MD, PhD, FMedSci, FSB, FRCP, FRCPEd

evidence

1 2 3 18

Dengue is a viral infection spread by mosquitoes; it is common in many parts of the world. The symptoms include fever, headache, muscle/joint pain and a red rash. The infection is usually mild and lasts about a week. In rare cases it can be more serious and even life threatening. There’s no specific treatment – except for homeopathy; at least this is what many homeopaths want us to believe.

And, of course, we don’t want to listen to just any odd homeopath, we want true experts to tell us the truth – for instance, experts like Dr. R.K. Manchanda, Deputy Director(Homoeopathy), Directorate of ISM & Homoeopathy, Govt. of NCT of Delhi and Dr. Surinder Verma, Assistant Director (Homoeopathy), Directorate of ISM & Homoeopathy, Govt. of NCT of Delhi. They authored an article which states the following:

There are about 25 homoeopathic drugs available for the treatment of dengue fever. These are Aconite., Arnica, Arsenic-alb., Arum-tri., Baptisia., Belladonna., Bryonia., Cantharis., China officinalis Colocynthis., Eupatorium perfoliatum., Ferrum metallicum., Gelsemium., Hamamelis., Ipecac., Lachesis, Merc-sol, Nux vomica., Podophyllum., Rhus toxicodendron., Rhus-venenata., Sanicula., Secale cornutum and Sul-acidum. These drugs had been successfully used by various homeopaths across the globe for its treatment and management. In 1996 during the epidemic of dengue in Delhi Eupatorium perfoliatum was found most effective.

Sadly, the article does not provide any evidence. A quick Medline search located one (!) single trial on the subject. Here is the abstract:

A double-blind, placebo-controlled randomized trial of a homeopathic combination medication for dengue fever was carried out in municipal health clinics in Honduras. Sixty patients who met the case definition of dengue (fever plus two ancillary symptoms) were randomized to receive the homeopathic medication or placebo for 1 week, along with standard conventional analgesic treatment for dengue. The results showed no difference in outcomes between the two groups, including the number of days of fever and pain as well as analgesic use and complication rates. Only three subjects had laboratory confirmed dengue. An interesting sinusoidal curve in reported pain scores was seen in the verum group that might suggest a homeopathic aggravation or a proving. The small sample size makes conclusions difficult, but the results of this study do not suggest that this combination homeopathic remedy is effective for the symptoms that are characteristic of dengue fever.

This is a 2007 study by a well-known US homeopath. Its results fail to confirm that homeopathy is effective for Dengue. So, surely the homeopathic community has since stopped claiming that homeopathy is an option for this infection!

No, you guessed correctly, they continue claiming that homeopathy works for Dengue. Currently, there are about half a million websites doing exactly that. An example is this article published YESTERDAY (!):

Alopathy is no more the only solution for Dengue these days. Especially in a place like Bengaluru where doctors and medicines are both expensive, residents have now turned to a cheaper and an effective alternative-Homeopathy to combat Dengue.People have been milling Homeopathy clinics and hospitals for an antidote. Dr Sudhir Babu of Javaji Advanced Homeopathy said, “People ask for some cure to keep the disease at bay. We do in fact have medicines to help build immunity against the ailment.”The dosage is for four or five days and is taken daily. Homeopathy has now become a trusted alternative in the field of medicine, especially because of its easy acceptibility among children and adults. According to a survey by IMRB, 100% people know about this form of medicine and 92% perceive it as a reputed form of treatment. The medicines that are administered depending on the symmptoms of Dengue Fever are Aconitum Napellus, Arsenicum Album, Belladonna, Bryonia Alba, Cantharis, Cinchona Officinalis, Eupatorium Perfoliatum, Gelsemium, Ipecacuanha, Nux Vomica, Rhus Toxicodendron and Rhus Venenata.

What I found particularly impressive here is the way popularity has been used to replace evidence. This, I think, begs several questions:

  • How long will homeopaths continue treating self-limiting conditions to claim success based no nothing but their natural history?
  • How long will they continue to lie to the public?
  • How long will they refuse to learn from the evidence?
  • How long will they ignore even the most fundamental rules of medical ethics?
  • How long will we let them get away with all this?

“THERE IS A SUCKER BORN EVERY MINUTE” – this quote is commonly attributed to P.T.Barnum. If he really coined the sentence, he certainly did not think of the little cups sucking in the skin of patients undergoing cupping therapy. Yet, the recent media coverage of cupping made me think of this quote. The suckers here are not the therapeutic devices employed for cupping but the athletes, the journalists and the general public.

In my experience, athletes are often very worried about their body. This is perhaps understandable but, at the same time, it makes them the ideal victims of all types of charlatans. I am therefore not really surprised to see that some Olympic athletes fell for cupping. They want to use every means allowed by the doping rules to enhance their performance. Cupping therapists claim all sorts of strange and unwarranted things, and some athletes seem to be gullible enough to believe them. Belief can perhaps not move mountains, but it might give you the edge in an Olympic competition.

The ‘beauty’ of cupping when applied to an athlete’s body is that its traces are so publicly visible. During Olympic games, this means that the entire world knows within hours about the cupping-habit of an athlete. What could be more exciting for journalists than these odd cupping marks decorating the muscular bodies of some Olympic athletes? If they are not worth a good story, what is?

There is hardly a newspaper on the planet that did not jump on this band-waggon full of snake oil – there is a sucker born every minute! Nothing wrong with reporting what is happening at the Olympic games, of course. But what has sometimes been reported in the press about cupping beggars belief. Rarely have I read so much nonsense about an alternative therapy in such a short time.

Do you need an example? The DAILY MAIL is as good – or rather bad? – as most; this is what the DM published yesterday on the subject: Chinese media have been cheering cupping’s appearance at the Olympics as proof of the value of traditional culture, with both the official Xinhua news agency and Communist Party mouthpiece People’s Daily touting the soft-power benefits. “Chinese traditions and products proliferate Olympic village”, read one headline on the People’s Daily website. Ding Hui, manager of the Lily Spring Health & Spa in Beijing, said she has seen a 30 percent jump in clients asking for cupping treatment since the Olympics started. “Even though Chinese people have known about it for a long time, they see a great athlete does it and see it really works,” Ding said. “For athletes, they build up harmful lactic acid in the body and cupping can help relieve it.”

You might think that, when reporting about a weird therapy, journalists have little options but to interview weird ‘experts’ relating cupping to even weirder ‘energies’, ‘life forces’, ‘meridians’, yin and yang, TCM, etc. But you would be wrong. They do of course have other options; they would only have needed to log on Medline to find hundreds of references related to the subject. If they had done that, they would even have found an abstract of mine that might have answered many of their question and would have clarified many of the questions about the scientific evidence for or against cupping. Here it is:

The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.

With just one further click on their keyboard, they would have been able to read the full text of my article which cautioned in no uncertain terms: The number of trials and the total sample size are too small to distinguish between any nonspecific or specific effects, which preclude any firm conclusions. Moreover, the methodological quality was often poor.

Sadly, few journalists seemed to have bothered to do this tiny bit of research. Why? Surely, journalists are trained to investigate their subject before putting pen to paper! Yes, most of them are, but a headline like THE EVIDENCE FOR CUPPING IS FLIMSY does not sell newspapers. The public wants something much more interesting – there is a sucker born every minute!

And what should be wrong with that? People deserve a bit of an entertaining story about their Olympic idols! Perhaps, but there is a downside, of course. The media-hype of the last week will create a demand. The general public will now want the very therapy that helped athletes win gold medals (never mind that it didn’t). Thanks to the media, cupping is now destined to become the alternative therapy of the future.

And what is wrong with that? Quite a lot, I think!

For one, quacks will jump on this fast-moving band-waggon filled with snake oil and try to divert as much cash as they can from their victims’ into their own bank accounts. Perhaps that would not be the worst effect. The worst would be, if some people believe what some quacks will undoubtedly tell them, that cupping is effective (“they see a great athlete does it and see it really works”) for all sorts of conditions, including serious diseases (“Cupping has also been used by some as an alternative treatment for cancer.”) – THERE IS A SUCKER BORN EVERY MINUTE (and some might even die sucking)!

No, I don’t want to put you off your breakfast… but you probably have seen so many pictures of attractive athletes with cupping marks and read articles about the virtues of this ancient therapy, that I feel I have to put this into perspective:

Cupping burnsI am sure you agree that this is slightly less attractive. But, undeniably, these are also cupping marks. So, if you read somewhere that this treatment is entirely harmless, take it with a pinch of salt.

Cupping has existed for centuries in most cultures, and there are several variations of the theme. We differentiate between wet and dry cupping. The above picture is of wet cupping gone wrong. What the US Olympic athletes currently seem to be so fond of is dry cupping.

The principles of both forms are similar. In dry cupping, a vacuum cup is placed over the skin which provides enough suction to create a circular bruise. Eventually the vacuum diminishes, and the cup falls off; what is left is the mark. In wet cupping, the procedure is much the same, except that the skin is injured before the cup is placed. The suction then pulls out a small amount of blood. Obviously the superficial injury can get infected, and that is what we see on the above picture.

In the homeopathic hospital where I worked ~40 years ago, we did a lot of both types of cupping. We used it mostly for musculoskeletal pain. Our patients responded well.

But why? How does cupping work?

The answer is probably more complex than you expect. It clearly has a significant placebo effect. Athletes are obviously very focussed on their body, and they are therefore the ideal placebo-responders. Evidently, my patients 40 years ago also responded to all types of placebos, even to the homeopathic placebos which they received ‘en masse’.

But there might be other mechanisms as well. A TCM practitioner will probably tell you that cupping unblocks the energy flow in our body. This might sound very attractive to athletes or consumers, and therefore could even enhance the placebo response, but it is nevertheless nonsense.

The most plausible mode of action is ‘counter-irritation’: if you have a pain somewhere, a second pain elsewhere in your body can erase the original pain. You might have a headache, for instance, and if you accidentally hit your thumb with a hammer, the headache is gone, at least for a while. Cupping too would cause mild to moderate pain, and this is a distraction from the muscular pain the athletes aim to alleviate.

When I employed cupping 40 years ago, there was no scientific evidence testing its effects. Since a few years, however, clinical trials have started appearing. Many are from China, and I should mention that TCM studies from China almost never report a negative result. According to the Chinese, TCM (including cupping) works for everything. More recently,also some trials from other parts of the world have emerged. They have in common with the Chinese studies that they tend to report positive findings and that they are of very poor quality. (One such trial has been discussed previously on this blog.) In essence, this means that we should not rely on their conclusions.

A further problem with clinical trails of cupping is that it is difficult, if not impossible, to control for the significant placebo effects that this treatment undoubtedly generates. There is no placebo that could mimic all the features of real cupping in clinical trials; and there is no easy way to blind either the patient or the therapist.

So, we are left with an ancient treatment backed by a host of recent but flimsy studies and a growing craze for cupping fuelled by the Olympic games. What can one conclude in such a situation?

Personally, I would, whenever possible, recommend treatments that work beyond a placebo effect, because the placebo response tends to be unreliable and is usually of short duration – and I am not at all sure that cupping belongs into this category. I would also avoid wet cupping, because it can cause substantial harm. Finally, I would try to keep healthcare costs down; cupping itself is cheap but the therapist’s time might be expensive.

In a nutshell: would I recommend cupping? No, not any more than using a hammer for counter irritation! Will the Olympic athletes care a hoot about my recommendations? No, probably not!

 

When a leading paper like the FRANKFURTER ALLGEMEINE ZEITUNG (FAZ) publishes in its science pages (!!!) a long article on homeopathy, this is bound to raise some eyebrows, particularly when the article in question was written by the chair of the German Association of Homeopaths (Deutscher Zentralverein homöopathischer Ärzte) and turns out to be a completely one-sided and misleading white-wash of homeopathy. The article (entitled DIE ZEIT DES GEGENEINANDERS IST VORBEI which roughly translates into THE DAYS OF FIGHTING ARE OVER)  is in German, of course, so I will translate the conclusions for you here:

The critics [of homeopathy] … view the current insights of conventional pharmacology as some type of dogma. For them it is unthinkable that a high potency can cause a self-regulatory and thus healing effect on a sick person. Homeopathic doctors are in their eyes “liars”. Based on this single argument, the critics affirm further that therefore no positive studies can exist which prove the efficacy of homeopathy beyond placebo. After all, high potencies “contain nothing”. The big success of homeopathy is a sore point for them, because efficacious high potencies contradict their seemingly rational-materialistic world view. Research into homeopathy should be stopped, the critics say. This tune is played unisono today by critics who formerly claimed that homeopaths block the research into their therapy. The fact is: homeopathic doctors are today in favour of research, even with their own funds, whenever possible. Critics meanwhile demand a ban.

In the final analysis, homeopathic doctors do not want a fight but a co-operation of the methods. Homeopathy creates new therapeutic options for the management of acute to serious chronic diseases. In this, homeopathy is self-evidently not a panacea: the physician decides with every patient individually, whether homeopathy is to be employed as an alternative, as an adjunct, or not at all. Conventional diagnostic techniques are always part of the therapy.

END OF QUOTE

[For those readers who read German, here is the German original:

Die Kritiker … betrachten die heutigen Erkenntnisse der konventionellen Pharmakologie als eine Art Dogma. Für sie ist es undenkbar, dass eine Hochpotenz einen selbstregulativen und damit heilenden Effekt bei einem kranken Menschen auslösen kann. Homöopathische Ärzte sind in ihren Augen “Lügner”. Von diesem einen Argument ausgehend, wird dann weiter behauptet, dass es deshalb gar keine positiven Studien geben könne, die eine Wirksamkeit der Homöopathie über einen Placebo-Effekt hinaus belegen. Schließlich sei in Hochpotenzen “nichts drin”. Der große Erfolg der Homöopathie ist ihnen ein Dorn im Auge, weil wirksame Hochpotenzen ihrem vermeintlich rational-materialistischen Weltbild widersprechen. Die Erforschung der Homöopathie solle gestoppt werden, heißt es. Unisono wird diese Melodie von Kritikern heute gespielt, von ebenjenen Kritikern, die früher behaupteten, die homöopathischen Ärzte sperrten sich gegen die Erforschung ihrer Heilmethode. Fakt ist: Heute setzen sich homöopathische Ärzte für die Forschung ein, auch mit eigenen Mitteln, soweit es ihnen möglich ist. Kritiker fordern mittlerweile das Verbot.

Letztlich geht es homöopathischen Ärzten allerdings nicht um ein Gegeneinander, sondern um ein Miteinander der Methoden. Durch die Homöopathie entstehen neue Therapieoptionen bei der Behandlung von akuten bis hin zu schweren chronischen Erkrankungen. Dabei ist die ärztliche Homöopathie selbstverständlich kein Allheilmittel: Bei jedem erkrankten Patienten entscheidet der Arzt individuell, ob er die Homöopathie alternativ oder ergänzend zur konventionellen Medizin einsetzt – oder eben gar nicht. Die konventionelle Diagnostik ist stets Teil der Behandlung.]

While translating this short text, I had to smile; here are some of the reasons why:

  • ‘conventional pharmacology’ is a funny term; do homeopaths think that there also is an unconventional pharmacology?
  • ‘dogma’… who is dogmatic, conventional medicine which changes almost every month, or homeopathy which has remained essentially unchanged since 200 years?
  • ‘liars’ – yes, that’s a correct term for people who use untruths for promoting their business!
  • ‘Based on this single argument’… oh, I know quite a few more!
  • ‘doctors are today in favour of research’ – I have recently blogged about the research activity of homeopaths.
  • ‘co-operation of the methods’ – I have also blogged repeatedly about the dangerous nonsense of ‘integrative medicine’ and called it ‘one of the most colossal deceptions of healthcare today’. Hahnemann would have ex-communicated the author for this suggestion, he called homeopaths who combined the two methods ‘traitors’!!!
  • ‘new therapeutic options’… neither new nor therapeutic, I would counter; to be accepted as ‘therapeutic’, one would need a solid proof of efficacy.
  • ’employed as an alternative’ – would this be ethical?
  • ‘Conventional diagnostic techniques are always part of the therapy’… really? I was taught that diagnosis and treatment are two separate things.

There were many comments  by readers of the FAZ. Their vast majority expressed bewilderment at the idea that the chair of the German Association of Homeopaths has been given such a platform to dangerously mislead the public. I have to say that I fully agree with this view: the promotion of bogus treatments can only be a disservice to public health.

According to an article in DER SPIEGEL, 4 patients of an alternative medicine centre died, while several other websites reported that the figure amounted to ‘just’ three. The centre in question is the Klaus Ross clinic in the German town of Bruggen-Bracht on the border with the Netherlands.

In addition to these fatalities, several further patients are being treated in hospital and German prosecutors in the town of Moenchengladbach have urged other patients showing any symptoms to “urgently seek medical advice.” Dutch police, who are supporting the inquiry, appealed for information from other patients, as newspapers reported the clinic had been using an experimental transfusion.

Concern was first raised when a 43-year-old Dutch woman with breast cancer complained of headaches and became confused after being treated at the clinic on July 25. She later lost the ability to speak, and died on July 30. The “cause of her death remains unclear,” the German prosecutors said in a statement earlier this week. Many Dutch people are known to have visited the clinic and while “it is not yet known exactly what happened, there is a health risk to patients who have undergone treatment at this clinic”, according to a statement by Dutch police.

Klaus Ross was cited saying that “one of our patients unexpectedly has passed away… We regret this seriously and are in shock as we heard the news. Our thoughts and deep condolences are with her family, friends and loved ones… we regret the suspicion set in the media that alternative medicine, and our clinic especially, could be held responsible…. Alternative medicine is always an extra tool to battle diseases.” Allegedly, Ross always advised patients to be monitored by their own doctors.

The centre in question specialised in ‘biological’ cancer therapies and beauty treatments; it has now been closed and Ross has reportedly been charged with manslaughter. The interventions on offer include a wide range of unproven therapies, including detox, oxygen therapy, various supplements, immunotherapy and hyperthermia. According to some reports, the therapy implicated in the fatalities was 3- bromopyruvate (3BP). 3BP is an experimental cancer treatment which is currently attracting much, mostly pre-clinical research. One review article summarized the evidence such:

Although the “Warburg effect”, i.e., elevated glucose metabolism to lactic acid (glycolysis) even in the presence of oxygen, has been recognized as the most common biochemical phenotype of cancer for over 80 years, its biochemical and genetic basis remained unknown for over 50 years. Work focused on elucidating the underlying mechanism(s) of the “Warburg effect” commenced in the author’s laboratory in 1969. By 1985 among the novel findings made two related most directly to the basis of the “Warburg effect”, the first that the mitochondrial content of tumors exhibiting this phenotype is markedly decreased relative to the tissue of origin, and the second that such mitochondria have markedly elevated amounts of the enzyme hexokinase-2 (HK2) bound to their outer membrane. HK2 is the first of a number of enzymes in cancer cells involved in metabolizing the sugar glucose to lactic acid. At its mitochondrial location HK2 binds at/near the protein VDAC (voltage dependent anion channel), escapes inhibition by its product glucose-6-phosphate, and gains access to mitochondrial produced ATP. As shown by others, it also helps immortalize cancer cells, i.e., prevents cell death. Based on these studies, the author’s laboratory commenced experiments to elucidate the gene basis for the overexpression of HK2 in cancer. These studies led to both the discovery of a unique HK2 promoter region markedly activated by both hypoxic conditions and moderately activated by several metabolites (e.g., glucose), Also discovered was the promoter’s regulation by epigenetic events (i.e., methylation, demethylation). Finally, the author’s laboratory turned to the most important objective. Could they selectively and completely destroy cancerous tumors in animals? This led to the discovery in an experiment conceived, designed, and conducted by Young Ko that the small molecule 3-bromopyruvate (3BP), the subject of this mini-review series, is an incredibly powerful and swift acting anticancer agent. Significantly, in subsequent experiments with rodents (19 animals with advanced cancer) Ko led a project in which 3BP was shown in a short treatment period to eradicate all (100%). Ko’s and co-author’s findings once published attracted global attention leading world-wide to many other studies and publications related to 3BP and its potent anti-cancer effect. This Issue of the Journal of Bioenergetics and Biomembranes (JOBB 44-1) captures only a sampling of research conducted to date on 3BP as an anticancer agent, and includes also a Case Report on the first human patient known to the author to be treated with specially formulated 3BP. Suffice it to say in this bottom line, “3BP, a small molecule, results in a remarkable therapeutic effect when it comes to treating cancers exhibiting a “Warburg effect”. This includes most cancer types.

While 3BP seems to show some promise, clinical trials have not yet been published and another review correctly cautioned that clinical trials using 3BP are needed to further support its anticancer efficacy against multiple cancer types… 

The person in charge of the centre, Klaus Ross, has no medical qualifications but claims to have studied naturopathy and was a ‘Heilpraktiker’. As such, he is probably not licenced to administer 3BP to cancer patients.

A standard series of out-patient cancer treatments at Mr Ross’ clinic was reported to cost around 10 000 Euros.

This is a post that I wanted to write for a while (I had done something similar on acupuncture moths ago); but I had to wait, and wait, and wait…until finally there were the awaited 100 Medline listed articles on homeopathy with a publication date of 2016. It took until the beginning of August to reach the 100 mark. To put this into perspective with other areas of alternative medicine, let me give you the figures for 3 other therapies:

  • there are currently  1 413 articles from 2016 on herbal medicine;
  • 875 on acupuncture;
  • and 256 on chiropractic.

And to give you a flavour of the research activity in some areas of conventional medicine:

  • there are currently almost 100 000 articles from 2016 on surgery;
  • 1 410 on statins;
  • and 33 033 on psychotherapy.

This suggests quite strongly, I think, that the research activity in homeopathy is relatively low (to put it mildly).

So, what do the first 100 Medline articles on homeopathy cover? Here are some of the findings of my mini-survey:

  • there were 4 RCTs;
  • 3 systematic reviews;
  • 8 papers on observational-type data (case series, observational studies etc.);
  • 9 animal studies;
  • 14 other pre-clinical or basic research studies;
  • 1 pilot study;
  • 14 investigations of the quality of homeopathic preparations;
  • 15 surveys;
  • 2 investigations into the adverse effects of homeopathic treatments;
  • 49 other papers (e. g. comments, opinion pieces, letters, perspective articles, editorials).

I should mention that, because I assessed 100 papers, the above numbers can be read both as absolute as well as percentage figures.

How should we interpret my findings?

As with my previous evaluation, I must caution not to draw generalizable conclusions from them. What follows should therefore be taken with a pinch of salt (or two):

  1. The research activity into homeopathy is currently very subdued.
  2. Arguably the main research question of efficacy does not seem to concern researchers of homeopathy all that much.
  3. There is an almost irritating abundance of papers that are data-free and thrive on opinion (my category of ‘other papers’).
  4. Given all this, I find it hard to imagine that this area of investigation is going to generate much relevant new knowledge or clinical progress.

Last Sunday evening, the Syrian, Mohammad D., tried to enter an open air festival in Ansbach, Germany. As he had no ticket, he was barred from entering. Later he exploded his bomb in front of one of the entrances of the festival. It killed him and injured 15 others, 4 seriously.

According to a report published in German, the 27-year old suicide-bomber had been treated since about half a year in an institution in Lindau called ‘Exilio’ by alternative therapists (Heilpraktiker) who offer ‘holistic help’ for immigrants under the leadership of Gisela und Axel von Maltitz.

The German ‘Heilpraktiker’ is an oddity left over from the Third Reich. Today, a Heilpraktiker hardly needs any education or training at all. What is more, he/she can claim to practice psychotherapy without proper training in psychotherapy. The Heilpraktiker in charge of Exilio, Axel von Maltitz, for instance, calls himself ‘Primärtherapeut, Heilpraktiker, Traumatherapie and Psychotherapie.’ The debate in Germany about the usefulness or otherwise of the Heilpraktiker has recently been stimulated by the publication of a critical book on the subject and can be expected to get more intense after the events in Ansbach.

‘Exilio’ apparently has a dubious reputation in Lindau, and the local officials had stopped co-operating with this clinic already over a year ago. The therapeutic team of Exilio does not seem to include a single qualified doctor, psychologist or psychiatrist.

The treatments employed in ‘Exilio’ include such dubious methods as Rebirthing, a technique involving “specific breathing exercises which allow individuals to re-experience memories from the past and to release feelings and sentiments that are suppressed / contained within the emotional physical self.” I am not aware of good evidence to show that Rebirthing is effective for any condition.

It seems clear that the Syrian suicide-bomber was seriously disturbed; apparently he already had previously tried to commit suicide. Nobody will ever know whether the atrocity of last Sunday could have been prevented, if he had received proper psychiatric attention. With hindsight, however, it seems clear that the alternative therapies he did receive were not effective.

A survey published in 2011 showed that one-third of Danish hospitals offered alternative therapies. In total, 38 hospitals offered acupuncture and one Eye Movement Desensitization and Reprocessing Light Therapy. The most commonly reported reason for offering CAM was “scientific evidence”.

Many readers of this blog might be amazed with both the high level of alternative medicine presence in Danish hospitals and the notion that this was due to ‘scientific evidence’. A recent article provides even more surprises about the Danish alternative medicine scene.

It revealed that 8 out of 10 Danes are interested in using some form of alternative medicine…Some 67 percent of Danes say the national healthcare system should be more open to alternative healing practices, such as homeopathy, acupuncture or chiropractic, and 60 percent would like to see these treatments covered by the public health insurance system. More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.

Charlotte Yde, the chairwoman at Sundhedsrådet, which is the umbrella organisation for alternative practitioners in Denmark, contends many Danes feel frustrated because they cannot freely discuss alternative treatment with their doctors. Alternative treatment researcher Helle Johannessen agrees that Danish doctors should openly discuss alternative medicine options with patients. “In other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark,” Johannessen told DR. “[International experience] shows that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients.”

This, it seems to me, is little more than a bonanza of fallacious thinking and misleading information.

  • The notion that popularity of a therapy has anything to do with its usefulness is a classical fallacy.
  • The notion that belief determines efficacy (More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.) or vice versa is complete nonsense.
  • The notion that many Danes … cannot freely discuss alternative treatment with their doctors is misleading: patients can discuss what they feel like with whom they feel like.
  • The notion that in other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark is also misleading: there are many European countries where LESS alternative therapies are being paid for via the public purse.
  • Finally, the notion that that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients – even if it were correct – does not mean that ALL alternative therapies are efficacious, safe, or cost-effective.

Who cares about Denmark?

Why should this be important?

Well, the Danes might care, and it is important because it provides an excellent example of how promoters of bogus treatments tend to argue – not just in Denmark, but everywhere. Unfortunately, politicians all too often fall for such fallacious notions. For them, a popular issue is a potential vote-winner. Within medical systems that are notoriously strapped for money, the looser will inevitably be optimal healthcare.

The UK petition to ban homeopathy for animals has so far achieved well over 3 000 signatures. Remarkably, it also prompted a reaction from the Faculty of Homeopathy which I reproduce here in full:

Response to petition calling on the RCVS to ban homeopathy

Homeopathy has a long history of being used successfully in veterinary practice for both domestic and farm animals. The EU recommends its use in its regulations on organic farms and is funding research into veterinary homeopathy as a way of reducing antibiotic use in livestock. It is nonsense to suggest that responsible pet owners and farmers are unable to distinguish between effective and ineffective medicines; they continue to use homeopathy because they see its benefits.

Membership of the Faculty of  Homeopathy (VetMFHom) is bestowed on qualified veterinary surgeons who have completed a minimum of three years study of homeopathy and after a rigorous examination procedure. It differentiates the qualified veterinary homeopath from an unlicensed healer.

In a statement, the Royal College of Veterinary Surgeons said “… homeopathy is currently accepted by society and recognised by UK medicines legislation, and does not, in itself, cause harm to animals”. Before going on to say it could see no justification for banning veterinary surgeons from practising homeopathy.

In an age when antibiotic resistance is such an important issue, veterinary surgeons and farmers who have found they can limit the use of these drugs by using homeopathy should be applauded and not attacked.


Peter Gregory
BVSc MRCVS VetFFHom
Veterinary Dean, Faculty of Homeopathy

 

Such sentiments resonate with those of the UK’s most influential supporter of homeopathy, Prince Charles. Speaking at a global leaders summit on antimicrobial resistance, Prince Charles  recently warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries at The Royal Society in London. “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”

It seems that both Prince Charles and Peter Gregory believe that homeopathy can be employed to reduce the use of antibiotics in animals. So, let’s analyse this hypothesis a little closer.

The way I see it, the belief must be based on one of two assumptions:

  1. Homeopathic remedies are effective in treating or preventing bacterial infections.
  2. If farmers administer homeopathic remedies to their life-stock, they are less likely to administer unnecessary antibiotics.

Assumption No 1 can be rejected without much further debate; there is no evidence whatsoever that homeopathic remedies have antibiotic efficacy. In fact, the consensus today is that highly diluted homeopathic remedies are pure placebos.

Assumption No 2, however, might be more plausible and therefore deserves further scrutiny.  If we do not tell the farmers nor the vets that homeopathic remedies are placebos, if, in other words, we mislead them to think they are efficacious medicines, they might give them to their animals instead of antibiotics. Consequently, the usage of antibiotics in animals would decrease. This strategy sounds plausible but, on second thought, it has many serious drawbacks:

  1. The truth has a high value in itself which we would disregard at our peril.
  2. One might not be able to keep the truth from the farmers and even less able to hide it from vets.
  3. If we mislead farmers and vets, we must also mislead the rest of the population; this means lots of people might start using homeopathic placebos even for serious conditions.
  4. Misleading farmers, vets and the rest of the population is clearly unethical.
  5. Misleading farmers and vets in this way might not be necessary; if there is abuse of antibiotics in farming, we ought to tackle this phenomenon directly.
  6. Misleading farmers and vets might be dangerous for at least two reasons: firstly, animals who truly need antibiotics would not receive adequate treatment; secondly, farmers and vets might eventually become convinced that homeopathy is efficacious and would therefore use it in all sorts of situations, even for serious diseases of humans.

Whichever way I twist and turn the assumption No 2, I fail to arrive at anything remotely sensible. But this leaves me with a huge problem: I would have to conclude that both the Veterinary Dean, Faculty of Homeopathy and the heir to the throne are bonkers… and, surely, this cannot be right either!!!

 

Nobody can doubt that, during the last 200 years, conventional medicine has made monumental progress. Homeopathy, however, has remained more or less like Hahnemann invented it. But now it seems as though homeopathy can celebrate an unprecedented step ahead. As so often in medicine, it originates from a commercial enterprise.

Genexa is a US firm that produces natural health products. On their website, they state that “At Genexa, we believe medicine should be free from unhealthy fillers and toxins”. They recently published a press-release introducing a line of homeopathic medicines certified organic by the U.S. Department of Agriculture and Non-GMO Project verified. They are keen to point out that these products “do not contain any genetically modified ingredients.” In fact, several of their remedies do not contain any active ingredients to speak of: they are homeopathic!

“We are extremely proud of our organic and non-GMO certifications – the seals are prominently featured on all our products and website for easy label reading and patient education,” stated David Johnson, CEO of Genexa, in their press-release. “Our quality standards are among the highest in the over-the-counter medicine industry.”

Genexa’s 11 homeopathic formulations are being advertised for the treatment of common health issues such as flu, cold, allergies, stress, pain, leg cramps, sleeplessness and jet lag. An entire line of products is, according to the press-release, specially formulated for children and includes treatments for cold, allergy and calming.

Genexa’s CMO proudly announced that “It’s important to us that our retail customers feel confident in the products and know they can trust they are purchasing medicines free from unhealthy fillers and toxins and simply focus on healing.” Presumably that trust must include the trust into the efficacy of the homeopathic remedies! Yes, I am pleased to report that, apparently it does; elsewhere they confirm this by stating that “Genexa holds itself to the highest standards in both quality and ethics.” The highest standards of ethics surely include that the remedies in question are demonstrably efficacious.

But how can we be sure? Are any of these homeopathic remedies supported by reasonably strong evidence? Oddly enough, despite all these affirmations, I did get my doubts when I tried to dig a bit deeper.

Take the homeopathic remedy called SLEEPOLOGY, for instance. The website informs us that “This homeopathic formulation consists of nine leading remedies designed to treat sleeplessness, inability to fall asleep, frequent waking, restless sleep and sleeplessness from stress, exhaustion, nervousness, excitability, restlessness, worries, irritability, and pain.” So, it’s a complex homeopathic remedy with 9 different ingredients. But is there any evidence of efficacy for this mixture? I am not aware of any clinical trials that have tested its efficacy. But I must be wrong, because on the website we are being told that “Clinical trials have demonstrated efficacy for treating sleeplessness for piper methysticum, and valeriana officinalis.” That may be so, but the trials were done with herbal extracts, not with homeopathic potencies! Could the statement therefore be more than a little misleading?

On the internet, I found all sorts of fascinating bits about the new homeopathic lines (my compliments to the PR firm that organised the launch!); for instance the revelation that: “The company’s proprietary medicines were created by and are regularly reviewed and enhanced by its chief medical officer, Dr. Todd Rowe*, a nationally respected physician with an expertise in homeopathic medicine formulation. Working with the Genexa team, Dr. Rowe and his team of chemists and pharmacists spent hundreds of hours meticulously formulating and testing the products. The result is a line of effective, potent medicines that are certified organic by the USDA and non-GMO verified by the Non-GMO Project. “Our formulations are based on tried and true principles for miasmatic and energetic balance, so that the remedies potentiate each other and promote the most positive patient outcomes,” said Dr. Rowe. “These powerful medicines work with your body to help it heal itself.”” However, I was unable to find out which potencies are being used for the Genexa homeopathic products. This information might not be that relevant: according to the homeopathic ‘like cures like’ principle, the effects of a substance are reversed through potentiation. This is why coffee, for instance, is potentised by homeopath to generate a sleeping remedy. Does it not follow then that, potentising two or more herbal ingredients that have hypnotic effects (as in SLEEPOLOGY), must generate a remedy for preventing sleep? A similarly puzzling lack of ‘homeopathic logic’ seems to apply to several other products in Genexa’s line of homeopathic remedies.

I have to admit, I am confused.

Could it be that the ‘breakthrough’ turns out to be a breakdown of ‘homeopathic logic’?

Let’s hope someone from Genexa reads these lines and can enlighten us.

[*he is the President of the American Medical College of Homeopathy]
1 2 3 18
Recent Comments

Note that comments can now be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories