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

death

The US ‘Public Citizen‘ is an American non-profit, progressive consumer rights advocacy group, and think tank based in Washington, D.C. They recently published an article entitled “FDA Guidance on Homeopathic Drugs: An Ongoing Public Health Failure“. Here are a few excerpts:

In December 2022, the U.S. Food and Drug Administration (FDA) issued new guidance on homeopathic drug products. The guidance states that the agency now “intends to apply a risk-based enforcement approach to the manufacturing, distribution and marketing of homeopathic drug products.”

Under this new risk-based approach, the agency plans to target its enforcement actions against homeopathic drug products marketed without FDA approval that fall within the following limited categories:

  • products with reports of injury that, after evaluation, raise potential safety concerns
  • products containing or purportedly containing ingredients associated with potentially significant safety concerns (for example, infectious agents or controlled substances)
  • products that are not administered orally or topically (for example, injectable drug products and ophthalmic drug products)
  • products intended to be used to prevent or treat serious or life-threatening diseases
  • products for vulnerable populations, such as immunocompromised individuals, infants and the elderly
  • products with significant quality issues (for example, products that are contaminated with foreign materials or objectionable microorganisms)

But this new FDA guidance fails to adequately address the public health threat posed by the agency’s decades-long permissive approach to these illegal drug products.

Under FDA regulations, prescription and over-the-counter (OTC) homeopathic products are considered drugs and are supposed to be subject to the same review and approval requirements as all other prescription and OTC medications. However, under a flawed enforcement policy issued in 1988, the FDA has allowed these drug products to be marketed in the U.S. without agency review or approval. Thus, all products labeled as homeopathic are being marketed without the FDA having evaluated their safety, effectiveness or quality…

… there is no plausible physiologic or medical basis to support the theory underlying homeopathy, nor is there evidence from well-designed, rigorous clinical trials showing that homeopathic drugs are safe and effective.

The FDA should declare unequivocally that all unapproved homeopathic drug products are illegal and direct all manufacturers to immediately remove such products from the market. In the meantime, as we have recommended for many years, consumers should not use homeopathic products. At best, the products are a waste of money, given the lack of any evidence that they are effective. At worst, they could cause serious harm because of the lack of FDA oversight to ensure safety.

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I fully agree with these sentiments. The harm caused by homeopathy is considerable and multi-facetted. Many previous posts have discudded these problems, e.g.:

Having warned about the dangers of homeopathy for decades, I feel it is high time for regulators across the world to take appropriate action.

It has been reported that two London councils have written to parents to warn that children who are not vaccinated against measles may need to self-isolate for 21 days if a classmate is infected with the disease. It comes after modelling by the UK Health Security Agency (UKHSA) warned that up to 160,000 cases could occur in the capital alone as a result of low vaccination rates. Just three-quarters of London children have received the two required doses of the MMR jab, which protects against measles. This is 10 per cent lower than the national average.

Barnet Council wrote to parents on July 20 warning that any unvaccinated child identified as a close contact of a measles case could be asked to self-isolate for up to 21 days. “Measles is of serious concern in London due to low childhood vaccination rates. Currently we are seeing an increase in measles cases circulating in neighbouring London boroughs, so now is a good time to check that your child’s MMR vaccination – which not only protects your child against measles but also mumps and rubella – is up to date,” the letter reads. “Children who are vaccinated do not need to be excluded from school or childcare,” the letter added.

Neighbouring Haringey Council also warned that children without both MMR doses may be asked to quarantine for 21 days. Just over two-thirds (67.9 per cent) of children in the area had received both doses by the age of five. The councils stated that they had sent the letters based on guidance by the UKHSA, but the agency said that headteachers should consider “excluding” unvaccinated pupils who become infected with measles rather than instructing them to self-isolate.

Data published by the UKHSA showed that 128 cases of measles were recorded between January 1 and June 30 this year, compared to 54 cases in the whole of 2022. Two-thirds of the cases were detected in London. The agency have said that there is a high risk of cases linked to overseas travel leading to outbreaks in specific population groups such as young people and under-vaccinated communities.

Dr Vanessa Saliba, a consultant epidemiologist at UKHSA, said: “When there are measles cases or outbreaks in nurseries or schools, the UKHSA health protection team will assess the situation, together with the school and other local partners, and provide advice for staff and pupils. “Those who are not up to date with their MMR vaccinations will be asked to catch up urgently to help stop the outbreak and minimise disruption in schools.”

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Measles is a significant concern with approximately 10 million people infected annually causing over 100,000 deaths worldwide. In the US before use of the measles vaccine, there were estimated to be 3 to 4 million people infected with measles annually, causing 400 to 500 deaths. Complications of measles include otitis media, diarrhea, pneumonia, and acute encephalitis. Measles is a leading cause of blindness in the developing world, especially in those who are vitamin A deficient. Malnourished children with measles are also at higher risk of developing noma (or cancrum oris), a rapidly progressive gangrenous infection of the mouth and face. Most deaths due to measles are caused by pneumonia, diarrhea, or neurological complications in young children, severely malnourished or immunocompromised individuals, and pregnant women. A rare sequela of measles is subacute sclerosing panencephalitis.

Back in 2003, we investigated what advice UK homeopaths, chiropractors and general practitioners give on measles, mumps and rubella vaccination programme (MMR) vaccination via the Internet. Online referral directories listing e-mail addresses of UK homeopaths, chiropractors and general practitioners and private websites were visited. All addresses thus located received a letter of a (fictitious) patient asking for advice about the MMR vaccination. After sending a follow-up letter explaining the nature and aim of this project and offering the option of withdrawal, 26% of all respondents withdrew their answers. Homeopaths yielded a final response rate (53%, n = 77) compared to chiropractors (32%, n = 16). GPs unanimously refused to give advice over the Internet. No homeopath and only one chiropractor advised in favour of the MMR vaccination. Two homeopaths and three chiropractors indirectly advised in favour of MMR. More chiropractors than homeopaths displayed a positive attitude towards the MMR vaccination.  We concluded that some complementary and alternative medicine providers have a negative attitude towards immunisation and means of changing this should be considered.

The problem is by no means confined to the UK. German researchers, for instance, showed that belief in homeopathy and other parental attitudes indicating lack of knowledge about the importance of vaccinations significantly influenced an early immunisation. Moreover, being a German homeopath has been independently associated with lower own vaccination behavior. Data from France paint a similar picture.

Some homeopaths, of course, claim that ‘homeopathic vaccinations’ are effective and preferable. My advice is: DON’T BELIEVE THESE CHARLATANS! A recent study demonstrated that homeopathic vaccines do not evoke antibody responses and produce a response that is similar to placebo. In contrast, conventional vaccines provide a robust antibody response in the majority of those vaccinated.

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, an international team of researchers analyzed the relationship between endorsement of so-called alternative medicine (SCAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787).

The results suggest that, in all the participating countries, SCAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average SCAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal.

The authors concluded that these results constitute a call to consider health care professionals’ attitudes toward SCAM as a factor that could hinder the implementation of immunization campaigns.

In my view, this is a very important paper. It shows what we on this blog have discussed often before: there is an association between SCAM and vaccination hesitancy. The big question is: what is the nature of this association. There are several possibilities:

  1. It could be coincidental. I think this is most unlikely; too many entirely different investigations have shown a link.
  2. It could mean that people start endorsing SCAM because they are critical about vaccination.
  3. It could be that people are critical about vaccination because they are proponents of SCAM.
  4. Finally, it could be that some people have a mind-set that renders them simultaneously hesitant about vaccination and fans of SCAM.

This study, like most of the other investigationson this subject, was not desighned to find out which possibility is most likely. I suspect that the latter two explanations apply both to some extend. The authors of this study argue that that, “from a theoretical point of view, this situation may be explicable by reasons that are both implicit (i.e., CAM would fit better with certain worldviews and ideological standpoints that conflict with the epistemology and values that underlies scientific knowledge) and explicit (i.e., some CAM techniques are doctrinally opposed to the use of vaccines). Although we have outlined these potential explanations for the observed relationships, more research is needed to better understand the underlying mechanisms”.

 

This systematic review with meta-analysis of randomized clinical trials (RCTs) estimated the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. The authors searched the MEDLINE, Cochrane CENTRAL, EMBASE, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022.Image result for death by neck manipulation

RCTs evaluating SMT compared to guideline-recommended and non-recommended interventions, sham SMT, and no intervention for adults with neck pain were eligible. Pre-specified outcomes included pain, range of motion, disability, health-related quality of life.

A total of 28 RCTs could be included. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short-term (standardized mean difference [SMD] 0.66; confidence interval [CI] 0.35 to 0.97) and long-term (SMD 0.73; CI 0.31 to 1.16), and for reducing disability at short-term (SMD 0.95; CI 0.48 to 1.42) and long-term (SMD 0.65; CI 0.23 to 1.06). Only transient side effects were found (e.g., muscle soreness).

The authors concluded that there was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain.

Harms cannot be adequately investigated on the basis of RCT data. Firstly, because much larger sample sizes would be required for this purpose. Secondly, RCTs of spinal manipulation very often omit reporting adverse effects (as discussed repeatedly on this bolg). If we extend our searches beyond RCTs, we find many cases of serious harm caused by neck manipulations (also as discussed repeatedly on this bolg). Therefore, the conclusion of this review should be corrected:

Low certainty evidence exists supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. The evidence of harm is, however, substantial. It follows that the risk/benefit ratio is not positive. Cervical SMT should therefore be discouraged.

In an aging society, it is crucial to understand why some people live long and others do not. There has been a proliferation of studies in recent years that highlight the importance of psycho-behavioral factors in the ways of aging, one of those psychological components is intelligence. In this meta-analysis, the association between intelligence and life expectancy in late adulthood is analysed through the Hazard Ratio (HR). The objectives are:

  • (i) to update a previous meta-analysis, especially the estimate of the association between survival and intelligence;
  • (ii) to evaluate the role of some moderators, especially the age of the participants, to explore intelligence–mortality throughout adulthood and old age.

The results show a positive relationship between intelligence and survival (HR: 0.79; 95% CI: 0.81–0.76). This association is significantly moderated by the years of follow-up, the effect size being smaller the more years elapse between the intelligence assessment and the recording of the outcome.

Fig. 2

The authors concluded that intelligence is a protective factor to reach middle-high age, but from then on survival depends less and less on intelligence and more on other factors.

The consistency of the primary studies is remarkable. This suggests that the association is real. Yet, the question remains: what causes the relationship between intelligence and longevity? Factors such as childhood environment, family income, schooling, and healthy/unhealthy lifestyle habits (diet, exercise, tobacco use, alcohol, illnesses), have been studied. There seems to be a reciprocal dynamic association between intelligence and health throughout life, and although there are several constructs associated with health/ illness and death (e.g., parental social class, intelligence in youth, more education, higher health literacy, healthy behaviors, and more affluent social class) shared genetic differences are likely to account for only a small proportion of these associations.

Arden and colleagues analyzed three twin studies (from the U.S., Denmark, and Sweden) and found a small positive phenotypic correlation between intelligence and lifespan, furthermore, in the combined sample, the genetic contribution to covariance was 95%; in the US study, 84%; in the Swedish study, 86%, and in the Danish study, 85%. These authors pointed out that any genetic factors contributing to intelligence and mortality may operate indirectly via good health choices.

Following this line of argument, I might (with my tongue placed firmly in my cheek) postulate that intelligence leads people to opt for medical treatments that are effective and thus prolong life, while avoiding so-called alternative medicines (SCAMs).

There is evidence that, in the US, Republican-leaning counties have had higher COVID-19 death rates than Democratic-leaning counties and similar evidence of an association between political party affiliation and attitudes regarding COVID-19 vaccination. This investigation assessed political party affiliation and mortality rates for individuals during the initial 22 months of the COVID-19 pandemic.

A cross-sectional comparison of excess mortality between registered Republican and Democratic voters between March 2020 and December 2021 adjusted for age and state of voter registration was conducted. Voter and mortality data from Florida and Ohio in 2017 linked to mortality records for January 1, 2018, to December 31, 2021, were used in data analysis. The main outcome measure was the excess weekly death rates during the COVID-19 pandemic adjusted for age, county, party affiliation, and seasonality.

Between January 1, 2018, and December 31, 2021, there were 538 159 individuals in Ohio and Florida who died at the age of 25 years or older in the study sample. The median age at death was 78 years (IQR, 71-89 years). Overall, the excess death rate for Republican voters was 2.8 percentage points, or 15%, higher than the excess death rate for Democratic voters (95% prediction interval [PI], 1.6-3.7 percentage points). After May 1, 2021, when vaccines were available to all adults, the excess death rate gap between Republican and Democratic voters widened from −0.9 percentage points (95% PI, −2.5 to 0.3 percentage points) to 7.7 percentage points (95% PI, 6.0-9.3 percentage points) in the adjusted analysis; the excess death rate among Republican voters was 43% higher than the excess death rate among Democratic voters. The gap in excess death rates between Republican and Democratic voters was larger in counties with lower vaccination rates and was primarily noted in voters residing in Ohio.

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The authors concluded that, in this cross-sectional study, an association was observed between political party affiliation and excess deaths in Ohio and Florida after COVID-19 vaccines were available to all adults. These findings suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic in the US.

In light of what has been discussed repeatedly, these findings are in my view most impressive and seem to speak for themselves. The authors are nevertheless prudent and stress that their study has several limitations which mean that we ought to interpret their results with caution.

  • First, there are plausible alternative explanations for the difference in excess death rates by political party affiliation beyond the explanatory role of vaccines discussed herein.
  • Second, the mortality data, although detailed and recent, only included approximately 83.5% of deaths in the US and did not include the cause of death. Although overall excess death patterns in our data are similar to those in other reliable sources, such as the Centers for Disease Control and Prevention National Center for Health Statistics data, it is possible that the deaths that our study data did not include may disproportionately occur among individuals registered with a particular political party, potentially biasing our results. In addition, the completeness of the mortality data may vary across states or time, potentially biasing our estimates of excess death rates.
  • Third, all excess death models rely on fundamentally untestable assumptions to construct the baseline number of deaths one would expect in the absence of the COVID-19 pandemic.
  • Fourth, because no information on individual vaccination status was available, analyses of the association between vaccination rates and excess deaths relied on county-level vaccination rates.
  • Fifth, the study was based on data from 2 states with readily obtainable historical voter registration information (Florida and Ohio); hence, the results may not generalize to other states.

We have discussed the Miracle Mineral Solution (MMS) before. Now it has been making headlines again. It has been reported that a Miami federal jury convicted a father and his three sons of selling a toxic bleach solution as a “miracle” medical cure out of a fake Florida church’s website to thousands of consumers across the US. Mark Grenon, 65, and sons Jonathan, 37, Joseph, 35, and Jordan, 29, chose to represent themselves in their two-day trial in Miami federal court. But they said nothing during the trial as if they were silently protesting the proceeding. Only after the 12-person jury hit them with a quick verdict did one of the Grenons speak up. “We will be appealing,” Joseph Grenon said.

During the trial and closing arguments, prosecutors portrayed the four defendants as con men who used a phony religious front on a website, the Genesis II Church of Health and Healing, to sell $1 million worth of their “Miracle Mineral Solution” a cure for 95% of the world’s known diseases, from AIDS to the coronavirus. “This whole Miracle Mineral Solution scheme was built on deception and dishonesty,” the prosecutor said during his closing argument, telling jurors that the Grenons “created a fake church to make it harder for the Food and Drug Administration and government to stop them from selling snake oil.” But, “this was no church,” he argued. “This was a scam for money — an old-fashioned scam.” The jury found the four defendants — all wearing beige inmate uniforms, ponytails, and flowing beards — guilty of conspiring to defraud the U.S. government and FDA, which regulates the food and drug industry, by distributing an unapproved and misbranded drug, Miracle Mineral Solution (MMS). That conviction carries up to five years in prison.

During the trial, the prosecutor said the Grenons called themselves “bishops” and peddled MMS as “sacraments” to consumers in South Florida and other parts of the US in exchange for a “donation” to the Genesis church, before the FDA cracked down on the family in 2020.

The Grenons were charged that April with conspiring to defraud the U.S. government after the outbreak of the COVID-19 pandemic when they defied FDA and court orders to stop distributing the toxic MMS substance. Their criminal case was the first pandemic-related enforcement action in Florida. In public warnings, FDA said it received several reports of hospitalizations and life-threatening conditions as people drank the dangerous substance.

MMS is a chemical solution containing sodium chlorite that, when mixed with water and a citric acid “activator,” turns into chlorine dioxide, a powerful bleach typically used for industrial water treatment or bleaching textiles, pulp, and paper. During the trial, a FDA agent testified about three Grenon-produced videos that pitched the solution as a cure for cancer, lung cancer, and COVID-19, among other deadly diseases. “We are trying to create a world without disease,” Mark Grenon said in one video, pitching the MMS substance. “It’s been proven to be tremendously effective in curing cancer.” Another video, dated March 8, 2020, was titled: “The coronavirus is curable. Do you believe it? You better!”

Prosecutors said the Grenon family’s religious front, the Genesis II Church of Health and Healing, sold tens of thousands of MMS orders in violation of federal law since 2010. It was in that year that Mark Grenon claims to have founded the organization with a man named Jim Humble in a plan to avoid governmental regulation and arrest as they promoted MMS as a miracle cure. Humble, a man who has dabbled in Scientology and professed to be a billion-year-old god, began promoting the substance as early as 2006 in self-published works after he claimed to have discovered its medical properties while on a gold-mining expedition in South America. After Humble supposedly stepped away from the organization in 2017, Grenon continued to manufacture, promote and sell MMS with his three sons.

The Grenons’ open defiance of a court order ultimately led to criminal charges and a federal raid on the family’s Bradenton home, where federal investigators say they found loaded guns, nearly 10,000 pounds of sodium chlorite powder, and thousands of bottles of MMS.

We have discussed the currently fashionable herbal remedy, ‘kratom‘, before:

Inadequate regulation of Kratom supplements put consumers at risk

News about Kratom: the herb was recently (semi-)legalized in Thailand

Kratom: a ‘herbal drug’ with the potental to do more harm than good

A quick recap:

Kratom is made of the leaves of Mitragyna speciosa, a tree endogenous to parts of Southeast Asia. It has been used traditionally for its stimulant, mood-elevating, and analgesic effects. The plant’s active constituents, mitragynine and 7-hydroxymitragynine, have been shown to modulate opioid receptors, acting as partial agonists at mu-opioid receptors and competitive antagonists at kappa- and delta-opioid receptors. Both alkaloids are G protein-biased agonists of the mu-opioid receptor and therefore, may induce less respiratory depression than classical opioid agonists. The Mitragyna alkaloids also appear to exert diverse activities at other brain receptors (including adrenergic, serotonergic, and dopaminergic receptors), which may explain the complex pharmacological profile of raw kratom extracts. By the early 2000s, kratom was increasingly used in the US as a substitute for prescription and illicit opioids for managing pain and opioid withdrawal by people seeking abstinence from opioids. There are numerous assessments where people have been unable to stop using kratom and withdrawal signs and symptoms are problematic. Kratom does not appear in normal drug screens and, when taken with other substances of abuse, may not be recognized.

Now it has been reported that the family of a Florida woman who died in 2021 after ingesting kratom has been awarded more than $11m from a distributor of the herbal extract. “There is of course no amount of money that will make up for the pain and suffering that Ms Talavera’s children are enduring because of their mother’s death,” Middlebrooks wrote in court records addressing the sanction against Kratom Distro. “The law nonetheless recognizes that the defendant must pay something, however inadequate.”

The US Drug Enforcement Agency in 2016 had imposed its strictest restrictions on kratom, which is made from the leaves of an evergreen tree and is often used by people to self-treat pain, anxiety, depression, and opioid addiction as well as withdrawal. There was an intense, immediate public backlash to that approach, however, and it prompted the DEA to rescind its prohibition of kratom, which is sold in stores and online.

The US Food and Drug Administration nonetheless has warned consumers over possible safety and addiction risks associated with kratom, and it has spoken in favor of more research aimed at gaining a better understanding of “the substance and its components”.

Friends of Talavera, a resident of the Florida community of Boynton Beach, introduced her to kratom years before her death. Her family said she regarded it as a safe, natural supplement and had taken some after buying it online from the Kratom Distro when her partner and the father of her youngest child – Biagio Vultaggio – found her unconscious in the living room on 20 June 2021. The 39-year-old Talavera was face down on the ground next to an open bag of a kratom derivative marketed as a “space dust”, her family has said. Vultaggio called paramedics, and they took Talavera to a hospital where she was pronounced dead. An autopsy later listed Talavera’s cause of death as acute intoxication from mitragynine, the main kratom component. The local coroner wrote in a report that “at high concentrations, mitragynine produces opioid-like effects, such as respiratory failure”.

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Kratom Disro claims that

Product Consistency

  • Our kratom powder is sourced directly from Indonesia monthly.  Your order was literally on a farm in Indonesia two months ago.  No old powder.
  • Our kratom extracts are produced in the US by a licensed chemist and a professionally trained staff.
  • We only use delicious flavors and quality ingredients.

Complete Transparency

  • Every batch of products we receive is lab tested and will not ship out without meeting our meticulous quality standards.
  • Current labs – We will never show you an out-of-date lab with our products.
  • Guaranteed purity levels and free of all toxins.

Get It When You Want It

  • Many orders shipped same day.
  • USPS shipping on all orders under 6 pounds.
  • Larger orders can ship USPS Priority for a small additional charge.

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Back to the above lawsuit:

One of the attorneys for Talavera’s family, Tamara Williams, said in a statement that the judgment won by her clients “should be a wakeup call to the kratom industry”. Williams’s law firm had also recently won a $2.5m jury verdict against a kratom manufacturer in Washington state after a separate lawsuit alleging wrongful death. A colleague of Williams called on government officials to take steps “to protect other families from having to deal with unnecessary kratom overdose deaths”.

As the organizer of several demos in the area of Linz, Austria, a ‘corona activist’ and ‘Holocaust denier’ had repeatedly made headlines over the past two years. Now the 39-year-old Austrian man is in the headlines yet again.

It has been reported that, on the evening of July 23, he was stopped by the police for a routine traffic control. His three children, aged 15, 11, and 5, were also in the car. “I know I’m wanted. I don’t have a driver’s license and I have a dead body in the trunk,” he said as he got out of the car. As the officers soon realized, he was only partly joking. A legal case for Holocaust denial was pending against the man who had not appeared at his main hearing last August, so a search was underway for him.

When police officers checked the car, they made the horrifying discovery. In the trunk was a woman’s body, wrapped in sheets. The dead woman turned out to be the wife, aged 38, of the driver. According to preliminary findings, she had died 4 hours earlier. Apparently, she had suffered from incurable cancer, and the police suspect that the illness had not been treated – her husband did not just not believe in vaccinations but disliked all drugs.

The husband, who already had several previous convictions, claimed that he was on his way to bury his wife somewhere “in nature”. The 39-year-old man was arrested and is now in pre-trial detention – though not for the incident with his wife’s body, but for Holocaust denial.  He is said to have compared the Corona measures to the Holocaust, and the arrest order was issued because he failed to appear for his trial.

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One does not need to be a clairvoyant to predict that this remarkable man will come up with more surprises. I wonder what he might think of next.

I don’t usually find reading medical papers scary. An article in the prestigious journal ‘Nature’ is the exception. Here is its abstract:

Long COVID is the patient-coined term for the disease entity whereby persistent symptoms ensue in a significant proportion of those who have had COVID-19, whether asymptomatic, mild or severe. Estimated numbers vary but the assumption is that, of all those who had COVID-19 globally, at least 10% have long COVID. The disease burden spans from mild symptoms to profound disability, the scale making this a huge, new health-care challenge. Long COVID will likely be stratified into several more or less discrete entities with potentially distinct pathogenic pathways. The evolving symptom list is extensive, multi-organ, multisystem and relapsing–remitting, including fatigue, breathlessness, neurocognitive effects and dysautonomia. A range of radiological abnormalities in the olfactory bulb, brain, heart, lung and other sites have been observed in individuals with long COVID. Some body sites indicate the presence of microclots; these and other blood markers of hypercoagulation implicate a likely role of endothelial activation and clotting abnormalities. Diverse auto-antibody (AAB) specificities have been found, as yet without a clear consensus or correlation with symptom clusters. There is support for a role of persistent SARS-CoV-2 reservoirs and/or an effect of Epstein–Barr virus reactivation, and evidence from immune subset changes for broad immune perturbation. Thus, the current picture is one of convergence towards a map of an immunopathogenic aetiology of long COVID, though as yet with insufficient data for a mechanistic synthesis or to fully inform therapeutic pathways.

The paper ends with this gloomy statement: “The oncoming burden of long COVID faced by patients, health-care providers, governments and economies is so large as to be unfathomable, which is possibly why minimal high-level planning is currently allocated to it. If 10% of acute infections lead to persistent symptoms, it could be predicted that ~400 million individuals globally are in need of support for long COVID. The biggest unknowns remain the joined-up scheme of its pathogenesis and thus the best candidate therapeutics to be trialled in randomized controlled trials, along with a better understanding of the kinetics of recovery and the factors influencing this. Some countries have invested in first-round funding for the pilot investigations. From the above, far more will be needed.”

In the context of this blog, we must, of course, ask: HAS SO-CALLED ALTERNATIVE MEDICINE (SCAM) SOMETHING TO OFFER?

I’m afraid that the short answer to this question is No!

However, one does not need to be a clairvoyant to predict that lots of therapeutic claims followed by plenty of methodologically weak (to put it politely) research will emerge from SCAM. Already some time ago, this homeopath indicated, that SCAM providers should see COVID as an opportunity: For homeopathy, shunned during its 200 years of existence by conventional medicine, this outbreak is a key opportunity to show potentially the contribution it can make in treating COVID-19 patients. 

We should not hold our breath to see the emergence of convincing evidence, but we must be prepared to warn the public from getting exploited by charlatans.

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