homeopathic treatments. Only 4 of these studies were randomized controlled trials, and only 10 were published in MEDLINE-indexed journals. Overall, the studies reported positive effects and even “cure” and reversal of HIV infection, but frequent methodological flaws call into question their internal and external validity. Common reasons for poor quality included small sample sizes, high drop-out rates, design flaws such as selection of inappropriate or weak outcome measures, flaws in statistical analysis, and reporting flaws such as lack of details on products and their standardization, poor or no description of randomization, and incomplete reporting of study results.
This review exposes a broad gap between the widespread use of TIMH therapies for HIV/AIDS, and the dearth of high-quality data supporting their effectiveness and safety. In light of the suboptimal effectiveness of vaccines, barrier methods and behavior change strategies for prevention of HIV infection and the cost and side effects of antiretroviral therapy (ART) for its treatment, it is both important and urgent to develop and implement a rigorous research agenda to investigate the potential risks and benefits of TIMH and to identify its role in the management of HIV/AIDS and associated illnesses in India.
2nd paper (I am a co-author of this one)
The use of complementary and alternative medicine (CAM) is widespread. Yet, little is known about the evidence supporting its use in HIV/AIDS. We conducted a systematic review of randomized clinical trials assessing the effectiveness of complementary therapies for HIV and HIV-related symptoms. Comprehensive literature searches were performed of seven electronic databases. Data were abstracted independently by two reviewers. Thirty trials met our predefined inclusion/exclusion criteria: 18 trials were of stress management; five of Natural Health Products; four of massage/therapeutic touch; one of acupuncture; two of homeopathy. The trials were published between 1989 and 2003. Most trials were small and of limited methodological rigour. The results suggest that stress management may prove to be an effective way to increase the quality of life. For all other treatments, data are insufficient for demonstrating effectiveness. Despite the widespread use of CAM by people living with HIV/AIDS, the effectiveness of these therapies has not been established. Vis à vis CAM’s popularity, the paucity of clinical trials and their low methodological quality are concerning.
Homeopathic medicine developed significant popularity in the nineteenth century in the United States and Europe as a result of its successes treating the infectious disease epidemics during that era. Homeopathic medicine is a medical system that is specifically oriented to using nanopharmacologic and ultramolecular doses of medicines to strengthen a person’s immune and defense system rather than directly attacking the microbial agents.
To review the literature referenced in MEDLINE and in nonindexed homeopathic journals for placebo-controlled clinical trials using homeopathic medicines to treat people with AIDS or who are human immunodeficiency virus (HIV)-positive and to consider a different theoretical and methodological approach to treating people with the viral infection.
A total of five controlled clinical trials were identified. A double-blinded, placebo-controlled study was conducted on 50 asymptomatic HIV-positive subjects (stage II) and 50 subjects with persistent generalized lymphadenopathy (stage III) in whom individualized single-remedy homeopathic treatment was provided. A separate body of preliminary research was conducted using homeopathic doses of growth factors. Two randomized double-blinded, placebo-controlled studies were conducted with a total of 77 people with AIDS who used only natural therapies over a 8-16-week period. Two other studies were conducted over a 2.5-year period with 27 subjects in an open-label format.
The first study was conducted by the Regional Research Institute for Homeopathy in Mumbai, India, under the Central Council for Research in Homeopathy, with the approval of the Ministry of Health and Family Welfare, Government of India. The second body of studies was conducted in clinic settings in California, Oregon, Arizona, Hawaii, New York, and Washington.
The first study found no statistically significant improvement in CD4 T-lymphocytes, but did find statistically significant pretest and post-test results in subjects with stage III AIDS, in CD4 (p = 0.008) and in CD8 (p = 0.04) counts. The second group of studies found specific physical, immunologic, neurologic, metabolic, and quality-of-life benefits, including improvements in lymphocyte counts and functions and reductions in HIV viral loads.
As a result of the growing number of people with drug-resistant HIV infection taking structured treatment interruptions, homeopathic medicine may play a useful role as an adjunctive and/or alternative therapy.
In 1996, [name removed] was convicted on charges of conspiracy and introducing an unapproved drug into interstate commerce and the 2nd U.S. Circuit Court of Appeals upheld the conviction. [Name removed]’s company, Writers and Researchers Inc. sold a drug called 714X to individuals and physicians, promoting it as a nontoxic therapy for AIDS, cancer, and other chronic diseases. The Food and Drug Administration (FDA) warned [name removed] that his marketing was illegal because the product had not been proven safe and effective for use in treating disease. [Name removed] argued that the product was a homeopathic drug, revealed by FDA tests to contain 94 percent water, and a mixture of nitrate, ammonium, camphor, chloride, ethanol, and sodium. The courts found that 714X was subject to FDA scrutiny because it was touted as a cure for cancer and AIDS.
So, what does this collective evidence tell us?
I think it makes it abundantly clear that there is no good reason to suggest that HIV/AIDS patients can be helped in any way by homeopathy. On the contrary, homeopathy might distract them from essential conventional care and it would needlessly harm their bank balance. It follows that claims to the contrary are bogus, unethical, reckless, and possibly even criminal.
Yesterday, I saw a Tweet stating:
It was followed by a list of specific indications:
- Anxiety and much more…
I responded to this Tweet by tweeting:
Homeopath in Cornwall specialising in misleading women
Minutes later I received a response from a homeopathy-fan:
That could be called libel Edzard. I would be careful.
So, should I be careful, and if so why?
Reading the thinly veiled threat, I wasn’t exactly shaking in my boots with fear (I was deeply involved in helping Simon Singh in his defence against the BCA’s libel action), but I nevertheless wanted to be sure of my position and conducted some ‘rough and ready’ searches for recent evidence to suggesting that homeopathy is effective for any of the conditions mentioned above. Here is what I found:
- Pregnancy. Yes, there is an RCT! It concluded that “homeopathy does not appear to prevent excessive body mass gain in pregnant women…” And another one concluding that “neither Pentazocine, or Chamomilla recutita offer substantial analgesia during labor.”
- Infertility. No RCT or other sound evidence.
- PCOS. Nothing
- PMS. No clinical trials.
- Fibroids. No clinical trials
- Depression. Even leading homeopaths seem to agree that there is no good evidence.
- Anxiety. Again, I could not find any sound evidence.
Don’t get me wrong, these statements are not based on full systematic reviews; that would take a while and hardly seems worth it. (If you want a good systematic review, I recommend this one; it concluded: “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.“) But my quick glance at the evidence is enough, I think, to justify my statement that the above claims by a homeopath are misleading. In fact, I believe that I could have used much stronger terminology without the slightest risk of being sued.
PERHAPS NEXT TIME!
A friend recently sent me the link to a video about ‘FUNCTIONAL CRANIAL RELEASE’ (well-worth watching, particularly, if you need cheering up) and when I heard a patient after the treatment exclaim: “kind’a like an orgasm”, I needed no further convincing; I just had to look into this extraordinary and little-known jewel of an alternative therapy.
If you watched the video, you might think FCR is simply pumping some air up your nostrils, but you are wrong: it is much more, and it is very scientific!
Functional Cranial Release (FCR) is the art and science of restoring normal brain and nervous system function by using Functional Neurology along with NeuroCranial Restructuring to improve the brain’s ability to function better. FCR was created by Dr. John Lieurance who currently practices in Sarasota, Florida. Dr Timothy Lim was personally trained by Dr John Lieurance and now offers FCR or Functional Cranial Release in Singapore. We have clients who fly in from all over the South East Asia and Oceania regions just to receive FCR treatment.
- Restores the brain’s ability to oxygenate itself through both improving air flow through the nasal passage and also the normal pumping action inherent in cranial rhythm that moves nutrients such as oxygen and neurotransmitters that bath the central nervous system keeping it healthy.
- Utilizes neurological testing to determine which pathways and brain centers are either firing too much or too little by testing the following; Examination of your eye’s movements and reflexes, your muscles or motor system, the autonomic nervous system, your circulation, your sensory system, the vestibular system (or) your ability to balance [repeatedly using a computerized balance platform]. Adjusting those pathways through the specific use of various modalities including one or more of the following; Very Specific Chiropractic Adjustments of the spine, extremities, and cranium, Soft Tissue or Massage, Eye Pattern & Eye Exercises, Canalith Repositioning (or) Eply’s, Vestibular Rehabilitative Modalities or VRT, and many others too numerous to list. The modalities used depend on the specific needs of each patient.
- A series of Cranial Releases are performed where the connective tissues that surround your brain and spinal cord called the Dura Mater are specifically released using endonasal balloon inflations. This is done in combination with the above mentioned functional neurologic modalities to provide the therapeutic effect to balance and normalize brain function. This normalization results in healing.
I bet you now wonder who this fabulous doctor Lieurance is. Wonder no more; he describes himself very well here:
Dr. John Lieurance, is a Naturopathic & Chiropractic Physician who has been in private practice in Sarasota for 20 years. He works at Advanced Rejuvenation, a multi-disciplinary clinic, with a focus on Chiropractic Functional Neurology, Functional Cranial Release (FCR), and musculoskeletal ultrasound.
It is easy to see that he is a real doctor, just look at his white coat and stethoscope!
And this website provides more valuable information about FCR:
Is FCR a Chiropractic adjustment ? Yes, FCR falls under the scope of Chiropractic care and is billed as a Chiropractic adjustment. If you are covered for Chiropractic care under your health insurance plan, then your FCR procedure will also be covered.
But what makes FCR so very attractive is that the list of conditions for which it is recommended is impressive and long; it even includes serious diseases such as Parkinson’s and stroke …
and don’t forget: ORGASM!!!
Lock 10 bright people into a room and tell them they will not be let out until they come up with the silliest idea in healthcare. It is not unlikely, I think, that they might come up with the concept of visceral osteopathy.
In case you wonder what visceral osteopathy (or visceral manipulation) is, one ‘expert’ explains it neatly: Visceral Osteopathy is an expansion of the general principles of osteopathy which includes a special understanding of the organs, blood vessels and nerves of the body (the viscera). Visceral Osteopathy relieves imbalances and restrictions in the interconnections between the motions of all the organs and structures of the body. Jean-Piere Barral RPT, DO built on the principles of Andrew Taylor Still DO and William Garner Sutherland DO, to create this method of detailed assessment and highly specific manipulation. Those who wish to practice Visceral Osteopathy train intensively through a series of post-graduate studies. The ability to address the specific visceral causes of somatic dysfunction allows the practitioner to address such conditions as gastroesophageal reflux disease (GERD), irritable bowel (IBS), and even infertility caused by mechanical restriction.
But, as I have pointed out many times before, the fact that a treatment is based on erroneous assumptions does not necessarily mean that it does not work. What we need to decide is evidence. And here we are lucky; a recent paper provides just that.
The purpose of this systematic review was to identify and critically appraise the scientific literature concerning the reliability of diagnosis and the clinical efficacy of techniques used in visceral osteopathy.
Only inter-rater reliability studies including at least two raters or the intra-rater reliability studies including at least two assessments by the same rater were included. For efficacy studies, only randomized-controlled-trials (RCT) or crossover studies on unhealthy subjects (any condition, duration and outcome) were included. Risk of bias was determined using a modified version of the quality appraisal tool for studies of diagnostic reliability (QAREL) in reliability studies. For the efficacy studies, the Cochrane risk of bias tool was used to assess their methodological design. Two authors performed data extraction and analysis.
Extensive searches located 8 reliability studies and 6 efficacy trials that could be included in this review. The analysis of reliability studies showed that the diagnostic techniques used in visceral osteopathy are unreliable. Regarding efficacy studies, the least biased study showed no significant difference for the main outcome. The main risks of bias found in the included studies were due to the absence of blinding of the examiners, an unsuitable statistical method or an absence of primary study outcome.
The authors (who by the way declared no conflicts of interest) concluded that the results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent.
It is hard not to appreciate the scientific rigor of this review or to agree with the conclusions drawn by the French authors.
But what consequences should we draw from all this?
The authors of this paper state that more and better research is needed. Somehow, I doubt this. Visceral osteopathy is not plausible and the best evidence available to date does not show it works. In my view, this means that we should declare it an obsolete aberration of medical history.
To this, the proponents of visceral osteopathy will probably say that they have tons of experience and have witnessed wonderful cures etc. This I do not doubt; however, the things they saw were not due to the effects of visceral osteopathy, they were due to chance, placebo, regression towards the mean, the natural history of the diseases treated etc., etc. And sometimes, experience is nothing more that the ability to repeat a mistake over and over again.
- If it looks like a placebo,
- if it behaves like a placebo,
- if it tests like a placebo,
IT MOST LIKELY IS A PLACEBO!!!
And what is wrong with a placebo, if it helps patients?
GIVE ME A BREAK!
WE HAVE ALREADY DISCUSSED THIS AD NAUSEAM. JUST READ SOME OF THE PREVIOUS POSTS ON THIS SUBJECT.
“MDs do not make false claims HAHAHA.”
This is from a comment I recently received on this blog.
It made me think.
Yes, of course, MDs do not always reveal the full truth to their patients; sometimes they might even tell lies (in this post, I shall use the term ‘lies’ for any kind of untruth).
So, what about these lies?
The first thing to say about them is obvious: THEY CAN NEVER JUSTIFY THE LIES OF OTHERS.
- the lies of the Tories cannot justify the lies of Labour party members,
- the lies of a plaintiff in court cannot justify any lies of the defendant,
- the lies of MDs cannot justify the lies of alternative practitioners.
The second thing to say about the lies of MDs is that, in my experience, most are told in the desire to protect patients. In some cases, this may be ill-advised or ethically questionable, but the motivation is nevertheless laudable.
- I might not tell the truth when I say (this really should be ‘said’, because I have not treated patients for many years) THIS WILL NOT HURT AT ALL. In the end, it hurt quite a bit but we all understand why I lied.
- I might claim that this treatment is sure to work (knowing full well that such a prediction is impossible), but we all know that I said so in order to maximise my patient’s compliance and expectation in order to generate the best possible outcome.
- I might dismiss a patient’s fear that his condition is incurable (while strongly suspecting that it is), but I would do this to improve his anxiety and well-being.
Yet, these are not the type of lies my commentator referred to. In fact, he provided a few examples of the lies MDs tell, in his opinion. He claimed that:
- They tell them that diabetes is not curable. False claim
- They compare egg intake with smoking on their affect to your health. False claim
- They say arthroscopic surgery of the knee is beneficial. False claim
- They state that surgery, chemo, and radiation is the only treatment for cancer. False claim
- They say that family association is the cause of most inflammatory conditions. False claim
I don’t want to go into the ‘rights or wrongs’ of these claims (mostly wrongs, as far as I can see). Instead, I would argue that any MD who makes a claim that is wrong behaves unethical and should retrain. If he erroneously assumes the claim to be correct, he is not fully informed (which, of course is unethical in itself) and needs to catch up with the current best evidence. If he makes a false claim knowing that it is wrong, he behaves grossly unethical and must justify himself in front of his professional disciplinary committee.
As this blog focusses on alternative medicine, let’s briefly consider the situation in that area. The commentator made his comments in connection to a post about chiropractic, so let’s look at the situation in chiropractic.
- Do many chiropractors claim to be able to treat a wide array of conditions without good evidence?
- Do they misadvise patients about conventional treatments, such as vaccinations?
- Do they claim that their spinal manipulations are safe?
- Do they tell patients they need regular ‘maintenance treatment’ to stay healthy?
- Do they claim to be able to diagnose subluxations?
- Do they pretend that subluxations cause illness and disease?
- Do they claim to adjust subluxations?
If you answered several of these questions with YES, I probably have made my point.
On reflection, it turns out that clinicians of all types do tell lies. Some are benign/white lies and others are fundamental, malignant lies. Most of us probably agree that the former category is largely negligible. The latter category can, however, be serious. In my experience, it is hugely more prevalent in the realm of alternative medicine. When it occurs in conventional medicine, appropriate measures are in place to prevent reoccurrence. When it occurs in alternative medicine, nobody seems to bat an eyelash.
My conclusion from these random thoughts: the truth is immeasurably valuable, and lies can be serious and often are damaging to patients. Therefore, we should always pursue those who tell serious lies, no matter whether they are MDs or alternative practitioners.
I have to admit that I had little hope it would come. But after sending my ‘open letter’ twice to their email address, I have just received this:
As you might remember, the AACMA had accused me of an pecuniary undeclared link with the pharmaceutical industry. Their claim was based on me having been the editor of a journal, FACT, which was co-published by the British Pharmaceutical Society (BPS). When I complained and the AACMA learnt that the journal had been discontinued, they retracted their claim but carried on distributing the allegation that I had formerly had an undeclared conflict of interest. When they finally understood that the BPS was not the pharmaceutical industry (all it takes is a simple Google search), and after me complaining again and again, they sent me the above email.
So, the AACMA have done the right thing?
Yes and no!
The have retracted their repeated lies.
But they have not done this publicly as requested (this is partly the reason for me writing this post to make their retraction public).
More importantly, they have not apologised !!!
Why should they, you might ask.
- Because they have (tried to) damage my reputation as an independent scientist.
- Because they have not done their research before making and insisting on a far-reaching claim.
- Because they have shown themselves too stupid to grasp even the most elementary issues.
By not apologising, they have, I find, shown how unprofessional they really are, and how much they lack simple human decency. On their website, the AACMA state that “since 1973, AACMA has represented the profession and values high standards in ethical and professional practice.” Personally, I think that their standards in ethical and professional practice are appalling.