MD, PhD, FMedSci, FSB, FRCP, FRCPEd

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Whenever a level-headed person discloses that a specific alternative therapy is not based on good evidence, you can bet your last shirt that a proponent of the said treatment responds by claiming that conventional medicine is not much better.

There are several variations to this theme. Today I want to focus on just one of them, namely the counter-claim that, only a short while ago, conventional medicine was not much better than the said alternative therapy (the implication is that it must be unfair to demand evidence from alternative medicine, while accepting a similar state of affairs in conventional medicine). The argument has recently been formulated by one commentator on this blog as follows:

“Trepanation, leeches for UTI’s, and bloodletting are all historical treatments of medical doctors…It’s hypocritical… to impute mainstream chiropractice to the profession’s beginnings and yet not admit that medicine’s founding and evolution was inbued with consistently scientific rigor.”

Sadly, some people seem to be convinced by such words, and this is why they are being repeated ad nauseam by interested parties. Yet the argument is fallacious for a range of reasons.

  • Firstly, it is based on the classical ‘tu quoque’ fallacy (appeal to hypocrisy).
  • Secondly – unless we happen to be historians – it is not the healthcare of the past that is relevant to our discussions. The question cannot be what this or that group of clinicians used to do; the question is HOW DO THEY TREAT THEIR PATIENTS TODAY?

As soon as we focus on this issue, it is impossible to deny that conventional medicine has made lots of progress and moved light years away from treatments such as trepanation, leeches, bloodletting and many others.

Why?

Why did we make such huge progress?

Because research showed that many of the traditional treatments were ineffective, unsafe and/or implausible (thus demonstrating that hundreds of years of experience – which alternative therapists rate so very highly – is of more than dubious value), and because we consequently developed and tested new therapies and subsequently used those treatments that passed these tests and were proven to do more good than harm.

By contrast, in the last decades, centuries and millennia, homeopathy, chiropractic, acupuncture, paranormal healing etc. did make no (or very little) progress. So much so that Hahnemann, for instance, would pass any exam for  homeopathy today. (If you disagree with this statement, please post a list of those treatments that have been given up by alternative therapists in the last 100 years or so.) Come to think of it, it is a hallmark of alternative medicine that it does not progress in the way conventional medicine does. It is almost completely static, a fact, that renders it akin to a dogma or a cult.

But why? Why is there no real progress in alternative medicine?

Don’t tell me that there is no research, research funding, etc. There are now hundreds of studies of homeopathy or chiropractic, thousands of acupuncture, and dozens of paranormal healing, for instance. The trouble is not the paucity of such research but its findings! The totality of the evidence in each of these areas fails to show that the therapy in question is efficacious.

And there we have, I think, another hallmark of alternative medicine: it is an area where research is only acted upon, if its findings are in line with the preconceptions and aspirations of its proponents.

I find this interesting!

It means, amongst other things, that research into alternative medicine tends not to be used for finding the truth or establishing new knowledge; it is mainly employed for the promotion of the therapy in question, regardless of what the truth about it might be (this would disqualify this exercise from being research and qualify it as PSEUDO-RESEARCH). If the research findings are such that they cannot be used for promotion, they are simply ignored or defamed as inadequate.

Originally, I had meant this blog to discuss all types of alternative therapies – well, perhaps not all (there are simply too many of them), but at least the most popular ones. And so far, I have omitted one that seems certainly quite wide-spread: CRYSTAL HEALING.

What the Dickens is crystal healing, you ask? It is the attempt to bring about healing with the power of crystals, of course. And how is it supposed to work? This is where things get quite nebulous; this website, for instance tells us that the repeating chemical structure of crystals is said to invest them with a kind of memory. This means that crystals have the power to hold energies. You may hold a quartz crystal with the intention of filling it with your love. This is what is meant by programming a crystal. You do not need any wires or a special connection with God – all you need is intention and focus. The crystal will remember your love, which will then permeate any environment in which the crystal is placed. Crystals can remember negative as well as positive energies and so will sometimes need to be cleansed. For instance, an amethyst will actually help to cleanse a room of negative energies (eg. anger) but this means that the amethyst, which will retain an element of that negative energy, will itself occasionally require cleansing.

Most crystal healers make fairly specific claims about the healing power of specific crystals. This website explains it in some detail. The following text is an extract of several key (only marginally altered) passages from much longer instructions about the use of different crystals for healing purposes:

Crystal healing specialists generally agree that garnet promotes rapid general healing and regeneration in users. Garnet also has a positive effect on disorders such as acid reflux, blood-related illnesses, and physical strength.

Rose quartz is considered, by practitioners of alternative medicine, to be the stone of love—in this case, love of the self, in the form of self-esteem and self-worth. Rose quartz is simply brimming with happiness, and is a very positive stone that can help bring out forgiveness, compassion, and tolerance in users.

Fluorite is of mental order and clarity, and can be used to help alleviate instability, paving the way for a more balanced view of life. Feeling tossed about on a sea of restless emotions? Try carrying fluorite with you throughout the day—it helps cleanse and detoxify the centers of emotion. Fluorite is also the stone of learning, and can improve concentration and focus, while simultaneously reducing the anxiety that can sometimes make retaining information difficult. If you’re a student, learning a new instrument, or facing a complex new job, fluorite may be the stone you’ll want to keep on your person.

Lapis lazuli is beneficial to the throat, vocal cords, and larynx, and can help to regulate endocrine and thyroid issues. This is one of the most effective stones to meditate with, as lapis lazuli is the stone of higher awareness, able to bring information to the mind in images rather than words. This is an especially great boon to those who have creative jobs, as their next big inspiration can come from this.

If you suffer from anxiety, hematite is for you. A heavy, calming stone, hematite is very grounding—it leaves the user feeling comfortable and “in the moment,” rather than being lost in memory or worry. This disconnection from the present—which many of us suffer from—is the cause of much discomfort. But by practicing mindfulness through meditation with hematite, you can reconnect with what’s currently going on in your life.

Alternative medicine practitioners consider jade to be the stone of the heart, and as such, affects this organ in a positive way, promoting heart health. Not only does jade promote physical heart health, but heals emotionally, as well. Focusing energies on the emotional heart, jade helps regulate what we embrace and what we resist, giving us better self-control, as well as a better picture of our own wants and needs.

Turquoise is powerful, giving peace to the spirit and well-being to the body. This stone induces a sense of serenity, keeping physically harmful stress and inflammation at bay. Holding turquoise can bring back focus and restore vitality. Turquoise is also a stabilizer, and can calm the nerves when working on a difficult problem, or when performing or speaking in public. It is known for its effectiveness in alleviating the fear of flying.

Obsidian is a protective stone, able to remove and guard against negativity. If you are trying to release issues from your past, including emotions such as anger, resentment, and fear, handling obsidian can help by allowing you to see them for what they are so that they can be dealt with. Physically, obsidian is said to benefit good health in muscle tissue and the digestive system, and can help rid the body of infection. It helps to reduce the pain of arthritis, joint problems, and cramps.

Citrine holds the power of granting energy and stamina and supporting proper metabolism. Especially beneficial for those suffering from chronic fatigue syndrome, this stone can bring back some much-needed vitality, and can even alleviate nausea and vomiting for those suffering from morning sickness. This gem also aids in keeping the nails, skin, and hair healthy, and is effective in relieving skin irritation of any kind. Emotionally, citrine is the gem of joy, helping the subconscious mind to accept happiness in life, releasing anger and negativity. This is the most effective gem for those suffering from depression—combined with the skills of a trained counselor, meditation with citrine can help channel happiness through you, imbuing you with real joy.

Whether you believe in the healing power of crystals or not, they are worth trying alongside your normal health regimen. At best, you’ll find a spiritual support for your physical and mental health goals. And at worst? You’ll be in possession of a few beautiful stones that make great meditative focal points. So do a little research and go try out a few of your favorite stones!

END OF QUOTES

Recently, I promised to be more respectful in my criticism of quackery, but when it comes to things like crystal healing this is a difficult task indeed. It goes almost without saying that there is not a jot of evidence for any of the therapeutic claims made in the above quotes or other promotional texts on crystal healing.

Who publishes this sort of nonsense? The above excerpts come from ‘BELIEFNET‘, the “leading lifestyle site dedicated to faith and inspiration. Beliefnet helps people find and walk a spiritual path that instills comfort, hope, strength and happiness. It is through this discovery that our readers are empowered to live a more meaningful life.”

Say no more!

The ‘CHRONICLE OF CHIROPRACTIC’ recently reported on the relentless battle within the chiropractic profession about the issue of ‘subluxation’. Here is (slightly abbreviated) what this publication had to say:

START OF QUOTE

Calling subluxation based chiropractors “unacceptable creatures” chiropractic researcher Keith H Charlton DC, MPhil, MPainMed, PhD, FICC, recently stated “. . . that it is no longer scientifically acceptable for any responsible chiropractic clinician to ever use the word subluxation except as theory . . .” Charlton made the comment to members of the Chiropractic Research Alliance a group of subluxation deniers who routinely disparage the concept of subluxation.

Charlton is a well known “Subluxation Denier” and frequently attacks subluxation based chiropractors in his peer reviewed research papers and on Facebook groups. According to Charlton in a paper published in the journal Chiropractic and Osteopathy: “The dogma of subluxation is perhaps the greatest single barrier to professional development for chiropractors. It skews the practice of the art in directions that bring ridicule from the scientific community and uncertainty among the public.”

On January 5, 2017 Charlton further stated: “We need NOW in 2017 and beyond to get rid of the quacks that do us so much harm. They need to be treated personally and professionally as utterly unacceptable creatures to be shunned and opposed at every turn. Time to get going on cleaning out the trash. And that includes all signs, websites, literature, handouts and speech of staff and chiropractors.”

…Charlton has testified against subluxation based chiropractors in regulatory board actions and appears to revel in it.

In his most recent pronouncement Charlton states that he is okay with subluxation as a “regional spine shape distortion” and asserts that this is a CBP subluxation. This contention is common with subluxation deniers who are willing to accept an orthopedic definition of subluxation absent the neurological component.

…Charlton states he uses the following techniques on his website:

  • Applied Kinesiology
  • Diversified
  • Motion Palpation
  • Sacro-Occipital Technique
  • Activator
  • Logan Basic

When this self-declared scientist was confronted with his use of Applied Kinesiology and these other techniques his response was essentially that he is engaging in a “bait and switch” and that he just has those on his website to get patients who are looking for those things. Charlton lists 21 “research papers” on his curriculum vitae though they are all simply commentaries or reviews not original clinical research. The majority of these opinion pieces are attacks on subluxation and the chiropractors who focus on it.

END OF QUOTE

What does this tell us?

  • It seems to me that the ‘anti-subluxation’ movement with in the chiropractic profession is by no means winning the battle against the ‘hard-core subluxationists’.
  • Chiropractors cannot resist the temptation to use ad hominem attacks instead of factual arguments. I suppose this is because the latter are in short supply.
  • The ‘anti-subluxationists’ present themselves as the evidence-based side of the chiropractic spectrum. This impression might well be erroneous. Giving up the myth of subluxation obviously does not necessarily mean abandoning other forms of quackery.

Homeopaths have, since about 200 years, insisted that their remedies are efficacious treatments for infectious diseases. As evidence for this notion, they often produce epidemiological data showing that a group of infected patients treated homeopathically had better results than another group treated conventionally. While potentially interesting, such findings never constitute proof, because the two groups might not have been comparable and many other factors could have determined the observed outcome. In fact, these stories are prime examples for the need of rigorously controlled trials when testing the efficacy of medical treatments.

Homeopaths are invariably unable to provide more compelling evidence for their claims. Instead, they repeat, since 200 years, their assumptions over and over again. Are they not aware, I ask myself, that the repetition of a lie does not create a truth?

What their repetition of lies sometimes does create, unfortunately, is some impact on a political level. This website explains it fairly well:

The Public Health Ministry (of Thailand) is thinking of implementing alternative therapy homeopathy in all districts of Sing Buri this year, after a report that it could boost the human’s body immunity to fight dengue fever, an inspector-general at the ministry said.

Homeopathic medicines had been given to Sing Buri volunteer students from kindergarten to lower-secondary level in a 2012-13 trial and it yielded satisfactory results, said Dr Jakkriss Bhumisawasdi, director of the Inspector-General Region for Bureau of Inspection and Evaluation.

The number of dengue fever cases in Sing Buri have gone down, taking its rankings from No 67 in the country (with one death) in 2011 to No 76 in 2012. As there was a nationwide dengue fever outbreak in 2013, Sing Buri reported the country’s lowest prevalence at 44.95 per 100,000 population.

Jakkriss said “homeopathy” was safe and low-cost and had been used in various countries including the United Kingdom, France, Italy, Switzerland, Belgium, the United States, Australia, India and Malaysia.

Pilot project

Next, the system of medicine would be implemented in Region 4 Bureau’s seven other provinces: Nakhon Nayok, Nonthaburi, Pathum Thani, Ayutthaya, Lop Buri, Sara Buri and Ang Thong. If this one district per province pilot project went well, they would consider implementing it across the country, he said.

Sing Buri Hospital paediatrician Dr Wali Suwatthika said the preparation involved dissolving Eupatorium herbal pills in drinking water. Each child would be given 3cc of this tasteless water every three months. The trial, which began in July 2012, covered 4,250 children in Muang district and only four of them developed mild dengue fever in one year, while seven out of the district’s 2,856 remaining kids who didn’t get the medicine had dengue fever, in a more severe condition.

Thailand reported 150,934 dengue fever patients last year, double the previous year’s number, and 133 deaths. As there is no vaccine for dengue fever, the Public Health Ministry used a combination of several measures, including the eradication of mosquito larva incubation grounds and a campaign for people to install mosquito nets.

END OF QUOTE

So, where is the evidence that homeopathy does anything at all for Dengue patients? The 2012-13 trial referred to above has, as far as I can see, not been published. This probably means that it was not a publishable study at all. The only study available on Medline is this one:

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

END OF QUOTE

The bottom line is simple and depressing: the totality of the best available evidence fails to show that homeopathy is efficacious for Dengue fever (or any other infectious disease). It is irresponsible to claim otherwise.

At a recent conference in Montréal (October 2016), the WFC (World Federation of Chiropractic) and the ACC (Association of Chiropractic Colleges) reached a consensus on education. Consequently, recommendations were produced that offer 12 key ‘take away messages’. I take the liberty of reproducing these statements entitled ‘Training Tomorrow’s Spine Care Experts’ (the square brackets were inserted by me and refer to brief comments I made below).

START OF QUOTE

1. Chiropractic educational institutions have a  responsibility to equip students with the skills and  attributes necessary to become future spinal health care experts. This includes a commitment to astute diagnostic ability, a comprehensive knowledge of spine-related disorders [1], appreciation for the contributions of other health professionals and a commitment to collaborative, patient-centered and evidence-informed care [2].

2. Technological advances [3] provide an opportunity for the chiropractic profession to enhance, evolve and standardize core education and practice. This is relevant to the teaching of chiropractic skills, sharing of learning resources and assessment of performance. Emerging technologies that support the development of clinically-competent practitioners should be embedded within chiropractic programs.

3. The teaching and learning of specialized manual assessment and treatment skills should remain a key distinguishing element of chiropractic curricula.

4. Surveys of the public have a demonstrated a desire for consistency in the provision of chiropractic services. Such consistency need not compromise the identities of individual institutions but will cultivate public trust and cultural authority [4].

5. Globally consistent educational and practice standards will facilitate international portability [5] and promote greater health equity in the delivery of spine care.

6. Chiropractic programs should espouse innovation and leadership in the context of ethical [6], sustainable business [7] practices.

7. Chiropractic educational curricula should reflect current evidence [8] and high quality guidelines [9], and be subjected to regular review to ensure that students are prepared to work in collaborative health care environments.

8. The training of tomorrow’ s spine care experts should incorporate current best practices in education.

9. Interdisciplinary collaboration and strategic partnerships present opportunities to position chiropractors as leaders [10] and integral team players in global spine care.

10. Chiropractic educational institutions should champion the integration of evidence informed clinical practice [11], including clinical practice guidelines, in order to optimize patient outcomes. This will in turn foster principles of lifelong learning and willingness to adapt practice methods in the light of emerging evidence [12].

11. Students, faculty, staff and administrators must all contribute to a learning environment that fosters cultural diversity, critical thinking [13], academic responsibility and scholarly activity.

12. Resources should be dedicated to embed and promote educational research activity in all chiropractic institutions.

END OF QUOTE

And here are my brief comments:

[1] Some chiropractors believe that all or most human conditions are ‘spine-related disorders’. We would need a clear statement here whether the WFC/ACC do support or reject this notion and what conditions we are actually talking about.

[2] ‘Evidence-informed’??? I have come across this term before; it is used more and more by quacks of all types. It is clearly not synonymous with ‘evidence-based’, but aims at providing a veneer of respectability by creation an association with EBM. In concrete terms, asthma, for instance, might, in the eyes of some chiropractors, be an evidence-informed indication for chiropractic. In other words, ‘evidence-informed’ is merely a card blanch for promoting all sorts of nonsense.

[3] It would be good to know which technical advances they are thinking of.

[4] Public trust is best cultivated by demonstrating that chiropractic is doing more good than harm; by itself, this point sounds a bit like PR for maximising income. Sorry, I am not sure what they mean by ‘cultural authority’ – chiropractic as a cult?

[5] ‘International portability’ – nice term, but what does it mean?

[6] I get the impression that many chiropractors do not know what is meant by the term ‘ethics’.

[7] But they certainly know much about business!

[8] That is, I think, the most relevant statement in the entire text – see below.

[9] Like those by NICE which no longer recommend chiropractic for back pain? No? They are not ‘high quality’? I see, only those that recommend chiropractic fulfil this criterion!

[10] Chiropractors as leaders? Really? With their (largely ineffective) manipulations as the main contribution to the field? You have to be a chiropractor to find this realistic, I guess.

[11] Again ‘evidence-informed’ instead of ‘evidence-based’ – who are they trying to kid?

[12] The evidence that has been emerging since many years is that chiropractic manipulations fail to generate more good than harm.

[13] In the past, I got the impression that critical thinking and chiropractic are a bit like fire and water.

MY CONCLUSION FROM ALL THIS

What we have here is, in my view, little more than a mixture between politically correct drivel and wishful thinking. If chiropractors truly want chiropractic educational curricula to “reflect current evidence”, they need to teach the following main tenets:

  • Chiropractic manipulations have not been shown to be effective for any of the conditions they are currently used for.
  • Other forms of treatment are invariably preferable.
  • Subluxation, as defined by chiropractors, is a myth.
  • Spine-related disorders, as taught in many chiropractic colleges, are a myth.
  • ‘Evidence-informed’ is a term that has no meaning; the proper word is ‘evidence-based’ – and evidence-based chiropractic is a contradiction in terms.

Finally, chiropractors need to be aware of the fact that any curriculum for future clinicians must include the core elements of critical assessment and medical ethics. The two combined would automatically discontinue the worst excesses of chiropractic abuse, such as the promotion of bogus claims or the financial exploitation of the public.

But, of course, none of this is ever going to happen! Why? Because it would mean teaching students that they need to find a different profession. And this is why I feel that statements like the above are politically correct drivel which can serve only one purpose: to distract everyone from the fundamental problems in that profession.

The WDDTY is not my favourite journal – far from it. The reason for my dislike is simple: far too many of its articles are utterly misleading and a danger to public health. Take this recent one entitled ‘Paleo-type diet reversing Crohn’s and ulcerative colitis’, for instance:

START OF QUOTE
Crohn’s disease and ulcerative colitis are being reversed solely by diet—essentially a Paleo diet. The non-drug approach has been successful in 80 per cent of children who’ve been put on the special diet.

The diet—called the specific carbohydrate diet (SCD)—has been pioneered by Dr David Suskind, a gastroenterologist at Seattle Children’s Hospital. The diet excludes grains, dairy, processed foods and sugars, other than honey, and promotes natural, nutrient-rich foods, including vegetables, fruits, meats and nuts.

Children are going into complete remission after just 12 weeks on the diet, a new study has discovered. Ten children with inflammatory bowel disease (IBD)—an umbrella term for Crohn’s and ulcerative colitis—were put on the diet, and eight were completely symptom-free by the end of the study. Suskind started exploring a dietary approach to IBD because he became convinced that the standard medical treatment of steroids or other medication was inadequate. “For decades, medicine has said diet doesn’t matter, that it doesn’t impact disease. Now we know that diet does have an impact, a strong impact. It works, and now there’s evidence,” he said.

END OF QUOTE

“For decades, medicine has said diet doesn’t matter, that it doesn’t impact disease”.

Really?

In this case, I must have studied an entirely different subject all these years ago at university – I had been told it was medicine but perhaps…???…!!!

It took me some time to find the original paper – they cited a wrong reference (2017 instead of 2016). But eventually I located it. Here is its abstract:

GOAL:

To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

BACKGROUND:

IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

STUDY:

Pediatric patients with mild to moderate IBD defined by pediatric Crohn’s disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

RESULTS:

Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

CONCLUSIONS:

SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.

What does this mean?

The WDDTY report bears very little resemblance to the journal article (let alone with the title of their article or any other published research by David Suskind).

How come?

I cannot be sure, but I would not be surprised to hear that the latter was ‘egged up’ to make the former appear more interesting.

If that is so, WDDTY are (once again) guilty of misleading the public to the point of endangering lives of vulnerable patients.

SHAME ON EVERY OUTLET THAT SELLS WDDTY, I’d say.

The ACUPUNCTURE NOW FOUNDATION (ANF) has featured on this blog before. Today I want to re-introduce them because I just came across one of their articles which I found remarkable. In it, they define what many of us have often wondered about: the most important myth about acupuncture.

Is it acupuncture’s current popularity, its long history, its mode of action, its efficacy, its safety?

No, here is the answer directly from the ANF:

The most important myth that needs to be put to rest is the idea promoted by a small group of vocal critics that acupuncture is nothing more than a placebo. Many cite the fact that studies showing acupuncture to be highly effective were of low quality and that several higher quality studies show that, while acupuncture was clinically effective, it usually does not outperform “sham” acupuncture. But those studies are dominated by the first quality issue cited above; studies with higher methodological rigor where the “real” acupuncture was so poorly done as to not be a legitimate comparison. Yet despite the tendency toward poor quality acupuncture in studies with higher methodological standards, a benchmark study was done that showed “real” acupuncture clearly outperforming “sham” acupuncture in four different chronic pain conditions.3 When you add this study together with the fact veterinary acupuncture is used successfully in many different animals, the idea of acupuncture only being placebo must now be considered finally disproven. This is further supported by studies which show that the underlying physiological pathways activated by acupuncture sometimes overlap, but can be clearly differentiated from, those activated by placebo responses.

Disappointed?

Yes, I was too.

The myth, according to the ANF, essentially is that sceptics do not understand the scientific evidence. And these blinkered sceptics even go as far as ignoring the findings from what the ANF consider to be a ‘benchmark study’! Ghosh, that’s nasty of them!!!

But, no – the benchmark study (actually, it was not a ‘study’ but a meta-analysis of studies) has been discussed fully on this blog (and in many other places too). Here is what I wrote in 2012 when it was first published:

An international team of acupuncture trialists published a meta-analysed of individual patient data to determine the analgesic effect of acupuncture compared to sham or non-acupuncture control for the following 4 chronic pain conditions: back and neck pain, osteoarthritis, headache, and shoulder pain. Data from 29 RCTs, with an impressive total of 17 922 patients, were included.

The results of this new evaluation suggest that acupuncture is superior to both sham and no-acupuncture controls for each of these conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than those of sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs.

Based on these findings, the authors reached the conclusion that “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”.

… even the enthusiastic authors of this article admit that, when compared to sham, the effect size of real acupuncture is too small to be clinically relevant. Therefore one might argue that this meta-analysis confirms what critics have suggested all along: acupuncture is not a useful treatment for clinical routine.

Unsurprisingly, the authors of the meta-analysis do their very best to play down this aspect. They reason that, for clinical routine, the comparison between acupuncture and non-acupuncture controls is more relevant than the one between acupuncture and sham. But this comparison, of course, includes placebo- and other non-specific effects masquerading as effects of acupuncture – and with this little trick (which, by the way is very popular in alternative medicine), we can, of course, show that even sugar pills are effective.

I do not doubt that context effects are important in patient care; yet I do doubt that we need a placebo treatment for generating such benefit in our patients. If we administer treatments which are effective beyond placebo with kindness, time, compassion and empathy, our patients will benefit from both specific and non-specific effects. In other words, purely generating non-specific effects with acupuncture is far from optimal and certainly not in the interest of our patients. In my view, it cannot be regarded as not good medicine, and the authors’ conclusion referring to a “reasonable referral option” is more than a little surprising in my view.

Acupuncture-fans might argue that, at the very minimum, the new meta-analysis does demonstrate acupuncture to be statistically significantly better than a placebo. Yet I am not convinced that this notion holds water: the small residual effect-size in the comparison of acupuncture with sham might not be the result of a specific effect of acupuncture; it could be (and most likely is) due to residual bias in the analysed studies.

The meta-analysis is strongly driven by the large German trials which, for good reasons, were heavily and frequently criticised when first published. One of the most important potential drawbacks was that many participating patients were almost certainly de-blinded through the significant media coverage of the study while it was being conducted. Moreover, in none of these trials was the therapist blinded (the often-voiced notion that therapist-blinding is impossible is demonstrably false). Thus it is likely that patient-unblinding and the absence of therapist-blinding importantly influenced the clinical outcome of these trials thus generating false positive findings. As the German studies constitute by far the largest volume of patients in the meta-analysis, any of their flaws would strongly impact on the overall result of the meta-analysis.

So, has this new meta-analysis finally solved the decades-old question about the effectiveness of acupuncture? It might not have solved it, but we have certainly moved closer to a solution, particularly if we employ our faculties of critical thinking. In my view, this meta-analysis is the most compelling evidence yet to demonstrate the ineffectiveness of acupuncture for chronic pain.

END OF QUOTE

The ANF-text then goes from bad to worse. First they cite the evidence from veterinary acupuncture as further proof of the efficacy of their therapy. Well, the only systematic review in this are is, I think, by my team; and it concluded that there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals. Some encouraging data do exist that warrant further investigation in independent rigorous trials.

Lastly, the ANF mentions acupuncture’s mode of action which they seem to understand clearly and fully. Congratulations ANF! In this case, you are much better than the many experts in basic science or neurology who almost unanimously view these ‘explanations’ of how acupuncture might work as highly adventurous hypotheses or speculations.

So, what IS the most important myth about acupuncture? I am not sure and – unlike the ANF – I do not feel that I can speak for the rest of the world, but one of the biggest myths FOR ME is how acupuncture fans constantly manage to mislead the public.

In real medicine, most doctors view telephone consultations as highly problematic and would use them but in emergency situations or when there is no realistic other choice. Not so in homeopathy! Here telephone consultations are actively promoted my many – many who have a financial interest in it, that is.

Take this press-release, for instance; I have slightly abbreviated the text but abstained from correcting the many mistakes to give you a realistic impression of the high standard of the firm offering it.

START OF QUOTE

Solviva Health is an online treatment initiative based on…  homeopathy. Since homeopathy’s introduction by Samuel Hahnemann in 1796, the popularity of this system is growing day by day [1]. According to World Health Organization, homoeopathy is the second largest system of medicine in the world [1]. India is one among the top nations to adopt this technique of curing and describes it as a natural way of healing. Solviva Health is an online homeopathic treatment platform that interacts with their patients through online initiatives like emails, video conferencing, web chat, telephonic and all other possible communication sources. The main motto of this initiative is to provide medical services not only to the local people of Mohali but also to extend the reach of this quality treatment to rest of India & all across the world. It’s one amongst very few genuine platforms to avail the world class homeopathic medical services without visiting the doctors…

Whenever you need an expert guidance, the doctor is just a phone call away.

The medical team present under SolvivaHealth is well-known personalities in their respective field. The clinic specializes in Allergies, Polycystic ovarian disease, Female disorders, Rheumatoid arthritis, Joint problems & Child disorders. Suppose, “Before a specified team of doctors has to handle a particular case, the patient can check all the doctors’ detail for testimonial verifications, which are available online on the official website.” As per many sources, homeopathic treatment do not have side-effects and one of the safe & reliable way to tackle Allergies, Asthma, Female Disorders which are usually not having any cure in Allopathy… “Solviva Health provides the much awaited first Indian homeopathy online consultancy treatment services, which allows you to get all the precise treatment at the comfort of your home.”

Solviva Health is one of the first of it’s kind in India that offers treatment via online or telephonic interactions between doctors and patients. They have successfully completed 3 years in offering quality homeopathic treatment services with a patient satisfaction rate of 95%.

END OF QUOTE

I am sure that Hahnemann would be turning in his Parisian grave, if he knew about this. He and most of his followers have always stressed the importance of taking a long and detailed history during an empathetic, personal encounter with the patient.

But there is another important aspect here to consider: telephone consultations are by definition devoid of any physical examination of the patient by the clinician. I know that, generally speaking, homeopaths attach much less importance to physically examining their patients. I always have found this odd and borderline negligent. To omit them completely is no longer borderline but crosses the line into unethical behaviour, I think.

To me, it seems as though Solviva Health (and all the other firms that offer homeopathy by telephone) have found a method of maximising their income, while minimising the already meagre benefit of homeopathy. As we all know, if homeopathy has any positive effects on patients, it is through the personal encounter with an empathetic clinician. Telephone services are likely to be far less effective than fact-to-face consultations at building constructive therapeutic relationships.

Yes, the festive season is upon us and therefore it is high time to discuss detox (yet again). As many of us are filling their fridges to the brim, most of us prepare for some serious over-indulgence. Following alt med logic, this must prompt some counter-measures, called detox.

The range of treatments advocated by detox-fans is weird and wide (see also below):

  • various alternative diets,
  • herbal, vitamins, minerals and other ‘natural’ supplements,
  • various forms of chelation therapy,
  • electromagnetic devices,
  • colonic irrigation and enemas,
  • various forms of skin bruising,
  • cupping,
  • sauna and other means of inducing extensive sweating,
  • homeopathy,
  • ear candles,
  • foot-baths,
  • etc., etc.

I suppose it was to be expected that detox often goes with other crazy beliefs. This website, for instance, shows that it is even associated with anti-vaxx:

START OF QUOTE

Whether you believe vaccines to be harmful or not, one has to admit that all the ingredients added to vaccines cannot be good for anyone, especially children.

As David Wolfe has discussed, vaccines contain the following: sucrose, fructose, dextrose, potassium phosphate, aluminum potassium sulfate, peptone, bovine extract, formaldehyde, FD&C Yellow #6, aluminum lake dye, fetal bovine serum, sodium bicarbonate, monosodium glutamate, aluminum hydroxide, benzethonium chloride, lactose thimerosal, ammonium sulfate, formaldehyde, glutaraldehyde, bovine extract), calf serum, aluminum phosphate, aluminum hydroxyphosphate sulfate, and ethanol.

That is a long scary list and many of these things will not leave the body naturally. Thus, a gentle detox is necessary.

Detoxification Bath

Living Traditionally suggests a detoxification bath with both Zendocrine and epsom salt. Zendocrine is an essential oil mixture made up of tangerine, rosemary, geranium, juniper berry, and cilantro. Rosemary, juniper berry, and cilantro are good choices for detoxification and tangerine and geranium are purifiers.

Garlic

Garlic has been scientifically proven to treat heavy metal poisoning. Organic Lifestyle Magazine suggests consuming three cloves a day to help remove toxins.

Silica

Silica is also good for a heavy metal detox. Natural News states, “Aluminum (Al) is passed out through the urine when one supplements silica. It seems there’s little danger of taking too much, as long as adequate water is consumed and vitamin B1 and potassium levels are maintained.”

One of the best ways to get silica in your system is with the horsetail herb, rye, barley, oats, wheat, and alfalfa sprouts nuts.

Chlorella

Chlorella is one of the best detoxifying substances available. According to Dr. Mercola, “Chlorella is uniquely designed to not bind to the minerals your body naturally needs to function optimally. It does not bind to beneficial minerals like calcium, magnesium, or zinc. It’s almost as if chlorella knows which metals belong in your body and which chemicals need to be removed. Supplementing with chlorella is like unleashing a tiny army inside your body to fight the battle of removing toxins from your tissues and ushering them back outside your body where they belong.”
You can take it in supplement form or add a powdered version to your smoothie.

Probiotics

Probiotics are what is needed to put good bacteria system to rights when it has been thrown off by toxins. “They can provide assistance by decreasing the number of bad bacteria while helping to restore balance between good and bad bacteria in the gut and to keep your body functioning properly.” (LiveStrong)

Some probiotic foods include: organic yogurt, kefir, sauerkraut, kombucha, and fermented vegetables.

Omega-3

Omega 3 oils are especially good for cell repair and keeping your brain healthy. This is because of their high fat content is similar to the fats that are naturally part of cell and brain systems. (Daily Mail)

A teaspoon daily should be enough or you could take a supplement.

Cilantro

According to Natural Society, cilantro is a very gentle detoxification tool. It is also effective for removing heavy metals from the brain.
For 2-3 weeks, add a teaspoon of cilantro to your food, smoothie, or just eat it up. You can also substitute with 6-7 drops of cilantro essential oil by adding it to your bath.

END OF QUOTE

Don’t you just adore the sources quoted by the author as evidence for his/her statements?

As I said, the therapies recommended for detox are diverse. Yet, they have one important feature in co<span style=”color: #668a1d;”>mmon: they are not based on anything remotely resembling good evidence. As I stressed in my article of 2012:

The common characteristics of all of these approaches are that they are unproved. Even experts who are sympathetic to alternative medicine and AD admit: ‘while there are hundreds of randomized controlled trials on drug and alcohol detox, there are no such trials of detox programs focusing on environmental toxins … at present, “detox” is certainly more of a sales pitch than a science’. The ‘studies’ of AD that have been published are of such poor methodological quality that no conclusions can be drawn from them.

While there is a total absence of sound evidence for benefit, some of these treatments have been associated with risks which depend on the nature of the treatment and can be particularly serious with diets (malnutrition), supplements (hepatoxicity), chelation (electrolyte depletion) and colonic irrigation (perforation of the colon).

Yet detox is big business’. A recent survey, for instance, suggested that 92% of US naturopaths use some form of detox. To lay people, its principles seem to make sense and, in many of us, the desire to ‘purify’ ourselves is deep rooted. Thus detox-entrepreneurs (including Prince Charles who, several years ago, launched a ‘Detox-Tincture’ via his firm Duchy Originals) are able to exploit a gullible public.

Proponents of detox are keen to point out that ‘a modern science of ‘detoxicology’ seems to be emerging’. If there is such a thing, it should address the following, fundamental questions:

  • What are the toxins and toxicants?
  • What evidence exists that they damage our health?
  • How do we quantify them?
  • How do we diagnose that a patient requires detox?
  • Which treatments are effective in eliminating which toxins?

Currently, there is insufficient evidence to answer any of these questions. Until this situation changes, I do not think a ‘science of detox’ exists at all.

Yesterday I received an electronic Christmas card from two homeopathic institutions called ‘Homeopathic Associates and The Homeopathic College’. It read: WISHING YOU THE BEST OF HEALTH AND HAPPINESS FOR THE NEW YEAR!

Naturally I was puzzled, particularly since I had no recollection of ever having been in contact with them. The card was signed by Manfred Mueller, MA, DHM, RSHom(NA), CCH, and I decided to find out more about this man. It turns out that Manfred Mueller developed The Mueller Method or “Extra-Strength Homeopathy” to meet today’s complex chronic conditions, drug induced disorders, vaccine injuries, toxic overload, radiation-induced health problems, cancers, etc.

Now, this sounds interesting, I thought, and read on. Just a few clicks further, Mueller offers his wisdom on homeopathic cancer treatments in a lengthy article entitled ‘Is Homeopathy an Effective Cancer Treatment?

According to Mueller, the answer to his question is a clear yes. I will spare you the torture of reading the entire paper (if you have masochistic tendencies, you can read it via the link I provided above); instead, I will just copy Mueller’s conclusion:

START OF QUAOTE

Laboratory studies in vitro and in vivo show that homeopathic drugs, in addition to having the capacity to reduce the size of tumors and to induce apoptosis, can induce protective and restorative effects. Additionally homeopathic treatment has shown effects when used as a complementary therapy for the effects of conventional cancer treatment. This confirms observations from our own clinical experience as well as that of others that when suitable remedies are selected according to individual indications as well as according to pathology and to cell-line indications and administered in the appropriate doses according to the standard principles of homeopathic posology, homeopathic treatment of cancer can be a highly effective therapy for all kinds of cancers and leukemia as well as for the harmful side effects of conventional treatment. More research is needed to corroborate these clinical observations.

Homeopathy over almost two decades of its existence has developed more than four hundred remedies for cancer treatment. Only a small fraction have been subjected to scientific study so far. More homeopathic remedies need to be studied to establish if they have any significant action in cancer. Undoubtedly the next big step in homeopathic cancer research must be multiple comprehensive double-blinded, placebo-controlled, randomized clinical trials. To assess the effect of homeopathic treatment in clinical settings, volunteer adult patients who prefer to try homeopathic treatment instead of conventional therapy could be recruited, especially in cases for which no conventional therapy has been shown to be effective.

Many of the researchers conducting studies — cited here but not discussed — on the growing interest in homeopathic cancer treatment have observed that patients are driving the demand for access to homeopathic and other alternative modes of cancer treatment. So long as existing cancer treatment is fraught with danger and low efficacy, it is urgent that the research on and the provision of quality homeopathic cancer treatment be made available for those who wish to try it.

END OF QUOTE

Amazing! What could be more wrong than this?

But it’s the season of joy and love; so, let’s not go into the embarrassing details of this article. Instead, I feel like returning the curtesy of Mr Mueller’s Christmas card. Therefore, I have decided to post this open ‘Christmas card’ to him:

Dear Mr Mueller,

thank you for your card, the good wishes, and the links you provided to your websites, articles, etc. I only read the one on cancer but was impressed. It is remarkably misguided, unethical and dangerous. Crucially, it has the potential to shorten the lives of many desperate patients. I therefore urge you to desist making your opinions public or from applying them in your clinical practice. I say this not merely because I am concerned about the patients that have the misfortune to fall into your hands, but also to prevent you from getting into trouble for immoral, unethical or unlawful behaviour.

In this spirit, I wish you happiness for the New Year.

Edzard Ernst

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