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

conflict of interest

Remember the Bavarian Homeopathy Study? I reported about it only a few days ago. Now the ‘German Homeopathic Doctors Association’ has published an interview with someone who allegedly knows more about it. Here is my translation:

Dr. Springer, what does it actually mean politically that this study came about at all?

First of all, it means that the work of several years was worthwhile and that we were able to convince those responsible with a carefully elaborated study design. It also shows how enormously important it is to have solid political contacts with parties, MPs, parliamentary groups, and spokespersons in health committees. In addition to persuasion, personal credibility and professional competence are indispensable for the growth of such contacts. This is also shown by the fact that LIMed (List of Integrative Medicine) in Bavaria (as in some other federal states) has succeeded in sending committed colleagues to the representations of the State Medical Association and the Medical District and County Association.

What is special about this study?

As far as I know, it is the first study worldwide to be carried out with hand-shaken high potencies (C 200 and C 1000). If the results were positive, the mechanism of action of homeopathy would not be clarified, but it would be proven that highly potentised medicinal substances have a healing effect that can be objectified scientifically.

Who is the sponsor of this study?

The Bavarian Parliament voted with an absolute majority to scientifically investigate the role of complementary medicine in the fight against increasing antibiotic resistance. Several study designs were submitted on this question, and our study approach won the bid in the end. The Bavarian State Ministry of Health and Care is financing the study and has won the Technical University of Munich as a partner – after all, it is one of Germany’s universities of excellence. This removes all doubts about the correct scientific conduct of the study.

What is to be investigated in the study?

It relates to a diagnosis with great relevance to healthcare: Women often suffer from recurrent urinary tract infections, which are often treated with antibiotics. This is always associated with the risk of causative bacteria developing resistance to antibiotics. As homeopathically qualified doctors, we know from decades of experience that we can reduce and even end the frequency of recurrent urinary tract infections and their occurrence with our homeopathic remedies. We want to put this experience to the test scientifically with this study.

How do you see the chances for a positive study result?

As doctors, we know what we do and what we can do. We will do everything in our power to show that we can do it! I would also like to take this opportunity to thank all those who have made this study possible and who are providing us with professional and scientific support!-

The interview was conducted by Ulf Riker, MD.

___________________________

The interview raises several questions:

  1. Dr. Springer confirms that the existence of the study and its financial support is mostly due to political influence. Is this how good science should be generated?
  2. Is it true that the study is the first to investigate potency homeopathy? Considering that the bestselling homeopathic, Oscillococcinum, is sold in the C200 potency, this seems to be a very questionable statement.
  3. If the results were to come out positive, would we really re-write the textbooks of physics and chemistry which state that the absence of an active molecule cannot have an effect?
  4. Does the involvement of the Technical University truly remove all doubts about the correct scientific conduct of the study?
  5. If the homeopathically qualified doctors conducting the study already claim to know from decades of experience that they can reduce and even end the frequency of recurrent urinary tract infections with homeopathic remedies, are they not going to be too biased in conducting such a study?
  6. If the trialists are determined to do everything in their power to show that homeopathy works, will the study generate a reliable result?
  7. My last question is, how reliable is Dr. Springer? I found another interview of him dated 2021. In it he stated about the homeopathic treatment of COVID patients: ” [There is a} group of Covid-19 patients … [to] whose successful treatment we as homeopathic physicians can certainly contribute. The symptomatology of these patients is considerable, sometimes severe, but not life-threatening. They suffer from headaches and pain in the limbs, dizziness, fever, have the often-quoted “dry cough”, sweat, and usually feel very weak. But they have not yet developed clinical symptoms of pneumonia. These patients – and they are by no means few – can be helped by medical homeopathy, I am firmly convinced, curatively. Provided, of course, that a very precise, individual homeopathic anamnesis is carried out, the patient is closely followed, the course of the disease is closely observed and the remedy administered is adjusted if necessary. By preventing an acute condition and hospitalization in these patients homeopathy could make a not inconsiderable contribution to overcoming these greatest health and social challenges in one hundred years.” That, I think might answer my question.

As I pointed out before, the study design looks rigorous. After reading this interview, I have my doubts that its execution will be rigorous as well.

I recently came across a truly baffling article. As it is in German, I translated it for you:

Supply shortages have kept pharmacies on tenterhooks for months, with more than 400 common medicines missing. The German Central Association of Homeopathic Doctors (DZVhÄ) suggests switching to alternative medicine as a solution: “We have homeopathic medicines that have been tried and tested in practice for more than 200 years and can replace many medicines that are currently not available,” says the president of the DZVhÄ , Dr Michaela Geiger.

The DZVhÄ is convinced that homeopathic medical practices can replace fever-reducing medicines, but in many cases also antibiotics and much more. However, Geiger qualifies: “Due to our medical training, we also know that cancer drugs such as the often cited Tamoxifen cannot be replaced by homeopathy”.

The homeopathic doctors respond directly to the sharpest argument of their critics: “But let’s assume that homeopathy only works via the placebo effect, as is being rumored, even then it would be an option, especially if other options are lacking,” says DZVhÄ vice-president Dr. Ulf Riker. Since homeopathically trained doctors can judge the general course of a disease, they can also distinguish a placebo effect from a medicinal effect.

If fever medication for children is lacking, parents should not be deprived of another “therapy option”, Riker said. “If you do not get your conventional fever medication in the coming weeks, visit a specialist pharmacy for naturopathy and homeopathy. If you are due for a medical consultation, experienced homeopathic doctors can prescribe a suitable homeopathic medicine for you,” he says.

Why do I find this so intriguing?

Essentially, what we have learned from the article is the following:

  1. “Tried and tested in practice for more than 200 years” is ‘homeopathy speak’ for “effective”, even if the evidence tells us otherwise.
  2. Homeopathic remedies can replace many evidence-based conventional medications such as fever-reducing medicines, antibiotics, and much more, even if the evidence tells us otherwise.
  3. Homeopaths know that cancer drugs cannot be replaced by homeopathy – except for those homeopaths who seem to have forgotten this simple lesson.
  4. Homeopathic placebos are a realistic option when there is a supply problem with effective drugs, even if the evidence tells us otherwise.
  5. Homeopathically trained doctors can distinguish a placebo effect from a medicinal effect, even if there is no evidence that any clinician can reliably do this.
  6. Homeopathic doctors prescribe suitable homeopathic medicine. Suitable for whom? As it is ineffective, it is unsuitable for the patient. Therefore, Riker is probably talking about the homeopath.

So, what have we really learned from this article? I don’t know about you, but I got the impression that the president and the vice president of the DZVhÄ do not seem to mind putting patients in danger, as long as they can promote homeopathy.

 

Wellness seems to be everywhere these days – I mean of course the term, not the state or condition. On Medline, we find in excess of 500 000 articles on wellness, just for the year 2022! Wellness is en vogue, sexy, politically correct, etc. It looks good to talk and write about it. Most importantly it is good business. A report by the Global Wellness Institute stated that in 2020 the wellness industry was valued at $4.5 trillion and continues to grow at a frightening rate.

Having studied some of the recent literature on the subject, I get the impression that, for many, wellness is foremost an excuse for waffling utter nonsense. Let me, therefore, today ask just 5 simple questions about wellness that are likely to reduce the wellness of the ‘wellness brigade’:

1.What is wellness?

It is quite evidently a sector that is unable to define itself. Here are just a few of the definitions that have been suggested. Wellness is:

A 2018 review revealed that there is a lack of a uniform definition of wellness and showed that there is insufficient evidence to support the clinical utility of a single particular wellness instrument.

2. How do we measure wellness? 

The short answer to this question is: nobody is quite sure. There simply is no generally accepted, well-validated measure. A few domains come to mind:

  • physical functioning,
  • somatic symptoms, e.g. pain,
  • psychological symptoms,
  • social functioning,
  • needs and satisfaction.

But there is no simple means to quantify wellness. If you think that I am exaggerating, consider this recent review: 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.

3. What affects wellness?

The short answer is: potentially everything. My very own wellness, for instance, deteriorates sharply, if I have to read yet another nonsensical article about it.

4. Which interventions improve wellness?

As we have seen in my previous post, this is where so-called alternative medicine (SCAM) comes in. Since there is no measure to quantify wellness, we just have to take the word of SCAM proponents for it: SCAM improves wellness!!!

It’s obvious!

Which specific SCAM?

Can I see the evidence?

Sorry, no questions allowed!

And if you dare to insist on evidence, the ‘wellness brigade’ would just give you a pitiful smile and say: wellness has to be experienced, not measured.

5. Are there risks?

Yes, of course! Here are just some of them:

  • The treatments advocated for wellness almost invariably cost money.
  • The treatments advocated for wellness almost invariably cause direct and indirect harm, as discussed in many of my previous posts.
  • Wellness treatments tend to give the impression that one can buy wellness like an expensive piece of clothing without putting in any real effort oneself.

Considering all this, I’d like to offer my very own definition of the sector:

Wellness is a fashionable paradise for charlatans in which they are protected from scientific scrutiny and feel at liberty to bullshit to their hearts’ content. 

 

The All-Party Parliamentary Group (APPG) on Beauty and Wellbeing, UK, has undertaken an investigation into the ‘complementary therapies sector’, to consider how the sector can support everyone’s physical health, mental health, and well-being and take pressure off the NHS. In their recent document, they state:

The complementary therapies industry is an integral part of the Personal Care sector, which includes beauty, wellbeing, and alternative therapies. These therapies can be key to supporting everyone’s health and mental wellbeing…

To ensure complementary therapies can adequately support the NHS, we need to attract more talent into the sector and ensure all therapists receive the right training to become highly skilled professionals.

We also need to enhance the perception of the professionalism within the sector, so that it is no longer seen as ‘frivolous and fluffy’ and non-essential. Building awareness and understanding of its value in supporting our nation’s health is one step. However, it also important to crack down on any bad practice and the ‘underground market’ of poor treatment…

The committee makes the following recommendations:

1. The Government must work with NHS England to better promote the benefits of social prescribing with GPs, nurses and other health and care professionals, and how they can refer people to non-clinical complementary therapy services.
2. The Personal Care sector team in the Department for Business, Energy, Industry and Strategy must work with officials within the Department for Health and Social Care responsible for social prescribing to better integrate complementary therapy services into the NHS, and produce guidance to support health professionals and therapists in doing so.
3. The Department for Health and Social Care must undertake or fund research studies to demonstrate the value of integrating complementary therapy services into the NHS through social prescribing.
4. The Department for Education must revisit the gap between the apprentice wage and minimum wage for apprentices aged 19+, and provide financial incentives for employers to take on learners on any ‘job ready ‘qualification.
5. The Government must give Environmental health officers (EHOs) greater powers to act quickly to deal with bad practice and lead a crack-down on tax evading businesses that are driving down prices and undermining legitimate businesses under pressure.

Conclusions
The evidence that we have received during this investigation clearly demonstrate that greater support
and recognition is needed for the complementary therapies sector to ensure that they are able support
everyone’s physical health, mental health and wellbeing and take pressure off the NHS.
We hope the Government will review our recommendations in order to support the complementary
therapies sector and ensure they have adequate funding and acknowledgement.

In case you are wondering what therapies they refer to, here is their complete list of the treatments (including links to what they seem to think about them):

Alexander technique

Aromatherapy

Body massage

Bowen technique

Cranio sacral therapy

Healing

Homeopathy

Hypnotherapy

Kinesiology

Microsystems acupuncture

Naturopathy

Nutritional therapy

Reflexology

Reiki

Shiatsu

Sports massage

Sports therapy

Yoga therapy

This could have made me laugh, had it not been so serious. The committee is composed of MPs who might be full of goodwill. Yet, they seem utterly clueless regarding the ‘complementary therapies sector’. For instance, they seem to be unaware of the evidence for some of the treatments they want to promote, e.g. craniosacral therapy, aromatherapy, Reiki, shiatsu, energy healing, or reflexology (which is far less positive than they seem to assume); and they aim at enhancing the “perception of the professionalism” instead of improving the PROFESSIONALISM of the therapists (which obviously would include adherence to evidence-based practice). And perhaps the committee might have given some thought to the question of whether it is ethical to push dubious therapies onto the unsuspecting public.

I could go on, but the perplexing wooliness of the document speaks for itself, I think.

And in case you are wondering who the MP members of the committee are, here is the list of its members:

• Carolyn Harris MP – Co-Chair
• Judith Cummins MP – Co-Chair
• Jessica Morden MP – Vice-Chair
• Jackie Doyle-Price MP – Vice-Chair
• Peter Dowd MP – Treasurer
• Nick Smith MP – Secretary
• Caroline Nokes MP – Member
• Sarah Champion MP – Member
• Alex Davies-Jones MP – Member
• Kate Osamor MP – Member
• John McNally MP – Member
• Kevan Jones MP – Member
• Gagan Mohindra MP- Member

The Secretariat for this APPG is Dentons Global Advisors with support from the National Hair and Beauty Federation, the Federation of Holistic Therapists and spabreaks.com.

 

PS

Two hours after having posted this, I begin to feel bad about being so dismissive. Let me thus try to do something constructive: I herewith offer to give one or more lectures to the committee about the evidence as it pertains to the therapies they included in their report.

The concept of ultra-processed food (UPF) was initially developed and the term coined by the Brazilian nutrition researcher Carlos Monteiro, with his team at the Center for Epidemiological Research in Nutrition and Health (NUPENS) at the University of São Paulo, Brazil. They argue that “the issue is not food, nor nutrients, so much as processing,” and “from the point of view of human health, at present, the most salient division of food and drinks is in terms of their type, degree, and purpose of processing.”

Examples of UPF include:

Ultra-processed food is bad for our health! This message is clear and has been voiced so many times – not least by proponents of so-called alternative medicine (SCAM) – that most people should now understand it.

But how bad?

And what diseases does UPF promote?

How strong is the evidence?

I did a quick Medline search and was overwhelmed by the amount of research on this subject. In 2022 alone, there were more than 2000 publications! Here are the conclusions from just a few recent studies on the subject:

Don’t get me wrong: this is not a systematic review of the subject. I am merely trying to give a rough impression of the research that is emerging. A few thoughts seem nonetheless appropriate.

  1. The research on this subject is intense.
  2. Even though most studies disclose associations and not causal links, there is in my view no question that UPF aggravates many diseases.
  3. The findings of the current research are highly consistent and point to harm done to most organs.
  4. Even though this is a subject on which advocates of SCAM are exceedingly keen, none of the research I saw was conducted by SCAM researchers.
  5. The view of many SCAM proponents that conventional medicine does not care about nutrition is clearly not correct.
  6. Considering how unhealthy UPF is, there seems to be a lack of effective education and action aimed at preventing the harm UPF does to us.

The UK medical doctor, Sarah Myhill, has a website where she tells us:

Everyone should follow the general approach to maintaining and restoring good health, which involves eating a paleo ketogenic diet, taking a basic package of nutritional supplements, ensuring a good night’s sleep on a regular basis and getting the right balance between work, exercise and rest. Because we live in an increasingly polluted world, we should probably all be doing some sort of detox regime.

She also happens to sell dietary supplements of all kinds which must surely be handy for all who want to follow her advice. Dr. Myhill boosted her income even further by putting false claims about Covid-19 treatments online. And that got her banned from practicing for nine months after a medical tribunal.

She posted videos and articles advocating taking vitamins and other substances in high doses, without evidence they worked. The General Medical Council (GMC) found her recommendations “undermined public health” and found some of her recommendations had the potential to cause “serious harm” and “potentially fatal toxicity”. The tribunal was told she uploaded a series of videos and articles between March and May 2020, describing substances as “safe nutritional interventions” which she said meant vaccinations were “rendered irrelevant”. But the substances she promoted were not universally safe and have potentially serious health risks associated with them, the panel was told. The tribunal found Dr. Myhill “does not practice evidence-based medicine and may encourage false reassurance in her patients who may believe that they will not catch Covid-19 or other infections if they follow her advice”.

Dr. Myhill previously had a year-long ban lifted after a General Medical Council investigation into her claims of being a “pioneer” in the treatment of chronic fatigue syndrome. In fact, the hearing was told there had been 30 previous GMC investigations into Dr. Myhill, but none had resulted in findings of misconduct.

Dr. Myhill is also a vocal critic of the PACE trial and biopsychosocial model of ME/CFS. Dr. Myhill’s GMC complaint regarding a number of PACE trial authors was first rejected without investigation by the GMC, after Dr. Myhill appealed the GMC stated they would reconsider. Dr. Myhill’s action against the GMC for failing to provide reasoning for not investigating the PACE trial authors is still continuing and began a number of months before the most recent GMC instigation of her practice started.

The recent tribunal concluded: “Given the circumstances of this case, it is necessary to protect members of the public and in the public interest to make an order suspending Dr. Myhill’s registration with immediate effect, to uphold and maintain professional standards and maintain public confidence in the profession.”

If you think that scanning through dozens of new scientific articles every week is a dry and often somewhat tedious exercise, you are probably correct. But every now and then, this task is turned into prime entertainment by some pseudoscientists trying to pretend to be scientists. Take, for instance, the latest homeopathy study by Indian researchers with no less than 9 seemingly impressive affiliations:

  • 1Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Salt Lake, Kolkata, West Bengal, India.
  • 2Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Block GE, Sector III, Salt Lake, Kolkata, West Bengal, India.
  • 3Department of Homoeopathy, State Homoeopathic Dispensary, Karaila, Pratapgarh, Uttar Pradesh, India.
  • 4Department of Homoeopathy, State Homoeopathic Dispensary, Tulsipur, Shrawasti, Uttar Pradesh, India.
  • 5Department of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Salt Lake, Kolkata, West Bengal, India.
  • 6State Homoeopathic Dispensary, Mangalbari Rural Hospital, Matiali Block, Jalpaiguri, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, India.
  • 7Department of Repertory, The Calcutta Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, West Bengal, India.
  • 8Department of Homoeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Village and Post Office: Gouripur (South), Police Station Bishnupur, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, India.
  • 9Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Tangra, Kolkata, West Bengal, India.

Now that I have whetted your appetite, here is their study:

Lumbar spondylosis (LS) is a degenerative disorder of the lumbar spine. Despite substantial research efforts, no gold-standard treatment for LS has been identified. The efficacy of individualized homeopathic medicines (IHMs) in lumbar spondylosis (LS) is unknown. In this double-blind, randomized, placebo-controlled trial, the efficacy of IHMs was compared with identical-looking placebos in the treatment of low back pain associated with LS. It was conducted at the National Institute of Homoeopathy, West Bengal, India.

Patients were randomized to receive IHMs or placebos; standardized concomitant care was administered in both groups. The Oswestry low back pain and disability questionnaire (ODQ) was used as the primary outcome measure; the Roland-Morris questionnaire (RMQ) and the short form of the McGill pain questionnaire (SF-MPQ) served as secondary outcome measures. They were measured at baseline and every month for 3 months. Intention-to-treat analyses (ITT) were used to detect any inter-group differences using two-way repeated measures analysis of variance models overall and by unpaired t-tests at different time points.

Enrolment was stopped prematurely because of time restrictions; 55 patients had been randomized (verum: 28; control: 27); 49 could be analyzed by ITT (verum: 26; control: 23).

The results are as follows:

  • Inter-group differences in ODQ (F 1, 47 = 0.001, p = 0.977), RMQ (F 1, 47 = 0.190, p = 0.665) and SF-MPQ total score (F 1, 47 = 3.183, p = 0.081) at 3 months were not statistically significant.
  • SF-MPQ total score after 2 months (p = 0.030) revealed an inter-group statistical significance, favoring IHMs against placebos.
  • Some of the SF-MPQ sub-scales at different time points were also statistically significant: e.g., the SF-MPQ average pain score after 2 months (p = 0.002) and 3 months (p = 0.007).
  • Rhus Toxicodendron, Sulphur, and Pulsatilla nigricans were the most frequently indicated medicines.

The authors concluded that owing to failure in detecting a statistically significant effect for the primary outcome and in recruiting a sufficient number of participants, our trial remained inconclusive.

Now that I (and hopefully you too) have recovered from laughing out loud, let me point out why this paper had me in stitches:

  • The trial was aborted not because of a “time limit” but because of slow recruitment, I presume. The question is why were not more patients volunteering? Low back pain with LS is extremely common. Could it be that patients know only too well that homeopathy does not help with low back pain?
  • If a trial gets aborted because of very low patient numbers, it is probably best not to publish it or at least not to evaluate its results at all.
  • If the researchers insist on publishing it, their paper should focus on the reason why it did not succeed so that others can learn from their experience by avoiding their mistakes.
  • However, once the researchers do run statistical tests, they should be honest and conclude clearly that, because the primary outcome measure showed no inter-group difference, the study failed to demonstrate that the treatment is effective.
  • The trial did not “remain inconclusive”; it was squarely negative.
  • The editor of the journal HOMEOPATHY should know better than to publish such nonsense.

A final thought: is it perhaps the ultimate proof of homeopathy’s ‘like cures like’ assumption to use sound science (i.e. an RCT), submit it to the homeopathic process of endless dilutions and succussions, and – BINGO – generate utter nonsense?

The McTimoney College of Chiropractic just announced that it has established a new four-year program in veterinary chiropractic for college students:

It means that those without a prior degree can undertake the training and education necessary to enter this coveted career. To date, animal chiropractors were required to have a prior qualification in human chiropractic or a degree in the relevant sciences.

Applications for the new program are being accepted from September 2023. Students will attend Abingdon-based University, Oxford, and a variety of practical locations, enabling the development of academic knowledge and the application of practical skills together . Modules include anatomy and physiology, veterinary science, practice and professionalism, and clinical skills, with a research dissertation running over the four-year course.

University director Christina Cunliffe said the new program was an exciting step in the development of chiropractic care for animals.

“Building on our decades of experience graduating confident, competent, and highly-skilled animal chiropractors, now is the time to open up this exciting career opportunity to college students.”

For the past 50 years, McTimoney College of Chiropractic has been training and educating human chiropractors to the highest regulatory standards. Over the past 20 years, animal chiropractic has developed to meet the requirements for this gentle, holistic treatment in the veterinary world.

Prospective students are invited to a Open House at McTimoney College of Chiropractic in Abingdon on February 16.

McTimoney Chiropractic for Animals identifies areas of stiffness, asymmetry, and poor range of motion within the skeletal system, particularly the spine and pelvis. This affects the muscles that surround these structures, as well as the nerve impulses that pass from the central nervous system to the periphery of the body. The adjustments are very light and fast, stimulating an instant response in the affected soft tissues and joints, promoting relaxation of muscle spasms, improving nerve function, and helping the skeletal structure regain better symmetry and movement again.

In many cases, animals suffer from underlying conditions such as arthritic changes or degenerative diseases that force them to compensate in their posture and movement in an attempt to remain comfortable. However, these offsets become increasingly entrenched and can be painful or uncomfortable, requiring chiropractic care to provide some relief. In other cases, the animals are working hard or competing and as such accumulate tension and asymmetries due to the demands of their work. Once again, chiropractic care helps relieve pain and promote performance, whether it’s faster speeds over hurdles for racehorses and events, better jumping style in showjumpers, or more extravagant movements for dressage stars.

Two recent graduates of the school’s Master of Animal Handling (Chiropractic) program did not hesitate to recommend the university. Natalie McQuiggan said that she had wanted to do McTimoney Chiropractic from a very young age, “but the process of doing it always seemed really daunting.

“But from the start, the staff and teachers were lovely and welcoming, and queries were answered promptly. I have really enjoyed my two years in the Master of Animal Handling (Chiropractic) program and would recommend anyone thinking of doing it to just do it.”

Pollyanna Fitzgerald said the university offered a supportive and welcoming learning environment, allowing her to grow and develop as a student and future professional. “There is always someone to talk to and offer encouragement when needed. As a student I have learned a lot and have been encouraged to believe in myself and it has been a wonderful place to learn.”

A free webinar, McTimoney’s Animal Chiropractic as a Careeron January 24 at 7:30 p.m. (GMT), is open to those who wish to learn more about the McTimoney technique and its application, and the training paths available to those interested in becoming a McTimoney Animal Chiropractor.

________________________

I think this announcement is puzzling on several levels:

  1. I was unable to find an ‘Abingdon-based University, Oxford’; could it be this institution that is a college and not a university?
  2. Christina Cunliffe seems to be (or has been?) affiliated with the McTimoney College of Chiropractic which is a bit odd, in my opinion.
  3. The college does not have ‘decades of experience’; it was founded only in 2001.
  4. Most importantly, I am unable to find a jot of good evidence that veterinary chiropractic is effective for any condition (see also here, here, and here). In case anyone is aware of any, please let me know. I’d be delighted to revise my judgment.

If I am right, the new course could be a fine example of quackademia where students are ripped off and taught to later rip off the owners of animals after the academically trained quacks have mistreated them.

Migraines are common headache disorders and risk factors for subsequent strokes. Acupuncture has been widely used in the treatment of migraines; however, few studies have examined whether its use reduces the risk of strokes in migraineurs. This study explored the long-term effects of acupuncture treatment on stroke risk in migraineurs using national real-world data.

A team of Taiwanese researchers collected new migraine patients from the Taiwan National Health Insurance Research Database (NHIRD) from 1 January 2000 to 31 December 2017. Using 1:1 propensity-score matching, they assigned patients to either an acupuncture or non-acupuncture cohort and followed up until the end of 2018. The incidence of stroke in the two cohorts was compared using the Cox proportional hazards regression analysis. Each cohort was composed of 1354 newly diagnosed migraineurs with similar baseline characteristics. Compared with the non-acupuncture cohort, the acupuncture cohort had a significantly reduced risk of stroke (adjusted hazard ratio, 0.4; 95% confidence interval, 0.35–0.46). The Kaplan–Meier model showed a significantly lower cumulative incidence of stroke in migraine patients who received acupuncture during the 19-year follow-up (log-rank test, p < 0.001).

The authors concluded that acupuncture confers protective benefits on migraineurs by reducing the risk of stroke. Our results provide new insights for clinicians and public health experts.

After merely 10 minutes of critical analysis, ‘real-world data’ turn out to be real-bias data, I am afraid.

The first question to ask is, were the groups at all comparable? The answer is, NO; the acupuncture group had

  • more young individuals;
  • fewer laborers;
  • fewer wealthy people;
  • fewer people with coronary heart disease;
  • fewer individuals with chronic kidney disease;
  • fewer people with mental disorders;
  • more individuals taking multiple medications.

And that are just the variables that were known to the researcher! There will be dozens that are unknown but might nevertheless impact on a stroke prognosis.

But let’s not be petty and let’s forget (for a minute) about all these inequalities that render the two groups difficult to compare. The potentially more important flaw in this study lies elsewhere.

Imagine a group of people who receive some extra medical attention – such as acupuncture – over a long period of time, administered by a kind and caring therapist; imagine you were one of them. Don’t you think that it is likely that, compared to other people who do not receive this attention, you might feel encouraged to look better after your health? Consequently, you might do more exercise, eat more healthily, smoke less, etc., etc. As a result of such behavioral changes, you would be less likely to suffer a stroke, never mind the acupuncture.

SIMPLE!

I am not saying that such studies are totally useless. What often renders them worthless or even dangerous is the fact that the authors are not more self-critical and don’t draw more cautious conclusions. In the present case, already the title of the article says it all:

Acupuncture Is Effective at Reducing the Risk of Stroke in Patients with Migraines: A Real-World, Large-Scale Cohort Study with 19-Years of Follow-Up

My advice to researchers of so-called alternative medicine (SCAM) and journal editors publishing their papers is this: get your act together, learn about the pitfalls of flawed science (most of my books might assist you in this process), and stop misleading the public. Do it sooner rather than later!

On 20/1/2023, I conducted multiple Medline searches aimed at generating a rough idea about which areas of so-called alternative medicine (SCAM) are currently more research active than others. I searched for:

  1. the topic in question
  2. clinical trial
  3. publication in 2023

Here are my findings (subject area and the number of hits):

  • TCM 56
  • dietary supplements 47
  • acupuncture 34
  • integrative medicine 27
  • mindfulness 26
  • herbal medicine 23
  • massage 10
  • aromatherapy 2
  • hypnotherapy 2
  • osteopathy 2
  • tai chi 2
  • chiropractic 1
  • homeopathy 0
  • iridology 0
  • naturopathy 0
  • Reiki 0

Several caveats must be considered, of course: The searches do not include all SCAMs. The results are not precise and most of the retrieved articles are not really clinical trials (in fact, only a minority are). The numbers are low because I deliberately did this exercise early in the year.

Yet, the findings do, I think, give an indication as to the current state of SCAM research and indicate which areas are more research active than others. To put the numbers in perspective, here are a few conventional therapies for which I searched on the same day and in the same manner:

  • pharmacology 539
  • physiotherapy 162
  • psychiatry 239
  • surgery 879

I think this makes one point fairly clear: SCAM is not an impressively research-active area. Another point stems from looking at the individual articles. TCM and acupuncture articles are almost exclusively authored by Chinese researchers. While this might not be surprising, the fact that herbal medicine is similar did amaze me; about half of the papers in this category are by Chinese authors. Essentially, this suggests that more than half of the SCAM articles currently originate from China. Considering the concerns one must have about Chinese SCAM research (see for instance here and here), do you think this finding might be worrying?

The far greater worry, I feel, is the attitude of the SCAM researchers publishing their work. Glancing at these papers I did not get the impression that many approached their subject critically, In fact, most of the papers looked to me overtly promotional and of poor quality. For instance, I did not see a single paper assessing the risks of SCAM which arguably is the most important issue in SCAM research. I admit that these concerns cannot be addressed by the above simple head count; they are best dealt with by critically analyzing individual studies – a task I regularly try to tackle on this blog

 

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