MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

conflict of interest

Yesterday, it has been reported that Indian scientists found the mode of action of homeopathic remedies. This is the newspaper article:

And this seems to be the abstract of the actual paper:

Homeopathic medicines contain ultra-low concentrations of metal and compounds, and it is challenging to classify homeopathic potencies using modern characterization tools. This work presents a novel experimental tool for classifying various homeopathic medicines under a low-frequency generated electromagnetic (EM) fields. A custom-built primary coil is used for generating EM fields at different excitation frequencies. The potentized test samples were prepared at decimal dilution scale of Ferrum with α‑lactose monohydrate and exhibited significant and distinct induced EM responses in the second sensing coil. The measured responses decrease logarithmically due to reducing Ferrum concentration. The resolution improved in higher potencies from 0.03 µV at 300 Hz to 0.24 µV at 4.8 kHz. Different compounds of homeopathic medicines were also investigated to produce distinct induced EM characteristics. These results were correlated with Raman spectroscopy, impedance analyser, and FT-IR analysis. The experimental investigation confirmed the classification of potencies and the technique developed to detect ultra-low metallic concentrations.

I might be a bit slow on the uptake – but I don’t see how this investigation proves anything. Perhaps someone can explain it to me?

I recently came across this editorial from the NEJM. I find it extremely relevant to the many discussions we have about so-called alternative medicine (SCAM) we have on this blog. I, therefore, take the liberty to copy a small section of it here without further comment, and encourage everyone to read the full paper:

…expertise and authority are increasingly seen as means for elites to establish and support existing hierarchies. There is, of course, some substance to this argument: although orthodox doctors may believe that their dominance and privilege are attributable to the rigor of the methods they use and that other schools of medicine were vanquished because of the superior results achieved by science-based practice, another version of the story sees the suppression of other approaches to healing (e.g., naturopathy, homeopathy, or chiropractic) as the result of ruthless actions by the American Medical Association and other forms of organized medicine. These critiques aren’t new; as Lewis Grossman writes in Choose Your Medicine, “medical freedom” arguments have long been used to oppose institutions intended to protect consumers, such as medical licensure and the FDA.3 The difference today is that the antiexpertise perspective has moved into the mainstream. With Google and Amazon having created a world in which people can frictionlessly obtain both information and nearly any product they want, it’s not hard to portray expert gatekeepers as barriers to patients’ ability to exercise choice.

Perhaps the most substantial threat to expertise is that members of the public are coming to believe that facts don’t exist — that all facts are political and therefore a matter of opinion. This mindset is fundamentally incompatible with the scientific practice of medicine, which depends on a shared commitment to backing up hypotheses with empirical evidence. Indeed, modern medicine owes much of its privileged position to a broad acceptance that the methods it uses can be relied on to make medical choices that are likely to do more good than harm.

A 1902 Supreme Court case, American School of Magnetic Healing v. McAnnulty, offers an instructive example of what could happen if all medical facts were seen as purely matters of opinion. The American School of Magnetic Healing in Nevada, Missouri, received 3000 pieces of mail every day, largely consisting of checks, money orders, and cash to purchase the healing services that the school advertised in newspapers throughout the United States. Patients who sent payments were instructed to lie down at a specified time wherever they were, and the healers at the magnetic school would, from Nevada, channel the healing energy of the universe into their bodies to heal them.3 The Post Office Department (which predated the Postal Service) concluded that this practice was a fraudulent operation using the mail and, after a hearing conducted by the postmaster general, stopped delivering mail to the school. The school sued, and the case went to the Supreme Court, which found in its favor.

Writing for the Court, Justice Rufus Peckham essentially rejected the existence of medical facts. “Just exactly to what extent the mental condition affects the body,” he wrote, “no one can accurately and definitely say.… Because the [school] might or did claim to be able to effect cures by reason of working upon and affecting the mental powers of the individual… who can say that it is a fraud?… Those who might deny the existence or virtue of the remedy would only differ in opinion from those who assert it. There is no exact standard of absolute truth by which to prove the assertion false and a fraud.”4 Although this decision was never expressly overruled, both Congress and the courts have since rejected the premise that the efficacy of treatments is purely a matter of opinion.

Differences of opinion within medicine are necessary for progress, and both licensing and certifying boards must therefore be careful to leave room for the expression of divergent views. Moreover, there is ongoing debate regarding the extent to which free-speech protections cover professional speech. But despite the existence of divergent views and areas for legitimate debate, there are some opinions that have been so thoroughly repudiated by existing evidence as to be considered definitively wrong.5 Constructive debates are possible only within a shared epistemic framework and with a commitment to the idea of verifiable facts. It’s incumbent on licensing and certifying boards to defend the existence of facts and to give the public a way to know when practitioners are making claims that are incompatible with reality.

When it comes to disciplining doctors, boards haven’t always lived up to public expectations — but that’s not a reason they should fall short yet again, especially during a lethal pandemic. Although there are many gray areas in medicine, some propositions are objectively wrong. For example, when a licensed physician insists that viruses don’t cause disease or that Covid-19 vaccines magnetize people or connect them to cell towers, professional bodies must be able to take action in support of fact- and evidence-based practice.

The public relies on the medical profession in times of grievous vulnerability and need. For the profession to earn and maintain the public’s trust — along with the privileges associated with the status of being licensed practitioners — medical boards must be able to differentiate practitioners who are providing fact-based advice from those who are not.

I had all but forgotten about these trials until a comment by ‘Mojo’ (thanks Mojo!) reminded me of this article in the JRSM by M.E. Dean. It reviewed these early trials of homeopathy back in 2006. Here are the crucial excerpts:

The homeopath in both trials was a Dr Herrmann, who received a 1-year contract in February 1829 to test homeopathy with the Russian military. The first study took place at the Military Hospital in the market town of Tulzyn, in the province of Podolya, Ukraine. At the end of 3 months, 164 patients had been admitted, 123 pronounced cured, 18 were convalescing, 18 still sick, and six had died. The homeopathic ward received many gravely ill patients, and the small number of deaths was shown at autopsy to be due to advanced gross pathologies. The results were interesting enough for the Russian government to order Herrmann to the Regional Military Hospital at St Petersburg to take part in a larger trial, supervised by a Dr Gigler. Patients were admitted to an experimental homeopathic ward, for treatment by Herrmann, and comparisons were made with the success rate in the allopathic wards, as happened in Tulzyn. The novelty was Gigler’s inclusion of a ‘no treatment’ ward where patients were not subject to conventional drugging and bleeding, or homeopathic dosing. The untreated patients benefited from baths, tisanes, good nutrition and rest, but also:

‘During this period, the patients were additionally subjects of an innocent deception. In order to deflect the suspicion that they were not being given any medicine, they were prescribed pills made of white breadcrumbs or cocoa, lactose powder or salep infusions, as happened in the homeopathic ward.’ (page 415)

The ‘no treatment’ patients, in fact, did better than those in both the allopathic and homeopathic wards. The trial had important implications not just for homeopathy but also for the excessive allopathic drugging and bleeding that was prevalent. As a result of the report, homeopathy was banned in Russia for some years, although allopathy was not.

… A well-known opponent of homeopathy, Carl von Seidlitz, witnessed the St Petersburg trial and wrote a hostile report. He then conducted a homeopathic drug test in February 1834 at the Naval Hospital in the same city in which healthy nursing staff received homeopathically-prepared vegetable charcoal or placebo in a single-blind cross-over design. Within a few months, Armand Trousseau and colleagues were giving placebo pills to their Parisian patients; perhaps in the belief that they were testing homeopathy, and fully aware they were testing a placebo response., A placebo-controlled homeopathic proving took place in Nuremberg in 1835 and even included a primitive form of random assignment—identical vials of active and placebo treatment were shuffled before distribution. Around the same time in England, Sir John Forbes treated a diarrhoea outbreak after dividing his patients into two groups: half received allopathic ‘treatment as usual’ and half got bread pills. He saw no difference in outcome, and when he reported the experiment in 1846 he added that the placebos could just as easily have been homeopathic tablets. In 1861, a French doctor gave placebo pills to patients with neurotic symptoms, and his attitude is representative: he called the placebo ‘orthodox homeopathy’, because, as he said, ‘Bread pills or globules of Aconitum 30c or 40c amount to the same thing’.

References:

3. Lichtenstädt J. Beschluss des Kaiserl. Russ. Menicinalraths [sic] in Beziehung auf die homöopathische Heilmethode. Litterarische Annalen der gesammten Heilkunde 1832. ;24:412 -20 [German translation of: Ministry of Internal Affairs (Conclusion of the Medical Council regarding homeopathic treatment). []Zhurnal Ministerstva Vnutrennih del 1823. ;3:49 -63] []
4. Herrmann D. Amtlicher Bericht des Herrn D. Herrmann über die homöopathische Behandlung im Militärhospitale zu Tulzyn in Podolien, welche er auf Befehl Sr. Maj. des Kaisers Nicolaus I. unternommen; nebst einer Abhandlung über die Kur der Wechselfieber. Annalen der homöopathischen Klinik 1831. ;2:380 -99 []
5. Seidlitz Cv. Ueber die auf Allerhöchste Befehl im St. Petersburger Militärhospitale angestellten homöopathischen Heilversuche. Wissenschaftliche Annalen der gesammten Heilkunde 1833;27:257 -333 []
6. Seidlitz Cv. Homöopathische Versuche. Wissenschaftliche Annalen der gesammten Heilkunde 1834. ;29:161 -79 []
7. Pigeaux DMP.Étonnantes vertus homoeopathiques de la mie de pain: Expériences faites à l’Hôtel-Dieu. Bulletin Général de Thérapeutique Médicale et Chirurgicale 1834. ;6:128 -31 []
8. Trousseau A, Gouraud H. Expériences homéopathiques tentées à l’Hôtel-Dieu de Paris. Journal des Connaissances Médico-Chirurgicales 1834. ;8:238 -41 []
9. Löhner G. Die homöopathischen Kochsalzversuche zu Nürnberg. Nuremberg: Löhner, 1835
10. Forbes J. Homoeopathy, Allopathy and ‘Young Physic’. Br Foreign Med Rev 1846. ;21:225 -65 [PMC free article] [PubMed[]
11. Lisle E. Feuilleton de l’homoeopathie orthodoxe. Union Méd 1861: 11-72
______________________________
None of these studies were perfect, of course. However, collectively they do seem to paint a picture that indicates what now the totality of the ~600 trials of homeopathy available to date confirm: homeopathy is a placebo therapy.
What a pity that this conclusion had not been drawn and generally accepted some 150 years earlier – just think of the effort and money that this would have saved.

This review investigated the characteristics, hotspots, and frontiers of global scientific output in acupuncture research for chronic pain over the past decade. the authors retrieved publications on acupuncture for chronic pain published from 2011 to 2022 from the Science Citation Index Expanded (SCI-expanded) of the Web of Science Core Collection (WoSCC). The co-occurrence relationships of journals/countries/institutions/authors/keywords were performed using VOSviewer V6.1.2, and CiteSpace V1.6.18 analyzed the clustering and burst analysis of keywords and co-cited references.

A total of 1616 articles were retrieved. The results showed that:

  • the number of annual publications on acupuncture for chronic pain has increased over time;
  • the main types of literature are original articles (1091 articles, 67.5 %) and review articles (351 articles, 21.7 %);
  • China had the most publications (598 articles, 37 %), with Beijing University of Traditional Chinese Medicine (93 articles, 5.8 %);
  • Evidence-based Complementary and Alternative Medicine ranked first (169 articles, 10.45 %) as the most prolific affiliate and journal, respectively;
  • Liang FR was the most productive author (43 articles);
  • the article published by Vickers Andrew J in 2012 had the highest number of citations (625 citations).

Recently, “acupuncture” and “pain” appeared most frequently. The hot topics in acupuncture for chronic pain based on keywords clustering analysis were experimental design, hot diseases, interventions, and mechanism studies. According to burst analysis, the main research frontiers were functional connectivity (FC), depression, and risk.

The authors concluded that this study provides an in-depth perspective on acupuncture for chronic pain studies, revealing pivotal points, research hotspots, and research trends. Valuable ideas are provided for future research activities.

I might disagree with the authors’ conclusion and would argue that they have demonstrated that:

  1. the acupuncture literature is dominated by China, which is concerning because we know that 1) these studies are of poor quality, 2) never report negative findings, and 3) are often fabricated;
  2. the articles tend to be published in journals that are more than a little suspect.

As we have seen recently, the reliable evidence that acupuncture remains effective is wafer-thin. Therefore, I feel that we are currently being misled by a flurry of rubbish publications that have one main aim: to distract from the fact that acupuncture might be nonsense.

Yes, this post is yet again about the harm chiropractors do.

No, I am not obsessed with the subject – I merely consider it to be important.

This is a case presentation of a 44-year-old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high-velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior.

The CT angiogram of the head and neck revealed bilateral vertebral artery dissection at the left V2 and right V3 segments. MRI brain confirmed an acute infarct in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus.

The authors discussed that arterial dissection accounts for about 2% of all ischemic strokes, but maybe between 8–25% in patients less than 45 years old. Vertebral artery dissection (VAD) can result from trauma from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing.

It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. Patients who have multiple chronic conditions are reporting higher use of so-called alternative medicine (SCAM), including chiropractic manipulation. Education about the association between VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, VAD symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.

Here we have a rare instance where the physicians who treated the chiro-victim were sufficiently motivated to present their findings and document them in the medical literature. Their report was published in 2021 as an abstract in conference proceedings. In other words, the report is not easy to find. Even though two years have passed, the full article does not seem to have emerged, and chances are that it will never be published.

The points I am trying to make are as follows:

  • Complications after chiropractic manipulation do happen and are probably much more frequent than chiros want us to believe.
  • They are only rarely reported in the medical literature because the busy clinicians who end up treating the victims do not consider this a priority and because many cases are settled in or out of court.
  • Normally, it would be the ethical/moral duty of the chiros who have inflicted the damage to do the reporting.
  • Yet, they seem too busy ripping off more patients by doing neck manipulations that do more harm than good.
  • And then they complain that the evidence is insufficient!!!

I have featured the ‘Münster Circle‘ before. The reason why I do it again today is that we have just published a new Memorandum entitled HOMEOPATHY IN THE PHARMACY. Here is its summary which I translated into English:

Due to questionable regulations in German pharmaceutical law, homeopathic medicines can be given the status of a medicinal product without having to provide valid proof of efficacy. As medicinal products, these preparations may then only be dispensed to customers in pharmacies, which, however, creates an obligation to also supply them on request or prescription. Many pharmacies go far beyond this and advertise homeopathic medicines as a useful therapy option by advertising them prominently in the window. In addition, customers are recommended to use them, corresponding lecture events are supported, and much more. Often, homeopathic preparations are even produced according to pharmacies’ own formulations and marketed under their own name.

For pharmacists and pharmaceutical technical assistants (PTAs) to perform their important task in the proper supply of medicines to the population, they must have successfully completed a scientific study of pharmacy or state-regulated training. This is to ensure that customers are informed and properly advised about their medicines according to the current state of knowledge.

After successfully completing their training or studies, PTAs and pharmacists are undoubtedly able to recognize that homeopathic medicines cannot be effective beyond placebo. They do not have any significant content of active ingredients – if, for example, the high potencies that are considered to be particularly effective still have any active ingredients at all. Consequently, pharmacists and PTAs act against their better knowledge to the detriment of their customers if they create the impression through their actions that homeopathic medicines represent a sensible therapeutic option and customers are thereby encouraged to buy and use them.

Although homeopathics have no potential for direct harm in the absence of relevant amounts of pharmacologically active substances in the preparations, their distribution should nevertheless be viewed critically. The use of homeopathy can mean losing valuable time and delaying the start of effective therapy. It is often accompanied by criticism, even rejection of scientifically oriented medicine and public health, for example when homeopathy is presented as the antithesis to a threatening “pharmaceutical mafia”.

The Münster Circle appeals to pharmacists and PTAs to stop advertising homeopathic medicines as an effective therapeutic option, to stop producing and marketing them themselves, and to advise their customers that homeopathic preparations are not more effective than placebo. The professional organizations of pharmacists and other providers of further training are called upon to no longer offer courses on homeopathy – except for convincingly refuting the often abstruse claims of the supporters.

_______________________

I have pointed out for at least 20 years now that pharmacists have an ethical duty toward their clients. And this duty does not involve misleading them and selling them useless homeopathic remedies. On the contrary, it involves advising them on the basis of the best existing evidence.

When I started writing and talking about this, pharmacists seemed quite interested (or perhaps just amused?). They invited me to give lectures, I published an entire series of articles in the PJ, etc. Of late, they seem to be fed up with hearing this message and the invitations have well and truly stopped.

They may be frustrated with my message – but not as frustrated as I am with their inertia. In my view, it is nothing short of a scandal that homeopathic remedies and similarly bogus treatments still feature in pharmacies across the globe.

This happens with such a regularity that I have decided to write about it; in fact, I shall do that in the form of an ‘open letter‘ to all concerned.

Background

A person or group of persons compose a complaint about my work in which they allege that I am engaged in a decade-long vendetta specifically against their particular form of so-called alternative medicine (SCAM). This letter is sent to me, or to a publisher of my articles/books, or to my peers at the university, or to anyone else they consider appropriate. Such interventions can at times be quite entertaining or even hilariously funny, but if they occur too often, they are also mildly irritating and wasteful. Foremost, they are based on a fundamental misunderstanding that might be worth clearing up with this …

 Open Letter

Dear advocate of the specific SCAM in question,

Dear professional organization of the specific SCAM in question,

I am sorry that my lecture/article/blog post/book/interview caused concern and led you to feel that I am running a long-term campaign or vendetta against the specific SCAM that you advocate. This letter is to assure you that your feeling is entirely erroneous: I am in no way targeting your specific SCAM.

If you have a look at my most recent book, for instance, you will see that, in it, I discuss a total of 202 different forms of SCAM and that – with good reason – I am highly critical of the vast majority of these methods. Imagine what it would mean to run a vendetta or campaign against all of these specific SCAMs. I would need a sizable team of co-workers involving lawyers, researchers, administrators, etc. to manage the task. I would also need plenty of funds to support the campaign, and I would most likely have more legal cases going than I have hair on my head.

The truth is that, since my retirement ~10 years ago, I do my research with no assistance whatsoever, I get no financial support or compensation for my work, and I am in contact with lawyers only when they ask me to serve as an expert witness. There simply is no evidence for the campaign that you feel does exist and you evidently misjudge my motives for criticizing your specific SCAM.

My aim is not to defame your specific SCAM or SCAM in general. I have no reason to do this. My aim is simply to inform the public responsibly and to prevent vulnerable people from getting harmed or ripped off. As I have studied the subject systematically for three decades, I feel I am competent, entitles, and duty-bound to try and do this.

I sincerely hope you are able to see the difference: you seem to think that I am destructively out to get you or your SCAM, while in truth I am constructively doing what responsible healthcare professionals (should) do.

Now that this misunderstanding has been cleared up, I thank you for reconsidering your position and stopping to claim things about me that are not true.

Best regards

Edzard Ernst

It has been reported that a young woman’s visit to a chiropractor left her unable to walk due to a torn artery.

Mariah Bond, 29, went to visit a chiropractor in the hope to get some relief from her neck pain. During the appointment, the chiropractor quickly twisted her neck from side to side. “It cracked both ways and I’d seen chiropractor videos so I thought it was normal but when I stood up I got super dizzy,” Mariah recalled. Next, Mariah started profusely vomiting and her hand began to tingle. Then she was rushed to a hospital.

It took a few hours before the doctors could find the diagnosis. “I was still throwing up constantly, it was non-stop. I couldn’t open my eyes because if I did I’d start throwing up because I was so dizzy,” Mariah said. “I was transferred via ambulance to another hospital where they did a CT scan and confirmed that I was having a stroke.”

It turned out that Mariah’s chiropractor dissected an artery in her neck which then limited the blood supply to the brain. Mariah was kept in the hospital for five days while her condition was monitored. During that time, she was left unable to walk. But slowly she did become able to rely on a zimmer frame to get around. “I couldn’t walk properly or correctly use my hands to eat, it was like I was a child. It was very weird. My brain was there but I couldn’t do it,” she stated. “My first stroke was a cerebral stroke and they were saying that I probably had a mini-stroke as I was having weird feelings in my legs. They were very confused because that wasn’t common with the stroke I had, so they said that I probably had two.”

Within a fortnight, Mariah was able to walk again but had to have physiotherapy for two months before she could return to work. After her last CT scan, she received the good news that the dissected vessel had completely healed. She said: “I was very strong-willed at the time because everyone was telling me how well I was handling this. I think my husband was more scared than I was, poor thing.”

Mariah has vowed never to visit a chiropractor again and is doing her best to raise awareness of the damage they can cause. “I was shocked because I’m so young and you don’t really hear about young people having strokes, especially from the chiropractor. I’m pretty paranoid with my neck now. I know I probably shouldn’t be but sometimes if I have a weird feeling in my head, it would probably be called PTSD, I automatically start thinking am I having a stroke? I start freaking out. I’d tell people not to go to a chiropractor. I’ve already told a million people not to do it. Just don’t go or at least don’t let them do your neck.”

____________________________

I would be surprised if this case ever got written up as a proper case report and published in a medical journal. We did a survey years ago where we found over 35 cases of severe complications after chiropractic in the UK within a period of 12 months. The most amazing result was that none of these cases had been published. In other words, under-reporting was precisely 100%.

Mariah’s case might be a true rarety, or it might be a fairly common event. It might be a most devastating occurrence, or there could be far worse events.

We simply do not know because under-reporting is huge.

Meanwhile, chiropractors – the professionals who should long have made sure that under-reporting becomes minimal or non-existent – claim that there is no evidence that strokes happen at all or regularly or often. They can do this because the medical literature seems to confirm their opinion. The only reporting system that seems to exist, the “chiropractic patient incident reporting and learning system” (CPiRLS), is for several reasons woefully inadequate and also plagued by under-reporting.

So, what advice can I possibly give to consumers in such a situation? I feel that the only thing one can recommend is to

stay well clear of chiropractors

until they finally present us with sufficient and convincing data.

 

 

This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of Chinese herbal medicine (CHM) combined with Western medicine (WM) in comparison with WM in reducing systolic and diastolic blood pressure for patients with primary hypertension (PHTN).

Various literature searches located a total of 29 studies that included 2623 patients. The results showed that the clinical effectiveness in the treatment of hypertension with CHM+WM was considerably higher than that with WM alone, clinical effective (RR 1.23, 95% CI [1.17, 1.30], P < 0.00001), and markedly effective (ME) in the patients (RR 1.66, 95% CI [1.52, 1.80], and P < 0.00001). Random effect in SBP (MD 7.91 mmHg,[6.00, 983], P < 0.00001) and DBP (MD 5.46 mmHg, [3.88, 6.43], P < 0.00001), a subgroup analysis was carried out based on the type of intervention, duration of treatment, and CHM formulas that showed significance. Furthermore, no severe side effects were reported, and no patients stopped treatment or withdrawal due to any severe adverse events.

The authors concluded that compared to WM alone, the therapeutic effectiveness of CHM combined with WM is significantly improved in the treatment of hypertension. Additionally, CHM with WM may safely and efficiently lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in individuals with PHTN. However, rigorous randomized controlled trials with a large sample, high quality, long duration of treatment, and follow-up are recommended to strengthen this clinical evidence.

The authors can boast of an impressive list of affiliations:

  • 1Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China; School of Pharmacy, Lebanese International University, 18644, Sana’a, Yemen.
  • 2Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China.
  • 3Key Laboratory of Chinese Materia Medica, Ministry of Education of Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China.
  • 4Department of Urology, Affiliated Hospital of Qingdao Binhai University, Qingdao, Shandong, China.
  • 5Department of Respiratory Diseases, Shandong Second Provincial General Hospital, Shandong University, Shandong, China.
  • 6Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China. Electronic address: [email protected].

Impressive in the sense of being impressively prone to bias, particularly knowing that ~80% of Chinese research findings have been shown to be fabricated and considering that Chinese authors as good as never publish anything negative about TCM.

But perhaps you still believe that the results reported here are 100% true? In this case, I might even agree with you. The reason is that the authors demonstrate in exemplary fashion what I have been saying so often before:

A+B is more than B alone!

Blood pressure is one of the many endpoints that are highly prone to placebo effects. Therefore, even the addition of an ineffective CHM to WM would lower blood pressure more effectively than WM alone.

But there is a third way of explaining the findings of this review: some herbal remedies might actually have a hypotensive effect. The trouble is that this review does come not even close to telling us which.

Guest post by Hans-Werner Bertelsen

As a self-confessed Asterix fan, I made a proposal to the Bremen Medical Association in 2019 that it should no longer orient itself towards the mainstream in the area of further training, but rather towards Klein-Bonum. The board found my proposal very good and unanimously deleted “homeopathy” from the postgraduate training regulations at the next board meeting. The media echo was tremendous. Words of “dam bursting” and “revolution” did the rounds. The “domino effect” was also often quoted in this context, because in the following years, many other German state medical associations followed the Bremen example and removed “homeopathy” from their further training regulations: Saxony-Anhalt, North Rhine, Schleswig-Holstein, Baden-Württemberg, Hamburg, Hesse, Brandenburg, Berlin, Mecklenburg-Western Pomerania, Lower Saxony, Saarland, and Bavaria.

Following the principle of logical plausibility, according to which it makes no sense to support dubious therapies that are not in one’s own training portfolio, but are still reimbursed by many health insurance funds, by convenient billing modalities, the Association of Statutory Health Insurance Physicians Bremen (KVHB) drew a line under the matter and terminated corresponding contracts on my advice. With the termination of the criticized selective contracts, the small federal state of Bremen thus set new standards in 2021. Since the termination, doctors can no longer conveniently provide “homeopathic services” online but have to bill their patients for their services.

But that was not all: the drumbeat of terminated billing contracts had not yet died down in the ears of the “homeopaths”, when only 3 months later, at the meeting of the Federal Medical Association, the next one followed: After a delegate from Bremen (do you want to know if this was a coincidence?) had submitted a motion for the deletion of “homeopathy” from the Model Continuing Medical Education Ordinance (MWBO), this was carried out after a democratic vote at the medical congress in Bremen. The Federal Medical Association thus officially declares this type of sham therapy to be no longer up-to-date, dispensable, and unworthy of further training.

In view of the vote democratically given by the Board, it seems bizarre that the Bavarian Medical Association, despite its own decision to remove “homeopathy” from the WBO, now invokes prolongations because of “transitional periods” in order to be able to continue offering courses in “homeopathy”. Contracts in this regard are to be considered secondary and no longer current. Therefore, the justification given by the ÄND proves to be flimsy and not stringent. The protection of patients from dangerous sham therapies in the case of the omission of indication-appropriate therapies saves lives and thus clearly represents the higher legal interest. Calls for “transitional periods” are redundant and negligently endanger the health of many people. On top of that, an unnecessary extension is a disrespect to the decision made by its own members in the democratic process.

But I remain optimistic that logical plausibility – free of backlogs (!) – will prevail in Bavaria as well. The vote has proven that there is a majority for this and that this majority will not be dominated by money or self-deception.

References

https://www.dr-bertelsen.de/documents/Screenshot_2023-02-10_at_11-36-05_Warum_eine_Aerztekammer_noch_immer_Homoeopathie-Kurse_anbietet-AEND.png

https://publikum.net/die-konigl-bayerische-zuckerkugel/

Ärztetag Bremen – Tooor!

 

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