conflict of interest
Warning: Exceptionally, this post is not on so-called alternative medicine but on a different scam.
The current issue of the BMJ carries an editorial that is worth quoting on my blog, I think. I have never made a secret of the fact that I am against Brexit. In fact, I re-took German nationality because of it. Therefore, I am in agreement with Kamran Abbasi, the BMJ editor and author of the editorial. Here are what I consider the two most important paragraphs from his article:
… In the absence of public debate and meaningful data six years after the UK’s Brexit referendum, we asked Richard Vize to examine the effects of Brexit on health and care (doi:10.1136/bmj.o1870).20 The news isn’t all bad, although there isn’t much good. Brexit hasn’t brought about a cut in NHS funding but did fail to deliver the £350m weekly windfall that Boris Johnson and others promised. The European Working Time Directive remains in place, and the predicted “stampede” of European doctors leaving the NHS hasn’t happened. But the impacts on social care and lower paid staff are harming delivery of care in an increasingly multidisciplinary service.
Health technology, life science industries, and research, where integration with Europe was greatest and benefits most obvious, are being damaged. Promises to cut red tape have created new complexities and been tarnished by suspect procurement practices at the height of the pandemic (doi:10.1136/bmj.o1893).21 Perhaps the most damning legacy of Brexit, however, is the state of unreadiness it created for a pandemic that required utmost readiness. Whether or not you agree Brexit was the right decision, you should at least agree that it is a decision worthy of question, analysis, and redoubled effort if the signs are good and possibly even reversal if the damage is too great.
This quote probably makes more sense if one also reads the paper referenced in its 2nd link. So, please allow me to quote from this article as well:
… In a highly critical report, the Commons Public Account Committee accuses the Department of Health and Social Care of “woefully inadequate record keeping” and failing to meet basic requirements to publicly report ministers’ external meetings or deal with potential conflicts of interest when awarding testing contracts to the company.
The committee said that large gaps in the document trail meant it was impossible to say the contracts were awarded properly in the way that would be expected, even allowing for the exceptional circumstances and accelerated processes in place at the time. The first contract, for £132m, was awarded at the height of the covid pandemic in March 2020, when the department had suspended the normal requirements for competition between suppliers in the award of government contracts.
The report noted that officials were aware of contacts between Matt Hancock, the then health and social care secretary, and Owen Paterson, a Conservative MP and paid consultant for Randox, and of hospitality that Hancock received from Randox’s founder Peter Fitzgerald in 2019, but failed to identify any conflicts of interest before awarding the first contract.
The department set up a “VIP lane,” through which suppliers put forward by officials, MPs, ministers, or Number 10 would be given priority. Suppliers coming through priority routes were awarded £6bn out of the total £7.9bn of testing contracts awarded between May 2020 and March 2021, the committee noted…
This is by no means all, and I do encourage you to read these articles in full. Once you have, you might ask yourself as I do:
Has Britain become a banana republic?
I have often called out unreliable or fraudulent research in the realm of Traditional Chinese Medicine (TCM). I think it is important to do so because the abundance of scientific misconduct is such that it has become a danger to public health. Today, I present yet another example:
This recent review claimed to summarize the evidence on TCM in treating MI, the clinical evaluations of TCM in treating male infertility (MI), and the molecular mechanisms of TCM effects. I was alerted to the fact that the authors cite a paper on acupuncture that I had co-authored. Here is the section in question from the review:
Acupuncture is one of the therapeutic techniques that are part of TCM. Acupuncture is a non-invasive technique and is regarded as free of risk if performed by trained personnel [35]. One of the advantages of acupuncture was that the incidence of adverse effects was substantially lower than that of many drugs or other accepted [35]. Acupuncture has been used in the treatment of male and female infertility and in assisted reproductive technology treatments for many years. A total of 100 patients with MI who met the diagnostic criteria were randomly divided into two groups [7]. Half of the patients received acupuncture treatment, and the other half received placebo acupuncture. After 10 weeks treatment, acupuncture successfully improved the indicators of the semen, including the spermatozoa survival rate, b-level activity rate, sperm density, sperm activity rate. A total of 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of acupuncture and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture [36]. Of the 279 cases of male sterility treated by the combination of acupuncture, pilose antler essence injection to acupoints and oral administration of Chinese materia medica, 142 cases (47.8%) were cured, 81 cases (27.3%) markedly effective, 53 cases (17.8%) effective and 21 cases (7.1%) ineffective [37]. The therapeutic effect of the combination of these three treatments was satisfactory.
Ref 7
Emerging evidence has shown that cell-cell interactions between testicular cells, in particular at the Sertoli cell-cell and Sertoli-germ cell interface, are crucial to support spermatogenesis. The unique ultrastructures that support cell-cell interactions in the testis are the basal ES (ectoplasmic specialization) and the apical ES. The basal ES is found between adjacent Sertoli cells near the basement membrane that also constitute the blood-testis barrier (BTB). The apical ES is restrictively expressed at the Sertoli-spermatid contact site in the apical (adluminal) compartment of the seminiferous epithelium. These ultrastructures are present in both rodent and human testes, but the majority of studies found in the literature were done in rodent testes. As such, our discussion herein, unless otherwise specified, is focused on studies in testes of adult rats. Studies have shown that the testicular cell-cell interactions crucial to support spermatogenesis are mediated through distinctive signaling proteins and pathways, most notably involving FAK, Akt1/2 and Cdc42 GTPase. Thus, manipulation of some of these signaling proteins, such as FAK, through the use of phosphomimetic mutants for overexpression in Sertoli cell epithelium in vitro or in the testis in vivo, making FAK either constitutively active or inactive, we can modify the outcome of spermatogenesis. For instance, using the toxicant-induced Sertoli cell or testis injury in rats as study models, we can either block or rescue toxicant-induced infertility through overexpression of p-FAK-Y397 or p-FAK-Y407 (and their mutants), including the use of specific activator(s) of the involved signaling proteins against pAkt1/2. These findings thus illustrate that a potential therapeutic approach can be developed to manage toxicant-induced male reproductive dysfunction. In this review, we critically evaluate these recent findings, highlighting the direction for future investigations by bringing the laboratory-based research through a translation path to clinical investigations.
This paper does not relate to the statement it is meant to support by the review authors.
Ref 35
The review by Qin et al (1) includes 5 trials none of which should have been included in a quality metaanalysis as the methodology was unconvincing: In the trial by Alraek et al., patients were randomised to receive either acupuncture or no treatment. This means that no attempt was made to control for the effects of placebo or extra attention. Therefore, this study does not demonstrate an effect of acupuncture as the outcome could be due to non-specific effects unrelated with this therapy. By contrast, the trial by Aune et al. did attempt to control for placebo effects by using a sham control group. Sham acupuncture was given using six needles superficially inserted in the calves, thighs or abdomen outside known acupuncture points or meridians. Needles were not manipulated in the sham group. Sham or placebo controls have the purpose of rendering patients unaware of whether they receive the real or the sham treatment. The method used here cannot achieve this aim; patients would be easily able to tell which intervention they received. In other words, this study also did not adequately control for placebo effects. The remaining three trials are all not Medline-listed, authored by Chinese investigators and published in inaccessible journals. This should disqualify them from inclusion as they were unverifiable by the peer review process. According to the published table, they were equivalence trials of acupuncture versus antibiotics with a sample size around 30. This means they are grossly underpowered and thus unable to generate reliable results. Unless BJOG peer reviewers could see the primary articles, or be provided with translations from Chinese, the systematic review should not have been accepted. The “many eyes of science” requires transparency, testing, challenge and verification. Although in the past, inconclusive results of acupuncture have not been thought to be due to Chinese influence (2), it has been noted that virtually all recent published acupuncture trials are “positive” (3), raising questions of publication and other biases. Our colleagues are under tremendous pressure to publish, but we do them no favours by effectively lowering the standard of scientific peer review. Elite journals too have an obligation to train and reiterate about publication ethics and sound scientific writing (4). As none of the primary studies convincingly demonstrated that acupuncture is an effective therapy for recurrent urinary tract infections, no positive conclusion was warranted. Although Qin et al. did state that the risk of bias of the included trials was generally high or unclear (1), the BJOG nevertheless allowed them to turn massive uncertainty into relatively firm, positive conclusions in the abstract (“Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs”) and tweetable abstract (“This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women”), thus leading to excited media headlines that inevitably mislead the public. ‘May’ is a weasel word which should be avoided as it is unfalsifiable (for example, pigs do not fly but they ‘may’ fly in the future). The definite, straightforward conclusion must be “There is no good evidence to support the use of acupuncture for the treatment and prophylaxis of recurrent UTIs”. It is not acceptable to give international credibility to an implausible modality that no objective, independent high-quality review has found effective beyond placebo (5). The dampening accompanying mini-commentary (6) does not undo the damage.
The review should be withdrawn while the primary papers are translated for peer reviewers to examine, the above limitations discussed in the text, and the positive ‘spin’ in conclusions corrected. These improvements would consolidate the researchers’ probity and justify the accolade of BJOG publication.
Our letter to the editor does not bear any relation to the statement it is meant to support by the review authors.
Ref 36
In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.
This small study is far from convincing and does not lend itself to far-reaching conclusions
Ref 37
Of the 279 cases of male sterility treated by the combination of acupuncture, pilose antler
essence injection to acupoints and oral administration of Chinese materia medica, 142
cases (47.8%) were cured, 81 cases (27.3%) markedly effective, 53 cases (17.8%) effective
and 21 cases (7.1%) ineffective. The therapeutic effect of the combination of these three
treatments was satisfactory.
This study had no control group and used two different therapies. Therefore, it does not allow any conclusion about the effectiveness of acupuncture.
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Perhaps you feel that these errors are trivial. But I would disagree. The review authors’ praise of acupuncture for MI is misplaced and will mislead the public. There are plenty of reviews on the subject, and those that are not overtly biased arrive at conclusions like these:
- The current evidence on acupuncture for oligoasthenozoospermia is inadequate to draw a solid conclusion due to the poor methodological quality. Rigorous full-scale RCTs are needed to validate the therapeutic efficacy and safety of acupuncture in treating oligoasthenozoospermia.
- The current evidence showing that acupuncture might improve poor semen quality is insufficient because of the small number of studies, inadequacy of procedures and/or insufficient information for semen analysis, high levels of heterogeneity, high risk of bias, and poor quality of reporting. Further large, well-designed RCTs are required.
So, how did this sloppy review come about?
Its authors are affiliated to the TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China, and the Tea Research Institute, Sichuan Academy of Agricultural Sciences, Chengdu 610066, China. A footnote tells us that their review was supported by the National Natural Science Foundation of China [No. 81973647] and the Xinglin scholar discipline promotion talent program of Chengdu University of traditional Chinese medicine [No. BSH2021018]. This sounds respectable enough.
The journal that published the review is ‘Pharmacological Research – Modern Chinese Medicine‘. Its stated aims are as follows: The journal publishes articles reporting on advances in our comprehension of mechanism and safety in experimental pharmacology and clinical efficacy and safety of pharmacologically active substances, including compound prescriptions, utilized in Traditional Chinese Medicine applying modern scientific research methods. Studies reporting also on the mechanisms of actions of the active substance(s) investigated are encouraged.
The editors in chief of the journal are Guan-Hua Du, PhD, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica, Beijing, China and Emilio Clementi, M.Mus, MD, PhD, University of Milan, Milan, Italy. No doubt, these are respectable scientists. And because they are, they should make sure that what they publish is correct – a criterion this recent review clearly does not meet.
I had totally forgotten this amusing little episode: According to THE GUARDIAN, Jacob Rees-Mogg (JRM) once tweeted that I should be locked up in the Tower of London!
If you are not from the UK, you may not know this Member of Parliament. So, let me explain.
JRM is the MP for North East Somerset and currently the ‘Minister for Brexit Opportunities and Government Efficiency’. His personal net worth is estimated to be well over £100 million. I probably don’t need to add much more about JRM; there is plenty about him on the Internet and on social media, for instance, this little gem:
Some of JRM’s medically relevant voting records are revealing:
- He voted against raising welfare benefits five times in 2013.
- He voted against higher benefits over long periods for those unable to work as a result of an illness or disability: 14 votes over 5 years.
- Between 2012-2016, he voted 52 times to reduce the spending on welfare benefits.
- He voted to exempt pubs and clubs where food is not served from the smoking ban in October 2010.
- He voted against a law to make private vehicles smoke-free if a child is present.
- He voted against allowing terminally ill people to be given assistance in ending their lives.
Wikipedia mentions that Rees-Mogg is against abortion in all circumstances, stating: “life begins at the point of conception. With same-sex marriage, that is something that people are doing for themselves. With abortion, that is what people are doing to the unborn child.” In September 2017, he expressed “a great sadness” on hearing about how online retailers had reduced pricing of emergency contraception.
In October 2017, it was reported that Somerset Capital Management, of which Rees-Mogg was a partner, had invested £5m in Kalbe Farma, a company that produces and markets misoprostol pills designed to treat stomach ulcers but widely used in illegal abortions in Indonesia. Rees-Mogg defended the investment by arguing that the company in question “obeys Indonesian law so it’s a legitimate investment and there’s no hypocrisy. The law in Indonesia would satisfy the Vatican”. Several days later, it was reported that the same company also held shares in FDC, a company that sold drugs used as part of legal abortions in India. Somerset Capital Management subsequently sold the shares it had held in FDC. Rees-Mogg said: “I am glad to say it’s a stock that we no longer hold. I would not try to defend investing in companies that did things I believe are morally wrong”.
In a nutshell, JRM seems to stand for pretty much everything that I am against. But that is no reason to send me to the Tower of London. So, what exactly was JRM referring to when he wanted me locked up?
The Guardian article explains: At a press conference to mark his retirement [Ernst] agreed with a Daily Mail reporter’s suggestion that the Prince of Wales is a “snake-oil salesman”. In the living room of his house in Suffolk he unpacks the label with the precision on which he prides himself. “He’s a man, he owns a firm that sells this stuff, and I have no qualms at all defending the notion that a tincture of dandelion and artichoke [Duchy Herbals detox remedy] doesn’t do anything to detoxify your body and therefore it is a snake oil.” Far from regretting the choice of words and the controversy it has generated, he appears to relish it.
Looking back at all this bizarre story, I am surprised that JRM did not advocate chopping my head off in the Tower of London. He must have been in a benevolent mood that day!
The UK Chiropractic Council is inviting you to help them re-formulate their educational standards. It is an occasion, some of my readers might find interesting. I, therefore, copy the relevant part of their announcement:
… Following a scoping review in 2021, which determined that the existing Education Standards, published in 2017, required development and updating, the GCC began revising the Education Standards in January 2022.
The revision will ensure that the Education Standards:
- Provide a realistic and comprehensive set of outcomes to be met by graduates on approved qualifications, demonstrating an ability to practise in accordance with the GCC Code.
- Take into account developments within the profession, increase focus on multi-disciplinary learning and different professions working more closely together across the UK, ensuring that graduates are well placed to meet the opportunities to care for patients in different contexts.
- Remain consistent, as appropriate, with the outcomes set by other UK healthcare frameworks and standards.
Purpose: why we are consulting
This consultation sets out our draft Education Standards for providers and Learning Outcomes for students, which reflect and build on the evidence and feedback we have obtained through our scoping review.
We seek stakeholders’ views on these draft Education Standards to ensure our final proposals are future-proof and fit for purpose.
We welcome all responses to the consultation.
Documents
The draft Education Standards on which we invite comments.
The equality impact assessment of the Education Standards, with comments invited within the consultation.
The GCC Education Standards consultation document in Word format.
Ways to respond
Submissions to this consultation can be made online (see below) or by email at [email protected] (click here to download the consultation document).
It is advisable to make a copy of your submission to prevent the loss of information due to internet, portal or connectivity issues. This should be done before pressing the submit button.
Information in responses, including personal information, may need to be published or disclosed under the access to information regimes (mainly the Freedom of Information Act 2000, the General Data Protection Regulation, the Data Protection Act 2018, and the Environmental Information Regulations 2004).
The GCC is a data controller registered with the Information Commissioner’s Office. We use personal data to support our work as the regulatory body for chiropractors. We may share data with third parties to meet our statutory aims and objectives, and when using our powers and meeting our responsibilities.
Closing date
The deadline for responses to this consultation on the draft Education Standards is 16 September 2022 at noon. The consultation will be publicised and stakeholders will be invited to comment…
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Personally, I think the GCC desperately needs to improve its educational (and other) standards. They claim that, “as the regulator for chiropractors, our role is to protect the public”. The case of the late John Lawler is one of many examples to show how unfit for this purpose the GCC truly is.
So, perhaps you might want to contribute to the consultation with a view to making UK chiropractors less of a danger to the public?
On 18/7/2022 the ‘WORLD FEDERATION OF CHIROPRACTIC’ published a statement on cervical artery dissection (CAD). Below are a few excerpts to which I have added a few numbers [in brackets] which refer to my comments below:
… On rare occasions, CAD has been reported to have occurred after a patient visited a chiropractor or other provider of manual therapy [1]. However, the best evidence available to date indicates that spinal manipulation does not stress the arteries enough to cause tearing of the arteries leading to dissection-related strokes [2]. Additional studies have concluded that patients are as likely to have consulted a primary care physician as receive spinal manipulation from a chiropractor prior to experiencing a CAD-related stroke [3]…
The provision of safe, high-quality, evidence-based, patient-centered care for these and other conditions is a priority for the chiropractic profession [4]. Rigorous research is core to the pursuit of that objective [5]. We urge caution in making claims that are in conflict with the current state of the evidence.
About the WFC
The World Federation of Chiropractic is an international, non-governmental organization whose members are the national associations of over 90 countries in seven world regions. It is a non-state actor in official relations with the World Health Organization and is the global authority for matters related to the chiropractic profession [6]…
References
Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 Apr;17(Suppl 1):176–83. Open access here.#
Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. Open access here.
Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. Open access here.
Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19. Open access here.
Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005 Jul;36(7):1575-80. Open access here.
Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. Open access here
Here are my brief comments based on the evidence discussed in dozens of posts previously published on this blog:
- As there is no post-marketing surveillance, nobody can say with any degree of confidence that CADs after chiropractic are rare.
- This is not the ‘best’ evidence. In fact, it has been refuted repeatedly.
- This study has also been refuted.
- Chiropractic is very far from being evidence-based.
- Rigorous research fails to show that chiropractic neck manipulations generate more good than harm.
- The WFC is a lobby group for chiropractic; its mission is ” to advance awareness, utilization, and integration of chiropractic internationally”. Its current director is Richard Brown who spear-headed the disaster when the BCA sued Simon Singh, lost, and caused immense reputational damage to chiropractic worldwide.
I recently looked at the list of best-sellers in homeopathy on Amazon. To my surprise, there were several books that were specifically focused on the homeopathic treatment of children. Since we had, several years ago, published a systematic review of this subject, these books interested me. Here is what Amazon tells us about them:
Homeopathic remedies are increasingly being used to treat common childhood ailments. They are safe, have no side effects or allergic reactions, are inexpensive and, above all, effective. In this guide, Dana Ullman explains what homeopathy is, how it works and how you can use it correctly to enhance your child’s health. He recommends remedies for more than 75 physical and emotional conditions, including: allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds and travel sickness
Without doubt, this is the most comprehensive book on homeopathic pediatrics. Included is a complete guide to the correct use of homeopathy, recommended remedies for the treatment of more than seventy-five common physical, emotional, and behavioral conditions, and valuable information on the essential medicines that all parents should have in their home medicine kits
Tricia Allen, a qualified homeopath, offers a host of practical advice on how to treat illness using natural, homeopathic remedies. Homeopathy differs from conventional medicine in that it does not only alleviate the individual symptoms of an illness, but treats the underlying state to ensure that the disease does not return, something which rarely occurs when using traditional remedies. This guide gives you advice on; what homeopathy is and how to use it; each stage of childhood and how to deal with the complaints that occur at that time of a child’s development; the most common childhood illnesses, how to take your own steps to treating them, which homeopathic remedies to use and when to seek medical help and first aid.
The Homeopathic Treatment of Children is indispensible at giving both a clear overall impression of the various major constitutional types, and also a detailed outline for reference at the end of each chapter. Not only does Paul Herscu draw from various sources (repertories and materia medica), he also adds indispensable original information from his successful practice.
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The fact that such books exist is perhaps not all that surprising. Yet, I do find the fact that they are among the best-selling books on homeopathy surprising – or to be more precise, I find it concerning.
Why?
Simple: children cannot give informed consent to the treatments they receive. Thus, consent is given for them by their parents or (I suspect often) not at all. This renders homeopathic treatment of children more problematic than that of fully competent adults.
Homeopathy has not been shown to be effective for any pediatric condition. I know Dana Ullman disagrees and claims it works for children’s allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds, and travel sickness. Yet, these claims are not based on anything faintly resembling sound evidence! Our above-mentioned systematic review reached the following conclusion: “The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition.”
And what follows from this state of affairs?
I am afraid it is this:
Treating sick children with homeopathy amounts to child abuse.
The US Food and Drug Administration created the Tainted Dietary Supplement Database in 2007 to identify dietary supplements adulterated with active pharmaceutical ingredients (APIs). This article compared API adulterations in dietary supplements from the 10-year time period of 2007 through 2016 to the most recent 5-year period of 2017 through 2021. Its findings are alarming:
- From 2007 through 2021, 1068 unique products were found to be adulterated with APIs.
- Sexual enhancement and weight-loss dietary supplements are the most common products adulterated with APIs.
- Phosphodiesterase-5 inhibitors are commonly included in sexual enhancement dietary supplements.
- A single product can include up to 5 APIs.
- Sibutramine, a drug removed from the market due to cardiovascular adverse events, is the most included adulterant API in weight loss products.
- Sibutramine analogues, phenolphthalein (which was removed from the US market because of cancer risk), and fluoxetine were also included.
- Muscle-building dietary supplements were commonly adulterated before 2016, but since 2017 no additional adulterated products have been identified.
The authors concluded that the lack of disclosure of APIs in dietary supplements, circumventing the normal procedure with clinician oversight of prescription drug use, and the use of APIs that are banned by the Food and Drug Administration or used in combinations that were never studied are important health risks for consumers.
The problem of adulterated supplements is by no means new. A similar review published 4 years ago already warned that “active pharmaceuticals continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after FDA warnings. The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.”
These papers relate to the US where supplement use is highly prevalent. The harm done by adulterated products is thus huge. If we focus on Chinese or Ayurvedic supplements, the problem might even be more serious. In 2002, my own review concluded that adulteration of Chinese herbal medicines with synthetic drugs is a potentially serious problem which needs to be addressed by adequate regulatory measures. Twenty years later, we seem to be still waiting for effective regulations that protect the consumer.
Progress in medicine, they say, is made funeral by funeral!
Today, I received an email advertising a book – nothing unusual, of course. But the book and its author are both quite unusual. Here is the text:
Dr. Farokh J. Master’s birth into homeopathy was in the year 1976, when he joined Bombay homeopathic medical college, after giving up his studies at the orthodox school of medicine. Dr Master was instrumental in starting homeopathic out-patient dept in many allopathic hospitals viz. Bombay Hospital, KEM Hospital & Ruby Hall, Pune. Besides his work as a senior Homeopath of the HHC, Dr. Farokh Master is teaching homeopathy (advanced level) at the Mumbai Homeopathic Medical College, part of Mumbai university. He is also teaching at other homeopathic colleges in India and abroad. He has given seminars in various countries like Austria, Australia, India, Japan etc…
Healing Cancer: A Homoeopathic Approach
As a homeopath one should not deter oneself in dealing with any type of cases, be it cancer. But for executing that an ultimate guidance is needed. Cancer is so much prevalent and challenging medical problem of today that a trustworthy source of accurate information becomes pertinent and this work of Dr. Farokh Master immediately propels at the top of quality books for cancer. Based on Master’s 40 years of experience this book was written for students to understand the basis of oncology and for practitioners for brushing-up of their knowledge in this growing discipline. Author says that to get a grasp on cancer cases we should believe in the potential of the homeopathic treatment, that healing from cancer refers to internal process of becoming whole and feeling harmonious with yourself and your environment.To even start with handling the cases of cancer one should be aware of understanding of cancer, its cause, pathophysiology, different types, conventional treatment and their side effects, integrative medicines, social problems in the treatment, such topics are well casted by Volume 1 of the book…• A whole chapter on Cadmium salts and cancer.• 51 “lesser known remedies” are briefly quoted and their usefulness in different situations and types of cancer exposed.• A long chapter deals with the “Indian drugs”, it is important that these remedies are used mostly in tincture or low potencies, as herbal or Ayurvedic remedies or food supplements relieving the patients. • The choice and differentiation between the remedies is then helped by the “Repertory of Cancer”, very well compiled and a highly useful section. “Clinical tips from my practice” given as a sub-chapter. • It ends with recommendations on how to deal with radiation illness and the side-effects of conventional treatment, as well as the treatment of pain and help with palliative care. For fighting and curing cancer and improving the quality and quantity of life of people, knowledge of Homeopathy, both philosophically and scientifically is needed which this work of art portrays delightfully.
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It is clear that Dr. Farokh J. Master does not suggest using homeopathy in addition to conventional cancer therapies. He foremost wants to employ it as an alternative cancer cure. It is also clear that, if his concepts were generally adopted, they could kill millions.
Some defenders of homeopathy might claim that this is not what most homeopaths would advocate; they would merely recommend homeopathy as an adjunct to conventional oncology. Yet, there are many examples to the contrary, and not just from India – after all, Hahnemann, the inventor of homeopathy, insisted that homeopathy must never be combined with ‘allopathic’ medicines.
So, the next time someone claims homeopathy to be harmless, please show them this post.
This cohort study was designed as undertaken to evaluate the protective effect of Arsenicum album 30C against COVID-19.
Participants were enrolled in a homeopathy intervention (HI) cohort (who received Arsenicum album) or in a non-intervention (NI) cohort (who received no systematic intervention) from COVID-19 containment areas of Delhi. Individuals of age 5 years or above were given four medicated pills of Arsenicum album 30C, while those from 1 to 5 years old were given two medicated pills in each dose.
The analysis included 10,180 individuals residing in 11 COVID-19 containment areas in Delhi, out of which 6,590 individuals were in the HI cohort and 3,590 individuals were in the NI cohort. The overall protective effect of Arsenicum album 30C was 83% (95% confidence interval [CI], 76.77 to 88.17): 45 cases per 6,590 (8.34 per 10,000 person-weeks) in the Arsenicum album 30C group versus 143 cases per 3,590 (45.01 per 10,000 person-weeks) in the NI cohort. The protective effect of Arsenicum album 30C against laboratory-confirmed COVID-19 was 74% (95% CI, 55.08 to 85.41): 18 cases per 6,590 (3.32 per 10,000 person-weeks) in the Arsenicum album 30C group versus 38 cases per 3,590 (11.85 per 10,000 person-weeks) in the NI cohort.
The authors concluded that the use of Arsenicum album 30C was associated with some protection against probable and laboratory-confirmed COVID-19 in a containment-zone setting. Randomized controlled trials are needed to confirm or refute these results.
It is remarkable, I feel, that the authors conclude Arsenicum album 30C was associated with some protection. All too often enthusiasts of homeopathy claim a causal link where there is none – but not this time, and I wonder why.
Unfortunately, I was unable to read the full text of the paper (it’s behind a paywall and I would be grateful for anyone to make it available). Thus, I cannot comment on one of the most crucial questions related to the study: how were the patients divided into the two groups?
It is clear that it was not by randomization. Yet only randomization would have created two fully comparable groups. The most likely explanation for the findings of this trial is therefore that the two groups differed in terms of one or more prognostic factors. This would explain why a group of patients receiving a placebo (Arsenicum album C30 is a dilution of Arsenic at a ratio of 1: 1000000000000000000000000000000000000000000000000000000000000 and therefore is a pure placebo [unless, of course, one believes in homeopathic magic) experience different outcomes from those receiving nothing.
As I said, the answer can only be found by studying the precise selection criteria used in this study. Until this is cleared up, I can only say three things for sure:
- A causal link between the treatment and the result is highly unlikely.
- It is regrettable that researchers do not use randomization for potentially important trials.
- It seems unethical to encourage placebo use for the prevention of a serious illness.
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UPDATE
I just received the full text from one of the authors. This is what they say about the allocation of the participants:
“Participants were enrolled in two cohorts: the homeopathy intervention (HI) cohort and the non-intervention (NI) cohort. Recruitment to the cohorts was at cluster level (containment area): the clusters were allotted to the HI cohort or the NI cohort as per convenience.”
I am afraid, this tells me very little, and my concerns noted above still apply.
A few other points are of relevance:
- The study was conducted between April and August 2020. This begs the question of why it took 2 years to publish the findings.
- The outcomes were verified via telephone. This means that social desirability might have influenced the results.
- The paper also confirms that there were many important differences between the groups that might have prognostic significance.
- The conclusion at the end of the paper does imply causality in stronger terms than the abstract: “The use of Arsenicum album 30C may help protect against COVID-19 infection. Randomized controlled trials are needed
to confirm or refute our findings.
It has been reported by several outlets that a young woman is fighting for her life after a chiropractic adjustment went horribly wrong. Caitlin Jensen had only recently graduated from University. When she went for what was meant to be a simple chiropractic adjustment on June 16, she suffered four dissected arteries in her neck, this damage led to cardiac arrest, stroke and her being without a pulse for over 10 minutes, requiring resuscitation.
She was rushed to the Memorial Hospital in Savannah, Georgia, where she was operated on. She was then taken to the neuro ICU in a critical condition with a traumatic brain injury. Every day since she’s been fighting. Currently, she is conscious and able to respond to verbal commands by blinking her eyes, as well as wiggling the toes of her left foot. However, most of her body remains paralyzed.
Her mother Darlene has been posting updates about her daughter’s condition on Facebook. On Saturday Darlene shared the latest news on the condition of her daughter. “She gave her best effort to smile today, and it was the most beautiful thing I’ve ever seen,” Darlene said. “She is progressing with her movements on the left side – wiggling and flexing. She can’t lift her arm yet, or turn her head. Her right side is unchanged – still no movement. Her face doesn’t move very much yet, but she can open her eyes widely to show surprise, and the left corner of her mouth tries to smile. Adorable. Still working on the pneumonia. The antiplatelet therapy seems to be going OK. We don’t see any signs of internal bleeding and are praying that it stays that way.”
And the day before, Darlene posted: “Two weeks ago tonight we didn’t know if Caitlin would make it through the night,” Darlene said. “Dire and catastrophic are two of the words that we heard from our ICU team. We knew they didn’t casually throw around words like that. But – she is alive, and every day is a little better. The accomplishments are both small and monumental at the same time. Today, she gave us a thumbs up. We have been working on this, and she got it! She also nodded again today. It helps to see these things because it reassures us that she is working hard to stay with us and recover. Caitlin is strong, disciplined, and well practised in exercising her brain, and I truly believe that her science background and all of her time studying is going to help her in this long journey. “
Studies have found that traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45, and recent chiropractic neck manipulation is among factors that can be associated with risk of vertebral artery dissection.
Following the tragedy, Caitlin’s mother, Darlene, launched a GoFundMe and has raised more than US$20,000 (AU $29,334 or £16,512) for her ongoing medical expenses.
It is clear that these news reports lack important medical details. What is equally clear is the fact that most such cases are never reported in the medical literature and are thus available only in this fragmented form. The reason for this lamentable situation is obvious: there is no post-marketing surveillance system for chiropractic (such a safeguard would be bad for business, of course).
Consequently, chiropractors across the globe continue to be able to say that such reports are unreliable. The medical literature, they are keen to point out, holds only very few case studies of serious risks of chiropractic spinal manipulation. Hence they falsely claim on every possible occasion that their adjustments are safe. The end effect is that many consumers continue to wrongly assume that chiropractic manipulations might be worth a try.
