You may recall, we have dealt with the JCAM many times before; for instance here, here, here and here. Now they have come out with another remarkable paper. This study – no, the authors called it a ‘pilot study’ – was to compare the efficacy of Emotional Freedom Techniques (EFT) with that of Cognitive-Behavioral Therapy (CBT) in reducing adolescent anxiety. Sixty-three American high-ability students in grades 6–12, ages 10–18 years, who scored in the moderate to high ranges for anxiety on the Revised Children’s Manifest Anxiety Scale-2 (RCMAS-2) were randomly assigned to one of three groups:
- CBT (n = 21),
- EFT (n = 21),
- or waitlist control (n = 21).
EFT is an alternative therapy that incorporates acupoint stimulation. Students assigned to the CBT or EFT treatment groups received three individual sessions of the identified protocols from trained graduate counseling, psychology, or social work students enrolled at a large northeastern research university. The RCMAS-2 was used to assess preintervention and postintervention anxiety levels in participants.
EFT participants showed significant reduction in anxiety levels compared with the waitlist control group with a moderate to large effect size. CBT participants did not differ significantly from the EFT or control.
The authors concluded that EFT is an efficacious intervention to significantly reduce anxiety for high-ability adolescents.
They also state in their abstract that EFT is an evidence-based treatment for anxiety…
Are you happy with these conclusions?
Are you convinced that this trial lends itself to establish efficacy of anything?
Are you impressed with the trial design, the sample size, etc?
Are you sure that EFT is plausible, credible or evidence-based in any way?
If you look up EFT, you will find that there is a surprising amount of papers on it. Most of them have one thing in common: they were published in highly dubious journals. The field does not inspire trust or competence. The authors of the study state that EFT is an easily implemented strategy that uses such techniques as awareness building, exposure, reframing of interpretation, and systematic desensitization, while teaching the participant to self-stimulate protocol-identified acupoints (i.e., acupuncture points) by tapping. The effectiveness of acupuncture for treating anxiety has been well documented. Rather than using acupuncture needles, EFT relies on the manual stimulation of the acupoints. A recent meta-analysis indicated that interventions using acupoint stimulation had a moderate effect size (Hedge’s g = −0.66 95% CI [−0.99, −0.33]) in reducing symptoms. In EFT, the client stimulates the protocol-identified acupoints by tapping on them. Preliminary studies have suggested that tapping and other alternative ways of stimulating acupuncture points to be as effective as acupuncture needling. The EFT protocol and identified acupoints that were used in this study are the ones recommended for research purposes by the Association for Comprehensive Energy Psychology…
Wikipedia tells us that “Emotional Freedom Techniques (EFT) is a form of counseling intervention that draws on various theories of alternative medicine including acupuncture, neuro-linguistic programming, energy medicine, and Thought Field Therapy (TFT). It is best known through Gary Craig’s EFT Handbook, published in the late 1990s, and related books and workshops by a variety of teachers. EFT and similar techniques are often discussed under the umbrella term “energy psychology”. Advocates claim that the technique may be used to treat a wide variety of physical and psychological disorders, and as a simple form of self-administered therapy. The Skeptical Inquirer describes the foundations of EFT as “a hodgepodge of concepts derived from a variety of sources, [primarily] the ancient Chinese philosophy of chi, which is thought to be the ‘life force’ that flows throughout the body.” The existence of this life force is “not empirically supported”. EFT has no benefit as a therapy beyond the placebo effect or any known-effective psychological techniques that may be provided in addition to the purported “energy” technique. It is generally characterized as pseudoscience and it has not garnered significant support in clinical psychology.”
A recent systematic review of EFT concluded that “there were too few data available comparing EFT to standard-of-care treatments such as cognitive behavioral therapy, and further research is needed to establish the relative efficacy of EFT to established protocols.”
Notwithstanding these and many other verdicts on EFT, we now are asked to agree with the new study that EFT IS EFFICACIOUS.
Is this a joke?
They want us to believe this on the basis of a PILOT STUDY? Such studies are not even supposed to test efficacy! (Yet the authors of the trial state that this study was designed to meet the American Psychological Association (APA) Division 12 quality control criteria and the Consolidated Standards for Reporting Trials (CONSORT) criteria. I have to admit, they could have fooled me!)
No, it is not a joke, it is yet another nonsense from the ‘The Journal of Complementary and Alternative Medicine’ which, in my view, should henceforth be called THE JOURNAL OF ALTERNATIVE FACTS (JAF).
Can intercessory prayer improve the symptoms of sick people?
Why should it? It’s utterly implausible!
Because the clinical evidence says so?
No, the current Cochrane review concluded that [the] findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
Yet, not all seem to agree with this; and some even continue to investigate prayer as a medical therpy.
For this new study (published in EBCAM), the Iranian investigators randomly assigned 92 patients in 2 groups to receive either 40 mg of propranolol twice a day for 2 month (group “A”) or 40 mg of propranolol twice a day for 2 months with prayer (group “B”). At the beginning of study and 3 months after intervention, patients’ pain was measured using the visual analogue scale.
All patients who participate in present study were Muslim. At the beginning of study and before intervention, the mean score of pain in patients in groups A and B were 5.7 ± 1.6 and 6.5 ± 1.9, respectively. According to results of independent t test, mean score of pain intensity at the beginning of study were similar between patients in 2 groups (P > .05). Three month after intervention, mean score of pain intensity decreased in patients in both groups. At this time, the mean scores of pain intensity were 5.4 ± 1.1 and 4.2 ± 2.3 in patients in groups A and B, respectively. This difference between groups was statistically significant (P < .001).
The above figure shows the pain score in patients before and after the intervention.
The authors concluded that the present study revealed that prayer can be used as a nonpharmacologic pain coping strategy in addition to pharmacologic intervention for this group of patients.
Extraordinary claims require extraordinary proof. This study is, in fact, extraordinary – but only in the sense of being extraordinarily poor, or at least it is extraordinary in its quality of reporting. For instance, all we learn in the full text article about the two treatments applied to the patient groups is this: “The prayer group participated in an 8-week, weekly, intercessory prayer program with each session lasting 45 minutes. Pain reduction was measured at baseline and after 3 months, by registered nurses who were specialist in pain management and did not know which patients were in which groups (control or intervention), using a visual analogue scale.”
Intercessory prayer is the act of praying on behalf of others. This mans that the patients receiving prayer might have been unaware of being ‘treated’. In this case, the patients could have been adequately blinded. But this is not made clear in the article.
More importantly perhaps, the authors fail to provide any numeric results. All that we are given is the above figure. It is not possible therefore to run any type of check on the data. We are simply asked to believe what the authors have written. I for one have great difficulties in doing so. All I do believe in relation to this article is that
- the journal EBCAM is utter trash,
- constantly publishing rubbish is unethical and a disservice to everyone,
- prayer does not need further research of this nature,
- and poor studies often generate false-positive findings.
The boom of alternative medicine in the US – and consequently in the rest of the developed world – is intimately connected with a NHI centre now called NCCIH (National Center for Complementary and Integrative Health). It was founded in the early 1990s because some politicians were bent on promoting quackery. Initially the institution had modest funding but, after more political interference, it had ample cash to pursue all sorts of activities, including sponsoring research into alternative therapies at US universities. A most interesting video summarising the history of the NCCIH can be seen here.
No other institution in the world had more funds for research into alternative medicine than the NCCIH, and it soon became the envy of alt med researchers globally. I have been invited by the NCCHI on several occasions and invariably was impressed by their apparent affluence. While we Europeans usually had to do our research on a shoe-string, our American colleagues seemed to be ‘rolling in it’.
I was often far less impressed with the research they sponsored. Not only it was invariably eye-wateringly expensive, but also its quality seemed often dismal. Sometimes, I even got the impression that research was used as a means of mainstreaming quackery for the unsuspecting American – and consequently world-wide – public.
An example of this mainstreaming is an article in JAMA published yesterday. Here is a short but telling excerpt:
Researchers led by Richard L. Nahin, PhD, MPH, lead epidemiologist at the NIH’s National Center for Complementary and Integrative Health (NCCIH), examined efficacy and safety evidence in 105 randomized controlled trials (RCTs) conducted between January 1966 and March 2016. The review—geared toward primary care physicians as part of the journal’s Symposium on Pain Medicine—focused on popular complementary approaches to common pain conditions.
Unlike a typical systematic review that assigns quality values to the studies, the investigators conducted a narrative review, in which they simply looked at the number of positive and negative trials. “If there were more positives than negatives then we generally felt the approach had some value,” Nahin explained. “If there were more negatives, we generally felt the approach had less value.” Trials that were conducted outside of the United States were excluded from the review.
Based on a “preponderance” of positive vs negative trials, complementary approaches that may offer pain relief include acupuncture and yoga for back pain; acupuncture and tai chi for osteoarthritis of the knee; massage therapy for neck pain; and relaxation techniques for severe headaches and migraine. Several other techniques had weaker evidence, according to the qualitative assessments, for specific pain conditions (see “Selected Complementary Health Approaches for Pain”). The treatments were generally safe, with no serious adverse events reported.
To me, this looks that NCCIH has now managed to persuade even the editors of JAMA to white-wash their dodgy science. The review referred to here is a paper we discussed some time ago on this blog. I then stated about it the following:
Reading the article carefully, it is impossible not to get troubled. Here are a few points that concern me most:
- the safety of a therapy cannot be evaluated on the basis of data from RCTs (particularly as it has been shown repeatedly that trials of alternative therapies often fail to report adverse effects); much larger samples are needed for that; any statements about safety in the aims of the paper are therefore misplaced;
- the authors talk about efficacy but seem to mean effectiveness;
- the authors only included RCTs from the US which must result in a skewed and incomplete picture;
- the article is from the National Center for Complementary and Integrative Health which is part of the NIH but which has been criticised repeatedly for being biased in favour of alternative medicine;
- not all of the authors seem to be NIH staff, and I cannot find a declaration of conflicts of interest;
- the discussion of the paper totally lacks any critical thinking;
- there is no assessment of the quality of the trials included in this review.
My last point is by far the most important. A summary of this nature that fails to take into account the numerous limitations of the primary data is, I think, as good as worthless. As I know most of the RCTs included in the analyses, I predict that the overall picture generated by this review would have changed substantially, if the risks of bias in the primary studies had been accounted for.
I find it puzzling that the ‘lead epidemiologist at the NIH’s National Center for Complementary and Integrative Health’ would publish such dubious research. Why does he do it? If you have watched the video mentioned above, you are inclined to think that it might be because of political interference.
However, I suggest another, in a way much more damming reason or contributing factor: the NCCIH has so long indulged in such poor science that even its top people have forgotten what good science looks like. I know this is a bold hypothesis; so, let me try to support it with some data.
Several years ago, my team together with several other researches have looked at the NCCIH-sponsored research systematically according to 4 different subject areas. Here are the conclusions of our articles reporting the findings:
Seven RCTs had a low risk of bias. Numerous methodological shortcomings were identified. Many NCCAM-funded RCTs of acupuncture have important limitations. These findings might improve future studies of acupuncture and could be considered in the ongoing debate regarding NCCAM-funding. [Focus on Alternative and Complementary Therapies Volume 17(1) March 2012 15–21]
This independent assessment revealed a plethora of serious concerns related to NCCAM studies of herbal medicine. [Perfusion 2011; 24: 89-102]
In conclusion, the NCCAM-funded RCTs of energy medicine are prime examples of misguided investments into research. In our opinion, NCCAM should not be funding poor-quality studies of implausible practices. The impact of any future studies of energy medicine would be negligible or even detrimental. [Focus on Alternative and Complementary Therapies Volume 16(2) June 2011 106–109 ]
In conclusion, our review demonstrates that several RCTs of chiropractic have been funded by the NCCAM. It raises numerous concerns in relation to these studies; in particular, it suggests that many of these studies are seriously flawed. [https://www.ncbi.nlm.nih.gov/pubmed/21207089]
I think I can rest my case and urge you to watch the video mentioned above.
On this blog, we have repeatedly discussed the issues around para-normal or spiritual healing practices. In one of these posts I concluded that these treatments are:
- utterly implausible
- not supported by good clinical evidence.
What follows seems as simple as it is indisputable: energy healing is nonsense and does not merit further research.
Yet both research and – more importantly – the practice of spiritual healing continue, not only in the developed world but even more so in poor and under-developed countries.
Traditional healers, known in Rwanda as Abarangi or Abacwezi claim to use their spiritual powers to heal sick patients. Recently, they urged their government to acknowledge them through proper regulation. Jean-Bosco Kajongi, the leader of the healers in Rwanda, said Abahereza are like doctors who have been selected by angels. “Umuhereza is someone who gets power from God to treat different diseases but particularly demonic possession such as ‘Amahembe’ and ‘Imandwa’. Sometimes, doctors detect something in the body, do surgery but find nothing. But Abarangi can identify the disease beforehand and heal it. Thus, we want to have legal personality and work with modern doctors because what we cure, they cannot even see it. Therefore, mortality rate would decrease.”
Abahereza claim to have God-given powers to heal any disease, provided that the patient has belief in their powers. Claudine Uwamahoro, a resident of Rulindo district is one of them. “Last year, I was transferred to Kanombe Military Hospital to have my leg cut off after they diagnosed me with cancer. Abarangi told me it was not cancer but rather ‘Imandwa.’ They treated me but I didn’t get healed immediately because I had not yet heeded God’s commandment because they do not use any medicines but only requires you to obey God and respect his commandments. Now my leg has been healed… Like Jesus came to save us so that we don’t perish, Umurangi also came so that we do not die of diseases that normal medicines cannot treat.”
Another patient agrees: “In 1983, I played football but later, Imandwa disabled me and my legs were paralyzed. I went to various hospitals and was given an assortment of medicines but they could not help. I always had fever; Doctors treated me but could not identify what kind of disease it really was. I even went to traditional healers but they didn’t have a solution. Pastors and priests prayed for me but in vain. Sorcerers also tried but failed. I was possessed by Imandwa and I was cured by Umurangi from Kirehe District. I believe that they have the power from God and when you respect their conditions, they treat and cure you completely.”
According to Alexia Mukahirwa, another witness, Umurangi is very powerful. “I was sick for 16 years. I went to different places and met many doctors. Some told me I had blood infection, others said it was stomach and intestinal infections. I consumed numberless medicines that never helped until I saw the power of Abarangi and believed them. Some people said that I had HIV/AIDS but it was not true. I only weighed 42 kilograms but now I have 68. Abarangi are powerful and may God bless them.”
James Mugabo, who is an “Umuhereza” or priest, said: “Before colonialism, people had their way of treating illness. But we have abandoned everything yet we should not.” The Director General of clinical services in the Ministry of Health responded by stating: “The law and policy are being drafted and will help us to know who does what kind of medicine and their identity. From that, we will know where to localize Abarangi in traditional or alternative.”
Hearing such things, we might smile and think ‘that’s Rwanda – this would not happen in developed countries’. But sadly, it does! These things happen everywhere. I know of healing ceremonies in the UK and the US that are embarrassingly similar to the ones in Rwanda – remember, for instance, the scenes seen on TV where Donald Trump was blessed by some evangelicals to receive the ability to win the election? And now they will probably claim that it worked!
Nothing to do with alternative medicine, you say? Perhaps this website on ‘spiritual homeopathy’ is more relevant then:
START OF QUOTE
What is spiritual homeopathy? It is based on the principle that “like cures like” and “wounds heal wounds” — the underlying wisdom of support groups. A Biblical story which illustrates this principle takes place on the ancient shepherding people’s journey through the desert. When they grew impatient and complained bitterly to Moses, God sent venomous snakes to bite the people. Many died. When the people confessed their sin, God told Moses to put a bronze snake on a pole. Those who were bitten and focused on the bronze snake did not die; they looked and lived.
Many years later Jesus said of his mission, “As Moses lifted up the serpent in the desert, so the Chosen One must be lifted up, so that everyone who believes on the Chosen One might have eternal life.” Jesus’ disciple Peter wrote, “By Christ’s wounds you are healed.” In “The Angel that Troubled the Waters,” Thornton Wilder wrote: “Without your wound where would your power be? … In love’s service only the wounded can serve.”
As the Thanksgiving and Christmas season approaches, spiritual homeopathy offers healing to all – because the Babe in the Manger is also the Wounded Healer
END OF QUOTE
I think I rest my case.
WARNING: THIS MIGHT MAKE YOU LAUGH OUT LOUDLY AND UNCONTROLLABLY.
Deepak Chopra rarely publishes in medical journals (I suppose, he has better things to do). I was therefore intrigued when I saw a recent article of which he is a co-author.
The ‘study‘ in question allegedly examined the effects of a comprehensive residential mind–body program on well-being. The authors describe it as “a quasi-randomized trial comparing the effects of participation in a 6-day Ayurvedic system of medicine-based comprehensive residential program with a 6-day residential vacation at the same retreat location.” They included 69 healthy women and men who received the Ayurvedic intervention addressing physical and emotional well-being through group meditation and yoga, massage, diet, adaptogenic herbs, lectures, and journaling. Key components of the program include physical cleansing through ingestion of herbs, fiber, and oils that support the body’s natural detoxification pathways and facilitate healthy elimination; two Ayurvedic meals daily (breakfast and lunch) that provide a light plant-based diet; daily Ayurvedic oil massage treatments; and heating treatments through the use of sauna and/or steam. The program includes lectures on Ayurvedic principles and lifestyle as well as lectures on meditation and yoga philosophy. The study group also participated in twice-daily group meditation and daily yoga and practiced breathing exercises (pranayama) as well as emotional expression through a process of journaling and emotional support. During the program, participants received a 1-hour integrative medical consultation with a physician and follow-up with an Ayurvedic health educator.
The control group simply had a vacation without any of the above therapies in the same resort. They were asked to do what they would normally do on a resort vacation with the additional following restrictions: they were asked not to engage in more exercise than they would in their normal lifestyle and to refrain from using La Costa Resort spa services. They were also asked not to drink ginger tea or take Gingko biloba during the 2 days before and during the study week.
Recruitment was via email announcements on the University of California San Diego faculty and staff and Chopra Center for Wellbeing list-servers. Study flyers stated that the week-long Self-Directed Biological Transformation Initiative (SBTI) study would be conducted at the Chopra Center for Wellbeing, located at the La Costa Resort in Carlsbad, California, in order to learn more about the psychosocial and physiologic effects of the 6-day Perfect Health (PH) Program compared with a 6-day stay at the La Costa Resort. The study participants were not blinded, and site investigators and study personnel knew to which group participants were assigned.
Participants in the Ayurvedic program showed significant and sustained increases in ratings of spirituality and gratitude compared with the vacation group, which showed no change. The Ayurvedic participants also showed increased ratings for self-compassion as well as less anxiety at the 1-month follow-up.
The authors arrived at the following conclusion: Findings suggest that a short-term intensive program providing holistic instruction and experience in mind–body healing practices can lead to significant and sustained increases in perceived well-being and that relaxation alone is not enough to improve certain aspects of well-being.
This ‘study’ had ethical approval from the University of California San Diego and was supported by the Fred Foundation, the MCJ Amelior Foundation, the National Philanthropic Trust, the Walton Family Foundation, and the Chopra Foundation. The paper’s first author is director of research at the Chopra Foundation. Deepak Chopra is the co-founder of The Chopra Center for Wellbeing.
Did I promise too much?
Isn’t this paper hilarious?
Just for the record, let me formulate a short conclusion that actually fits the data from this ‘study’: Lots of TLC, attention and empathy does make some people feel better.
This is hardly something one needs to write home about; and certainly nothing to do a study on!
But which journal would publish such unadulterated advertising?
On this blog, I have mentioned the JACM several times before. Recently, I wrote about the new man in charge of it. I concluded stating WATCH THIS SPACE.
I think the wait is now over – this paper is from the latest issue of the JACM, and I am sure we all agree that the new editor has just shown us of what he is made and where he wants to take his journal.
Just as I thought that this cannot get any better, it did! It did so in the form of a second paper which is evidently reporting from the same ‘study’. Here is its abstract unaltered in its full beauty:
The effects of integrative medicine practices such as meditation and Ayurveda on human physiology are not fully understood. The aim of this study was to identify altered metabolomic profiles following an Ayurveda-based intervention. In the experimental group, 65 healthy male and female subjects participated in a 6-day Panchakarma-based Ayurvedic intervention which included herbs, vegetarian diet, meditation, yoga, and massage. A set of 12 plasma phosphatidylcholines decreased (adjusted p < 0.01) post-intervention in the experimental (n = 65) compared to control group (n = 54) after Bonferroni correction for multiple testing; within these compounds, the phosphatidylcholine with the greatest decrease in abundance was PC ae C36:4 (delta = -0.34). Application of a 10% FDR revealed an additional 57 metabolites that were differentially abundant between groups. Pathway analysis suggests that the intervention results in changes in metabolites across many pathways such as phospholipid biosynthesis, choline metabolism, and lipoprotein metabolism. The observed plasma metabolomic alterations may reflect a Panchakarma-induced modulation of metabotypes. Panchakarma promoted statistically significant changes in plasma levels of phosphatidylcholines, sphingomyelins and others in just 6 days. Forthcoming studies that integrate metabolomics with genomic, microbiome and physiological parameters may facilitate a broader systems-level understanding and mechanistic insights into these integrative practices that are employed to promote health and well-being.
Now that I managed to stop laughing about the first paper, I am not just amused but also puzzled by the amount of contradictions the second article seems to cause. Were there 65 or 69 individuals in the experimental group? Was the study randomised, quasi-randomised or not randomised? All of these versions are implied at different parts of the articles. It turns out that they randomised some patients, while allocating others without randomisation – and this clearly means the study was NOT randomised. Was the aim of the study ‘to identify altered metabolomic profiles following an Ayurveda-based intervention’ or ‘to examine the effects of a comprehensive residential mind–body program on well-being’?
I am sure that others will find further contradictions and implausibilites, if they look hard enough.
The funniest inconsistency, in my opinion, is that Deepak Chopra does not even seem to be sure to which university department he belongs. Is it the ‘Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA.’ as indicated in the 1st paper or is it the ‘Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA’ as listed in the 2nd article?
Does he know from which planet he is?
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.
Yes, I know, lately I have been neglecting my ‘ALT MED HALL OF FAME’. This is entirely my fault; there are so many candidates waiting to be admitted that, I have been hesitant as to who should be next. Today, I came across an article about Deepak Chopra and his latest book, Super Genes. It tells “how lifestyle shifts can help you reboot your health at a genetic level.” If it were just for this single sentence, he would deserve to be admitted – no, not into what you just thought, into the ‘ALT MED HALL OF FAME’, of course’.
I will save you the expense of buying his book (don’t worry, Deepak is already a multi-millionaire) by repeating what the article said about his ‘6 pillars of wellbeing’ (another cracker!!!):
• A typical modern diet is very likely to cause inflammation, which research has linked to many chronic diseases and obesity.
• To reduce inflammation, add prebiotics – substances that buffer the body from inflammation – such as oatmeal, pulpy orange juice, bran cereal and bananas to your breakfast.
• Consume probiotics – foods that contain active bacteria – once a day for gut health. These foods include active yoghurt, pickles and sauerkraut.
• Eat mindfully – eat only when you’re genuinely hungry and stop when you are full.
• Reduce snacking by eating only one measured portion in a bowl; never eat straight from a bag or packet.
• Three factors generally lie behind the problem of chronic stress: repetition, unpredictability and a lack of control. Think of a dog barking outside your window; you don’t know when it will end and you have no way of stopping it.
• Decrease background noise and distractions at work. Also, avoid multitasking by dealing with one thing at a time.
• Leave work on time at least three times a week and don’t bring work home. Leave the office at the office.
• Avoid people who are sources of pressure and conflict. Even normal office behaviour, such as forming cliques and gossiping, is a source of stress that has the potential to be emotionally devastating.
• If you struggle to deal with negative emotions, ask your doctor about cognitive behaviour therapy.
• The secret to exercise is this: keep going and don’t stop. It’s better to be active all your life at a lower level, rather than to be at a near professional-level in high school, say, and then stop completely.
• At work get up and move around once an hour and devote half your lunch break to movement, even if it’s walking around the block.
• Be in nature more: go outside for five to 10 minutes three times a day.
• Acquire more active friends and join them in their activities. Plan a shared exercise activity with your spouse or friends twice a week.
• Make leisure time more creative – think beyond TV or internet.
• Volunteer to help the needy with housecleaning, painting and repairs.
This will serve as both exercise and a morale boost.
• Meditate every day for 10 minutes.
Sit with your eyes closed in a quiet place, put your attention on the tip of your nose and focus on the sensation of your breath coming in and out of your nostrils.
• Don’t look at meditation as an aid for the bad days you experience (“I’m feeling good today, so I don’t need to meditate”). It should be a lifelong practice.
• Take 10 minutes out of your lunch break to sit alone with eyes closed, preferably outside in nature.
• Notice what a relief it is to take big deep breaths when you are upset or nervous, and how ragged your breath becomes when you are anxious or stressed.
• Join an organised meditation course in your area. Search for meetup.com to find local groups that meet all around the country.
• Make your bedroom as dark as possible. If total darkness is impossible, wear a sleep mask.
• Drink a glass of warm almond milk, which is rich in calcium and promotes melatonin, a hormone that helps to regulate the sleep-wake cycle.
• Experiment with herbal teas associated with good sleep such as chamomile, valerian, passionflower, lavender and kava kava.
• Explore abhyanga, a self-massage technique that uses warmed sesame oil, lightly massaged into arms, legs, neck and torso (go to YouTube to see tutorials).
• Don’t ignore insomnia. In some studies sleep disorders have been associated with triggering Alzheimer’s disease and are also associated with high blood pressure.
• Take responsibility for your feelings. Wellbeing depends upon happiness, yet most people don’t really make that connection.
• Write down five specific things that make you happy and, on a daily basis, do at least one of them.
• Set a “good news policy” at meal times, whether it’s the radio station you choose to listen to or the topic of conversation around the table.
• Explore a time in your past when you were happy and learn from it, whether that means re-embracing an old hobby or getting in touch with an old friend.
• Become comfortable with delayed gratification – consider how your choices will make you feel in the future as well as today.
END OF QUOTE
My favourite website about Deepak Chopra is the one by Tom Williamson. It states that “it has been said by some that the thoughts and tweets of Deepak Chopra are indistinguishable from a set of profound sounding words put together in a random order, particularly the tweets tagged with “#cosmisconciousness”. This site aims to test that claim! Each “quote” is generated from a list of words that can be found in Deepak Chopra’s Twitter stream randomly stuck together in a sentence.” It seems to me that Deepak himself might have made ample use of this site for writing his latest book, and if you should ever run out of platitudes or empty phrases, this site will serve you well.
Deepak has published plenty of best-sellers, but he has as good as nothing to show for himself in the peer-reviewed medical literature. (When you are that famous, you obviously don’t need to bother anymore with trivia such as evidence, science and all that jazz.) This means that I had to deviate from my usual admission criteria for the “prophet of alternative medicine”, as Deepak likes to be called. But he is well worth making an exception, I am sure you agree, he is the absolute super-star!
Super-star of what?
I let you decide!
This series of post is quite good fun – at least for me who is writing it. But I also hope that it is useful to those readers who are tempted to consult alternative practitioners. My intention is to stimulate people’s ability to think critically and to provide some sort of guide for patients which might help them in deciding which practitioners to avoid.
In this spirit, I now offer you the next instalment of three ‘tricks of the trade’:
NATURAL IS GOOD
Everyone working in advertising will confirm: the ‘natural label’ is a great asset for boosting sales of all sorts of things. Practitioners of alternative medicine have long appreciated this fact and exploited it to the best of their abilities. They stress the ‘naturalness’ of their treatments ad nauseam, and more often than not they use the term misleadingly.
For instance, there is nothing natural to thrust a patients spine beyond the physiological range of motion [chiropractic]; there is nothing natural in endlessly diluting and shaking remedies which may or may not have their origin in a natural substance [homeopathy]; there is nothing natural in sticking needles into the skin of patients [acupuncture].
Moreover, the notion of a benign ‘mother nature’ is naïvely misleading. Ask those who have been at sea during a storm or who have been struck by lightning.
My advice is to see through transparent marketing slogans and to tell the anyone who goes on about the ‘naturalness’ of his therapy to buzz off.
When one goes to a meeting of alternative practitioners, the term ‘energy’ is mentioned more often than at a board meeting of EDF. The difference is that the alternative brigade does not mean really energy when they speak of energy; they mean ‘vital force’ or one of the many related terms from other traditions.
Practitioners do prefer to use ‘energy’ because this sounds modern and impressive to many consumers. Crucially, it avoids disclosing how deeply steeped the therapists are in vitalism and vitalistic ideas. Whereas rational thinkers have discarded such concepts more than a century ago, alternative medicine advocates find it hard to do the same – if they did, there would be little else to underpin their various ‘philosophies’.
My advice is to avoid clinicians who are ‘vitalists’ because adhering to long obsolete concepts is a sure sign of dangerous backward thinking.
STIMULATING THE IMMUNE SYSTEM
‘Your immune system need stimulating!’ – how often have we heard that from practitioners of alternative medicine? By contrast, conventional clinicians are most reserved about such aims; they might try to stimulate the immune system in certain, rare circumstances. Quite often they need to achieve the opposite effect and use powerful drugs to suppress the immune system. But even when they aim at stimulating the immune system of a patient, they would not use any of the treatments alternative practitioners swear by.
How come? There are several reasons:
- The alternative ‘immune stimulants’ do not really stimulate the immune system.
- Stimulating the immune system is rarely a desirable therapeutic aim.
- Stimulating a normal immune system is hardly possible.
- For many of us, stimulating the immune system might even be a very risky business (if it were at all achievable).
My advice is to ask your practitioner precisely why he wants to stimulate your immune system. If he can give you a good reason, ask him to try stimulating his own immune system first and to show you the proof that his therapy can do such a thing.
You have to admit, quacks had a difficult time recently:
- homeopathy has been disclosed as humbug,
- chiropractic is not much better,
- ‘acupuncture awareness week’ left acupuncturists bruised…
Need I go on?
One has to pity these guys; their income is dwindling; they have no pensions, no unions to protect them etc., they know nothing other than quackery…what can they do? They are clearly fighting for survival.
I suggest we all focus, use our imagination and come up with come constructive ideas to help them.
Alright, I start: HOLISTIC DOPING
The fate of the poor (not in a monetary sense, of course) tennis star Sharapova gave me that brainwave.
Our elite athletes are in a pickle: they feel the need to enhance their performance but more and more ways of achieving this with cleverly administered drugs are becoming illegal. Their livelihood is at stake almost as much as that of our dear quacks.
What if the two groups jointed forces?
What if they decided to help solve each others’ problems?
This could be a classical win/win situation!
I am sure homeopaths, chiropractors, acupuncturists etc. could design holistic program for improving athletic performance. It would be highly individualised and embrace body, mind, spirit, sole and anything else they can think of. It could include the newest concepts in quantum healing, energy field, qi, vital force, etc. The advantages are obvious, I think:
- none of these interventions will ever be found on a list of forbidden drugs,
- the program will work perfectly well because it will generate large placebo responses,
- performance will therefore increase (as always in alternative medicine, anecdotal ‘evidence’ will suffice) ,
- and so will the quacks’ cash flow.
Is there a downside? Not really…oh, hold on…yes there is!
My idea is not that original; others have had it already. In fact, there are quite a few quacks offering alternatives to good old-fashioned doping.
THAT’S THE AWFUL THING ABOUT QUACKERY: ALL THE GOOD IDEAS TURN OUT TO BE ALREADY TAKEN!
Therapeutic touch (TT) is a popular ‘energy therapy’ which is based on the use of hand movements and detection of ‘energy field congestion’ to correct alleged imbalances that, in turn, are postulated to stimulate self-healing. The effectiveness of TT during radiotherapy for breast cancer is unknown, and this study was aimed at shedding some light on it.
Women undergoing adjuvant radiation for stage I/II breast cancer post surgery were recruited for this study. TT treatments were administered to patients in the experimental group three times per week following radiation therapy. The control group did not receive any TT. Both groups had conventional care in addition.
The effectiveness of TT was evaluated by documenting the ‘time to develop’ and the ‘worst grade of radiation’ dermatitis. Toxicity was assessed using NCIC CTC V3 dermatitis scale. Cosmetic rating was performed using the EORTC Breast Cosmetic Rating. The quality of life, mood and energy, and fatigue were assessed by EORTC QLQ C30, POMS, and BFI, respectively. The parameters were assessed at baseline, and serially during treatment.
A total of 49 patients entered the study (17 in the TT group and 32 in the control group). Median age in TT arm was 63 years and in control arm was 59 years. TT was considered feasible as all 17 patients screened completed TT treatment. There were no side effects observed with the TT treatments. In the TT group, the worst grade of radiation dermatitis was grade II in nine patients (53%). Median time to develop the worst grade was 22 days. In the control group, the worst grade of radiation dermatitis was grade III in 1 patient. However, the most common toxicity grade was II in 15 patients (47%). Three patients did not develop any dermatitis. Median time to develop the worst grade in the control group was 31 days. There was no difference between cohorts for the overall EORTC cosmetic score and there was no significant difference in before and after study levels in quality of life, mood and fatigue.
Based on these findings, the authors drew the following conclusions: This study is the first evaluation of TT in patients with breast cancer using objective measures. Although TT is feasible for the management of radiation induced dermatitis, we were not able to detect a significant benefit of TT on NCIC toxicity grade or time to develop the worst grade for radiation dermatitis. In addition, TT did not improve quality of life, mood, fatigue and overall cosmetic outcome.
Like all forms of ‘energy healing’, TT lacks any biological plausibility and is not clinically effective. At best, it can generate a placebo-response; but in this particular study it did not even manage that.
Is it not time to stop fooling patients with outright quackery?
Is it not time to stop spending scarce research resources on such nonsense?
Is it not time that editors stop considering such rubbish for publication?
Is it not time to stop allowing TT-proponents to undermine rationality?
Is it not time to make progress and move on?