MD, PhD, FMedSci, FSB, FRCP, FRCPEd

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The title of the press-release was impressive: ‘Columbia and Harvard Researchers Find Yoga and Controlled Breathing Reduce Depressive Symptoms’. It certainly awoke my interest and I looked up the original article. Sadly, it also awoke the interest of many journalists, and the study was reported widely – and, as we shall see, mostly wrongly.

According to its authors, the aims of this study were “to assess the effects of an intervention of Iyengar yoga and coherent breathing at five breaths per minute on depressive symptoms and to determine optimal intervention yoga dosing for future studies in individuals with major depressive disorder (MDD)”.

Thirty two subjects were randomized to either the high-dose group (HDG) or low-dose group (LDG) for a 12-week intervention of three or two intervention classes per week, respectively. Eligible subjects were 18–64 years old with MDD, had baseline Beck Depression Inventory-II (BDI-II) scores ≥14, and were either on no antidepressant medications or on a stable dose of antidepressants for ≥3 months. The intervention included 90-min classes plus homework. Outcome measures were BDI-II scores and intervention compliance.

Fifteen HDG and 15 LDG subjects completed the intervention. BDI-II scores at screening and compliance did not differ between groups. BDI-II scores declined significantly from screening (24.6 ± 1.7) to week 12 (6.0 ± 3.8) for the HDG (–18.6 ± 6.6; p < 0.001), and from screening (27.7 ± 2.1) to week 12 (10.1 ± 7.9) in the LDG. There were no significant differences between groups, based on response (i.e., >50% decrease in BDI-II scores; p = 0.65) for the HDG (13/15 subjects) and LDG (11/15 subjects) or remission (i.e., number of subjects with BDI-II scores <14; p = 1.00) for the HDG (14/15 subjects) and LDG (13/15 subjects) after the 12-week intervention, although a greater number of subjects in the HDG had 12-week BDI-II scores ≤10 (p = 0.04).

The authors concluded that this dosing study provides evidence that participation in an intervention composed of Iyengar yoga and coherent breathing is associated with a significant reduction in depressive symptoms for individuals with MDD, both on and off antidepressant medications. The HDG and LDG showed no significant differences in compliance or in rates of response or remission. Although the HDG had significantly more subjects with BDI-II scores ≤10 at week 12, twice weekly classes (plus home practice) may rates of response or remission. Although the HDG, thrice weekly classes (plus home practice) had significantly more subjects with BDI-II scores ≤10 at week 12, the LDG, twice weekly classes (plus home practice) may constitute a less burdensome but still effective way to gain the mood benefits from the intervention. This study supports the use of an Iyengar yoga and coherent breathing intervention as a treatment to alleviate depressive symptoms in MDD.

The authors also warn that this study must be interpreted with caution and point out several limitations:

  • the small sample size,
  • the lack of an active non-yoga control (both groups received Iyengar yoga plus coherent breathing),
  • the supportive group environment and multiple subject interactions with research staff each week could have contributed to the reduction in depressive symptoms,
  • the results cannot be generalized to MDD with more acute suicidality or more severe symptoms.

In the press-release, we are told that “The practical findings for this integrative health intervention are that it worked for participants who were both on and off antidepressant medications, and for those time-pressed, the two times per week dose also performed well,” says The Journal of Alternative and Complementary Medicine Editor-in-Chief John Weeks

At the end of the paper, we learn that the authors, Dr. Brown and Dr. Gerbarg, teach and have published Breath∼Body∼Mind©, a technique that uses coherent breathing. Dr. Streeter is certified to teach Breath∼Body∼Mind©. No competing financial interests exist for the remaining authors.

Taking all of these issues into account, my take on this study is different and a little more critical:

  • The observed effects might have nothing at all to do with the specific intervention tested.
  • The trial was poorly designed.
  • The aims of the study are not within reach of its methodology.
  • The trial lacked a proper control group.
  • It was published in a journal that has no credibility.
  • The limitations outlined by the authors are merely the tip of an entire iceberg of fatal flaws.
  • The press-release is irresponsibly exaggerated.
  • The authors have little incentive to truly test their therapy and seem to use research as a means of promoting their business.

On their website, ‘CBC News’ just published an article that is relevant to much what we have been discussing here. I therefore take the liberty of showing you a few excerpts:

START OF QUOTES

…A CBC News analysis of company websites and Facebook pages of every registered chiropractor in Manitoba found several dozen examples of statements, claims and social media content at odds with many public health policies or medical research.

Examples include:

  • Offers of treatments for autism, Tourette’s syndrome, Alzheimer’s disease, colic, infections and cancer.
  • Anti-vaccination literature and recently published letters to the editor from chiropractors that discourage vaccination.
  • An article claiming vaccines have caused a 200 to 600 per cent increase in autism rates.
  • A statement that claims the education and training of a chiropractor is “virtually identical” to that of a medical doctor.
  • Discouraging people from getting diagnostic tests such as CT scans, colonoscopies and mammograms.
  • An informational video discouraging the use of sunscreen.

…”It misleads the public in two areas. Firstly, those who choose to go for chiropractic care, particularly for things like infection and autism and things that we know they’re not going to be beneficial for, it misleads those individuals and gives them false hope for treatment that will not be effective,” he [Dr. Alan Katz, director of the Manitoba Centre for Health Policy] said. “Putting these things up on their website also puts the doubt in the minds of others about what we do know works, and as a result those people may not seek the right type of care for conditions that could deteriorate if they don’t seek that care.”

The Manitoba Chiropractors Association declined an interview request but did say it would review the content.

health-care-lies

This image disparaging medical treatments and physicians appeared on a chiropractor’s clinic Facebook page.

…The Manitoba Chiropractors Association has previously addressed certain issues with its membership through an internal communication. “In Manitoba, the administration of ‘vaccination and immunization’ currently falls outside the scope of chiropractic practice,” the communication said. It also cautioned members that:

  • “Chiropractors may be liable for opinions they provide to patients/public in circumstances where it would be reasonably foreseeable that the individual receiving the opinion would rely on it.
  • “Providing professional opinions on the issue of vaccination and immunization would likely be found by a court to be outside the scope of practice of a chiropractor.”

The association also said, “The degree to which a chiropractor can or cannot discuss ‘vaccination and immunization’ or other health-care procedures that are outside the scope of practice with a patient is currently being reviewed by the board of directors.”…

fluoride-hitler

A local chiropractor shared this message on their company Facebook page. Health Canada says fluoride concentrations in drinking water do not pose a risk to human health and are endorsed by over 90 national and international professional health organizations. (Facebook)

The fact that members of a regulated health profession are actively disseminating questionable medical information while benefiting from public funds is cause for concern, Katz said. “Should we as a society be paying for the services of professionals, and I use that word loosely, that are advocating care that is contrary to the official public policy?”

 

fever-baby-ad

Information on fevers posted online by a Manitoba chiropractor. The College of Family Physicians of Canada says that if a infant has a temperature of 100.4°F (38°C) or higher to call the doctor or immediately go to an emergency room.

…A letter by Winnipeg chiropractor Henri Marcoux was published last February in Manitoba’s francophone weekly newspaper La Liberté, in response to an article in which a regional health authority expert was interviewed about influenza immunizations.

Marcoux wrote that he does not recommend flu vaccines, calling them “toxic.” He further stated that the flu virus actually “purifies our systems” and said that he believes flu vaccines are “driven by a vast operation orchestrated by pharmaceutical companies.” People should instead focus on general wellness — which includes chiropractic treatment — to stave off the flu, he wrote.

treating-chiro…Now-retired chiropractor and long-time anti-vaccination advocate Gérald Bohémier wrote a later letter in support of Marcoux that also appeared in La Liberté.

Letters then poured in from members of the community, including a resident and two physicians who took exception to these statements. Marcoux told the CBC’s French service, Radio-Canada, that he does not believe his views are at odds with public health. He stands by his letter, he said, adding if society as a whole took health and wellness more seriously — rather than trying to treat symptoms — the need for vaccines would dissipate or never would have existed in the first place…

END OF QUOTES

Some chiropractors will respond that this is Canada and that elsewhere the situation is much better. I fear that this is not necessarily true – and if it is better in the UK, it is not because of the efforts of chiropractors or their professional organisations. In the UK, the situation has improved because of the work of organisations such as the Nightingale Collaboration and The Good Thinking Society. Likewise, in other countries, progress is being generated not by chiropractors but by critical thinkers and critics of quackery.

Homeopaths have, as I reported previously, claimed to be able to ‘cure’ homosexuality. This is why I was less amazed than you might be when I came across a comment about a woman who tried a homeopathic solution called Dr. Reckeweg R20 Glandular Drops for Women. Nonetheless, the story is so remarkable that I cannot resist sharing it with you.

The solution promises to fix pituitary dysfunction, goiters, obesity, Grave’s diseases, Addison’s disease, and “lesbian tendencies.” The product also brags that it is “derived and potentised from fetal tissues.”

A much more detailed description of the remedy in question can be found here:

Dr. Reckeweg R20 Glandular drops for women, goitre, endocrine dysfunction, Graves disease, addisons disease, Adiposity (Overweight)

Dr Reckeweg R20 Glandular drops are indicated for frigidity in women. Dr.Reckeweg R20 drops treats endocrine dysfunction in women through individual remedies like Glandulae suprarenaises, Hypophysis that is derived and potentised from fetal tissues based on Arndt-Schulz principle. Also indicated for growth disturbances, obesity due to pituitary dysfunction, Goiter (swelling in neck due to thyroid enlargement), Grave’s diseases (auto immune disease from hyperthyroidism), Addison’s disease (due to deficient hormones from adrenal cortex), myxoedema (swelling due to under active thyroid glands), etc.

Introduction The disorders of glands in the human body can affect the physiological functions due to excess or deficient hormones. This occurs when glands like the adrenal or pituitary do not function properly resulting in too much or too little hormones being released. This includes important HORMONEs like cortisol aldosterone and sex hormones produced by adrenal gland and Growth hormone, Prolactin, Adrenocorticotropin (ACTH), Thyroid-stimulating hormone (TSH). For example too much aldosterone increases blood pressure whereas Adrenal insufficiency results in fatigue, muscle weakness, decreased appetite, and weight loss. Pituitary glandtumor is another manifestation of The disorders of glands in the human body and is fairly common in adults.

About Dr.Reckeweg R 20 drops is a popular homeopathic medicine to treat disorders of glands in human body and acts through a proprietary blend of several homeopathic herbs (available in drops). It has key Ingredients like hypophysis, pancreas etc that act on endocrine dysfunction, obesity that is caused due to pituitary dysfunction, growth disturbances. It is also indicated for swelling of the neck resulting from enlargement of the thyroid gland (goiter), swelling of the neck and protrusion of the eyes resulting from an overactive thyroid gland (Graves disease), disease characterized by progressive anemia, low blood pressure, great weakness, and bronze discoloration of the skin (Addisons disease) and swelling of the skin and underlying tissues giving a waxy consistency (myxoedema).

Indicated for following medical conditions Adiposity (Overweight), Disturbances of endocrive gland, Disturbances of gland,Obesity (Overweight)

INGREDIENTS: Dr.Reckeweg R 20 drops for women contains: Glandulae Thymi D12, Thyreoidinum D12, Hypophysis D12, Pancreas D12, Glandulae Supratenales D12, Ovaria D12 In R 20.

How the ingredients in Dr.Reckeweg R 20 drop work? The key properties in Dr.Reckeweg R 20 drops are derived from the following ingredients to treat disorders of glands in women

Glandulae suprarenales – treats abnormal physical weakness (asthenia), reduction of weight and condition causing abnormal weakness of certain muscles (myasthenia). It also treats asthma, allergic conditions, deficiency of glucose in the bloodstream (hypoglycaemia) and abnormal increase in muscle tension and a reduced ability of a muscle to stretch (hypertonia).

Hypophysis – it helps to control internal secretion, contents of the lactic acid in blood, mineralization and fluidic content of body.

Pancreas – treats pancreatic diabetes and stimulates production of the digestive secretions.

Testes (male) or Ovaria (female) – treats disorders of glands in human body such as senility (condition of being senile i.e. old age), inclining potency (male’s ability to achieve an erection or to reach orgasm), faulty memory, functional disturbances of glands. It also treats depression, inferiority complex, and condition in which one or both of the testes fail to descend from the abdomen (cryptorchidism), nocturnal involuntary urination (enuresis) and sexual dysfunction to maintain an erection of the penis (impotency).

Treats the failure of a female to respond to sexual stimulus (frigidity), lesbian tendencies, congestion and faulty circulation

It also reduces the hyperactivity of pituitary (hypophysis).

Glandulae thyme – treats exhaustion and congenital disorder arising from a chromosome defect, causing intellectual impairment and physical abnormalities (mongolism).

Thyreoidinum – it regulates thyroid gland, myxoedema, and interrupted development of the thyroid gland. It also treats condition of having low body temperature (hypothermy), excess of cholesterol in the bloodstream (hypercholesterolaemia) and retarded intellectual development.

DOSAGE: Generally 3 times daily 10 to 15 drops of Dr.Reckeweg R 20 in some water.

Complimentary medicines to R20: R26 drops (to increase reactivity after debilitating illness), R59 (in obesity)

SIZE:. 22 ML sealed Bottle

Encouraged by such scientific-sounding words, the women in question gives the remedy a try. By day four of the treatment, she writes, “At 3 AM, I find myself singing along to ‘You wanna see cunt, you wanna see pussy’ with someone else’s lipstick on my face.”

The conclusion of the author of the article is this: “So it looks like homeopathic fetus water does not in fact cure lesbianism. Still, as far as gay conversion therapy treatments go, it’s pretty tame — there’s no exorcism or electrocution, at least.”

I am sure by now you wonder about the Reckeweg remedy line. Here are two short paragraphs from my book to explain:

Dr. Reckeweg was a German homeopathic physician who practised complex homeopathy and developed homotoxicology as well as homaccorde, i. e. the administration of multiple potencies of the same remedies in one single preparation. He started a commercially successful line of combination remedies. The remedies are recommended for conventional diagnostic indications, but treated with homeopathically manufactured mixtures. According to proponents, they therefore built a bridge between conventional and homeopathic medicine. In the early 1970s, Reckeweg sold 50% of his company to the Delton Group and moved to the US.

Homotoxicology is a method inspired by homeopathy which was developed by Hans Heinrich Reckeweg (1905 – 1985). He believed that all or most illness is caused by an overload of toxins in the body. The toxins originate, according to Reckeweg, both from the environment and from the malfunction of physiological processes within the body. His treatment consists mainly in applying homeopathic remedies which usually consist of combinations of single remedies, because health cannot be achieved without ridding the body of toxins. The largest manufacturer and promoter of remedies used in homotoxicology is the German firm Heel.

And to put some icing on this cake: Heel was, of course, one of the firms who financed a journalist for systematically defaming me (more here, here and here).

The British Chiropractic Association (BCA) has lost all credibility after suing Simon Singh for drawing the public’s attention to the fact that they were ‘happily promoting bogus treatments’. Now, it seems, they are trying to re-establish themselves with regular, often bogus or dubious pronouncements about back pain. It looks as though they have learnt nothing. A recent article in THE INDEPENDENT is a good example of this ambition, I think:

START OF QUOTE

Skinny jeans and coats with big fluffy hoods can contribute to painful back problems, chiropractors have warned.

Nearly three-quarters of women have experienced back pain, according to a survey by the British Chiropractic Association (BCA), who said fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame.

Wearing very tight jeans can restrict mobility and force other muscles to strain as they try to compensate for the resulting change in posture, chiropractor Rishi Loatey told The Independent.

“If they’re incredibly tight, you won’t be able to walk as you normally would,” he said.

“You’ve got a natural gait, or stride, that you would take, and the knee, hip and lower back all move to minimise the pressure coming up through the joints.

“However, if one of those areas isn’t moving as it should be, it’s going to cause more pressure elsewhere.”

While 73 per cent of women from a sample of more than 2,000 said they have had back pain, more than a quarter – 28 per cent – said they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.

Lower back pain is the most common cause of disability worldwide, with 9.4 per cent of people suffering from it, according to a previous study.

High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.

A number of high-profile campaigns against “sexist” dress codes requiring women to wear high heels at work have made reference to this fact.

But backless shoes, flimsy ballet pumps and some soft boots can also damage your back if they are worn too often, said Mr Loatey.

“If you imagine the back of a shoe, the bit that goes round the back is supposed to be quite firm, so it grips the rear foot,” he said. “If you don’t have that, then your foot is more mobile in the shoe.”

“If they’re not the right size, they’re a bit loose or they don’t have the bit at the back, you’re almost gripping the shoe as you walk, which again changes the way you walk,” said Mr Loatey, adding that ideally shoes should be laced up at the front to make sure the foot is held firmly.

A third of women surveyed by the BCA were unaware that their clothing choices could harm their backs and necks.

Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.

They should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead, he said.

END OF QUOTE

This piece strikes me as pure promotion of chiropractic – health journalism at its worse, I’d say. What is more objectionable than the promotion, it is full of half truths, ‘alternative facts’ and pure invention. Let me list a few statements that I find particularly doggy:

  1. “Skinny jeans and coats with big fluffy hoods can contribute to painful back problems.” Do they have any evidence for this? I don’t know of any!
  2. “…fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame [for back problems].” Idem!
  3. “Wearing very tight jeans can restrict mobility and force other muscles to strain…” Idem!
  4. “…it’s going to cause more pressure elsewhere.” Idem!
  5. 28% of women said “they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.” To make the findings from a survey look like scientific evidence for cause and effect is at best misleading, at worst dishonest.
  6. “…according to a previous study“. It turns out that this previous study was of occupational back pain which has nothing to do with tight jeans etc.
  7. “High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.” A link to the evidence would be nice – if there is any.
  8. “But backless shoes, flimsy ballet pumps and some soft boots can also damage your back – if they are worn too often…” Evidence needed – if there is any.
  9. “Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.” Concrete recommendations require concrete evidence or a link to it.
  10. Women “should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead.” Idem.

At this point congratulations are in order, I feel.

Firstly to THE INDEPENDENT for publishing one of the most inadequate health-related article which I have seen in recent months.

Secondly to the BCA for their stubborn determination to ‘happily promoting bogus’ notions. Instead of getting their act together when found out to advertise quackery in 2008, they sued Simon Singh (unsuccessfully, I hasten to add). Instead of cutting out the nonsense once and for all, they now promote populist ‘alternative facts’ about the causes of back pain. Instead of behaving like a professional organisation that promotes high standards and solid evidence, they continue to do the opposite.

One cannot but be impressed with so much intransigence.

On 13 March, the UK Charity Commission published the following announcement:

This consultation is about the Commission’s approach to deciding whether an organisation which uses or promotes CAM therapies is a charity. For an organisation to be charitable, its purposes must be exclusively charitable. Some purposes relate to health and to relieve the needs of the elderly and disabled.

We are seeking views on:

  • the level and nature of evidence to support CAM
  • conflicting and inconsistent evidence
  • alternative therapies and the risk of harm
  • palliative alternative therapy

Last year, lawyers wrote to the Charity Commission on behalf of the Good Thinking Society suggesting that, if the commission refused to revoke the charitable status of organisations that promote homeopathy, it could be subject to a judicial review. The commission responded by announcing their review which will be completed by 1 July 2017.

Charities must meet a “public benefit test”. This means that they must be able to provide evidence that the work they do benefits the public as a whole. Therefore the consultation will have to determine what nature of evidence is required to demonstrate that a CAM-promoting charity provides this benefit.

In a press release, the Charity Commission stated that it will consider what to do in the face of “conflicting or inconsistent” evidence of a treatment’s effectiveness, and whether it should approach “complementary” treatments, intended to work alongside conventional medicine, differently from “alternative” treatments intended to replace it. In my view, however, this distinction is problematic and often impossible. Depending on the clinical situation, almost any given alternative therapy can be used both as a complementary and as an alternative treatment. Some advocates seem to cleverly promote their therapy as complementary (because this is seen as more acceptable), but clearly employ it as an alternative. The dividing line is often far too blurred for this distinction to be practical, and I have therefore long given up making it.

John Maton, the commission’s head of charitable status, said “Our consultation is not about whether complementary and alternative therapies and medicines are ‘good’ or ‘bad’, but about what level of evidence we should require when making assessments about an organisation’s charitable status.” Personally, I am not sure what this means. It sounds suspiciously soft and opens all sorts of escape routes for even the most outright quackery, I fear.

Michael Marshall of the Good Thinking Society said “We are pleased to see the Charity Commission making progress on their review. Too often we have seen little effective action to protect the public from charities whose very purpose is the promotion of potentially dangerous quackery. However, the real progress will come when the commission considers the clear evidence that complementary and alternative medicine organisations currently afforded charitable status often offer therapies that are completely ineffective or even potentially harm the public. We hope that this review leads to a policy to remove such misleading charities from the register.”

On this blog, I have occasionally reported about charities promoting quackery (for instance here, here and here) and pointed out that such activities cannot ever benefit the public. On the contrary, they are a danger to public health and bring many good charities into disrepute. I would therefore encourage everyone to use this unique occasion to write to the Charity Commission and make their views felt.

 

The notorious tendency of pharmacist to behave like shop-keepers when it comes to the sale of bogus remedies has been the subject of this blog many times before. In my view, this is an important subject, and I will therefore continue to report about it.

On the website of the AUSTRALIAN JOURNAL OF PHARMACY (AJP), we find interesting new data on Australian pharmacists’ love affair with bogus alternative medicine. The AJP recently ran a poll asking readers: “Do you stock Complementary Medicines (CMs) in your pharmacy?” The results of this little survey so far show that 54% of all participating pharmacists say they stock CMs, including homeopathic products. About a quarter (28%) of respondents stock CMs but not homeopathic products. And 9% said they “only stock evidence-based CMs”. Three percent completely refuse to stock CMs, while 2% stock them but with clear in-store labels saying that they may not work. One person stated they stock CMs but have recently decided to no longer do so.

The President of the Pharmaceutical Society of Australia (PSA) Joe Demarte commented on these findings: “The latest survey results, showing over 40% of pharmacists are adhering to PSA’s Code of Ethics on complementary medicines, are very encouraging… However it’s disappointing that some pharmacists are still stocking homeopathy products, which are not supported by PSA’s Code of Ethics or our Position Statement on Complementary Medicines… Irrespective of the products stocked in a pharmacy, the important thing is when discussing the use of complementary medicines with consumers, pharmacists must ensure that consumers are provided with the best available information about the current evidence for efficacy, as well as information on any potential side effects, drug interactions and risks of harm… It’s important for pharmacists to provide a fair, honest and balanced view of the current evidence available on all complementary medicines,” Demarte added.

NSW pharmacist Ian Carr, who is a member of the Friends of Science in Medicine group, commented that many pharmacists may not have much choice when it comes to stocking complementary and alternative medicines. “CMs policy is not being filtered through the professional assessment of the pharmacist… It’s basically a business deal with the franchise, and as a pharmacist taking on a franchise you’ve basically got to sign those rights away about what you get to sell. Some of the chains offer basically everything that is available, no questions asked. As an independent pharmacist I am able to make my own decisions about what to stock… We’ve got a ‘de-facto’ corporatisation happening with marketing groups and franchises, and I’m concerned the government will look at this trend and ask, why are we not deregulating the industry to reflect the apparent reality of pharmacy today? We’re only playing into the hands of people who want deregulation… We should be telling people in no uncertain terms that if something is on the shelf it doesn’t mean it’s been assessed or approved by the TGA… There is no doubt that there has been a long-term relationship between the supplement industry and pharmacy. But it was also a few decades ago that researchers started applying the concept of evidence-based medicine to healthcare generally. That should have been the point where we said, ‘we’re not just going to be a conduit for your products without questioning their basis in evidence’. That’s where we lost the plot. The question now is: where do we draw that line? I’m really trying to say to my fellow pharmacists: Please let us reassess the unquestioning support of the CM industry, or we’ll all be tarred with the same brush. I and many others are concerned about – and fighting for – the reputation of the pharmacy profession.”

A BMC Complementary and Alternative Medicine survey by researchers from Alfred Hospital in Melbourne found that 92% thought pharmacists should provide safety information about CMs, while 93% thought it important for pharmacists to be knowledgeable about CMs. This shows a huge divide between what is happening in Australian pharmacy on the one side and ethical demands or public opinion on the other side. What is more, there is little reason to believe that the situation in other countries is fundamentally different.

And did you notice this little gem in the comments above?  “…over 40% of pharmacists are adhering to PSA’s Code of Ethics…” – the PSA president finds this ‘VERY ENCOURAGING’.

When I saw this, I almost fell off my chair!

Does the president know that this means that 60% of his members are violating their own code of ethics?

Is that truly VERY ENCOURAGING, I ask myself.

My answer is no, this is VERY WORRYING.

 

Dana Ullman is an indefatigable promotor of bogus claims and an unwitting contributor of hilarity. Therefore he has become a regular feature of this blog (see for instance here, here and here). His latest laughable assertion is that lead and other poisonings can be successfully treated with homeopathy.

Just to make sure: lead poisoning is no joke. The greatest risk is to brain development in babies, where irreversible damage can occur. Higher levels can damage the kidneys and nervous system in both children and adults. Very high lead levels may cause seizures, unconsciousness and death.

In view of this, Ullman’s claim is surprising, to say the least. In order to persuade the unsuspecting public of his notion, Ullman first cites a review of basic research on homeopathy and toxins published in Human and Experimental Toxicology. “Of forty high-quality studies, 27 showed positive results from homeopathic treatment”, Ullman states.

Now, now, now Dana!

Has your mom not taught you that telling porkies is forbidden?

Or did you perhaps miss this line in the article’s abstract? “The quality of evidence in these studies was low with only 43% achieving one half of the maximum possible quality score and only 31% reported in a fashion that permitted re-evaluation of the data. Very few studies were independently replicated using comparable models.”

Hardly ‘high quality studies’, wouldn’t you agree?

But this review was of pre-clinical studies; what about the much more important clinical evidence?

Here Ullman cites one trial where a potentized homeopathic remedy, Arsenicum Album 30C, was administered to  55 people who were entered into a double-blind, placebo-controlled trial. According to Ullman, the homeopathically treated group “experienced higher excretion of arsenic in their urine for the first eleven days, compared to those given a placebo.”

Na, na, na, Dana, this is getting serious!!!

Another porky – and not even a little one.

The authors of this study clearly stated that, at the end of the 11-day RCT, there was no significant difference between the homeopathy and the placebo group: “The differences in the concentration between the two groups (drug versus placebo) were generally a little higher during the first week, but subsequently the differences were not so palpable, particularly at the 11th day.” And for those who are a bit slow on the uptake, they even included a graph that makes it abundantly clear.

The only other clinical study cited by Ullman in support of his surprising claim is a double-blind randomized trial which was conducted with 131 workers who suffered lead poisoning at the Ajax battery plant in Bauru, São Paulo State, Brazil. Subjects were prescribed homeopathic doses of lead (Plumbum metallicum 15C) or placebo which they took orally for 35 days. The results of this RCT show that homeopathy is not better than placebo.

So, we seem to have all of two RCTs on the subject (I did a quick Medline-search and also found no further RCTs), and both are negative.

Anyone who is not given to compulsive porky-telling would, I guess, conclude from this evidence that people suffering from lead poisoning should urgently see conventional experts and avoid homeopaths at all costs – not so Dana Ullman who boldly concludes his article with these words:

“As an adjunct to conventional medical treatment, professional homeopathic care is recommended for people who have been exposed (or think they have been exposed) to toxic substances… Even if you do not have a professional homeopath in your town, many homeopathic practitioners “see” their patients via Skype or do consultations over the telephone. Unlike acupuncturists, who put needles in you, or chiropractors, who adjust your spine, homeopaths are not “hands-on”: they simply need to conduct a detailed interview… If your symptoms are serious or potentially serious, it is important to see a professional homeopath and/or physician. While a homeopath will commonly prescribe a safe homeopathic dose of the toxic substance to which one was exposed, the homeopath may instead decide that a different substance more closely matches the patient’s unique symptoms…”

It takes a lot these days to make me speechless but there, Dana, you almost succeeded!

‘Natural News’ are not my favourite source of information. In fact, they consistently misinform the public about vaccines, alternative therapies and many other things. In other words, they have proven themselves to be vile mis-informers and a danger to public health.

Yet recently they have provided a valuable service to all of us: they have shown that the natural treatments they regularly promote for every ailment do not actually work for paranoia. Let me explain.

Natural News just announced that Google have “blacklisted the entire Natural News domain and removed over 140,000 pages from its index. The take down of Natural News happened this morning, and it follows a pattern of censorship we’re seeing being leveled against other pro-Trump websites. Google sent no warning whatsoever to our “webmaster tools” email address on file with them. The shut off of Natural News was clearly driven by a human decision, not an algorithm. We’re currently attempting to determine Google’s claimed justification for censoring our entire website, and we hope to have NaturalNews.com restored in Google’s index.”

The announcement continues:

Natural News is, of course, one of the world’s top educational and activism sources exposing the lies of dangerous medicine, toxic mercury in vaccines, the corporate-quack science behind GMOs, cancer industry fraud and so on. By providing truthful, empowering and passionate information to the public, we harm the profit model of the corrupt medical cartels that fund the media, lobby the government and influence internet gatekeepers with advertising money. (Google has already declared war on natural medicine and nutritional supplements, all but banning them from being advertised on Google Adsense.)

“The removal of Natural News from Google’s index means that millions of people may now be unnecessarily harmed by toxic medicines, herbicides and brain-damaging mercury in vaccines because they are being denied the “other side of the story” that’s censored by the corporate-controlled media. By censoring Natural News, Google is, in effect, siding with the criminal pharmaceutical industry that has been charged with multiple felony crimes and caught bribing doctors, fraudulently altering scientific studies, conducting medical experiments on children and price fixing their drugs to maximize profits.

“In effect, censorship of Natural News is part of the establishment’s war on humanity which includes depopulation measures (Bill Gates), covert infertility vaccines, corporate-run media disinfo campaigns and a full-on assault against scientific truth and free speech conducted in the public interest…

“It’s clear to me that Natural News is being targeted primarily because of our support for President Trump and his review of vaccine safety. It is now apparent that any person who engages in real science, critical thinking or any attempt to protect children from the brain damaging effects of mercury in vaccines is going to be silenced, discredited, smeared and blacklisted. This is an astonishing realization about the depths of total corruption in society today and how the medical cartels control information to maximize their profits off human suffering…”

END OF QUOTE

Regular readers of my blog might remember that Natural News have caught my eye several times before. Here are just 4 of the many more posts where they featured prominently:

Like so many in alternative medicine, Natural News seems to be driven by conspiracy theories to a point where paranoia is hard to deny. And that is precisely the service Natural News are providing us today; after so many years of disservice this must surely be celebrated! They demonstrate quite clearly that none of the treatments they are deeply involved in works for this condition. They do that by not even considering that Google banned them because they are constantly endangering the health of the public in the most vile, libellous and objectionable ways imaginable.

Hardly surprising, you will say, the therapies in question are all bogus!

Yes, of course, but it is nice to have a confirmation directly from the horse’s mouth, isn’t it?

The objective of the ‘Portland Centre for Integrative Medicine’ in Bristol, UK is to “offer an Integrative Medicine (IM) approach to healthcare that seeks to deliver the best complementary care and lifestyle approaches”. Specifically, they

  • “Aim to maximise individual choice and care to improve health, wellbeing and quality of life
  • Support a whole person care approach through a working collaboration between people and practitioners to improve health and well-being
  • Work to raise awareness about IM and increasing the availability of quality IM services for service users and their referring clinicians
  • Support ‘Self Care Strategies’ across the South West by promoting and supporting self-care and self-management of health and well-being by using healthy living solutions
  • Offer a centre for academic excellence for IM education and training, research and evaluation.”

Academic excellence does not normally entail telling porkies – but the Portland Centre seems willing to make an exception for a good cause: homeopathy. At least, this is the impression I got when reading their recent post entitled HOMEOPATHY, THE FACTS (surprisingly similar title as my latest book: HOMEOPATHY, THE UNDILUTED FACTS). The 6 ‘Portland facts’ turn out to be so surprising that I could simply not resist copying them here:

START OF QUOTE

1 It’s more than just a placebo

Homeopathy has been used successfully on babies, young children and animals. In these cases, the patients have no idea what medication they are taking, so the placebo argument does not hold.

2 Homeopathy costs the NHS very little

The total amount spent on Homeopathy in the NHS is approximately £4 million per year, representing less than 1% of the total NHS budget. In contrast, the NHS spends £282 million annually on anti-depressants which one study suggests only benefit 11% of patients diagnosed with depression.

3 Homeopathy is more than a passing fad

Homeopathy has been used for over 200 years and has been available on the NHS since the health service was formed in 1948. It is an important part of the health systems in many European countries including France, Germany and Italy.

4 Homeopathy is safe

When used approximately the practice is extremely safe as it produces no dangerous side-effects and can be used in conjunction with conventional medicines. In comparison, the European Commission estimated in 2008 that adverse reactions to conventional drugs kill 197,000 EU citizens each year.

5 Many treatments have limited evidence

A clinical evidence surgery carried out by the British Medical Journal found that out of 3000 medical treatments 50% were classified as having “unknown effectiveness”.

6 In support of high dilutions

What I can say now is that the high dilutions are right. High dilutions of something are not nothing. They are water structures which mimic the original molecules. It’s no pseudoscience. It’s no quackery. These are real phenomena which deserve further study,” Professional Luc Montagnier, French virologist and Nobel Laureate speaking in 2010.

END OF QUOTE

Regular readers of this blog will not really need any comments; in their absurdity, the 6 ‘Portland facts’ speak almost for themselves. For those who are not regulars, let me briefly add a few words (in doing so, I follow the numbering above).

1) The most comprehensive and independent review of the evidence in the history of homeopathy has failed to confirm that homeopathy has any therapeutic effects beyond placebo. This applies to kids as much as it applies to animals. Placebo effects in animals and kids are well documented.

2) Much more important than the costs of homeopathy is the fact that the continued use of homeopathy on the NHS makes a mockery of the principles of EBM. Either we believe in evidence (in which case, homeopathy has no place in the NHS), or we don’t (in which case, anything goes and we regress to the dark ages of healthcare).

3) Appeal to tradition is a classic fallacy and not an argument in support of anything.

4) Most, but not all, homeopathic remedies are safe. However, homeopaths are often very unsafe, for instance when they insist to treat life-threatening conditions with their placebos, or when they advice against vaccinating children. Conventional medicines can certainly cause harm but, on balance, they unquestionably generate more good than harm – and this is clearly not the case for homeopathy.

5) Tu quoque is another classic fallacy and no argument in favour of homeopathy. EBM is a relatively new concept and progress in conventional medicine is now breathtakingly fast. By contrast, homeopathy did not progress since the days Hahnemann invented it.

6) The appeal to authority is yet another classic fallacy. The ‘Montagnier story’ merely shows that even Nobel laureates can make foolish mistakes, particularly if they venture outside their area of expertise. Poor Montaigner lost all credibility since he embarked on high dilutions.

I hope that you had as much fun reading the ‘Portland porkies’ as I had commenting on them. I think they are hilarious, particularly if we consider that the Portland Centre is the direct successor of the Bristol Homeopathic Hospital. Here is what Wikipedia has to say about this institution:

“Bristol Homeopathic Hospital was a hospital in the city of Bristol in south-west England, specializing in homeopathic treatments. It was founded in 1852 but had a history as a dispensary dating back to 1832.[1] It later became a National Health Service hospital.

From 1925, the hospital was based in its own building, Cotham House,[2] in the Cotham area of Bristol. On 7 January 2013 the hospital moved operations from Cotham to the South Bristol Community Hospital.[3] In-patient services had been provided at Cotham House until 1986, when they were moved to the Bristol Eye Hospital, with out-patients continuing at Cotham House.[2][3]

Homeopathic services ceased at the Hospital in October 2015,[4][5] partly in response to a campaign against the public funding of homeopathy lead by the Good Thinking Society[6] and public figures such as Simon Singh and Edzard Ernst. University Hospitals Bristol confirmed to the Clinical Commissioning Group that it would cease to offer homeopathic therapies from October 2015, at which point homeopathic therapies would no longer be included in the contract.[5]

Homeopathic services in the Bristol area were relocated to the Portland Centre for Integrative Medicine, described as “a new independent social enterprise.”[5] In response to a FOI request, Bristol Clinical Commissioning Group revealed that “there are currently no (NHS) contracts for homeopathy in place with the Portland Centre.”[5]

END OF WIKI QUOTE

Of course, this Wiki page is slightly misleading on at least one issue (No, I don’t mean the fact that I am called a ‘public figure’ rather than a professor and expert in alternative medicine who has published more on the subject than anyone else): Hospitals are never closed in response to a campaign (as far as I know) but hospitals might get closed because of what a campaign discloses. In the Bristol case, the campaign disclosed that there is no good evidence for homeopathy (see above) and therefore no good reason to carry on wasting scarce NHS funds on it – perhaps just a slight but, I think, important difference!

Back to the 6 ‘Portland porkies’.

As we have seen, they are nowhere close to real facts – but they certainly are funny.

While studying the services offered by the Portland Centre, I found a course on ‘creative writing’. Aha, I thought, this must be the explanation: the 6 ‘Portland porkies’ are not the result of research, study or knowledge. Far from it! They clearly are the fruits of exceedingly creative writing.

So, well done Portland Centre: at least one of your aims seems to be within reach!

We have discussed the risks of (chiropractic) spinal manipulation more often than I care to remember. The reason for this is simple: it is an important subject; making sure that as many consumers know about it will save lives, I am sure. Therefore, any new paper on the subject is likely to be reported on this blog.

Objective of this review was to identify characteristics of 1) patients, 2) practitioners, 3) treatment process and 4) adverse events (AE) occurring after cervical spinal manipulation (CSM) or cervical mobilization. Systematic searches were performed in 6 electronic databases. Of the initial 1043 studies, 144 studies were included.

They reported 227 cases. 117 cases described male patients with a mean age of 45 (SD 12) and a mean age of 39 (SD 11) for females. Most patients were treated by chiropractors (66%) followed by non-clinicians (5%), osteopaths (5%), physiotherapists (3%) and other medical professions. Manipulation was reported in 95% of the cases (mobilisations only in 1.7%), and neck pain was the most frequent indication.

Cervical arterial dissection (CAD) was reported in 57% of the cases and 46% had immediate onset symptoms; in 2% onset of symptoms took for more than two weeks. Other complications were disc rupture, spinal cord swelling and thrombus. The most frequently reported symptoms included disturbance of voluntary control of movement, pain, paresis and visual disturbances.

In most of the reports, patient characteristics were described poorly. No clear patient profile, related to the risk of AE after CSM, could be extracted. However, women seem more at risk for CAD.

The authors concluded that there seems to be under-reporting of cases. Further research should focus on a more uniform and complete registration of AE using standardized terminology.

I do not want to repeat what I have stated in previous posts on this subject. So,let me just ask this simple question: IF THERE WERE A DRUG MARKTED FOR NECK PAIN BUT NOT SUPPORTED BY GOOD EVIDENCE FOR EFFICACY, DO YOU THINK IT WOULD BE ON THE MARKET AFTER 227 CASES OF SEVERE ADVERSE EFFECTS HAD BEEN DESCRIBED?

I think the answer is NO!

If we then consider the huge degree of under-reporting in this area which might bring the true figure up by one or even two dimensions, we must ask: WHY IS CERVICAL MANIPULATION STILL USED?

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