MD, PhD, FMedSci, FSB, FRCP, FRCPEd

evidence

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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]

It would be easy to continue this series on ‘tricks of the trade’ for quite a while. But this might get boring, and I have therefore decided to call it a day. So here is the last instalment (feel free to post further tricks that you may know of [in the comments section below]):

CRITICS DON’T UNDERSTAND

It is almost inevitable that, sooner or later, someone will object to some aspect of alternative medicine. In all likelihood, his or her arguments are rational and based on evidence. If that happens, the practitioner has several options to save his bacon (and income). One of the easiest and most popular is to claim that “of course, you cannot agree with me because you do not understand!”

The practitioner now needs to explain that, in order to achieve the level of expertise he has acquired, one has to do much more than to rationalise or know about science. In fact, one has to understand the subject on a much deeper level. One has to immerse oneself into it, open one’s mind completely and become a different human being altogether. This cannot be achieved by scientific study alone; it requires years of meditative work. And not everyone has the ability to go down this difficult path. It takes a lot of energy, insight and vision to become a true healer. A true Deepak Chopra is not born but trained through hard work, dedication and concentration.

Critics who disagree are really to be pitied. They fail to exist on quite the same level as those who ‘are in the know’. Therefore one must not get annoyed with those who disagree, they cannot understand because they have not seen the light.

My advice is to start thinking critically and read up about the NO TRUE SCOTSMAN FALLACY; this will quickly enable you to look beyond the charisma of these gurus and expose their charlatanry to the full.

RESEARCH IS BEING SUPRESSED

Some critics stubbornly insist on evidence for the therapeutic claims made by quacks. That attitude can be awkward for the alternative practitioner – because usually there is no good evidence.

Cornered in this way, quacks often come up with a simple but effective conspiracy theory: the research has been done and it has produced fabulous results, but it has been supressed by… well, by whoever comes to mind. Usually BIG PHARMA or ‘the scientific establishment’ have to be dragged out into the frame again.

According to this theory, the pharmaceutical industry (or whoever comes in handy) was so shaken by the findings of the research that they decided to make it disappear. They had no choice, really; the alternative therapy in question was so very effective that it would have put BIG PHARMA straight out of business for ever. As we all know BIG PHARMA to be evil to the core, they had no ethical or moral qualms about committing such a crime to humanity. Profits must come before charity!

My advice is to explain to such charlatans that such conspiracy theories do, in fact, merely prove is that the quack’s treatment is not effective against their prosecution complex.

CRITICS ARE BOUGHT AND CORRUPT

If  critics of alternative medicine become threatening to the quackery trade, an easy and much-used method is to discredit them by spreading lies about them. If the above-mentioned ploy “they cannot understand” fails to silence the nasty critics, the next step must be to claim they are corrupt. Why else would they spend their time exposing quackery?

Many people – alternative practitioners included – can only think of financial motivations; the possibility that someone might do a job for altruistic reasons does not occur to them. Therefore, it sounds most plausible that the critics of alternative medicine are doing it for money – after all, the quacks also quack for money.

My advice to potential users of alternative medicine who are confused by such allegations: do your own research and find out for yourself who is bought by whom and who has a financial interest in quackery selling well.

EVEN NOBEL PRIZE WINNERS AGREE WITH US

It is true, there are some Nobel Prize winners who defend homeopathy or other bogus treatments. Whenever this happens, the apologists of alternative medicine have a field day. They then cite the Nobel laureate ad nauseam and imply that his or her views prove their quackery to be correct.

Little do they know that they are merely milking yet another classical fallacy and that such regrettable events merely demonstrate that even bright people can make mistakes.

My advice is to check what the Nobel laureate actually said – more often than not, it turns out that a much-publicised quote is, in fact, a misquote – and what his or her qualifications are for making such a statement; a Nobel Prize in literature, for instance, is not a sufficient qualification for commenting on healthcare issues.

AS I ALRADY SAID: IF YOU KNOW OF MORE ‘TRICKS OF THE QUACKARY TRADE’, PLEASE POST THEM BELOW.

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.

ENERGY

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:

  1. The alternative ‘immune stimulants’ do not really stimulate the immune system.
  2. Stimulating the immune system is rarely a desirable therapeutic aim.
  3. Stimulating a normal immune system is hardly possible.
  4. 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.

In part one and part two of this series of posts, we have discussed altogether six ‘tricks of the trade’:

TREAT A NON-EXISTING CONDITION

MAINTENANCE TREATMENT

IT MUST GET WORSE BEFORE IT GETS BETTER

THINK HOLISTICALLY

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

A CURE TAKES A LONG TIME

Now it is time to disclose three more.

DETOX

Alternative therapies are hugely diverse, but they nevertheless have a few characteristics in common. One is that many of their practitioners try to persuade their patients that they are being poisoned. This sounds odd, however, it is true.

Most alternative therapists tell their patients sooner or later that they need to ‘detox’ and, as it happens, their type of treatment is ideally suited to achieve this aim. Detox is short for detoxification which, in real medicine, is the term used for weaning addicts off their drugs. In alternative medicine, it is used as a marketing slogan.

Yes, detox, as used in alternative medicine, is nothing but a marketing slogan. I have several reasons for this statement:

  • The poisons in question are never accurately defined. Instead, we hear only vague terminologies such as metabolic waste products or environmental toxins. The reason for that lack of precision is simple: once the poison is named, we could be able to measure it and test the efficacy of the treatment in  question in eliminating it from the body. But this is the last thing these ‘detoxers’ want because we would soon establish how bogus their claims are.
  • None of the alternative therapies claimed to detox our body take any toxin from us; all they do take from us is our cash.
  • Our body has powerful organs and mechanisms to detoxify (skin, lungs, kidneys, liver). These take care of all the toxins we undoubtedly are exposed to. If any of these organs fail, we do not need homeopathic globoli or detoxifying diets, or electric foot baths or any other charlatanry; in this case, we are more likely to need an A&E department’s intensive care.

My advice is, as soon as you hear the word ‘detox’ from a quack, ask for your money back and go home.

THE TEST OF TIME

Another thing that many alternative therapies have in common is their age. They have almost all been around for hundreds, if not thousands of years. To the enthusiasts of alternative medicine, this means that these interventions have ‘stood the test of time’; they argue that acupuncture, for instance, would not be around any more, if it were not effective. They tell their patients, write in books and argue in debates that the age of their therapy is like a badge of approval from millions of people before us, a badge that surely weighs more that modern scientific studies (which tend to cast doubt on the effectiveness of the treatments in question).

This line of thinking has always puzzled me. We are talking of TECHNOLOGIES, health technologies, in fact. Would we argue that a hot air balloon is an older technology that an aeroplane and therefore better suited for transporting people from A to B? The fact that acupuncture was developed thousands of years ago might just mean that it was invented by relatively ignorant people who understood too little about the human body to create a truly effective intervention. And the fact that blood-letting was used for centuries (and thus killed millions), might teach us a lesson about the true value of ‘the test of time’ in medicine.

My advice is to offer leeches, blood-letting and mercury cures to those who try to persuade you that the test of time has meaningful therapeutic implications.

TREATING THE ROOT CAUSE OF THE DISEASE

Alternative practitioners often claim that, in conventional medicine, doctors only treat the symptoms of their patients, whereas they treat the root causes of the illness. I have often wondered where this assumption and the fierce conviction with which it is so often expressed come from. I have to conclude that the explanations are quite simple.

  • This notion is the mantra that is being taught over and over again during the practitioners’ training. It even constitutes a central message of most ‘textbooks’ for the aspiring alternative practitioner.
  • More importantly in the context of this post, the notion is a clever sales-trick. It sounds profound and logical to many consumers who lean towards alternative medicine. Crucially, it kills two flies with one stroke: it denigrates conventional healthcare and, at the same time, elevates alternative medicine.

The idea that alternative practitioners treat the root causes is  based on the practitioners’ understanding of aetiology. If a traditional acupuncturist, for instance, is convinced that all disease is the expression of an imbalance of life-forces, and that needling acupuncture points will re-balance these forces thus restoring health, he must automatically assume that he is treating the root causes of any condition. If a chiropractor believes that all diseases  are due to ‘subluxations’ of the spine, it must seem logical to him that spinal ‘adjustment’ is synonymous with treating the root cause of whatever complaint his patient is suffering from.

These are concepts that are deeply engrained into the minds of alternative practitioners. And they have one embarrassing feature in common: they are false! Some practitioners surely must know that; yet I have so far not met one who therefore would have stopped using it. The reason must be that, as a trick of the trade to increase his cash flow, it is invaluable.

My advice is to use your abilities for critical thinking, explain to the practitioner who tells you that he is going to treat the root causes of your condition that he is a quack, and look for a proper physician.

 

We were recently informed that Americans spend more than US$ 30 billion per year on alternative medicine. This is a tidy sum by anyone’s standards, and we may well ask:

Why do so many people opt for alternative medicine?

The enthusiasts claim, of course, that this is because alternative medicine is effective and safe. As there is precious little data to support this claim, it is probably not the true answer. There must be other reasons, and I could name several. For instance, it could be due to consumers being conned by charlatans.

During the 25 years or so that I have been researching alternative medicine, I got the impression that there are certain ‘tricks of the trade’ which alternative practitioners use in order to convince the often all too gullible public. In this series of posts, I will present some of them.

Here are the first three:

TREAT A NON-EXISTING CONDITION

There is nothing better for committing a health fraud than to treat a condition that the patient in question does not have. Many alternative practitioners have made a true cult of this handy option. Go to a chiropractor and you will in all likelihood receive a diagnosis of ‘subluxation’. See a TCM practitioner and you might be diagnosed suffering from ‘chi deficiency’ or ‘chi blockage’ etc.

Each branch of alternative practitioners seem to have created their very own diagnoses, and they have one thing in common: they are figments of their imaginations. To arrive at such diagnoses, the practitioner would often use diagnostic techniques which have either been found to lack validity, or which have never been validated at all. Many practitioners appreciate all of this, of course, but it would be foolish of them to admit it – after all, these diagnoses earn them the bulk of their living!

The beauty of a non-existing diagnosis is that the practitioner can treat it, and treat it and treat it…until the client has run out of money or patience. Then, one day, the practitioner can proudly announce to his patient “you are completely healthy now”. This happens to be true, of course, because the patient has been healthy all along.

My advice for preventing to get fleeced in this way: make sure that the diagnosis given by an alternative practitioner firstly exists at all in the realm of real medicine and secondly is correct; if necessary ask a real healthcare professional.

MAINTENANCE TREATMENT

As I just stated, practitioners like to treat and treat and treat conditions which simply do not exist. When – for whatever reason – this strategy fails, the next ‘trick of the trade’ is often to convince the patient of the necessity of ‘maintenance’ treatment. This term describes the regular treatment of an individual who is entirely healthy but who, according to the practitioner, needs regular treatments in order not to fall ill in future. The best example here is chiropractic.

Many chiropractors proclaim that maintenance treatment is necessary for keeping a person’s spine aligned – and only a well-serviced spine will keep all of our body’s systems working perfectly. It is like with a car: if you don’t service it regularly, it will sooner or later break down. You don’t want this to happen to your body, do you? To many ‘worried well’, this sounds so convincing that they actually fall for this scam. It goes without saying that the value of maintenance treatment is unproven.

My advice is to start running as soon as a practitioner mentions maintenance treatments.

IT MUST GET WORSE BEFORE IT GETS BETTER

Many patients fail to experience an improvement of their condition or even feel worse after receiving alternative treatments. Practitioners of alternative medicine love to tell these patients that this is normal because things have to get worse before they get better. They tend to call this a ‘healing crisis’. Like so many notions of alternative practitioners, the healing crisis is a phenomenon for which no or very little compelling evidence was ever produced.

Imagine a patient with moderately severe symptoms consulting a practitioner and receiving treatment. There are only three things that can happen to her:

  • she can get better,
  • she might experience no change at all,
  • or she might get worse.

In the first scenario, the practitioner would obviously claim that his therapy is responsible for the improvement. In the second scenario, he might say that, without his therapy, things would have deteriorated. In the third scenario, he would tell his patient that the healing crisis is the reason for her experience. In other words,  the myth of the healing crisis is little more than a ‘trick of the trade’ to make even these patients continue supporting the practitioner’s livelihood.

My advice: when you hear the term ‘healing crisis’, go and find a real doctor to help you with your condition.

 

 

 

 

“When orthodox medicine has nothing more to offer” is the title of an article by Dr Elizabeth Thompson, a UK medical homeopath. The article was written years ago, but it is still an excellent example for disclosing the dangerously false and deeply unethical reasoning used by many alternative practitioners. The notion that all sorts of disproven treatments like homeopathy are justified when orthodox medicine has nothing more to offer is so very prevalent that I decided to do this post analysing it.

In the following, you see the most relevant sections of Dr Thompson’s original article (in normal print) and my brief comments (in brackets and in bold):

…Some people come when conventional treatments can no longer offer them anything to save their lives. This is a frightening time for them and although the homeopathic approach may not offer a cure at this late stage of their illness (Is she implying that, in some cases, homeopathy can cure cancer?), it can often offer hope of a different kind. (Surely, one does not need homeopathy for giving patients hope). Sometimes it helps people to outlive the prognosis given to them by months or even years. (A prognosis is not a precise time of death; it is based on statistics and therefore depicts a likelihood, not a certainty. Thus patients outlive their prognosis all the time regardless of treatments.) Sometimes it helps them need less (less than what? there is no control group and therefore the statement seems nonsensical) in the way of conventional medicine including pain killers and offers them continuing support despite progressive disease (is she trying to say that in conventional medicine patients with progressive disease do not get continuing support?).

As a doctor working in both conventional and complementary cancer care I have learned the importance of integrating these two perspectives (the integration of unproven therapies into EBM can only render the latter less effective). Ideally the doctor practising homeopathy would work as an integral part of a much wider team which would include family members, nurses, general practitioners, oncologists, surgeons, palliative physicians and other complementary therapists (the concept of a multi-disciplinary team for cancer is one from conventional medicine where it has long been routine). It is disappointing sometimes to see that other healthcare professionals can be unsupportive of a person’s desire to use complementary therapies and for some people the knowledge that the team is not working together can cause doubt and insecurity (for the majority of patients, however, it might be reassuring to know that their oncology-team is evidence-based).

Some patients come at the beginning of their diagnosis wanting to support their bodies with gentler (homeopathic remedies are not gentler, they are ineffective) approaches and help themselves recover from some difficult and powerful treatments such as chemotherapy and radiotherapy (Why are they being told that alternative therapies are effective in achieving these aims when there is no good evidence to show that this is true? Isn’t that unethical?). As well as using homeopathic medicines (no good evidence of effectiveness!!!), the GHH also has experience in using Mistletoe which is given by injection and has been shown to stimulate the group of white cells whose numbers can be depleted during chemotherapy and radiotherapy (also no good evidence that it works clinically!!!).

Other patients come when they have finished most of their treatments but may still not be feeling well despite being given the all clear by their doctors (same again: no good evidence!!!)…

One wonderful aspect of the homeopathic approach is that it can be a very important opportunity to help someone re-evaluate their life and their health (We don’t need to prescribe placebos for that, this aim is better reached by employing a clinical psychologist).

Sometimes hurts in the past have never been healed and sitting with someone as they describe difficult experiences can be itself therapeutic. Combining this therapeutic listening time with substances from nature that gently stimulate the body’s own healing potential (where is the evidence for that claim?) can be an approach that through patient demand and research (what research?) we can demonstrate is really worth offering to many more people…

END OF QUOTE

 

This text shows in an exemplary fashion how desperate patients can be convinced to make dramatically wrong choices. If you read Dr Thompson’s text without my comments, it probably sounds fairly reasonable to many people. I can understand why patients and carers end up thinking that homeopathy or other disproven therapies are reasonable options WHEN ORTHODOX MEDICINE HAS NOTHING MORE TO OFFER.

But the claim of homeopaths and others that mainstream medicine has, in certain cases, nothing more to offer is demonstrably wrong. Supportive and palliative care are established and important parts of conventional medicine. To deny this fact amounts to a lie! The implied scenario where a patient is told by her oncology team: “sorry but we cannot do anything else for you”, does quite simply not exist. The argument is nothing else but a straw-man – and a vicious one at that.

Moreover, the subsequent argument of homeopaths, “as ‘they’ have given you up, we now offer you our effective homeopathic remedies”, is not supported by good evidence. In other words, one lie is added to another. To call this unethical, would be the understatement of the year, I think.

It has been reported that ‘Boots the Chemist’ have filed several legal complaints against The Guardian in relation to articles published by the paper in relation to its April 2016 investigation. The Guardian articles in question alleged that Boots, the UK’s largest pharmacy chain, had placed undue pressure on its pharmacists to perform medicines use reviews so that it could claim the maximum payments possible from the NHS. In other words, The Guardian implied that Boots was trying to get more money from our NHS than might have been due.

Personally, I am always uneasy when I hear that someone takes legal action on such matters. I think that legal complaints of such a nature can turn out to be counter-productive, both in general and in this particular instance.

Why?

There could be several reasons. For instance, such actions might give someone the idea of filing complaints against Boots. I am sure it is not difficult to find reasons for that.

In the realm of alternative medicine, for example, someone might question whether selling homeopathic remedies in Boot’s section ‘pharmacy and health’ is not misleading. These remedies might be seen by a naïve customer as masquerading as medicines. As readers of this blog know all too well, they do not, in fact, contain anything (other than lactose) that has any pharmacological activity. Therefore Boots should best market them in the category of ‘confectionary’.

One might even suspect that Boots are fully aware of all this. After all, a spokesperson for the company stated years ago during a parliamentary inquiry: “I have no evidence to suggest that they [homeopathic remedies sold by Boots] are efficacious …”

And it is also not the first time that Boots have been challenged for selling products they know to be placebos. This is what The Guardian reported in 2008 about the issue: “Ernst accuses the company [Boots] of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.”

A similar void of evidence also applies to Boot’s wide range of Bach Flower Remedies and aromatherapy oils.

Or am I wrong?

Perhaps Boots want to post links to the evidence in the  comment section below?

I am always keen to learn and only too happy to change my mind in view of new, compelling evidence!

Boots also sell a very wide range of herbal medicines, and here the situation is quite different: herbal medicines actually contain molecules that might have pharmacological effects, i. e. they might heal or might harm you. And many of these products imply indications for which they should be taken. I will pick just one example to explain: HERBAL SLIM AID.

Yes, you are absolutely correct – this product is (according to its name) not for gaining weight, it’s for reducing it. Each coated tablet contains 45 mg of extract (as dry extract) from Bladderwrack thallus (Fucus vesiculosus L.) (5:1) (equivalent to 225 mg of Fucus) Extraction solvent: water, ,30 mg Dandelion Root (Taraxacum officinale Weber ex Wigg), 27 mg of extract (as dry extract) from Boldo leaf (Peumus boldus Molina) (4-6:1) (equivalent to 108-162 mg of Boldo leaf) Extraction solvent: Methanol 70% v/v, 10 mg Butternut Bark (Juglans cinerea L.).

Now, I thought I know quite a bit about herbal slimming aids, after all, we had a research focus on this topic for several years and have published about a dozen papers on the subject. But oddly, I cannot remember that this mixture of herbs has been shown to reduce body weight.

Perhaps Boots want to post evidence for the efficacy and safety of this product as well?

I certainly hope so, and I would instantly withdraw any hint of a suspicion that Boots are selling unproven or disproven medicines.

Where is all this going?

I have to admit that am not entirely sure myself.

I suppose all I wanted to express was that it might be unwise to throw stones when one is sitting in a glass-house – a cliché, I know, but it’s true nevertheless.

 

 

 

CONFLICTS OF INTEREST:

None [except I don’t like those who easily take legal action against others]

Turmeric (Curcuma longa) is a truly fascinating plant with plenty of therapeutic potential. It belongs to the ginger family, Zingiberaceae and is native to southern Asia. Its main active ingredients are curcumin (diferuloylmethane) and the related compounds, demethoxycurcumin and bis-demethoxycurcumin (curcuminoids) which are secondary metabolites. Turmeric  has been used extensively in Ayurvedic medicine and has a variety of pharmacologic properties including antioxidant, analgesic, anti-inflammatory, and antiseptic activities.

In the often weird world of alternative medicine, turmeric is currently being heavily hyped as the new panacea. Take this website, for instance; it promotes turmeric for just about any ailment known to mankind. Here is a short excerpt to give you a flavour (pun intended, turmeric is, of course, a main ingredient in many curries):

It comes at a surprise to a lot of people that herbs can be highly effective, if not more effective, than conventional medications …

To date, turmeric is one of the top researched plants. It was involved in more than 5,600 peer-reviewed and published biomedical studies. In one research project that extended over a five year period, it was found that turmeric could potentially be used in preventive and therapeutic applications. It was also noted that it has 175 beneficial effects for psychological health…

The 14 Medications it Mimics

Or should we say the 14 medications that mimic turmeric, since turmeric has been around much longer than any chemical prescription drug. Here’s a quick look at some of them:

  • Lipitor: This is a cholesterol drug that is used to reduce inflammation and oxidative stress inside of patients suffering from type 2 diabetes. When the curcuminoid component inside of turmeric is properly prepared, it can offer the same effects (according to a study published in 2008).
  • Prozac: This is an antidepressant that has been overused throughout the past decade. In a study published back in 2011, turmeric was shown to offer beneficial effects that helped to reduce depressive behaviors (using animal models).
  • Aspirin: This is a blood thinner and pain relief drug. In a study done in 1986, it was found that turmeric has similar affects, which makes it a candidate for patients that are susceptible to vascular thrombosis and arthritis.
  • Metformin: This is a drug that treats diabetes. It is used to activate AMPK (to increase uptake of glucose) and helps to suppress the liver’s production of glucose. In a study published in 2009, it was found that curcumin was 500 to 100,000 times more effective at activating AMPK ad ACC.
  • Anti-Inflammatory Drugs: This includes medications like ibuprofen, aspirin and dexamethasone, which are designed to reduce inflammation. Again, in 2004, it was proven that curcumin was an effective alternative option to these chemical drugs.
  • Oxaliplatin: This is a chemotherapy drug. A study done in 2007 showed that curcumin is very similar to the drug, acting as an antiproliferative agent in colorectal cell lines.
  • Corticosteroids: This is a steroid medication, which is used to treat inflammatory eye diseases. In 1999, it was found that curcumin was effective at managing this chronic condition. Then in 2008, curcumin was used in an animal model that proved it could also aid in therapy used to protect patients from lung transplantation-associated injuries by “deactivating” inflammatory genes.

Turmeric Fights Drug-Resistant Cancers… it’s been shown that curcumin can battle against cancers that are resistant to chemotherapy and radiation…

END OF QUOTE

As I said, turmeric is fascinating and promising, but such hype is clearly counter-productive and dangerous. As so often, the reality is much more sobering than the fantasy of uncritical quacks. Research is currently very active and has produced a host of interesting findings. Here are the conclusions (+links) of a few, recent reviews:

Overall, there is early evidence that turmeric/curcumin products and supplements, both oral and topical, may provide therapeutic benefits for skin health. However, currently published studies are limited and further studies will be essential to better evaluate efficacy and the mechanisms involved.

This meta-analysis of RCTs suggested a significant effect of curcumin in lowering circulating TNF-α concentration.

While statistical significant differences in outcomes were reported in a majority of studies, the small magnitude of effect and presence of major study limitations hinder application of these results.

Overall, scientific literature shows that curcumin possesses anti-diabetic effects and mitigates diabetes complications.

The highlighted studies in the review provide evidence of the ability of curcumin to reduce the body’s natural response to cutaneous wounds such as inflammation and oxidation. The recent literature on the wound healing properties of curcumin also provides evidence for its ability to enhance granulation tissue formation, collagen deposition, tissue remodeling and wound contraction. It has become evident that optimizing the topical application of curcumin through altering its formulation is essential to ensure the maximum therapeutical effects of curcumin on skin wounds.

What emerges from a critical reading of the evidence is that turmeric has potential in several different areas. Generally speaking, clinical trials are still thin on the ground, not of sufficient rigor and therefore not conclusive. In other words, it is far too early to state or imply that we all should rush to the next health food store and buy the supplements.

On the contrary, at this stage, I would even warn people not to be seduced by the unprofessional hype and wait until we know more – much more. There might be risks associated with ingesting turmeric at high doses over long periods of time. And there are fundamental open questions about oral intake. One recent review cautioned: …its extremely low oral bioavailability hampers its application as therapeutic agent.

WATCH THIS SPACE!

The ACUPUNCTURE NOW FOUNDATION (ANF) have recently published a document that is worth drawing your attention to. But first I should perhaps explain who the ANF are. They state that “The Acupuncture Now Foundation (ANF) was founded in 2014 by a diverse group of people from around the world who were concerned about common misunderstandings regarding acupuncture and wanted to help acupuncture reach its full potential. Our goal is to become recognized as a leader in the collection and dissemination of unbiased and authoritative information about all aspects of the practice of acupuncture.”

This, I have to admit, sounds like music to my ears! So, I studied the document in some detail – and the music quickly turned into musac.

The document which they call a ‘white paper’ promises ‘a review of the research’. Reading even just the very first sentence, my initial enthusiasm turned into bewilderment: “It is now widely accepted across health care disciplines throughout the world that acupuncture can be effective in treating such painful conditions as migraine headaches, and low back, neck and knee pain, as well as a range of painful musculoskeletal conditions.” Any review of research that starts with such a deeply uncritical and overtly promotional statement, must be peculiar (quite apart from the fact that the ANF do not seem to appreciate that back and neck pain are musculoskeletal by nature).

As I read on, my amazement grew into bewilderment. Allow me to present a few further statements from this review (together with a link to the article provided by the ANF in support and a very brief comment by myself) which I found more than a little over-optimistic, far-fetched or plainly wrong:

Male fertility, especially sperm production and motility, has also been shown to improve with acupuncture. In a recent animal study, electro-acupuncture was found to enhance germ cell proliferation. This action is believed to facilitate the recovery of sperm production (spermatogenesis) and may restore normal semen parameters in subfertile patients.

The article supplied as evidence for this statement refers to an animal experiment using a model where sperm are exposed to heat. This has almost no bearing on the clinical situation in humans and does not lend itself to any clinical conclusions regarding the treatment of sub-fertile men.

In a recent meta-analysis, researchers concluded that the efficacy of acupuncture as a stand-alone therapy was comparable to antidepressants in improving clinical response and alleviating symptom severity of major depressive disorder (MDD). Also, acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of post-traumatic stress disorder (PTSD). The incidence of adverse events with acupuncture was significantly lower than antidepressants.

The review provided as evidence is wide open to bias; it was criticised thus: “the authors’ findings did not reflect the evidence presented and limitations in study numbers, sample sizes and study pooling, particularly in some subgroup analyses, suggested that the conclusions are not reliable”. Moreover, we need to know that by no means all reviews of the subject confirm this positive conclusion, for instance, thisthis, or this one; all of the latter reviews are more up-to-date than the one provided by ANF. Crucially, a Cochrane review concluded that “the evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture”.

“A randomized controlled trial of acupuncture and counseling for patients presenting with depression, after having consulted their general practitioner in primary care, showed that both interventions were associated with significantly reduced depression at three months when compared to usual care alone.”

We have discussed the trial in question on this blog. It follows the infamous ‘A+B versus B’ design which cannot possibly produce a negative result.

Now, please re-read the first paragraph of this post; but be careful not to fall off your chair laughing.

There would be more (much more) to criticise in the ANF report but, I think, these examples are ENOUGH!

Let me finish by quoting from the ANF’s view on the future as cited in their new ‘white paper’: “Looking ahead, it is clear that acupuncture is poised to make significant inroads into conventional medicine. It has the potential to become a part of every hospital’s standard of care and, in fact, this is already starting to take place not only in the U.S., but internationally. The treatment is a cost-effective and safe method of relieving pain in emergency rooms, during in-patient stays and after surgery. It can lessen post-operative nausea, constipation and urinary difficulties, and have a positive impact on conditions like hypertension, anxiety and insomnia…

Driven by popular demand and a growing body of scientific evidence, acupuncture is beginning to be taken seriously by mainstream conventional medicine, which is incorporating it into holistic health programs for the good of patients and the future of health care. In order for this transition to take place most effectively, misunderstandings about acupuncture need to be addressed. We hope this white paper has helped to clarify some of those misunderstandings and encourage anyone with questions to contact the Acupuncture Now Foundation.”

My question is short and simple: IGNORANCE OR FRAUD?

 

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