evidence
Acupuncture is questionable.
Acupressure is highly questionable.
Auricular acupressure is extremely questionable.
This study investigated the effect of auricular acupressure on the severity of postpartum blues. A randomized sham-controlled trial was conducted from February to November 2021, with 74 participants who were randomly allocated into two groups of either routine care + auricular acupressure (n = 37), or routine care + sham control (n = 37). Vacaria seeds with special non-latex adhesives were used to perform auricular acupressure on seven ear acupoints. There were two intervention sessions with an interval of five days. In the sham group, special non-latex adhesives without vacaria seeds were attached in the same acupoints as the intervention group. The severity of postpartum blues, fatigue, maternal-infant attachment, and postpartum depression was assessed. 
Auricular acupressure was associated with a significant effect in the reduction of postpartum blues on the 10th and 15th days after childbirth (SMD = −2.77 and −2.15 respectively), postpartum depression on the 21st day after childbirth (SMD = −0.74), and maternal fatigue on 10th, 15th and 21st days after childbirth (SMD = −2.07, −1.30 and −1.32, respectively). Also, the maternal-infant attachment was increased significantly on the 21st day after childbirth (SMD = 1.95).
The authors concluded that auricular acupressure was effective in reducing postpartum blues and depression, reducing maternal fatigue, and increasing maternal-infant attachment in the short-term after childbirth.
Let me put my doubts about these conclusions in the form of a few questions:
- If you had sticky tape on your ear, would you sometimes touch it?
- If you touched it, would you feel whether a vacaria seed was contained in it or not?
- Would you, therefore, say that such a trial could be properly blinded (not to forget the therapists who were, of course, in the know)?
- If the trial was thus de-blinded, would you claim that patient expectation did not influence the outcomes?
If you answered all of these questions with NO, you are – like I – of the opinion that the results of this trial could have easily been brought about, not by the alleged effects of acupressure, but by placebo and other non-specific effects.
Austrian doctors recently received a notice in their mailbox about a postgraduate training event that is remarkable, to say the least.
The Vienna Medical Association is organizing a postgraduate training course on “Complementary Medical Homeopathy for Post- and Long Covid“. The date for the event is 20.4.2023. Registration for it is via the Association’s “Department of Complementary and Integrative Medicine”.
In case you ask, what is wrong with such a course? There is no scientific evidence that homeopathy has a specific, positive effect in long/post covid. Therefore the announced event has about the same validity as a lecture series for:
- BUNGEE JUMPING FOR DIABETES
or
- DOUGHNUT EATING FOR CORONARY HEART DISEASE
or
- CIGARETTE SMOKING IN CANCER PREVENTION
While relevant pseudomedicine training courses have in the past been organized by the relevant Austrian SCAM-organizations, the Vienna Medical Association itself is now joining the ranks of the organizers of pseudomedicine training courses. Whereas pseudomedicine has so far been the domain of physicians in private practice in Austria, it now appears to be promoted by the Vienna Medical Association in hospitals as well.
The Vienna Medical Association boldly claims that MEDICAL ETHICS IS THE BASIS OF OUR WORK. Well guess what, guys: teaching nonsense is not very ethical!
The ‘tasks and goals’ of the Association’s ‘Department for Complementary and Integrative Medicine’ of the Vienna Medical Association are explained on their website:
The aim of our department is to represent doctors with additional diplomas in the medical association and to inform about the value of their special therapeutic approaches better than previously – particularly in cases of serious side effects of conventional therapies.
In the sense of conveying up-to-date, high-quality, medical, and complementary education and training in complementary medicine, our department aims to publish relevant articles and announcements of dates of the respective professional societies in the chamber’s own media.
Practice-oriented introductory lectures or study groups on the following topics are also planned topics:
- medical homeopathy,
- psychosomatic relaxation therapy (bipolar harmonising abdominal breathing, autogenic training),
- acupuncture,
- regulation therapy based on skin resistance measurements at acupuncture points,
- TCM,
- herbal therapy, etc.
“Up-to-date, high-quality, medical, and complementary education and training in complementary medicine” – oh really? If the Association’s “Department of Complementary and Integrative Medicine” is truly interested in this, I herewith offer to give a free lecture series for them that would teach them the high-quality evidence truly shows.
Meanwhile, as there is no good evidence that homeopathy is an effective therapy for post/long Covid, the question of whether the ‘Vienna Medical Association’ has taken leave of its senses, must be answered in the affirmative.
A German newspaper reported the experience of two journalists who went undercover to consult several practitioners of so-called alternative medicine to receive treatment for Hodgkin lymphoma. Here are several passages from their important article (my translation, my bolding)
… Doctor Uwe Reuter invites us in. He is sitting behind an iMac on which he sometimes shows me pictures of his therapies. He is around 50, tall and lean, his face looks particularly serious through frameless glasses. I tell him my story. He listens attentively, and then it seems for a while as if he can’t decide what to advise me. Finally, he has it: I should first do a “diagnostic series” in his clinic, three or even better five days, for about 1000 Euros. This would include “electromagnetic measurements” for the “energy balance of individual organs”. Only then can he determine which therapy might be indicated in my case. “Hypnosis, homeopathy, vitamin B17 infusions” will probably play a role, says Reuter, and a “fever therapy” in which I will be injected with dead bacteria.
“In addition to chemotherapy or alone?”, I ask. The doctor says he can’t make this decision for me, I should make it from my “inside”. I have to understand that my illness does not come from the outside and that therapies only have a supporting effect – the healing “has to come from within”.
… In the end, Reuter suggests postponing chemotherapy for a quarter of a year and using his therapy to “push aside everything that prevents healing” – toxins, distractions, and fears. The cost? Around 10,000 Euros for the entire therapy…
[Next doctor is] the well-known alternative doctor Klaus Maar in Düsseldorf… His wrinkled face is dominated by a large nose, his hair is enviably thick and black for a man of his age. “Well,” he says in his comforting voice, “why don’t you describe what happened to you?” I am nervous. Will he believe that I am terminally ill? I stammer and tell my story. He listens to me, looks at me, answers calmly, and takes his time – and attention that few orthodox doctors can afford today, which is one of the reasons that drive people into the arms of alternative healers.Finally, Maar advises a “heat therapy” in which the tumor is heated locally. Yet Klaus Maar is still one of the more serious healers. He does not directly advise against chemotherapy, but warns about the side effects. In the end, he recommends postponing it for a fortnight and starting the 8,000-euro heat treatment as soon as possible. “But don’t delay, don’t blame me and say I delayed the chemotherapy,” Maar says. I guess that’s his way of hedging his bets: If he were to successfully dissuade me from chemotherapy, my family could sue him one day. I come across such phrases again and again.
… next visit; the alternative practitioner Ursula Stoll specializes in “Germanic New Medicine”. Ryke Geerd Hamer, a former doctor, founded this doctrine in the early 1980s as a reaction to “Jewish” orthodox medicine. No wonder it enjoys great popularity in völkisch circles. Hamer’s abstruse and dangerous theories led to the withdrawal of his license. He continued to practice illegally, however, and several of his patients died… Even Ursula Stoll thinks he was crazy – but not his theory… Stoll practices in Öhringen, an idyllic little town north of Stuttgart, in her nondescript detached house. She wears a white shirt and horn-rimmed glasses, her brown hair pinned back in a plait, an accurate governess with a stern look.
As I tell her about my suffering, she quickly interrupts me: “What is cancer?” she asks. We have to get rid of the term. There is no such thing as cancer. All I have is a swelling of the lymph nodes in my neck. That’s all. The cause: a self-deprecation of a professional nature. In my case, there is also an existential fear, and like a fish on land, I store water in my body in order to survive. Hence the swollen lymph nodes. Metastases? There are none. The medical report? She skims over it casually and asks: Did you sweat when you were sick? Did the sweat smell? Did it have a color? Where exactly was the itch?
I tell her about the lecture I gave and that my boss didn’t like. Yes! That could be the reason for the cancer. She says my symptoms are a reaction to this slight, my body is trying to heal itself, but the first chemotherapy interrupted and disrupted the process. Her advice to beat the cancer: I should move back in with my parents, life as a single person is too much for me, Berlin is a terrible city anyway… I ask again about chemotherapy. “I personally wouldn’t do it,” she says, “and for my children and my parents I would decide the same.” There it is again, this nappy-soft formulation with which the healers evade their legal responsibility. One more question: isn’t it dangerous to forego chemotherapy? The alternative practitioner Ursula Stoll: “Humans can withstand a lot.”
… Since the spiritual healers Wolfgang Bittscheidt and Teresa Schuhl were favorably discussed on German TV, their practice in Siegburg near Bonn has enjoyed great popularity: appointments are made only months in advance. When we are asked into the treatment room, it is dark, the blinds are half closed. A candle burns on the dark wooden desk. Teresa Schuhl is blond, has blue eyes, and seems cool and aloof, gesticulating strangely with her hands. She whispers more than she speaks; I have to lean forward to understand her. Her advice? “If you were my son right now, I would say, hands off chemo!” For herself, she would decide the same. “One possibility is vitamin B17. Have you heard of it?”
I have heard of it. The so-called vitamin B17 is in fact not a vitamin at all, but a toxic substance, related to prussic acid. It is currently experiencing a boom in the alternative scene and has no proven benefit for cancer. Several people have died from overdoses.
Schuhl is now poking around in my spiritual life and in the relationship between me and my parents. She also suspects a trauma behind my cancer. “The thyroid represents the hormonal. The balance between male and female. Do you know where you belong? Male or female?” What is she trying to say?
“I come from Tajikistan,” he says, “where they say: sickness is a sacred time. When you are sick, God talks to you. He tells you what life really is. What we live is not life, it’s shit. Sickness asks us to make a change.” He continues, “Death is the most beautiful thing there is. Like a trip to the Caribbean. Why are we afraid of it? On this tortured planet here?”
After this introduction, my head is spinning, but now the actual treatment begins. I lie down on a couch. Schuhl runs her hands over my stomach and holds my shoulder. At the same time, she says prayers. She changes into the extinct Aramaic that is sometimes used in Christian services. Then she leaves me alone. Later, her partner, a licensed doctor, recommends that I read up on vitamin B17, come to them once a month and light a candle in a church in Cologne. I walk out of the practice befuddled…
The practitioners protect themselves legally. They make the patients sign contracts stating that the patient has been informed about orthodox medicine and that they reject it willy-nilly, even though the information is often not worth mentioning. What would be the solution?
… The doctor Achim Schuppert in Bonn suspects mobile phone radiation as the cause of my tumor and wants to measure my magnetic aura. It was important to him to “exclude electrosmog as a possible damaging factor”, he writes later.
Lothar Hollerbach, who runs an alternative practice in a Heidelberg city villa, gives a philosophical lecture: “We are spiritual beings and only for a short time in a mobile home we call a body.” Every crisis is a lesson, he says, but perhaps that lesson is for the next life. One of the things he recommends to me for recovery is Rudolf Steiner‘s lectures. How many patients has he successfully treated? He doesn’t count them, Hollerbach waves off. And after all, it’s not just about surviving. Some of his patients could have led a totally different life “in the next incarnation”. For those who long for death – his practice is highly recommended…
… The “medical director” Elke Tegel, a blonde alternative practitioner, leads me through the bright house, shows me the “inner world travel room” where traumatic situations are processed, the room for “healing music“, and also the impressive machine for “high-frequency therapy“, in which electrical energy is supplied to the cells. Costs: 13670 Euros for five weeks.
Cancer, says the alternative practitioner, is “suppressed anger and suppressed resentment”; Hodgkin’s lymphoma in particular is about guilt. She asks: “Where do you feel guilty? Guilty of being a man?” Later she advises a “biological chemotherapy” of highly concentrated vitamin C. This, she says, is far superior to conventional chemo. She confuses my well-treatable Hodgkin’s lymphoma with the fundamentally different non-Hodgkin’s lymphoma. And justifies herself: “With us, it’s not about diagnosis, that’s not of interest.” …
________________________
What I like about this report is that they exposed both doctors and non-medically trained practitioners, i.e. Heilpraktiker. We see yet again that the study of medicine does not protect people from becoming dangerous charlatans. Yet, there are important differences between doctors and Heilpraktiker:
- Only a very small proportion of doctors would treat Hodgkin lymphoma with ineffective quackery, whereas the proportion with Heilpraktiker would, I guess, be not far from 100%.
- Doctors will get struck off for such behavior, whereas this happens to Heilpraktiker as good as never.
Conspiracy beliefs have become a major issue and obstacle to progress. While holding conspiracy beliefs has been associated with several detrimental social, personal, and health consequences, little research has been dedicated to systematically reviewing the methods that could reduce conspiracy beliefs.
A team of researchers conducted a systematic review to identify and assess interventions that have sought to counter conspiracy beliefs. They included 25 studies (total N = 7179) and discovered that, while the majority of interventions were ineffective in terms of changing conspiracy beliefs, several interventions were particularly effective. Interventions that fostered an analytical mindset or taught critical thinking skills were found to be the most effective in terms of changing conspiracy beliefs.
Approximately half of the examined interventions consisted of priming-based tasks. The majority of these interventions demonstrated a significant change in conspiracy beliefs. The effects were all either small or very small. Participants who were primed to be less susceptible to persuasion tactics showed significantly lower conspiracy beliefs when compared to controls among three experimental comparisons. These effects were shown to range from small to medium.
Interventions that primed participants to engage in analytical thinking resulted in primed participants having lower conspiracy beliefs than controls. However, the effects of these differences were small. Other priming interventions focused on manipulating participants’ sense of control. They had mixed results, either increasing or decreasing conspiracy beliefs with very small effects.
About a sixth of all interventions used inoculation methods. All successfully reduced conspiracy beliefs, relative to controls, all with either medium or large effects. Inoculations that identified the factual inaccuracies of conspiracy beliefs were found to be the most effective of all the interventions in the review. Inoculations that demonstrated the logical fallacies of conspiracy beliefs were found to be the second most effective intervention.
The authors concluded that their review found that overall, the majority of current conspiracy interventions are ineffective in terms of changing conspiracy beliefs. Despite this, we have identified several promising interventions that may be fruitful to pursue in future studies. We propose that a focus on inoculation-based and critical thinking interventions will bear more promising results for future research, though further efforts are needed to reduce participant burden and more easily implement these interventions in the real world.
The identification of the factual inaccuracies of conspiracy beliefs plus the stimulation of critical thinking are two aims I actively pursue with this blog. Thus, one might hope that I do make a small contribution to the reduction of conspiracy beliefs.
Yes, one might hope – but judging from many comments posted in the discussion sections, one could easily get a different impression.
Low back pain (LBP) affects almost all of us at some stage. It is so common that it has become one of the most important indications for most forms of so-called alternative medicine (SCAM). In the discussions about the value (or otherwise) of SCAMs for LBP, we sometimes forget that there are many conventional medical options to treat LBP. It is therefore highly relevant to ask how effective they are. This overview aimed to summarise the evidence from Cochrane Reviews of the efficacy, effectiveness, and safety of systemic pharmacological interventions for adults with non‐specific LBP.
The Cochrane Database of Systematic Reviews was searched from inception to 3 June 2021, to identify reviews of randomised controlled trials (RCTs) that investigated systemic pharmacological interventions for adults with non‐specific LBP. Two authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools. The review focused on placebo comparisons and the main outcomes were pain intensity, function, and safety.
Seven Cochrane Reviews that included 103 studies (22,238 participants) were included. There was high confidence in the findings of five reviews, moderate confidence in one, and low confidence in the findings of another. The reviews reported data on six medicines or medicine classes: paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs), muscle relaxants, benzodiazepines, opioids, and antidepressants. Three reviews included participants with acute or sub‐acute LBP and five reviews included participants with chronic LBP.
Acute LBP
Paracetamol
There was high‐certainty evidence for no evidence of difference between paracetamol and placebo for reducing pain intensity (MD 0.49 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI ‐1.99 to 2.97), reducing disability (MD 0.05 on a 0 to 24 scale (higher scores indicate worse disability), 95% CI ‐0.50 to 0.60), and increasing the risk of adverse events (RR 1.07, 95% CI 0.86 to 1.33).
NSAIDs
There was moderate‐certainty evidence for a small between‐group difference favouring NSAIDs compared to placebo at reducing pain intensity (MD ‐7.29 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI ‐10.98 to ‐3.61), high‐certainty evidence for a small between‐group difference for reducing disability (MD ‐2.02 on a 0‐24 scale (higher scores indicate worse disability), 95% CI ‐2.89 to ‐1.15), and very low‐certainty evidence for no evidence of an increased risk of adverse events (RR 0.86, 95% CI 0. 63 to 1.18).
Muscle relaxants and benzodiazepines
There was moderate‐certainty evidence for a small between‐group difference favouring muscle relaxants compared to placebo for a higher chance of pain relief (RR 0.58, 95% CI 0.45 to 0.76), and higher chance of improving physical function (RR 0.55, 95% CI 0.40 to 0.77), and increased risk of adverse events (RR 1.50, 95% CI 1. 14 to 1.98).
Opioids
None of the included Cochrane Reviews aimed to identify evidence for acute LBP.
Antidepressants
No evidence was identified by the included reviews for acute LBP.
Chronic LBP
Paracetamol
No evidence was identified by the included reviews for chronic LBP.
NSAIDs
There was low‐certainty evidence for a small between‐group difference favouring NSAIDs compared to placebo for reducing pain intensity (MD ‐6.97 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI ‐10.74 to ‐3.19), reducing disability (MD ‐0.85 on a 0‐24 scale (higher scores indicate worse disability), 95% CI ‐1.30 to ‐0.40), and no evidence of an increased risk of adverse events (RR 1.04, 95% CI ‐0.92 to 1.17), all at intermediate‐term follow‐up (> 3 months and ≤ 12 months postintervention).
Muscle relaxants and benzodiazepines
There was low‐certainty evidence for a small between‐group difference favouring benzodiazepines compared to placebo for a higher chance of pain relief (RR 0.71, 95% CI 0.54 to 0.93), and low‐certainty evidence for no evidence of difference between muscle relaxants and placebo in the risk of adverse events (RR 1.02, 95% CI 0.67 to 1.57).
Opioids
There was high‐certainty evidence for a small between‐group difference favouring tapentadol compared to placebo at reducing pain intensity (MD ‐8.00 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI ‐1.22 to ‐0.38), moderate‐certainty evidence for a small between‐group difference favouring strong opioids for reducing pain intensity (SMD ‐0.43, 95% CI ‐0.52 to ‐0.33), low‐certainty evidence for a medium between‐group difference favouring tramadol for reducing pain intensity (SMD ‐0.55, 95% CI ‐0.66 to ‐0.44) and very low‐certainty evidence for a small between‐group difference favouring buprenorphine for reducing pain intensity (SMD ‐0.41, 95% CI ‐0.57 to ‐0.26).
There was moderate‐certainty evidence for a small between‐group difference favouring strong opioids compared to placebo for reducing disability (SMD ‐0.26, 95% CI ‐0.37 to ‐0.15), moderate‐certainty evidence for a small between‐group difference favouring tramadol for reducing disability (SMD ‐0.18, 95% CI ‐0.29 to ‐0.07), and low‐certainty evidence for a small between‐group difference favouring buprenorphine for reducing disability (SMD ‐0.14, 95% CI ‐0.53 to ‐0.25).
There was low‐certainty evidence for a small between‐group difference for an increased risk of adverse events for opioids (all types) compared to placebo; nausea (RD 0.10, 95% CI 0.07 to 0.14), headaches (RD 0.03, 95% CI 0.01 to 0.05), constipation (RD 0.07, 95% CI 0.04 to 0.11), and dizziness (RD 0.08, 95% CI 0.05 to 0.11).
Antidepressants
There was low‐certainty evidence for no evidence of difference for antidepressants (all types) compared to placebo for reducing pain intensity (SMD ‐0.04, 95% CI ‐0.25 to 0.17) and reducing disability (SMD ‐0.06, 95% CI ‐0.40 to 0.29).
The authors concluded as follows: we found no high‐ or moderate‐certainty evidence that any investigated pharmacological intervention provided a large or medium effect on pain intensity for acute or chronic LBP compared to placebo. For acute LBP, we found moderate‐certainty evidence that NSAIDs and muscle relaxants may provide a small effect on pain, and high‐certainty evidence for no evidence of difference between paracetamol and placebo. For safety, we found very low‐ and high‐certainty evidence for no evidence of difference with NSAIDs and paracetamol compared to placebo for the risk of adverse events, and moderate‐certainty evidence that muscle relaxants may increase the risk of adverse events. For chronic LBP, we found low‐certainty evidence that NSAIDs and very low‐ to high‐certainty evidence that opioids may provide a small effect on pain. For safety, we found low‐certainty evidence for no evidence of difference between NSAIDs and placebo for the risk of adverse events, and low‐certainty evidence that opioids may increase the risk of adverse events.
This is an important overview, in my opinion. It confirms what I and others have been stating for decades: WE CURRENTLY HAVE NO IDEAL SOLUTION TO LBP.
This is regrettable but true. It begs the question of what one should recommend to LBP sufferers. Here too, I have to repeat myself: (apart from staying as active as possible) the optimal therapy is the one that has the most favourable risk/benefit profile (and does not cost a fortune). And this option is not drugs, chiropractic, osteopathy, acupuncture, or any other SCAM – it is (physio)therapeutic exercise which is cheap, safe, and (mildly) effective.
Guided imagery is said to distract patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduce pain by producing pleasing mental images.
This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. It included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001).
The authors concluded that guided imagery reduces short-term postoperative pain after lower extremity surgery.
I did not want to spend $52 to access the full article. Therefore, I can only comment on what the abstract tells me – and that is regrettably not a lot.
In fact, we don’t even learn what treatment was given to the control group. I guess that both groups receive standard post-op care and the control group received nothing in addition. This would mean that the observed effect might be entirely due to placebo and other non-specific effects. If that is so, the authors’ conclusion is not accurate.
I happen to think that guided imagery is a promising albeit under-researched therapy. Therefore, I am particularly frustrated to see that the few trials that do emerge of this option are woefully inadequate to determine its value.
During the coronavirus disease 2019 pandemic, Ayurvedic herbal supplements and homeopathic remedies were promoted as immune boosters (IBs) and disease-preventive agents. This happened in most parts of the world but nowhere more intensely than in India.
The present study examined the clinical outcomes among patients with chronic liver disease who presented with complications of portal hypertension or liver dysfunction temporally associated with the use of IBs in the absence of other competing causes. This Indian single-center retrospective observational cohort study included patients with chronic liver disease admitted for the evaluation and management of jaundice, ascites, or hepatic encephalopathy temporally associated with the consumption of IBs and followed up for 180 days. Chemical analysis was performed on the retrieved IBs.
From April 2020 to May 2021, 1022 patients with cirrhosis were screened, and 178 (19.8%) were found to have consumed complementary and alternative medicines. Nineteen patients with cirrhosis (10.7%), jaundice, ascites, hepatic encephalopathy, or their combination related to IBs use were included. The patients were predominantly male (89.5%). At admission, 14 (73.75%) patients had jaundice, 9 (47.4%) had ascites, 2 (10.5%) presented with acute kidney injury, and 1 (5.3%) had overt encephalopathy. Eight patients (42.1%) died at the end of the follow-up period. Hepatic necrosis and portal-based neutrophilic inflammation were the predominant features of liver biopsies.
Ten samples of IBs, including locally made ashwagandha powder, giloy juice, Indian gooseberry extracts, pure giloy tablets, multiherbal immune-boosting powder, other multiherbal tablets, and the homeopathic remedy, Arsenicum album 30C, were retrieved from our study patients. Samples were analyzed for potential hepatotoxic prescription drugs, known hepatotoxic adulterants, pesticides, and insecticides, which were not present in any of the samples. Detectable levels of arsenic (40%), lead (60%), and mercury (60%) were found in the samples analyzed. A host of other plant-derived compounds, industrial solvents, chemicals, and anticoagulants was identified using GC–MS/MS. These include glycosides, terpenoids, phytosteroids, and sterols, such as sitosterol, lupeol, trilinolein, hydroxy menthol, methoxyphenol, butyl alcohol, and coumaran derivatives.
The authors concluded that Ayurvedic and Homeopathic supplements sold as IBs potentially cause the worsening of preexisting liver disease. Responsible dissemination of scientifically validated, evidence-based medical health information from regulatory bodies and media may help ameliorate this modifiable liver health burden.
The authors comment that Ayurvedic herbal supplements and homeopathic remedies sold as IBs, potentially induce idiosyncratic liver injury in patients with preexisting liver disease. Using such untested advertised products can lead to the worsening of CLD in the form of liver failure or portal hypertension events, which are associated with a high risk of mortality compared to those with severe AH-related liver decompensation in the absence of timely liver transplantation. Severe mixed portal inflammation and varying levels of hepatic necrosis are common findings on liver histopathology in IB-related liver injury. Health regulatory authorities and print and visual media must ensure the dissemination of responsible and factual scientific evidence-based information on herbal and homeopathic “immune boosters” and health supplements to the public, specifically to the at-risk patient population.
Research by the Milner Center for Evolution at the University of Bath, U.K., along with colleagues at the Universities of Oxford and Aberdeen, found that trust in scientists has hugely increased since the COVID-19 pandemic. The study also found that people were more likely to take the COVID-19 vaccine if their trust in the science had increased.
Using data from a survey of more than 2,000 U.K. adults commissioned by the Genetics Society, the team asked individuals whether their trust in scientists had gone up, down, or stayed the same.
- A third of people reported that their trust in scientists had gone up.
- When Pfizer, a company that made COVID-19 vaccines, was used as an example of the pharma industry, more people reported a positive response than when GlaxoSmithKline, a company not associated with the COVID-19 vaccine, was mentioned.
- The researchers also found that people who reported holding a negative view of science before the pandemic had become even more negative.
- People reporting increased trust were most likely to take the COVID-19 vaccine.
- Those preferring not to do so reported a decline in trust.
This is an interesting study with relevance to many discussions we had on this blog. I recommend reading it in full. Here are the abstract and link to the paper:
While attempts to promote acceptance of well-evidenced science have historically focused on increasing scientific knowledge, it is now thought that for acceptance of science, trust in, rather than simply knowledge of, science is foundational. Here we employ the COVID-19 pandemic as a natural experiment on trust modulation as it has enabled unprecedented exposure of science. We ask whether trust in science has on the average altered, whether trust has changed the same way for all and, if people have responded differently, what predicts these differences? We 1) categorize the nature of self-reported change in trust in “scientists” in a random sample of over 2000 UK adults after the introduction of the first COVID vaccines, 2) ask whether any reported change is likely to be real through consideration of both a negative control and through experiment, and 3) address what predicts change in trust considering sex, educational attainment, religiosity, political attitude, age and pre-pandemic reported trust. We find that many more (33%) report increased trust towards “scientists” than report decreased trust (7%), effects of this magnitude not being seen in negative controls. Only age and prior degree of trust predict change in trust, the older population increasing trust more. The prior degree of trust effect is such that those who say they did not trust science prior to the pandemic are more likely to report becoming less trusting, indicative of both trust polarization and a backfire effect. Since change in trust is predictive of willingness to have a COVID-19 vaccine, it is likely that these changes have public health consequences.
Sure, the LP is dangerous nonsense, but this begs the question of whether so-called alternative medicine (SCAM) has anything to offer for patients suffering from ME/CFS. If the LP story tells us anything, then it must be this: we should not trust single trials, particularly if they seem dodgy. In other words, we should look at systematic reviews that synthesize ALL clinical trials and evaluate them critically.
To locate this type of evidence I conducted several Medline searches and found several recent systematic reviews that address the issue:
Context: A variety of interventions have been used in the treatment and management of chronic fatigue syndrome (CFS). Currently, debate exists among health care professionals and patients about appropriate strategies for management.
Objective: To assess the effectiveness of all interventions that have been evaluated for use in the treatment or management of CFS in adults or children.
Data sources: Nineteen specialist databases were searched from inception to either January or July 2000 for published or unpublished studies in any language. The search was updated through October 2000 using PubMed. Other sources included scanning citations, Internet searching, contacting experts, and online requests for articles.
Study selection: Controlled trials (randomized or nonrandomized) that evaluated interventions in patients diagnosed as having CFS according to any criteria were included. Study inclusion was assessed independently by 2 reviewers. Of 350 studies initially identified, 44 met inclusion criteria, including 36 randomized controlled trials and 8 controlled trials.
Data extraction: Data extraction was conducted by 1 reviewer and checked by a second. Validity assessment was carried out by 2 reviewers with disagreements resolved by consensus. A qualitative synthesis was carried out and studies were grouped according to type of intervention and outcomes assessed.
Data synthesis: The number of participants included in each trial ranged from 12 to 326, with a total of 2801 participants included in the 44 trials combined. Across the studies, 38 different outcomes were evaluated using about 130 different scales or types of measurement. Studies were grouped into 6 different categories. In the behavioral category, graded exercise therapy and cognitive behavioral therapy showed positive results and also scored highly on the validity assessment. In the immunological category, both immunoglobulin and hydrocortisone showed some limited effects but, overall, the evidence was inconclusive. There was insufficient evidence about effectiveness in the other 4 categories (pharmacological, supplements, complementary/alternative, and other interventions).
Conclusions: Overall, the interventions demonstrated mixed results in terms of effectiveness. All conclusions about effectiveness should be considered together with the methodological inadequacies of the studies. Interventions which have shown promising results include cognitive behavioral therapy and graded exercise therapy. Further research into these and other treatments is required using standardized outcome measures.
Introduction: Chronic fatigue syndrome (CFS) affects between 0.006% and 3% of the population depending on the criteria of definition used, with women being at higher risk than men.
Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic fatigue syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results: We found 46 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antidepressants, cognitive behavioural therapy (CBT), corticosteroids, dietary supplements, evening primrose oil, galantamine, graded exercise therapy, homeopathy, immunotherapy, intramuscular magnesium, oral nicotinamide adenine dinucleotide, and prolonged rest.
Background: Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of unknown aetiology. Chronic fatigue syndrome (CFS), also termed myalgic encephalomyelitis (ME), is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population.
Methods: Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs) of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded.
Results: A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium.
Conclusions: The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.
Background: There is no curative treatment for chronic fatigue syndrome (CFS). Traditional Chinese medicine (TCM) is widely used in the treatment of CFS in China.
Objective: To evaluate the effectiveness and safety of TCM for CFS.
Methods: The protocol of this review is registered at PROSPERO. We searched six main databases for randomized clinical trials (RCTs) on TCM for CFS from their inception to September 2013. The Cochrane risk of bias tool was used to assess the methodological quality. We used RevMan 5.1 to synthesize the results.
Results: 23 RCTs involving 1776 participants were identified. The risk of bias of the included studies was high. The types of TCM interventions varied, including Chinese herbal medicine, acupuncture, qigong, moxibustion, and acupoint application. The results of meta-analyses and several individual studies showed that TCM alone or in combination with other interventions significantly alleviated fatigue symptoms as measured by Chalder’s fatigue scale, fatigue severity scale, fatigue assessment instrument by Joseph E. Schwartz, Bell’s fatigue scale, and guiding principle of clinical research on new drugs of TCM for fatigue symptom. There was no enough evidence that TCM could improve the quality of life for CFS patients. The included studies did not report serious adverse events.
Conclusions: TCM appears to be effective to alleviate the fatigue symptom for people with CFS. However, due to the high risk of bias of the included studies, larger, well-designed studies are needed to confirm the potential benefit in the future.
Background: As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). But there are certain doubts as well in the effectiveness of its treatment due to the lack of a comprehensive and evidence-based medical proof to dispel the misgivings. Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture.
Methods: We comprehensively reviewed literature including PubMed, EMBASE, Cochrane library, CBM (Chinese Biomedical Literature Database) and CNKI (China National Knowledge Infrastructure) up to May 2016, for RCT clinical research on CFS treated by acupuncture and moxibustion. Traditional direct meta-analysis was adopted to analyze the difference between AM and other treatments. Analysis was performed based on the treatment in experiment and control groups. Network meta-analysis was adopted to make comprehensive comparisons between any two kinds of treatments. The primary outcome was total effective rate, while relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics.
Results: A total of 31 randomized controlled trials (RCTs) were enrolled in analyses. In traditional direct meta-analysis, we found that in comparison to Chinese herbal medicine, CbAM (combined acupuncture and moxibustion, which meant two or more types of acupuncture and moxibustion were adopted) had a higher total effective rate (RR (95% CI), 1.17 (1.09 ~ 1.25)). Compared with Chinese herbal medicine, western medicine and sham-acupuncture, SAM (single acupuncture or single moxibustion) had a higher total effective rate, with RR (95% CI) of 1.22 (1.14 ~ 1.30), 1.51 (1.31-1.74), 5.90 (3.64-9.56). In addition, compared with SAM, CbAM had a higher total effective rate (RR (95% CI), 1.23 (1.12 ~ 1.36)). In network meta-analyses, similar results were recorded. Subsequently, we ranked all treatments from high to low effective rate and the order was CbAM, SAM, Chinese herbal medicine, western medicine and sham-acupuncture.
Conclusions: In the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.
Objectives: This meta-analysis aimed to assess the effectiveness and safety of Chinese herbal medicine (CHM) in treating chronic fatigue syndrome (CFS). Methods: Nine electronic databases were searched from inception to May 2022. Two reviewers screened studies, extracted the data, and assessed the risk of bias independently. The meta-analysis was performed using the Stata 12.0 software. Results: Eighty-four RCTs that explored the efficacy of 69 kinds of Chinese herbal formulas with various dosage forms (decoction, granule, oral liquid, pill, ointment, capsule, and herbal porridge), involving 6,944 participants were identified. This meta-analysis showed that the application of CHM for CFS can decrease Fatigue Scale scores (WMD: -1.77; 95%CI: -1.96 to -1.57; p < 0.001), Fatigue Assessment Instrument scores (WMD: -15.75; 95%CI: -26.89 to -4.61; p < 0.01), Self-Rating Scale of mental state scores (WMD: -9.72; 95%CI:-12.26 to -7.18; p < 0.001), Self-Rating Anxiety Scale scores (WMD: -7.07; 95%CI: -9.96 to -4.19; p < 0.001), Self-Rating Depression Scale scores (WMD: -5.45; 95%CI: -6.82 to -4.08; p < 0.001), and clinical symptom scores (WMD: -5.37; 95%CI: -6.13 to -4.60; p < 0.001) and improve IGA (WMD: 0.30; 95%CI: 0.20-0.41; p < 0.001), IGG (WMD: 1.74; 95%CI: 0.87-2.62; p < 0.001), IGM (WMD: 0.21; 95%CI: 0.14-0.29; p < 0.001), and the effective rate (RR = 1.41; 95%CI: 1.33-1.49; p < 0.001). However, natural killer cell levels did not change significantly. The included studies did not report any serious adverse events. In addition, the methodology quality of the included RCTs was generally not high. Conclusion: Our study showed that CHM seems to be effective and safe in the treatment of CFS. However, given the poor quality of reports from these studies, the results should be interpreted cautiously. More international multi-centered, double-blinded, well-designed, randomized controlled trials are needed in future research.
What does all that tell us?
Disappointingly, it tells me that SCAM has preciously little to offer for ME/CFS patients.
But what about the TCM treatments? Aren’t the above reviews quite positive TCM?
Yes, they are but I nevertheless recommend taking them with a healthy pinch of salt.
Why?
Because we have seen many times before that, for a range of reasons, Chinese researchers of TCM draw false positive conclusions. That may sound unfair, harsh, or even racist, but I think it’s true. If you disagree, please show me a couple of systematic reviews of TCM for any human disease by Chinese researchers that have drawn negative conclusions.
And what is my advice to patients suffering from ME/CSF?
I think the best I can offer is this: be very cautious about the many claims made by SCAM enthusiasts; if it sounds too good to be true, it probably is!
The Lightning Process (LP) is a therapy for ME based on ideas from osteopathy, life coaching, and neuro-linguistic programming. LP is claimed to work by teaching people to use their brains to “stimulate health-promoting neural pathways”. One young patient once described it as follows: “Whenever you get a negative thought, emotional symptom, you are supposed to turn on one side and with your arm movements in a kind if stop motion, just say STOP very firmly and that is supposed to cut off the adrenaline response.”
Allegedly, the LP teaches individuals to recognize when they are stimulating or triggering unhelpful physiological responses and to avoid these, using a set of standardized questions, new language patterns, and physical movements with the aim of improving a more appropriate response to situations. The LP involves three group sessions on consecutive days where participants are taught theories and skills, which are then practiced through simple steps, posture, and coaching.
Does LP work?
Some think it does, particularly in Norway, it seems.
Proponents of the ‘LP’ in Norway claim that 90% of all ME patients get better after trying it. However, such claims seem to be more than questionable.
- In the Norwegian ME association’s user survey from 2012 with 1,096 participants, 164 ME patients stated that they had tried LP. 21% of these patients experienced improvement or great improvement and 48% got worse or much worse.
- In Norway’s National Research Center in Complementary and Alternative Medicine, NAFKAM’s survey from 2015 amongst 76 patients 8 had a positive effect and 5 got worse or much worse.
- A survey by the Norwegian research foundation, published in the journal Psykologisk, with 660 participants, showed that 62 patients had tried LP, and 5 were very or fairly satisfied with the results.
Such figures seem to reflect the natural history of the condition and may be totally unrelated to LP.
The LP instructors’ claims of a 90% positive effect are used for marketing and for lobbying. Their aim is to influence politicians, health authorities, and welfare and disability benefits authorities. They want to get the LP course approved as part of the public health service.
The company ‘Aktiv Prosess’ was started by LP instructors Live Landmark and Vibeke C. Hammer. In an article in the Norwegian medical journal Tidsskriftet in 2016, Landmark describes her own customer satisfaction survey from 2008 as «generating a hypothesis». Landmark has also written a book about her personal story and holds lectures for medical students, medical doctors, and nurses. Now she is trying to run a clinical trial which, many experts believe, is far from rigorous and set up to produce a positive result.
Positive experiences with LP have received massive media coverage for 15 years. Anecdotes are recycled in the media and give the impression of being a higher number than reality. We rarely hear about those who deteriorated: https://lp-fortellinger.no/ (English language link here).
The NICE guidelines for ME/CFS specifically (and in my view rightly) warn against offering LP to ME patients.
