MD, PhD, FMedSci, FSB, FRCP, FRCPEd

death

The new guidelines by the American College of Physicians entitled ‘Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians’ have already been the subject of the previous post. Today, I want to have a closer look at a small section of these guidelines which, I think, is crucial. It is entitled ‘HARMS OF NONPHARMACOLOGIC THERAPIES’. I have taken the liberty of copying it below:

“Evidence on adverse events from the included RCTs and systematic reviews was limited, and the quality of evidence for all available harms data is low. Harms were poorly reported (if they were reported at all) for most of the interventions.

Low-quality evidence showed no reported harms or serious adverse events associated with tai chi, psychological interventions, multidisciplinary rehabilitation, ultrasound, acupuncture, lumbar support, or traction (9,95,150,170–174). Low-quality evidence showed that when harms were reported for exercise, they were often related to muscle soreness and increased pain, and no serious harms were reported. All reported harms associated with yoga were mild to moderate (119). Low-quality evidence showed that none of the RCTs reported any serious adverse events with massage, although 2 RCTs reported soreness during or after massage therapy (175,176). Adverse events associated with spinal manipulation included muscle soreness or transient increases in pain (134). There were few adverse events reported and no clear differences between MCE and controls. Transcutaneous electrical nerve stimulation was associated with an increased risk for skin site reaction but not serious adverse events (177). Two RCTs (178,179) showed an increased risk for skin flushing with heat compared with no heat or placebo, and no serious adverse events were reported. There were no data on cold therapy. Evidence was insufficient to determine harms of electrical muscle stimulation, LLLT, percutaneous electrical nerve stimulation, interferential therapy, short-wave diathermy, and taping.”

The first thing that strikes me is the brevity of the section. Surely, guidelines of this nature must include a full discussion of the risks of the treatments in question!

The second thing that is noteworthy is the fact that the authors confirm the fact I have been banging on about for years: clinical trials of alternative therapies far too often fail to mention adverse effects.  I have often pointed out that the failure to report adverse effects in clinical trials is an unacceptable violation of medical ethics. By contrast, the guideline authors seem not to feel strongly about this omission.

The third thing that is noteworthy is that the guidelines evaluate the harms of the treatments purely on the basis of the adverse effects reported in the clinical trials and systematic reviews included in their efficacy assessments. This is nonsensical for at least two reasons:

  1. The guideline authors themselves are aware that the trials very often fail to mention adverse effects.
  2. For any assessment of harm, one has to go far beyond the evidence of clinical trials, because trials tend to be too small to pick up rare adverse effects, and because they are always conducted under optimally controlled conditions where adverse effects are less likely to occur than in real life.

Together, these features of the assessment of harms explain why the guideline authors arrive at conclusions which are oddly misguided; I would even feel that they resemble a white-wash. Here are two of the most overt misjudgements:

  • no harms associated with acupuncture,
  • only trivial harm associated with spinal manipulations.

The best evidence we have today shows that acupuncture leads to mild adverse effects in about 10% of all cases and is also associated with very severe complications (e.g. pneumothorax, cardiac tamponade, infections, deaths) in an unknown number of patients. More details can be found for instance here, here, here and here.

And the best evidence available shows that spinal manipulation leads to moderately severe adverse effects in ~50% of all cases. In addition, we know of hundreds of cases of very severe complications resulting in stroke, permanent neurological deficits or deaths. More details can be found for instance here, here, here and here.

In the introduction, I stated that this small section of the guidelines is crucial.

Why?

The reason is simple: any responsible therapeutic decision has to be based not just on the efficacy of the treatment in question but on its risk/benefit balance. The evidence shows that the risks of some alternative therapies can be considerable, a fact that is almost totally neglected in the guidelines. Therefore, the recommendations of the new guidelines by the American College of Physicians entitled ‘Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians’ are in several aspects not entirely correct and need to be reconsidered.

Is spinal manipulative therapy (SMT) dangerous? This question has kept us on this blog busy for quite some time now. To me, there is little doubt that SMT can cause adverse effects some of which are serious. But many chiropractors seem totally unconvinced. Perhaps this new overview of reviews might help to clarify the issue. Its aim was to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT.

The authors searched five electronic databases from inception to December 8, 2015 and included reviews on any type of studies, patients, and SMT technique. The primary outcome was SAEs. The quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, they used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated.

A total of 283 eligible reviews were identified, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe.

The authors concluded that it is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed.

This article is valuable, if only for the wealth of information one can extract from it. There are, however, numerous problems. One is that the overview included mostly reviews of the effectiveness of SMT for various conditions. We know that studies of SMT often do not even mention AEs. If such studies are then pooled in a review, they inevitably generate an impression of safety. But this would, of course, be a false-positive result!

The authors of the overview are aware of this problem and address it in the following paragraph: “When only considering the subset of reviews, where the objective was to investigate AEs (37 reviews), then 8 reviews (22%) expressed that SMT is safe, 13 reviews (35%) expressed that SMT is harmful and 16 reviews (43%) were neutral or unclear regarding the safety of SMT. Hence, there is a tendency that a bigger proportion of these reviews are expressing that SMT is harmful compared to the full sample of reviews…”

To my surprise, I found several of my own reviews in the ‘neutral or unclear’ category. Here are the verbatim conclusions of three of them:

  1. It is concluded that serious cerebrovascular complications of spinal manipulation continue to be reported.
  2. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome.
  3. These data indicate that mild and transient adverse events seem to be frequent. Serious adverse events are probably rare but their incidence can only be estimated at present.

I find it puzzling how this could be classified as neutral or unclear. The solution of the puzzle might lie in the methodology used: “we appraised the communicated opinions of each review concerning the safety of SMT based on their conclusions regarding the AEs and SAEs. This was done by two reviewers independently (SMN, LK), who judged the communicated opinions as either ‘safe’, ‘neutral/unclear’ or ‘harmful’, based on the qualitative impression the reviewers had when reading the conclusions. The reviewers had no opinion about the safety/harmfulness of SMT before commencing the judgements. Cohen’s weighted Kappa was calculated for the agreement between the reviewers, with a value of 0.40–0.59 indicating ‘fair agreement’, 0.60–0.74 indicating ‘good agreement’ and ≥0.75 indicating ‘excellent agreement’. Disagreements were resolved by a third reviewer (MH).”

In other words, the categorisation was done on the basis of subjective judgements of two researchers. It seems obvious that, if their attitude was favourable towards SMT, their judgements would be influenced. The three examples from my own work cited above indicates to me that their verdicts were indeed far from objective.

So what is the main message here? In my view, it can be summarized in the following quote from the overview: “a bigger proportion of these reviews are expressing that SMT is harmful …”

Yes, yes, yes – I know that, if you are a chiropractor (or other practitioner using mostly SMT), you are unlikely to agree with this!

Perhaps you can agree with this statement then:

As long as there is reasonable doubt about the safety of SMT, and as long as we cannot be sure that SMT generates more good than harm, we should be very cautious using it for routine healthcare and do rigorous research to determine the truth (it’s called the precautionary principle and applies to all types of healthcare).

‘The use of a harmless alternative therapy is not necessarily wrong. Even if the treatment itself is just a placebo, it can help many patients. Some patients feel better with it, and it would be arrogant, high-handed and less than compassionate to reject such therapies simply because they are not supported by sufficient scientific evidence’.

How often have I heard this notion in one or another form?

I hear such words almost every day.

Arguments along these lines are difficult to counter. Any attempt to do so is likely to make us look blinkered, high-handed and less than compassionate.

Yet we all – well almost all – know that the notion is wrong. Not only that, it can be dangerous.

I will try to explain this with a concrete example of a patient employing a harmless alternative remedy with great success… until… well, you’ll see.

The patient is a married women with two kids. She is well known to her doctor because she has suffered from a range of symptoms for years, and the doctor – despite extensive tests – could never find anything really wrong with her. He knows about his patient’s significant psychological problems and has, on occasion, been tempted to prescribe tranquilizers or anti-depressants. Before he does so, however, he tells her to try Rescue Remedies@ (homeopathically diluted placebos from the range of Bach Flower Remedies). The patient is generally ‘alternatively inclined’, seems delighted with this suggestion and only too keen to give it a try.

After a couple of weeks, she reports that the Rescue Remedies (RR) are helping her. She says she can cope much better with stressful situations and has less severe and less frequent headaches or other symptoms. As she embarks on a long period of taking RR more or less regularly, she becomes convinced that the RR are highly effective and uses them whenever needed with apparent success. This goes on for months, and everyone is happy: the patient feels she has finally found a ‘medication that works’, and the doctor (who knows only too well that RR are placebos) is pleased that his patient is suffering less without needing real medication.

Then, a few months later, the patient notices that the RR are becoming less and less effective. Not only that, she also thinks that her headaches have changed and are becoming more intense. As she has been conditioned to believe that the RR are highly effective, she continues to take them. Her doctor too agrees and encourages her to carry on as before. But the pain gets worse and worse. When she develops other symptoms, her doctor initially tries to trivialise them, until they cannot be trivialised any longer. He eventually sends her to a specialist.

The patient has to wait a couple of weeks until an appointment can be arranged. The specialist orders a few tests which take a further two weeks. Finally, he diagnoses a malignant, possibly fast growing brain tumour. The patient has a poor prognosis but nevertheless agrees to an operation. Thereafter, she is paralysed on one side, needs 24-hour care, and dies 4 weeks post-operatively.

The surgeon is certain that, had he seen the patient several months earlier, the prognosis would have been incomparably better and her life could have been saved.

I suspect that most seasoned physicians have encountered stories which are not dissimilar. Fortunately they often do not end as tragically as this one. We tend to put them aside, and the next time the situation arises where a patient reports benefit from a bogus treatment we think: ‘Even if the treatment itself is just a placebo, it might help. Some patients feel better with it, and it would be arrogant, high-handed and less than compassionate to reject this ‘feel-good factor’.

I hope my story might persuade you that this notion is not necessarily correct.

If you are unable to make your patient feel better without resorting to quackery, my advice is to become a pathologist!!!

I have published many articles on the risks of various alternative treatments (see for instance here, here, here, here, here and here) – not because I am alarmist but because I have always felt very strongly that, for a researcher into alternative medicine, the most important issue must be to make sure users of these therapies are as safe as possible. Usually I differentiated between direct and indirect risks. The former relate to the risks of the treatment and include, for instance, liver damage caused by a herbal remedy or stroke due to neck manipulation. The latter are mainly due to the poor, often irresponsible advice given by many therapists.

A recent article adopted the same terminology when reviewing the risks of alternative medicine specifically for cancer patients. As the indirect risks are often neglected, I will here quote the relevant section of this paper in full:

…Health care physicians and oncology experts have an ethical responsibility to initiate the communication regarding the use of complementary therapies with cancer patients. However, according to data obtained from this literature review, oncology doctors and physicians will discuss complementary therapies only when a patient him/herself raises this issue within a consultation. This passive attitude was linked to a lack of sufficient scientific evidence for positive outcomes of complementary therapies found in high quality randomized controlled trials (RCTs). Oncology nurses, on the other hand, sometimes actively promote complementary modalities that they find to correspond with their vision of holistic care.

According to the included studies, complementary providers often differ from conventional health care providers in their understanding of treatment concepts, philosophies and diagnostic procedures. This leads to different models of disease causality (cells, blood, nerves vs. energy, vital force, meridians) and treatment philosophy (reductionism vs. holism). As many complementary providers are philosophically oriented towards personal and spiritual growth, patients may feel guilty if the disease continues to advance despite the patients’ best spiritual and mental efforts. According to Broom and colleagues, such philosophies may also give patients false hope of recovery.

Another indirect risk connected to the combination of conventional and complementary treatment in cancer care is the lack of regulation and standardized education in many countries. Currently, there are, for example, no standard training requirements for complementary providers working in cancer care or any other health care setting in the EU. According to Mackareth et al., complementary providers in England need specific training to learn how to practice safely.

Moreover, there is a need for common medical terminology to bridge the communication gap between health care providers working outside the conventional health care system. Common medical terminology may reduce the existing communication gap between conventional and complementary providers about mutual patients. To minimize communication gap between physicians, oncology experts and complementary providers, a medical complementary record should include a treatment plan with conventional and complementary diagnosis, explanation of terminology, possible treatment interactions, description of the complementary treatment plan and goals. If possible, the quality of any complementary supplement given should be reported.

END OF QUOTE

As I said, I find it important to discuss the indirect risks of alternative medicine, and I am therefore pleased that the authors of this article addressed them. At the same time, I find their text remarkably tame.

Why are they not more open and forceful about what, after all, amounts to a serious public health issue? The answer might be simpler than expected: most of them are affiliated with the ‘National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway’. Could it be that open warnings about outright quackery is not what suits this unit?

So, what might be an open and frank approach to discussing the indirect risks of alternative medicine? In my view, it should make several points abundantly clear and transparent:

  • Alternative practitioners (APs) are usually not trained to advise patients responsibly, particularly in cases serious disease.
  • The training of APs is often inadequate and sometimes resembles more to brain-washing than to proper education.
  • Consequently, APs often woefully over-estimate what their therapy can achieve.
  • The patients of APs are often desperate and ready to believe even the tallest tales.
  • APs have a huge conflict of interest – in order to make a living they need to treat as many patients as possible and are therefore not motivated to refer them to more suitable care.
  • APs are frequently in denial when it comes to the risks of their treatments.
  • APs are not educated such that they understand the full complexities of serious illness.
  • As a result, APs far too often misguide their patients to make tragically wrong choices thus putting their health at serious risk.
  • In most countries, the regulators turn a blind eye to this huge problem.

These are by no means trivial  points, and they have nothing to do with a ‘turf war’ between conventional and alternative medicine. They relate to our ethical duty to keep our patients as safe as we can. It has been estimated that, in oncology alone, 1 – 5% of deaths are due to patients opting to have alternative instead of conventional treatments. This amounts to an unbearably high absolute number of patients dying prematurely due to the indirect risks of alternative medicine.

It is high time, I think, that we tackle this issue systematically and seriously.

Stable angina is a symptom of coronary heart disease which, in turn, is amongst the most frequent causes of death in developed countries. It is an alarm bell to any responsible clinician and requires causal, often life-saving treatments of which we today have several options. The last thing a patient needs in this condition is ACUPUNCTURE, I would say.

Yet acupuncture is precisely the therapy such patients might be tempted to employ.

Why?

Because irresponsible or criminally naïve acupuncturists advertise it!

Take this website, for instance; it informs us that a meta-analysis of eight clinical trials conducted between 2000 and 2014 demonstrates the efficacy of acupuncture for the treatment of stable angina. In all eight clinical trials, patients treated with acupuncture experienced a greater rate of angina relief than those in the control group treated with conventional drug therapies (90.1% vs 75.7%)….

I imagine that this sounds very convincing to patients and I fear that many might opt for acupuncture instead of potentially invasive/unpleasant but life-saving intervention. The original meta-analysis to which the above promotion referred to is equally optimistic. Here is its abstract:

Angina pectoris is a common symptom imperiling patients’ life quality. The aim of this study is to evaluate the efficacy and safety of acupuncture for stable angina pectoris. Clinical randomized-controlled trials (RCTs) comparing the efficacy of acupuncture to conventional drugs in patients with stable angina pectoris were searched using the following database of PubMed, Medline, Wanfang and CNKI. Overall odds ratio (ORs) and weighted mean difference (MD) with their 95% confidence intervals (CI) were calculated by using fixed- or random-effect models depending on the heterogeneity of the included trials. Total 8 RCTs, including 640 angina pectoris cases with 372 patients received acupuncture therapy and 268 patients received conventional drugs, were included. Overall, our result showed that acupuncture significantly increased the clinical curative effects in the relief of angina symptoms (OR=2.89, 95% CI=1.87-4.47, P<0.00001) and improved the electrocardiography (OR=1.83, 95% CI=1.23-2.71, P=0.003), indicating that acupuncture therapy was superior to conventional drugs. Although there was no significant difference in overall effective rate relating reduction of nitroglycerin between two groups (OR=2.13, 95% CI=0.90-5.07, P=0.09), a significant reduction on nitroglycerin consumption in acupuncture group was found (MD=-0.44, 95% CI=-0.64, -0.24, P<0.0001). Furthermore, the time to onset of angina relief was longer for acupuncture therapy than for traditional medicines (MD=2.44, 95% CI=1.64-3.24, P<0.00001, min). No adverse effects associated with acupuncture therapy were found. Acupuncture may be an effective therapy for stable angina pectoris. More clinical trials are needed to systematically assess the role of acupuncture in angina pectoris.

In the discussion section of the full paper, the authors explain that their analysis has several weaknesses:

Several limitations were presented in this meta-analysis. Firstly, conventional drugs in control group were different, this may bring some deviation. Secondly, for outcome of the time to onset of angina relief with acupuncture, only one trial included. Thirdly, the result of some outcomes presented in different expression method such as nitroglycerin consumption. Fourthly, acupuncture combined with traditional medicines or other factors may play a role in angina pectoris.

However, this does not deter them to conclude on a positive note:

In conclusion, we found that acupuncture therapy was superior to the conventional drugs in increasing the clinical curative effects of angina relief, improving the electrocardiography, and reducing the nitroglycerin consumption, indicating that acupuncture therapy may be effective and safe for treating stable angina pectoris. However, further clinical trials are needed to systematically and comprehensively evaluate acupuncture therapy in angina pectoris.

So, why do I find this irresponsibly and dangerously misleading?

Here a just a few reasons why this meta-analysis should not be trusted:

  • There was no systematic attempt to evaluate the methodological rigor of the primary studies; any meta-analysis MUST include such an assessment, or else it is not worth the paper it was printed on.
  • The primary studies all look extremely weak; this means they are likely to be false-positive.
  • They often assessed not acupuncture alone but in combination with other treatments; consequently the findings cannot be attributed to acupuncture.
  • All the primary studies originate from China; we have seen previously (see here and here) that Chinese acupuncture trials deliver nothing but positive results which means that their results cannot be trusted: they are false-positive.

My conclusion: the authors, editors and reviewers responsible for this article should be ashamed; they committed or allowed scientific misconduct, mislead the public and endangered patients’ lives.

We have become used to bogus claims made by homeopaths – far too much so, I would argue. Therefore, we let the vast majority of their bogus claims pass without serious objections. Yet exposing bogus claims would be an important task, particularly when they relate to serious conditions. Doing this might even save lives!

According to the website of the ‘HOMEOPATHIC DOCTOR’, homeopathy is mild in nature and tends to modify the body’s natural immunity. It is the responsibility of the immune system of the body to protect it from all sorts of damage, whether from bacteria or viruses or from any other disease. It also helps in repairing any damage that may occur at any time. Homeopathic medicines help strengthen the natural immunity of the body so that it can perform its natural functions in a more efficient manner.

5 Best Homeopathic remedies for Ulcerative Colitis

In my experience, homeopathic medicines like Merc Sol, Baptisia, Nux Vomica, Arsenic Album and Phosphorus have been found to be quite effective in the treatment of Ulcerative Colitis…

Merc Sol- One of the best homeopathic medicines for ulcerative colitis with blood and tenesmus

When there is too much bleeding with tenesmus and other symptoms, Merc Sol is one of the best homeopathic medicines for ulcerative colitis. There are frequent stools with blood being discharged almost every time. The patient is a sweaty sort of patient who keeps on sweating most of the time. Creeping sort of chilliness may be felt in the back.

Nux Vomica- One of the best homeopathic remedies for ulcerative colitis due to high life

When the problem has occurred from living a high life, Nux Vomica is one of the best homeopathic remedies for ulcerative colitis. Excess of alcohol, stimulants like tea and coffee, late night partying and other habits incident to modern lifestyle can contribute to such a problem. The patient is usually a chilly sort of patient who cannot tolerate cold. He is unusually angry and that too at trifles.

Arsenic Album – One of the best homeopathic medicines for ulcerative colitis with anxiety and restlesness

When the predominant symptoms are the mental symptoms of anxiety and restlessness, Arsenic Album is one of the best homeopathic medicines for ulcerative colitis. The patient gets anxious, worried and restless for no rhyme or reason. There may be weakness which may be disproportionately more than the problem. There is increased thirst for water, though the patient takes a small quantity or a sip at a time.

Baptisia – One of the best homeopathic remedy for ulcerative colitis with low grade fever

When there is low grade fever present along with other symptoms, Baptisia is one of the best homeopathic remedy for ulcerative colitis. The patient has great muscular soreness all over the body as if bruised and beaten. Appetite is reduced or next to nil. At the same time, there is constant desire for water. Stools are very offensive, thin and watery.

Phosphorus – One of the best homeopathic medicine for ulcerative colitis with increased thirst for cold water

When there is intense thirst for cold water, Phosphorus is one of the best homeopathic medicine for ulcerative colitis. The patient is usually tall and thin. The diarrhoea is copious. Stool is watery and profuse bleeding may be present. Patient feels too weak and more so after passing a stool.

The ‘HOMEOPATHIC DOCTOR’s first statement was ‘in my experience…’? Unfortunately most patients will not understand what this expression truly means when written by a homeopath. It means THERE IS NOT A JOT OF EVIDENCE FOR ANY OF THIS. Had he stated this clearly, it would probably have been the only correct sentence in the whole article.

People who understand medicine a bit might laugh at such deluded clinicians and their weird, unethical recommendations. However, patients who are chronically ill and therefore desperate might take them seriously and follow their advice. Patients who suffer from potentially life-threatening diseases like ulcerative colitis might then cause serious damage to themselves or even die.

And this is precisely the reason why I will continue to expose these charlatans for what they are: irresponsible, unethical, uninformed, dangerous quacks

For far too many proponents of alternative medicine, belief in alternative methods seems disappointingly half-hearted. Not so for this enthusiast who invented an alternative form of resuscitation – but sadly failed.

This article explains:

A Russian woman spent more than 4 months trying to bring her dead husband back to life. How?  With the help of holy water and prayer!

The retired therapist said she didn’t report the death of her 87-year-old husband because she believed she could revive him by sprinkling holy water on his body and reading prayers. The woman’s bizarre secret was revealed when she accidentally flooded the apartment below, and a neighbour forced his way into her home to turn off the water. He found the almost completely mummified husband laying on the living-room couch. Forensic pathologists determined that the man had been dead for 4 – 6 months, but found no traces of violence on his body and concluded he had died of natural causes.

Neighbours said that they did sense a strange smell coming out of the apartment, but didn’t think anything of it. The deceased had suffered a serious injury to his leg in 2015 and had been bed-ridden since then. Therefore his disappearance from public view went unnoticed. To make sure nobody interfered with her resuscitations, the woman told everyone that he was fine, but too tired for receiving guests. Even the couple’s children were asked not to visit.

The 76-year-old woman who had worked as a doctor for most of her life, became interested in the occult and obsessed with the work of Leonid Konovalov, a Russian psychic who stars in a television show where he tries to communicate with the dead. “When we started talking to the woman, it turned out that she was fascinated by alternative medicine and believed that, by sprinkling holy water on her husband, she would be able to bring him back, to revive him,” Chief investigator commented.

Is there a lesson in this story?

Perhaps this one: conviction in one’s methods might be good, but evidence is better.

This sad story was reported across the world. It is tragic and, at the same time, it makes me VERY angry. A women lost her life after giving birth due to the incompetence of her midwife. On this website, we learn the following gruesome details:

Many question the culpability of Australian midwife Gaye Demanuele in the wake of the investigations into the death of Caroline Lovell during her home birth in 2012. And while Demanuele played a major role in Lovell’s passing, a closer look may show the real culprit: homeopathy. In January 2012, Demanuele, an outspoken home birth advocate, served as senior midwife in Lovell’s home birth. After giving birth, Lovell experienced severe blood loss and begged to call an ambulance. According to the investigating coroner, Demanuele refused several times, never checking her patient’s blood pressure or effectively monitoring her blood loss. Demanuele instead tried a homeopathic “remedy” to relieve Lovell’s anxiety. Only after Lovell fainted in a pool of her own blood and went into cardiac arrest was she taken to a hospital, where she died 12 hours later…

We know that many midwifes are besotted with alternative medicine. Their love-affair with quackery had to lead to serious harm sooner or later. This story is thus tragic and awful – but it is not surprising.

What makes me angry, is the complete lack of critical comment from homeopaths and their professional organisations. Where are the homeopaths who state clearly and categorically that the use of homeopathic remedies in the situation described above (and indeed in midwifery generally) is not based on sound evidence? In fact, it is criminal charlatanry!

Homeopaths are usually not lost for words.

Where is the homeopathic organisation stating that a bleeding patient does not need homeopathy?

How should we interpret this deafening silence?

Does it mean that those homeopaths who quietly tolerate charlatanry are themselves charlatans?

If so, would this not be 100% of them?

If you ever receive an email from ‘edzardernst@yahoo.com’, please be aware that it is not from me. It comes from some clown who seems to want to pretend to be me.

How do I know? I received a short email from that very person. Here is its full text in all its beauty:

You are the most bullshit person i know who claim to be a good doctor by putting other professions down. you are a killer because of your false information.”

What does that tell us about the identity of the author?

  1. He does not seem to be an admirer of my work.
  2. He feels strongly about something.
  3. He does not mince his words.
  4. He does not write very good English.
  5. He is not very well-informed [I do not think that I ever claimed to be a ‘good doctor’].
  6. He is factually wrong [I have not ever killed anyone for any reason].

What he presumably wants to express is that, in his view, the information I publish on this blog and perhaps elsewhere has the potential to kill patients. This is a somewhat disturbing assumption because the opposite is truly my intention.

It is a great pity that the author of these lines did not manage to be a little more specific.

  1. Does he [somehow, I presume the author is male] think that, by warning readers of all sorts of quackery and outright health fraud, I might kill someone?
  2. Does he believe that my repeated warnings about the lack of good evidence for alternative medicine drive patients into the arms of even more dangerous clinicians?
  3. Or is he just an unfortunate sufferer of a serious mental condition such as paranoia?

As I am totally in the dark here and cannot even begin to answer these questions, I will leave it to you, the readers of this post, to decide.

Or perhaps the author of this charming email wants to enlighten us?

Many people seem to believe that homeopathy is harmless. It is a belief that can easily be shown to be wrong, and this blog has repeatedly done just that. Perhaps the best researched issue here is the stance of many homeopaths against vaccination.  But this is by no means all.

There are uncounted books, articles and websites which mislead consumers into believing that they can cure their illnesses with homeopathy. Take the website of ‘STAR HOMEOPATHY’ for instance. This organisation makes fantastic promises:

Star homeopathy, a chain of super specialty homeopathic clinic’s founded by a group of practically high qualified doctors with the vision to provide the best medical treatment in a scientific and most advanced way with the use of latest clinical knowledge and medical diagnostic equipment.

We boast of a combined experience of 200 years in the science of Homeopathy. We have 35 years of personal experience to provide you world-class solutions in health care. Experience the odour of advanced and New-Age Homeopathy–only at Star Homeopathy Clinics. It is no more a slow and long drawn treatment process.

You can rely on us to get world class homeopathic solutions for your problems like : Hair loss, Dandruff , Joint pains, Neck pain, Knee pain, Gastric and duodenal ulcer, Piles, Fissure, Fistula, Asthma, Skin and respiratory allergies , Sinusitis, Acne ,Hyperpigmentation , Psoriasis, Migraine , Headache, Anxiety, Depression , Sexual problems like Erectile dysfunction ,Premature ejaculation, Hormonal imbalance in female, Low sperm count in men…

We at star homeopathy, confidently say that we accurately diagnose the disease condition and treat all chronic diseases very efficiently without harming the patient’s body.

Such statements are bound to inspire confidence to many people who are chronically ill and frustrated with the fact that they need to take drugs for the rest of their lives to stay alive. Patients suffering from diabetes, for instance. They might hope that STAR HOMEOPATHY has a solution for them. And true enough, they do:

How Homoeopathy helps to cure Diabetes?

In homeopathy, diabetes is seen as a reflection of the body’s inability to function optimally. There is an imbalance that results in the body’s incapacity to effectively utilize the insulin that it produces, or to produce sufficient insulin for its needs. While symptoms often disappear after conventional treatment, the vital force does not. Homoeopathy can be used effectively in the treatment of diabetes. Here we mainly concentrate on functioning of the pancreas in efficient insulin production. The metabolic condition of a patient suffering from diabetes requires both therapeutic and nutritional measures to correct the illness. Homeopathy can regulate sugar metabolism while helping to resolve the metabolic disturbances that lead to diabetes. Furthermore, homeopathy helps stimulate the body’s self-healing powers in order to prevent complications such as open leg sores and other dysfunctions of the blood vessel, loss of vision, kidney failure. Homeopathic treatment does not target one illness, an organ, a body part or a symptom. Remedies are prescribed based on an assembly of presenting symptoms, their stresses in life.

Commonly indicated Homoeopathic remedies:

Syzygium: A most useful remedy in diabetes mellitus. No other remedy causes in so marked degree the diminution and disappearance of sugar in the urine. Prickly heat in upper part of the body; small red pimples itch violently. Great thirst, weakness, emaciation. Very large amounts of urine.. Diabetic ulceration.. Syzygium Jambolanum has marked action on diabetes mellitus as it causes marked diminution of sugar in urine. Great thirst with weakness, emaciation inspite of proper nutritious diet. Profuse urination of high specific gravity. Small red pimples with much itching. Syzygium Jambolanum also helps in treating old ulcers of skin associated with diabetes mellitus.

Uranium nitricum: Uranium Nitricum is a chief diuretic remedy. There is copious urination with incontinence of urine. It is indicated in glycosuria with increased urination, emaciation and tympanites. Uranium Nitiricum also helps in enuresis, the patient is unable to retain urine without pain. Burning in urethra, with very acid urine. There is a tendency to great emaciation, debility and general dropsy. Causes glycosuria and increased urine. Is known to produce nephritis, diabetes, degeneration of the liver, high blood pressure and dropsy. Its therapeutic keynote is Great emaciation, debility and tendency to ascites and general dropsy. Backache and delayed menses. Dry mucous membranes and skin.

Lycopodium: Diabetes. Anger during disease. Lost of self confidence. The right side conditions works well and thus improve the liver and kidney functioning as conditions Neuropathy. There is constipation due to inactivity of the rectum. Impotence. Intense desire for sweets.

So, if you think that homeopathy is harmless, think again!

Following this advice, could mean the death of many diabetics.

No treatment for which hugely exaggerated claims abound can ever be safe.

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