MD, PhD, FMedSci, FSB, FRCP, FRCPEd

conflict of interest

1 2 3 15

When given the diagnosis ‘CANCER’, most people go into some sort of shock. Once they have recovered, they are likely to learn that they now face many months of very aggressive treatments which will reduce their quality of life to almost zero. This, they are told, is no guarantee but will merely increase their chances to survive the cancer.

Understandably, before they make what might be the most important decision of their lives, patients are desperate and tempted to look elsewhere to find out for themselves what their options are. It would be foolish to simply accept what their team of health care professionals have been saying. With decisions as important as this one, it is wise to listen to second and possibly third opinions. Who could argue with this logic?

Most cancer patients then go on the Internet and have a look at what alternatives are on offer. Here they find virtually millions of sites offering information. A person with pancreatic cancer might thus be unfortunate enough to stumble over a site called What Alternative Medicine works best against Pancreatic Cancer? If she does, her life is at risk.

You think I am exaggerating? In this case, let me quote from this website (I made no changes whatsoever, not even corrections of the spelling mistakes):

Just to remind you this particular thread is concerned with alternative treatments for cancer. People here are seeking information about alternative medicine. Now we all know that immunotherapy represents potentially a great leap forward in the treatment of cancer in the mainstream medical community although the stats are still pretty low for repsonse most of which have been done on melanoma patients. Nonetheless impresive compared to the useless toxic treatments peddled by the drug industry over the last 30 years. Interferon being one of the worst treatments inflicted on many a poor cancer patient along with chemo and radiation for which many cancers have little or no response and are extremely toxic. I make no false claims about the work of Dr Kelley or Dr Gonzalez for that matter. For those willing to dig a little and research their work they will find a body of good evidence for their protocol.

You might say that this is an extreme exception of irresponsible, life-threatening misinformation. But I disagree. The Internet is full with sites of this nature. They promote treatments for which there is no good evidence; what is worse, they encourage patients to forego conventional treatments which might save their lives. If anyone then dares to point this out, he will be attacked for being in the pocket of ‘Big Pharma’.

I know, a little insignificant post like mine will change very little, but I also feel strongly that, if I do not keep banging on about this issue, who else will warn patients that misinformation from the Internet and other sources can kill?

Recently I had an unpleasant exchange with an Australian naturopath by the name of Brett Smith. It started by him claiming that ‘chemo’ only kills cancer patients and enriches the pharmaceutical industry. And then it got worse, much worse, and very unpleasant. This got me interested in Mr Smith and prompted me to look him up. Brett Smith describes himself on his website:

Brett is a graduate of Sydney University masters degree program in Herbal Medicine run through it’s acclaimed faculty of pharmacy. He also earned a degree in Health Science from the University of New England making him one of the most qualified Naturopaths in Australia. Brett ran a successful naturopathic clinic in Bondi Junction for 6 years before selling it and founding HealthShed.com and writing and researching a book on Type 2 Diabetes.

In a world of chaos and confusion, the one area you have some semblance of control over is your health. One of the issues around this subject that frustrates me is the conflicting information consistently bombarding us. If we can land a pod on Mars why do we still not know the fundamental pathways to human health.

One of the reasons is the big food corporations that have a vested interest in keeping you reaching to the shelves for their dead foods and the one thing I can assure you of, without any doubt, is that dead food makes dead people. If people understood the true power of foods, herbs and the odd supplement in reaching their health potentials we could eradicate many diseases scourging the planet today – heart disease, diabetes, alzheimer’s, thyroid conditions, asthma, the list is seriously endless.

The other part of the problem is us. We choose the “easy” option too many times, generation after generation after generation. What chance do our children have? Always looking for the Magic Pill. Another thing I can assure you of is that the vast majority of pharmaceutical drugs prescribed is completely unnecessary.

Natural therapists risks making the same mistakes as the pharmaceutical medical industry in becoming an elitist therapy guided by profit at expense of the patient.

I’m committed to helping inspire and empower people to optimal health through simple yet highly effective methods. Despite all the white noise, optimum health is open to us all, rich or poor, old or young. In fact, it’s your birth right. Claim it.

I also looked up his ‘health shed’. Amongst other things, it turns out to be a treasure trove of utter nonsense and anti-medical propaganda written by several experts of equally high standing – worth reading, if you have a minute! To give you a flavour, I have chosen a post entitled Which is Greater Threat, Measles or Measles Vaccine?:

Brett Smith N.D

Sometimes in life you just have to put your neck (and your reputation) on the line. I’ve been told on more than one occasion not to run vaccination stories. I’m sorry but I cannot ignore this ‘debate’ right now. Immunisation is a beautiful theory and with the right delivery method and ingredients may have a future, but as it is now we need to stop and have a very close look at this issue. Vaccines are not safe for everyone and vaccine injuries are not rare. Hep B shots on a one day old infant is actually criminal and I will debate any expert anytime, anywhere on that particular subject. Until then hear what Dr Jeffrey Dach has to say on the subject. 

by Jeffrey Dach MD

A recent measles outbreak at Disneyland of at least 70 cases (Jan 2015) has created quite a stir in the media. Five of the cases were fully vaccinated, indicating the measles vaccine confers only temporary immunity. Clearly there is no “failure to vaccinate”, as measles has broken out in highly vaccinated populations. It is obviously a failure of the vaccine. Unlike the vaccine, real measles infection confers life-long immunity. 

Measles in 2008

In 2008, a similar resurgence in measles cases was reported. An increase in reported cases of measles from 42 to 131 prompted a 2008 New York Times editorial warning of re-emergence of “many diseases” if vaccination rates drop. A quote from the New York Times:

“If confidence in all vaccines were to drop precipitously, many diseases would re-emerge and cause far more harm than could possibly result from vaccination.”

Confidence in Vaccines Has Been Lost

Unfortunately, confidence in vaccines has already been lost according to Shona Hilton in her article, ”Who do parents believe about MMR”. According to Shona Hilton, young parents are mistrustful of the media and the pediatricians who have financial incentives to push vaccines.

What is the Evidence for an Autism/ Vaccine Link?

The Hanna Poling Case

In the case of Hannah Poling, the federal vaccine court has agreed to compensate Poling’s family, conceding that her autism was caused by vaccination. The federal court has already paid out more than $1.5 billion for vaccine related injury or death.

Italian Court Conceded MMR Caused Autism

In 2012, the Italian Health Ministry conceded the MMR vaccine caused autism in nine-year-old Valentino Bocca. Exactly how many other cases exist is unknown because court records are usually sealed from public view.

Abnormal MMR Antibody Response in Autistic Kids

An important finding was found in a 2002 report in Biomedical Science by Dr. Singh entitled ” Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism.”

The authors found elevated antibody levels to MMR (Measles Mumps Rubells Vaccine) in 60% of autistic children, none in controls. The elevated MMR antibodies in autistic children detected “measles HA protein”, which is unique to the measles subunit of the vaccine. Over 90% of the autistic children with elevated MMR antibodies, also had elevated MBP (myelin basic protein) antibodies, suggesting a strong association between MMR and CNS autoimmunity in autism. The authors state:

“Stemming from this evidence, we suggest that an inappropriate antibody response to MMR, specifically the measles component thereof, might be related to pathogenesis of autism.”

“In light of these new findings, we suggest that a considerable proportion of autistic cases may result from an atypical measles infection that does not produce a rash but causes neurological symptoms in some children. The source of this virus could be a variant MV or it could be the MMR vaccine.”

A second paper in 2003 by the same group confirmed these findings: Singh, Vijendra K., and Ryan L. Jensen. ” Elevated Levels of Measles Antibodies in children with Autism.” Pediatric neurology 28.4 (2003): 292-294.

According to Bernadine Healy MD, Director of the National Institute of Health (NIH) in 1991, there is credible published, peer-reviewed scientific studies that support the idea of an association between autism and vaccines. Rather than oppose all vaccinations, Dr Healy suggests modifying the vaccination schedule to make them safer. Left Image Courtesy of Bernadine Healy MD Huffington Post.

How to Make the Vaccine Schedule Safer?

Don Miller MD in this article on Lew Rockwell, provides a safer vaccination schedule. For example, the vaccination schedule can be made safer by waiting until child’s immune system is better developed after age 2, by moving from the combined MMR shot to individual doses, avoiding thimerosol, and avoiding the live vaccines…

Vitamin A and measles

Numerous medical publications have shown health benefits for Vitamin A in treatment of measles.

Conclusion

Clearly, there is a trade off in terms of benefits and risks of vaccines. Rather than deny the adverse effects of vaccines, we should be openly discussing how to make the vaccine schedule safer, as Don Miller MD and Bernadine Healy MD suggest.

If this had been a exceptional excursion into quackery, I would probably not have mentioned it. But Smith’s ‘health shed’ is full of it. Here are just three further examples:

The Truth About Chemotherapy – History, Effects and Natural Alternatives

The Amazing Cancer-Fighting Properties of Pineapple

Amazing Herb Kills 98% Of Cancer Cells In Just 16 Hours

Such dangerous nonsense tends to make me first speechless and then quite angry. This man claims to be one of the best educated naturopaths in Australia. If that is true, what is the rest of the naturopaths like? He wants to ’empower people to optimal health’. In truth, he and many like him are experts on misinformation that potentially could shorten the lives of many patients.

A 2016 article set out to define the minimum core competencies expected from a certified paediatric doctor of chiropractic using a Delphi consensus process. The initial set of seed statements and sub-statements was modelled on competency documents used by organizations that oversee chiropractic and medical education. The statements were then distributed to the Delphi panel, reaching consensus when 80% of the panelists approved each segment. The panel consisted of 23 specialists in chiropractic paediatrics from across the spectrum of the chiropractic profession. Sixty-one percent of panellists had postgraduate paediatric certifications or degrees, 39% had additional graduate degrees, and 74% were faculty at a chiropractic institution and/or in a postgraduate paediatrics program. The panel was initially given 10 statements with related sub-statements formulated by the study’s steering committee. On all 3 rounds of the Delphi process the panelists reached consensus; however, multiple rounds occurred to incorporate the valuable qualitative feedback received.

The results of this process reveal that the Certified Paediatric Doctor of Chiropractic requires 8 sets of skills. (S)he will …

1) Possess a working knowledge and understanding of the anatomy, physiology, neurology, psychology, and developmental stages of a child. a) Recognize known effects of the prenatal environment, length of the pregnancy, and birth process on the child’s health. b) Identify and evaluate the stages of growth and evolution of systems from birth to adulthood. c) Appraise the clinical implications of developmental stages in health and disease, including gross and fine motor, language/communication, and cognitive, social, and emotional skills. d) Recognize normal from abnormal in these areas. e) Possess an understanding of the nutritional needs of various stages of childhood.

2) Recognize common and unusual health conditions of childhood. a) Identify and differentiate clinical features of common physical and mental paediatric conditions. b) Identify and differentiate evidence-based health care options for these conditions. c) Identify and differentiate clinical features and evidence-based health care options for the paediatric special needs population.

3) Be able to perform an age-appropriate evaluation of the paediatric patient. a) Take a comprehensive history, using appropriate communication skills to address both child and parent/ guardian. b) Perform age-appropriate and case-specific physical, orthopaedic, neurological, and developmental examination protocols. c) When indicated, utilize age-appropriate laboratory, imaging, and other diagnostic studies and consultations, according to best practice guidelines. d) Appropriately apply and adapt these skills to the paediatric special needs population. e) Be able to obtain and comprehend all relevant external health records.

4) Formulate differential diagnoses based on the history, examination, and diagnostic studies.

5) Establish a plan of management for each child, including treatment, referral to, and/or co-management with other health care professionals. a) Use the scientific literature to inform the management plan. b) Adequately document the patient encounter and management plan. c) Communicate management plan clearly (written, oral, and nonverbal cues) with both the child and the child’s parent/guardian. d) Communicate appropriately and clearly with other professionals in the referral and co-management of patients.

6) Deliver skilful, competent, and safe chiropractic care, modified for the paediatric population, including but not limited to: a) Manual therapy and instrument-assisted techniques including manipulation/adjustment, mobilization, and soft tissue therapies to address articulations and/or soft tissues. b) Physical therapy modalities. c) Postural and rehabilitative exercises. d) Nutrition advice and supplementation. e) Lifestyle and public health advice. f) Adapt the delivery of chiropractic care for the paediatric special needs population.

7) Integrate and collaborate with other health care providers in the care of the paediatric patient. a) Recognize the role of various health care providers in paediatric care. b) Utilize professional inter-referral protocols. c) Interact clearly and professionally as needed with health care professionals and others involved in the care of each patient. d) Clearly explain the role of chiropractic care to professionals, parents, and children.

8) Function as a primary contact, portal of entry practitioner who will. a) Be proficient in paediatric first aid and basic emergency procedures. b) Identify and report suspected child abuse.

9) Demonstrate and utilize high professional and ethical standards in all aspects of the care of paediatric patients and professional practice. a) Monitor and properly reports of effects/adverse events. b) Recognize cultural individuality and respect the child’s and family’s wishes regarding health care decisions. c) Engage in lifelong learning to maintain and improve professional knowledge and skills. d) Contribute when possible to the knowledge base of the profession by participating in research. e) Represent and support the specialty of paediatrics within the profession and to the broader healthcare and lay communities.

I find this remarkable in many ways. Let us just consider a few items from the above list of competencies:

Identify and differentiate evidence-based health care options… such options would clearly not include chiropractic manipulations.

Identify and differentiate clinical features and evidence-based health care options for the paediatric special needs population… as above. Why is there no mention of immunisations anywhere?

Perform age-appropriate and case-specific physical, orthopaedic, neurological, and developmental examination protocols. If that is a competency requirement, patients should really see the appropriate medical specialists rather than a chiropractor.

Establish a plan of management for each child, including treatment, referral to, and/or co-management with other health care professionals. The treatment plan is either evidence-based or it includes chiropractic manipulations.

Deliver skilful, competent, and safe chiropractic care… Aren’t there contradictions in terms here?

Manual therapy and instrument-assisted techniques including manipulation/adjustment, mobilization, and soft tissue therapies to address articulations and/or soft tissues. Where is the evidence that these treatments are effective for paediatric conditions, and which conditions would these be?

Clearly explain the role of chiropractic care to professionals, parents, and children. As chiropractic is not evidence-based in paediatrics, the role is extremely limited or nil.

Function as a primary contact, portal of entry practitioner… This seems to me as a recipe for disaster.

Demonstrate and utilize high professional and ethical standards in all aspects of the care of paediatric patients… This would include obtaining informed consent which, in turn, needs to include telling the parents that chiropractic is neither safe nor effective and that better therapeutic options are available. Moreover, would it not be ethical to make clear that a paediatric ‘doctor’ of chiropractic is a very far cry from a real paediatrician?

So, what should the competencies of a chiropractor really be when it comes to treating paediatric conditions? In my view, they are much simpler than outlined by the authors of this new article: I SEE NO REASON WHATSOEVER WHY CHIROPRACTORS SHOULD TREAT CHILDREN!

The Nobel laureate Venkatraman Ramakrishnan recently called homeopathy ‘bogus’. “They (homeopaths) take arsenic compounds and dilute it to such an extent that just a molecule is left. It will not make any effect on you. Your tap water has more arsenic. No one in chemistry believes in homeopathy. It works because of placebo effect,” he was quoted saying.

But what does he know about homeopathy? This was the angry question of homeopaths around the world when the Nobel laureate’s views became international headlines.

Nothing! Exclaimed the furious homeopaths with one voice.

If we want to get an informed opinion, we a true expert.

The Queen’s homeopath Dr Fisher? No, he has been known to tell untruths.

Doctor Michael Dixon, the adviser to Prince Charles who recently defended homeopathy? No, he is not even a homeopath.

Dana Ullman, the voice of US homeopathy? Heavens, he is a homeopath but not one who is known to be objective.

Alan Schmukler perhaps? He too seems to have difficulties with critical thinking.

Perhaps we need to ask an experienced and successful homeopath like doctor Akshay Batra; someone with both feet on the ground who knows about the coal face of health care today. He recently spoke out for the virtues of homeopathy explaining that it is based on the ingenious idea that ‘like cures like: “For example if you are suffering from constant watering eyes, you will be given allium cepa which comes from onions, something that causes eyes to water. Homeopathy works like a vaccine”. Dr Batra claims that the failure of allopathy (mainstream medicine) is causing the present boom in homeopathy. “With the amount of deaths taking place due to allopathic medicine and its side effects, we can see people resorting to homeopathy,” he said. “Certain children using asthma inhalers suffer from growth issues or develop unusual facial hair. Homeopathy avoids that and uses a natural remedy that treats the root cause,” he added.

The top issues treated with homeopathy, according to Dr Batra, are hair and skin problems. “A lot of ailments today effecting hair and skin are because of internal diseases. Hair loss in women has become very prevalent and can be due to cystic ovaries, low iron levels or hormonal imbalance due to thyroid,” explained Dr Batra. “We find the root cause and treat that, since hair loss could just be a symptom and we need to treat the ailment permanently. Allopathic medicines just give you a quick fix, and not treat the root cause, while we give a more long term, complete solution,” he added. Homeopathy is mind and body medicine: “A lot of people today are under pressure and stress. Homeopathic treatment also helps in relieving tension hence treating the patient as a whole,” said Dr Batra.

I bet you now wonder who is this fabulous expert and homeopath, doctor Batra.

He has been mentioned on this blog before, namely when he opened the first London branch of his chain of homeopathic clinics claiming that homeopathy could effectively treat the following conditions:

Yes, Dr Akshay Batra is the managing director and chairman of Dr Batra’s Homeopathic Clinic, an enterprise that is currently establishing clinics across the globe.

And now we understand, I think, why the Nobel laureate and the homeopathy expert have slightly different views on the subject.

Who would you believe, I wonder?

Consensus recommendations to the ‘National Center for Complementary and Integrative Health from Research Faculty in a Transdisciplinary Academic Consortium for Complementary and Integrative Health and Medicine’ have just been published. It appeared in this most impartial of all CAM journals, the ‘Journal of Alternative and Complementary Mededicine’. Its authors are equally impartial: Menard MB 1, Weeks J 2, Anderson 3, Meeker 4, Calabrese C 5, O’Bryon D 6, Cramer GD 7

They come from these institutions:

  • 1 Crocker Institute , Kiawah Island, SC.
  • 2 Academic Consortium for Complementary and Alternative Health Care , Seattle, WA.
  • 3 Pacific College of Oriental Medicine , New York, NY.
  • 4 Palmer College of Chiropractic , San Jose, CA.
  • 5 Center for Natural Medicine , Portland, OR.
  • 6 Association of Chiropractic Colleges , Bethesda, MD.
  • 7 National University of Health Sciences , Lombard, IL

HERE IS THE ABSTRACT OF THE DOCUMENT IN ITS FULL AND UNABBREVIATED BEAUTY:

BACKGROUND:

This commentary presents the most impactful, shared priorities for research investment across the licensed complementary and integrative health (CIH) disciplines according to the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). These are (1) research on whole disciplines; (2) costs; and (3) building capacity within the disciplines’ universities, colleges, and programs. The issue of research capacity is emphasized.

DISCUSSION:

ACCAHC urges expansion of investment in the development of researchers who are graduates of CIH programs, particularly those with a continued association with accredited CIH schools. To increase capacity of CIH discipline researchers, we recommend National Center for Complementary and Integrative Health (NCCIH) to (1) continue and expand R25 grants for education in evidence-based healthcare and evidence-informed practice at CIH schools; (2) work to limit researcher attrition from CIH institutions by supporting career development grants for clinicians from licensed CIH fields who are affiliated with and dedicated to continuing to work in accredited CIH schools; (3) fund additional stand-alone grants to CIH institutions that already have a strong research foundation, and collaborate with appropriate National Institutes of Health (NIH) institutes and centers to create infrastructure in these institutions; (4) stimulate higher percentages of grants to conventional centers to require or strongly encourage partnership with CIH institutions or CIH researchers based at CIH institutions, or give priority to those that do; (5) fund research conferences, workshops, and symposia developed through accredited CIH schools, including those that explore best methods for studying the impact of whole disciplines; and (6) following the present NIH policy of giving priority to new researchers, we urge NCCIH to give a marginal benefit to grant applications from CIH clinician-researchers at CIH academic/research institutions, to acknowledge that CIH concepts require specialized expertise to translate to conventional perspectives.

SUMMARY:

We commend NCCIH for its previous efforts to support high-quality research in the CIH disciplines. As NCCIH develops its 2016-2020 strategic plan, these recommendations to prioritize research based on whole disciplines, encourage collection of outcome data related to costs, and further support capacity-building within CIH institutions remain relevant and are a strategic use of funds that can benefit the nation’s health.

AND WHY DID THIS SURPRISE ME?

Well, I would have expected that such an impartial, intelligent bunch of people who are doubtlessly capable of critical analysis would have come up with a totally different set of recommendations. For instance:

  1. Integrative health makes no sense.
  2. Integrative medicine is a disservice to patients.
  3. Integrative health is a paradise for charlatans.
  4. No more research is required in this area.
  5. Research already under way should be stopped.
  6. Money ear-marked for integrative health should be diverted to other investigators researching areas that show at least a glimpse of promise.

Alright, you are correct – my suggestions are neither realistic nor constructive. One cannot expect that they will turn down all these lovely research funds and give it to real scientists. One has to offer them something constructive to do with the money. How about projects addressing the following research questions?

  1. How many integrative health clinics offer evidence-based treatments?
  2. Is the promotion of bogus treatments in line with the demands of medical ethics?
  3. If we need to render health care more holistic, humane, patient-centred, why not reform conventional medicine?
  4. Is the creation of integrative medicine a divisive development for health care?
  5. Is humane, holistic, patient-centred care really an invention of integrative medicine, and what is its history?
  6. Which of the alternative treatments used in integrative medicine can be shown to do more good than harm?
  7. What are the commercial drivers behind the integrative health movement?
  8. Is there a role for critical thinking within integrative health?
  9. Is integrative health creating double standards within medicine?
  10. What is better for public health, empty promises about ‘the best of both worlds’ or sound evidence?

What a question, you might say. And you would be right, it’s a most awkward one, so much so that I cannot answer it for myself.

I NEED YOUR HELP.

Here is the story:

Ten years ago, with the help of S Lejeune and an EU grant, my team conducted a Cochrane review of Laertrile. To do the ‘ground work’, we hired an Italian research assistant, S Milazzo, who was supervised mainly by my research fellow Katja Schmidt. Consequently, the review was published under the names of all main contributors: Milazzo, Ernst, Lejeune, Schmidt.

In 2011, an update was due for which the help of Dr Markus Horneber, the head of a German research team investigating alt med in relation to cancer, was recruited. By then, Milazzo and Schmidt had left my unit and, with my consent, Horneber, Milazzo and Schmidt took charge of the review. I was then sent a draft of their update and did a revision of it which consisted mostly in checking the facts and making linguistic changes. The article was then published under the following authorship: Milazzo S, Ernst E, Lejeune S, Boehm K, Horneber M (Katja had married meanwhile, so Boehm and Schmidt are the same person).

A few days ago, I noticed that a further update had been published in 2015. Amazingly, I had not been told, asked to contribute, or informed that my name as co-author had been scrapped. The authors of the new update are simply Milazzo and Horneber (the latter being the senior author). Katja Boehm had apparently indicated that she did no longer want to be involved; I am not sure what happened to Lejeune.

I know Markus Horneber since donkey’s years and had co-authored several other papers with him in the past, so I (admittedly miffed about my discovery) sent him an email and asked him whether he did not consider this behaviour to amount to plagiarism. His reply was, in my view, unhelpful in explaining why I had not been asked to get involved and Horneber asked me to withdraw the allegation of plagiarism (which I had not even made) – or else he would take legal action (this was the moment when I got truly suspicious).

Next, I contacted the responsible editor at the Cochrane Collaboration, not least because Horneber had claimed that she had condoned the disputed change of authorship. Her reply confirmed that “excluding previous authors without giving them a chance to comment is not normal Cochrane policy” and that she did, in fact, not condone the omission of my name from the list of co-authors.

The question that I am asking myself (not for the first time, I am afraid – a similar, arguably worse case has been described in the comments section of this post) is the following: IS THIS A CASE OF PLAGIARISM OR NOT? In the name of honesty, transparency and science, it requires an answer, I think.

Even after contemplating it for several days, I seem to be unable to find a conclusive response. On the one hand, I did clearly not contribute to the latest (2015) update and should therefore not be a co-author. On the other hand, I feel that I should have been asked to contribute, in which case I would certainly have done so and remained a co-author.

For a fuller understanding of this case, I here copy the various sections of the abstracts of the 2011 update (marked OLD) and the 2015 update without my co-authorship (marked NEW):

 

OLD

Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous.

NEW

Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous.

OBJECTIVES:

OLD

To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin.

NEW

To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin.

SEARCH METHODS:

OLD

We searched the following databases: CENTRAL (2011, Issue 1); MEDLINE (1951-2011); EMBASE (1980-2011); AMED; Scirus; CancerLit; CINAHL (all from 1982-2011); CAMbase (from 1998-2011); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language.

NEW

We searched the following databases: CENTRAL (2014, Issue 9); MEDLINE (1951-2014); EMBASE (1980-2014); AMED; Scirus; CINAHL (all from 1982-2015); CAMbase (from 1998-2015); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language.

SELECTION CRITERIA:

OLD

Randomized controlled trials (RCTs) and quasi-RCTs.

NEW

Randomized controlled trials (RCTs) and quasi-RCTs.

DATA COLLECTION AND ANALYSIS:

OLD

We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria.

NEW

We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria.

MAIN RESULTS:

OLD

We located over 200 references, 63 were evaluated in the original review and an additional 6 in this update. However, we did not identify any studies that met our inclusion criteria.

NEW

We located over 200 references, 63 were evaluated in the original review, 6 in the 2011 and none in this update. However, we did not identify any studies that met our inclusion criteria.

AUTHORS’ CONCLUSIONS:

OLD

The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.

NEW

The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.

END OF ABSTRACT

I HOPE THAT YOU, THE READER OF THIS POST, ARE NOW ABLE TO TELL ME:

HAVE I BEEN PLAGIARISED?

P S

After the response from the Cochrane editor, I asked Horneber whether he wanted to make a further comment because I was thinking to blog about this. So far, I have not received a reply.

MORE than £150,000 was spent by NHS Grampian on homeopathic treatments last year. Referrals to homeopathic practitioners cost £37,000 and referrals to the Glasgow Homoeopathic Hospital cost £7,315 in 2014-15. In view of the fact that highly diluted homeopathic remedies are pure placebos, any amount of tax payers’ money spent on homeopathy is hard to justify. Yet an NHS Grampian spokeswoman defended its use of by the health board with the following words:

“We have a responsibility to consider all treatments available to NHS patients to ensure they offer safe, effective and person-centred care. We also have a responsibility to use NHS resources carefully and balance our priorities across the population as well as individuals. We also recognise that patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited. Homeopathy can be considered in this arena and we remain connected with the wider debate on its role within the NHS while regularly reviewing our local support for such services within NHS Grampian.”

Mr Spence, a professional homeopath, was also invited to defend the expenditure on homeopathy: “When a friend started talking to me about homeopathy I thought he had lost his marbles. But it seemed homeopathy could fill a gap left by orthodox medicine. Homeopathy is about treating the whole person, not just the symptoms of disease, and it could save the NHS an absolute fortune. If someone is in a dangerous situation or they need surgery then they need to go to hospital. It’s often those with chronic, long-term problems where conventional treatment has not worked that can be helped by homeopathy.”

What do these arguments amount to, I ask myself.

The answer is NOTHING.

The key sentence in the spokeswomen’s comment is : “patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited.” This seems to admit that the evidence fails to support homeopathy. Therefore, so the argument, we have to abandon evidence and consider experience, opinion etc. This seemingly innocent little trick is nothing else than the introduction of double standards into health care decision making which could be used to justify the use of just about any bogus therapy in the NHS at the tax payers’ expense. It is obvious that such a move would be a decisive step in the wrong direction and to the detriment of progress in health care.

The comments by the homeopath are perhaps even more pitiful. They replace arguments with fallacies and evidence with speculation or falsehoods.

There is, of course, a bright side to this:

IF HOMEOPATHY IS DEFENDED IN SUCH A LAUGHABLE MANNER, ITS DAYS MUST BE COUNTED.

While some chiropractors now do admit that upper neck manipulations can cause severe problems, many of them simply continue to ignore this fact. It is therefore important, I think, to keep alerting both consumers and chiropractors to the risks of spinal manipulations. In this context, a new article seems relevant.

Danish doctors reported a critical case of bilateral vertebral artery dissection (VAD) causing embolic occlusion of the basilar artery (BA) in a patient whose symptoms started after chiropractic Spinal manipulative therapy (cSMT). The patient, a 37-year-old woman, presented with acute onset of neurological symptoms immediately following cSMT in a chiropractic facility. Acute magnetic resonance imaging (MRI) showed ischemic lesions in the right cerebellar hemisphere and occlusion of the cranial part of the BA. Angiography demonstrated bilateral VADs. Symptoms remitted after endovascular therapy, which included dilatation of the left vertebral artery (VA) and extraction of thrombus from the BA. After 6 months, the patient still had minor sensory and cognitive deficits.

The authors concluded that, in severe cases, VAD may be complicated by BA thrombosis, and this case highlights the importance of a fast diagnostic approach and advanced intravascular procedure to obtain good long-term neurological outcome. Furthermore, this case underlines the need to suspect VAD in patients presenting with neurological symptoms following cSMT.

I can already hear the excuses of the chiropractic fraternity:

  • this is just a case report,
  • the risk is very rare,
  • some investigations even deny any risk at all,
  • the risk of many conventional treatments is far greater.
However, these excuses are lame for a number of reasons:
  • as there are no functioning monitoring systems, nobody can tell with certainty how big the risk truly is,
  • the precautionary principle in health care compels us to take even the slightest of suspicions of harm seriously,
  • the risk/benefit principle compels us to ask whether the demonstrable benefits of neck manipulations outweigh its suspected risks.

The last point is perhaps the most important: AS FAR AS I CAN SEE, THERE IS NO INDICATION FOR NECK MANIPULATIONS FOR WHICH THE BENEFIT IS SUFFICIENTLY CERTAIN TO JUSTIFY ANY SUCH RISKS.

Recently I have focussed several posts on well-known homeopaths and proponents of homeopathy; they include 6 prominent defenders of this therapy:

Dr Peter Fisher, the Queen’s homeopath,

Dr Michael Dixon, GP, chair of the NHS Alliance, the College of Medicine  and holder of many other posts,

Prof Michael Frass, intensive care physician at the University of Vienna,

Christian Boiron, general manager of Boiron, the world’s largest homeopathic manufacturer,

Christophe Merville, lead pharmacist at Boiron,

Dana Ullman, US homeopath and entrepreneur.

This inevitably begs the question what these people might have in common. After some consideration, I think, there are the following common denominators (you might see others; if so, please let me know):

  1. Most have conflicts of interest, yet try to hide this fact as best as they can, a circumstance which could be seen as less than honest.
  2. Most are quick of accusing critics of homeopathy of dishonesty and harbour conspiracy theories of various kinds.
  3. Most seem unable to think critically.
  4. They never criticise each other, not even for demonstrably wrong remarks or actions.
  5. Most use fallacious arguments regularly.
  6. Most rely on cherry-picking their evidence.
  7. Most display anti-scientific tendencies, yet rely on ‘cutting edge science’ as soon as they can interpret it in favour of homeopathy.
  8. They seem to be unable to learn in the light of new evidence.
  9. They seem never able to change their mind about things related to homeopathy.
  10. This gives them a distinct flair of fanaticism and arrogance.
  11. Most seem to have an odd attitude towards medical ethics.
  12. Most try to mislead the public by claiming things which are evidently not true.

The last point is, in my view, the most striking, important and disturbing issue. I ask myself what reasons these individuals have to tell untruths and whether ‘telling untruths’ is the same as ‘telling lies’. The first part of this question seems to be answered by the fact that most have powerful conflicts of interest; that is to say their livelihood depends on misleading the public about homeopathy. But are they lying or telling untruths?

This is a potentially important difference, I think.

An untruth is a statement which is false. By contrast, a lie is a false statement made with deliberate intent to deceive. So, are the untruths issued by the above-named homeopaths lies or untruths?

I would not dare to decide on the answer of this question…but hope my readers have some suggestions.

A recent article in the LIVERPOOL ECHO caught my eye. It is about the possibility that the NHS in Liverpool might stop funding their homeopathy service . Maybe I should read the LIVERPOOL ECHO more often, because the short article is most revealing.

It first cites the chairman of the local NHS Clinical Commissioning Group, Dr Nadim Fazlani saying that “There is little evidence that homeopathy has a clinical benefit so, as a governing body, our preferred option would be to stop commissioning this service. However, it is important that the people have an opportunity to provide their views before a decision is made.”

Fair enough!

I would like to mention, however, that health care is not a beauty contest or a supermarket shelve. We don’t have popular votes for bone marrow transplants or bypass surgery either. Why? Not because we don’t believe in democracy but because the general public cannot possibly understand medicine well enough. This is why we send some of our kids to medical school and other institutions to help us comprehend and eventually take responsible decisions for us. It is, I think, an ethical imperative to base important health care decisions of this nature on the best evidence and expertise, and it seems foolish to expect the public to have either.

Then the article in the LIVERPOOL ECHO quotes a statement of the Liverpool homeopathy service which is run by GPs Dr Hugh Nielsen and Dr Sue de Lacy: “The patients we see generally have long-standing, complex conditions that are often difficult to treat with conventional medicine. Yet regular audits of our clinic show a very high level of patient satisfaction, with patients consistently reporting an improvement in their health. As experienced doctors trained in homeopathy we see it working every day and that is why we believe Liverpool CCG – and more importantly the patients the CCG serves – is getting excellent value for the relatively small amount of funding the service receives.”

I find this interesting, not least because the arguments used by these two GPs are, in my view, miles better than those we have seen on this blog recently by Christian Boiron, Dana Ullman, Dr Michael Dixon or the Queen’s homeopath Dr Fisher all put together. At least they do not contain blatant lies!

This does not mean, however, that the arguments of the two homeopaths from Liverpool are convincing. They are not – for the following 4 reasons:

  1. True, long-standing, complex conditions are often difficult to treat with conventional medicine. But if they are difficult to treat with real medicine, they surely are even more difficult to treat with fake medicine.
  2. I have no problem believing that their audits show high level of patient satisfaction, with patients consistently reporting an improvement in their health. But we need to be quite clear that these effects are not brought about by the homeopathic remedies which contain zero active ingredients. They are due to the compassion shown by these homeopath. If they prescribed real medicine in addition to providing compassion, their results would in all likelihood be even better.
  3. It is also true that an experienced doctor trained in homeopathy will see it working every day. But the ‘it’ refers not to the remedy, it relates to the compassion – and to convey compassion, we do not need bogus treatments.
  4. It is a little misleading to claim that homeopathy is ‘excellent value’. The remedies contain nothing but lactose, and £ 5-10 for a gram or two of lactose is jolly expensive! So, the remedies are over-priced placebos, and the consultations might be good value.

Despite these counter-arguments, I must congratulate these two GPs from Liverpool: they seem to be so much more honest and intelligent than the defenders of homeopathy mentioned above.

1 2 3 15
Recent Comments

Note that comments can now be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories