MD, PhD, FMedSci, FSB, FRCP, FRCPEd

fraud

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This new RCT by researchers from the National Institute of Complementary Medicine in Sydney, Australia was aimed at ‘examining the effect of changing treatment timing and the use of manual, electro acupuncture on the symptoms of primary dysmenorrhea’. It had four arms:

  1. low frequency manual acupuncture (LF-MA),
  2. high frequency manual acupuncture (HF-MA),
  3. low frequency electro acupuncture (LF-EA)
  4. and high frequency electro acupuncture (HF-EA).

A total of 74 women were given 12 treatments over three menstrual cycles, either once per week (LF groups) or three times in the week prior to menses (HF groups). All groups received a treatment in the first 48 hours of menses. The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry.

During the treatment period and 9 month follow-up all groups showed statistically significant reductions in peak and average menstrual pain compared to baseline. However, there were no differences between groups. Health related quality of life increased significantly in 6 domains in groups having high frequency of treatment compared to two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups. HF-MA was most effective in reducing secondary menstrual symptoms compared to both–EA groups.

The authors concluded that acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry. The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant. This may be due to a lack of power. The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered randomised controlled trials.

If I were not used to reading rubbish research of alternative medicine in general and acupuncture in particular, this RCT would amaze me – not so much because of its design, execution, or write-up, but primarily because of its conclusion (why, oh why, I ask myself, did PLOS ONE publish this paper?). They are, I think, utterly barmy.

Let me explain:

  • acupuncture treatment reduced menstrual pain intensity” – oh no, it didn’t; at least this is not what the study proves; the fact that pain was perceived as less could be due to a host of factors, for instance regression towards the mean, or social desirability; as there was no proper control group, nobody can tell;
  • the lack of difference between treatments “may be due to a lack of power”. Yes, but more likely it is due to the fact that all versions of a placebo therapy generate similar outcomes.
  • acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered randomised controlled trials”. Why? Because the authors have a quasi-religious belief in acupuncture? And if they have, why did they not design their study ‘appropriately’?

The best conclusion I can suggest for this daft trial is this: IN THIS STUDY, THE PRIMARY ENDPOINT SHOWED NO DIFFERENCE BETWEEN THE 4 TREATMENT GROUPS. THE RESULTS ARE THEREFORE FULLY COMPATIBLE WITH THE NOTION THAT ACUPUNCTURE IS A PLACEBO THERAPY.

Something along these lines would, in my view, have been honest and scientific. Sadly, in acupuncture research, we very rarely get such honest science and the ‘National Institute of Complementary Medicine in Sydney, Australia’ has no track record of being the laudable exception to this rule.

To a significant extend, this blog has always exposed untruths in the realm of alternative medicine – not just one or two, but hundreds. Obviously, some of them are more clear-cut than others. If, for instance, someone claims that acupuncture has been proven to be effective for a given condition, this many seem like a lie or untruth to you, like a misinterpretation of the evidence to someone else, or like the truth to a third person.

But there are some statements which are demonstrably false. These are often the most irritating lies, frequently forwarded by people who should know better and who nevertheless insist on not being truthful. Below I have listed a few, randomly-chosen examples upon which I have previously commented. For clarity, I have copied the quotes in question, linked them to my original posts, named the authors in brackets, and added a brief comment by myself in bold print.

I was at Exeter when Ernst took over what was already a successful Chair in CAM. (anonymous reviewer of my book at Amazon)

Anyone can check this fairly easily, for instance, in my memoir ‘A SCIENTIST IN WONDERLAND’, there was no pre-existing chair at Exeter.

Ernst’s leak of the Smallwood report (also front page lead in The Times, August 2005), (Dr Peter Fisher, homeopath of the Queen)

This was painfully investigated during a 13 (!) months inquiry which found that I did not leak this report. Again you find the full details in my memoir.

…homeopathic care is recommended for people who have been exposed (or think they have been exposed) to toxic substances… (Dana Ullman US homeopath)

As far as this statement implies that homeopathy is effective for treating intoxications, this is not only a lie but a very dangerous nonsense.

Homeopathy has a long history of being used successfully in veterinary practice for both domestic and farm animals. (UK Faculty of Homeopathy)

If this is to suggest that homeopathy is of proven effectiveness in treating diseases of animals, this is a lie.

Homeoprophylaxis, the homeopathic vaccine alternative, prevents disease through nosodes. (Lisa is the mastermind behind All Natural Ideas)

Homeoprophylaxis has never been proven to prevent any disease; this lie could kill millions.

There are essentially two categories of critics. The first category consists of individuals who are totally ignorant of homeopathy and just repeating propaganda they’ve been exposed to. The second category is people who know that homeopathy works, but have a vested financial interest in destroying it. (Alan Schmukler, US homeopathy)

This lie is quite funny in its transparent defamation of the truth, I think.

Homeopathy works like a vaccine. (Dr Batra, Indian homeopath)

Homeopathy does not even remotely work like a vaccine; in fact, it works like a placebo, if at all.

…UK invests 0% of its research budget on CAM… (Dr Michael Dixon, GP and advisor to Prince Charles)

There has always been a sizable budget for CAM-research in the UK.

Even cancer viruses have, on record, been put into vaccinations. There is no actual vaccine for cancer. The only reason to put cancer viruses in the mix is to create more cases of cancer. In this day and age, one of the most dangerous things you can do for your health is to get vaccinated… (US homeopath)

In this short quote, there are more lies than I care to comment on. The paranoia of the anti-vaccination brigade is astounding and endangers many lives.

A lie is a statement used intentionally for the purpose of deception. In alternative medicine, we encounter so many lies that one would need to continually publish volume after volume to expose just the most harmful untruths. The danger of these lies is that some people might believe them. This could seriously harm their health. Another danger is that we might get used to them, trivialise them, or – like Trump and co – start thinking of them as ‘alternative facts’.

I will continue to do my best to prevent any of this from happening.

 

I have repeatedly cautioned about the often poor quality of research into alternative medicine. This seems particularly necessary with studies of acupuncture, and especially true for such research carried out in China. I have also frequently noted that certain ‘CAM journals’ are notoriously prone to publishing rubbish. So, what can we expect from a paper that:

  • is on alternative medicine,
  • focusses on acupuncture,
  • is authored by Chinese researchers,
  • was published in the Journal of Alternative and Complementary Medicine (JACM)?

The answer is PROBABLY NOT A LOT!

As if for confirming my prediction, The JACM just published this systematic review. It reports pairwise and network meta-analyses to determine the effectiveness of acupuncture and acupuncture-related techniques for the treatment of psoriasis. A total of 13 RCTs were included. The methodological quality of these studies was ‘not rigorous’ according to the authors – in fact, it was lousy. Acupoint stimulation seemed to be more effective than non-acupoint stimulation. The short-term treatment effect was superior to the long-term effect (as one would expect with placebo). Network meta-analysis suggested that acupressure or acupoint catgut embedding generate superior effects compared to medications. It was noted that acupressure was the most effective treatment of all the acupuncture-like therapies.

The authors concluded that acupuncture-related techniques could be considered as an alternative or adjuvant therapy for psoriasis in short term, especially of acupressure and acupoint catgut embedding. This study recommends further well-designed, methodologically rigorous, and more head-to-head randomized trials to explore the effects of acupuncture-related techniques for treating psoriasis.

And what is wrong with that?

EVERYTHING!

  • The review is of very poor quality.
  • The primary studies are even worse.
  • The English language is defective to the point of being not understandable.
  • The conclusions are misleading.

Correct conclusions should read something like this: Due to the paucity and the poor quality of the clinical trials, this review could not determine whether acupuncture and similar therapies are effective for psoriasis.

And then there is, of course, the question about plausibility. How plausible is the assumption that acupuncture might affect a genetic autoimmune disease like psoriasis. The answer, I think, is that the assumption is highly unlikely.

In the above review, most of the 13 primary RCTs were from China. One of the few studies not conducted in China is this one:

56 patients suffering from long-standing plaque psoriasis were randomized to receive either active treatment (electrostimulation by needles placed intramuscularly, plus ear-acupuncture) or placebo (sham, ‘minimal acupuncture‘) twice weekly for 10 weeks. The severity of the skin lesions was scored (PASI) before, during, and 3 months after therapy. After 10 weeks of treatment the PASI mean value had decreased from 9.6 to 8.3 in the ‘active’ group and from 9.2 to 6.9 in the placebo group (p < 0.05 for both groups). These effects are less than the usual placebo effect of about 30%. There were no statistically significant differences between the outcomes in the two groups during or 3 months after therapy. The patient’s own opinion about the results showed no preference for ‘active’ therapy. It was also clear from the answers that the blinded nature of the study had not been discovered by the patients. In conclusion, classical acupuncture is not superior to sham (placebo) ‘minimal acupuncture‘ in the treatment of psoriasis.

Somehow, I trust these conclusions more than the ones from the review!

And somehow, I get very tired of journal editors failing to do their job of rejecting papers that evidently are embarrassing, unethical rubbish.

The homeopath and homeopathic entrepreneur Fran Sheffield has made appearances on this blog before; for instance, I quoted her stating that homeoprophylaxis has a remarkable record of safety – vaccines less so. From the homeopath’s point of view they are still associated with risks: the dose is too strong, they have toxic additives, and they’re given by inappropriate pathways. Homeoprophylaxis has avoided these problems. It’s also versatile, inexpensive, quick to produce and easy to distribute…

I believe such irresponsible nonsense brought her into trouble; a Federal judge concluded that: “there is no reasonable basis, in the sense of an adequate foundation, in medical science to enable the First Respondent and the Second Respondent to state that Homeopathic Treatments are safe and effective as an alternative to the Vaccine for the Prevention of Whooping Cough”.

Perhaps this is why Fran is now focussing on less contentious (but equally profitable) subjects? In any case, Fran is back with an article claiming that homeopathy is effective for treating over-sexed children and adults.

If you happen to be a bit under the weather today, you should read it – it will cheer you up, I am sure:

START OF QUOTE

Hyos [Hyoscyamus niger]…is frequently well-suited to over-sexualised behaviour in either children or adults. Other helpful remedies also exist but Hyos is especially useful when the child is prone to jealousy, foolishness, silly, irritating behaviour they refuse to stop, anxiety about water, twitching, jerking and grimacing, and restless hands that constantly move, touch and pull at things. While not all these symptoms have to be present before Hyos can be prescribed, some degree of similarity should exist. In pronounced cases, epilepsy and mania may be present.

When parents in my clinic first hear that a homeopathic remedy like Hyos can return their child’s over-sexualised behaviour back to normal they usually look at me with disbelief but within a week of taking a dose, significant changes have usually taken place. By the next appointment, some weeks later, I normally hear that the silly behaviour and jealousy have reduced – or gone completely – along with the inappropriate sexuality. All this and more from one simple remedy.

On reading this, if you are wondering if treatment has to be forever, the answer is no. As with any form of homeopathic treatment, when physical and behavioural symptoms improve, the remedy is given less often. Once the symptoms have stopped so is the remedy as the child is back to a healthy state and no further treatment is needed.

If your child has this embarrassing and annoying problem, hopefully it helps to know that its not “just the way they are” but  an imbalance that can be corrected. To achieve this, please see a reputable and qualified homeopath who can help you in your child’s treatment. The bonus is that as their precocious behaviour improves with treatment, so will their other health problems and life will become easier and more pleasant for all.

Fran Sheffield (Homeopath)

References

http://www.news.com.au/national/red-light-on-abnormal-child-sex-behaviour/story-e6frfkvr-1226264224011 

END OF QUOTE

If you think that Fran is an oddity amongst homeopaths in prescribing homeopathic remedies for sexual problems (or if you assume that there is a jot of evidence for homeopathic treatments of such conditions), you are mistaken. The Internet is full with similar advice. My favourite site must be this one because it offers very concrete help. Here are some of the prescriptions:

Some of the common and effective homeopathic remedies for treatment of loss of libido are Iodium, Plumbum Metallicum, Argentum Nitricum.

  • Iodium: A useful remedy in men with loss of sexual power, with atrophied testes.
  • Plumbum Metallicum: Valuable remedy in men with loss of sexual desire with constricted feeling of the testicles, and loss of sexual desire with progressive muscular atrophy.
  • Argentum Nitricum: Useful remedy in nervous and anxious men with Complete loss of libido or in whom erection fails when coition is attempted.

Some of the common remedies used in treatment of impotence are Agnus castus, Argentum nitricum, Caladium, Causticum, Lycopodium, Selenium metallicum, Staphysagria.

  • Agnus castus: If impotence develop after you have led a life of intense and frequent sexual activity for many years Agnus castus may be useful. If you feel a cold sensation in the genitals Agnus castus is indicated.
  • Argentum nitricum: Useful remedy in men whose erection fails when sexual intercourse is attempted, particularly if thinking about the problem makes it worse.
  • Caladium: Useful remedy for men whose genitals are completely limp…

The question that occurred to be when reading this is the following: Is there any conceivable stupidity in which homeopaths do not indulge?

 

Systematic reviews are aimed at summarising and critically evaluating the evidence on a specific research question. They are the highest level of evidence and are more reliable than anything else we have. Therefore, they represent a most useful tool for both clinicians and researchers.

But there are, of course, exceptions. Take, for instance, this recent systematic review by researchers from the

  • Texas Chiropractic College, Pasadena, the Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport,
  • Department of Planning, Policy and Design, University of California, Irvine,
  • VA Puget Sound Health Care System, Tacoma,
  • New York Chiropractic College, Seneca Falls,
  • Logan University College of Chiropractic, Chesterfield,
  • University of Western States, Portland.

Its purpose was to evaluate the effectiveness of conservative non-drug, non-surgical interventions, either alone or in combination, for conditions of the shoulder. The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were

  • shoulder impingement syndrome (SIS),
  • rotator cuff-associated disorders (RCs),
  • adhesive capsulitis (AC),
  • nonspecific shoulder pain.

Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low- to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions.

The authors concluded that the findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions.

This review has so many defects that it would be boring to list them here.

The PRISMA guidelines  – I happen to be a co-author – state, for instance, that the abstract (the above text is from the abstract) should provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number. It is obvious that the review authors have omitted several of these items.

And that is just the abstract!  There is much, much more to criticise in this paper.

The most striking deficit, in my view, is the useless conclusion: the one from the abstract (the part of the paper that will be read most widely) could have been written before the review had even been started. It is therefore not based on the data presented. Crucially it does not match the stated aim of this review (“to evaluate the effectiveness of conservative…interventions”).

But why? Why did the authors bother to follow PRISMA? Why did they formulate this bizarre conclusion in their abstract? Why did they do a review in the first place?

I fear, the answers might be embarrassingly simple:

  • They only pretended to follow PRISMA guidelines because that gives their review a veneer of respectability.
  • They formulated the conclusions because otherwise they would have needed to state that the evidence for manual therapy is less than convincing.
  • They conducted the review to promote chiropractic, and when the data were not as they had hoped for, they just back-paddled in an attempt to hide the truth as much as possible.

If this were an isolated case, I would not have bothered to mention it. But sadly, in the realm of chiropractic (and alternative medicine in general) we currently witness a plethora of rubbish reviews (published by rubbish journals). To the naïve observer, they might look rigorous and therefore they will be taken seriously. The end-effect of this pollution of the literature with rubbish is that we get a false-positive impression about the validity of the treatments in question. Consequently, we will see a host of wrong decisions on all levels of healthcare.

The big question is: HOW DO WE PROTECT OURSELVES FROM THIS DANGEROUS TREND?

I only see one solution: completely disregard certain journals that have been identified to regularly publish nonsense. Sadly, the wider medical community is far from having arrived at this point. As far as I can see, the problem has not even been identified yet as a serious issue that needs addressing. For the foreseeable future, we will probably have to live with this type of pollution of our medical literature.

I was surprised to receive this email yesterday: “Hello Edzard Ernst, You may remember I got in touch last week regarding losing a loved one to the ravages of drugs or alcohol. I just wanted to remind you that Narconon is here to help. For over fifty years Narconon drug and alcohol rehabilitation centres have been successfully reversing the tide of addiction for men and woman from all walks of life. The Narconon programme has saved them from the misery of addiction, and the potential of an early grave. We not only address the cause of the addiction, we resolve them…”

The email was signed by a man from ‘Narconon International’. First I thought someone has been counting the empty bottles in my bin, then I read it again and noticed the word ‘NARCONON’ and remembered that I once wrote about it. A quick search located my article from THE GUARDIAN 2012:

Imagine a therapy that “enables an individual to rid himself of the harmful effects of drugs, toxins and other chemicals that lodge in the body and create a biochemical barrier to spiritual well-being“. If you were told that the treatment was entirely natural and had already “enabled hundreds of thousands to free themselves from the harmful effects of drugs and toxins and so achieve spiritual gains”, wouldn’t you be tempted to try it?

Who doesn’t want a body free of nasty chemicals? And who wouldn’t be delighted at the chance to counter a growing threat to an “advancement in mental … wellbeing”?

These claims are being made for the “Purification Rundown” (“Purif” for short) and the closely related Narconon detox programmes, which mainly consist of regular exercise, sauna and nutrition, with industrial doses of vitamins and minerals added for good measure. Some of the claims are quite specific: the Purif programme is supposed to increase your IQ, reduce the level of cancer-causing agents in your body, and even enable you to lose weight easily and quickly. The Narconon programme is more specifically targeted at drug and alcohol dependency and is claimed to have an impressive success rate of 75%.

Both programmes were developed by L Ron Hubbard (1911-1986) and are currently marketed by the Church of Scientology. The CoS is not generally known to be an organisation that promotes healthcare programmes. Hubbard, the pulp-fiction writer who founded the CoS, portrayed himself somewhat over-optimistically as a pioneer, innovator and nuclear physicist.

He taught his followers that, at their core, humans contain a “thetan”. After creating the universe, thetans accidentally became trapped in physical bodies and, through scientology, we can restore the immortal, omnipotent, god-like powers of the “thetan” within us. Weird stuff that is the preserve of Hollywood eccentrics, you might think, but perhaps the CoS’s detox-ventures are an attempt to conquer new territory?

A typical course of treatment lasts several weeks and consists of many hours of exercise and sauna every day. This regimen is supplemented with megadoses of vitamins and minerals, which can cause problems. Niacin, one vitamin that is given in high doses as part of the regimen, can be particularly dangerous. The US National Institutes of Health warns that at high doses it can cause “liver problems, gout, ulcers of the digestive tract, loss of vision, high blood sugar, irregular heartbeat, and other serious problems.” It should not be taken by people who already have liver damage.

Seven fatalities of people undergoing the Narconon programme are currently being investigated in Oklahoma, although the CoS says these deaths are not connected with the treatment regimen itself.

Whatever the truth regarding these deaths, a review of the evidence about the treatment regimen’s effectiveness – carried out by the Norwegian Knowledge Centre for the Health Services in 2008 – found no good evidence that the Narconon programme works:

There is currently no reliable evidence for the effectiveness of Narconon as a primary or secondary drug prevention program. This is partly due to the insufficient research evidence about Narconon and partly due to the non-experimental nature of the few studies that exist.

The claim that such detox treatments eliminate toxins from the body is, of course, easily testable. All we would need to do is define what toxin we are talking about and measure the change in levels of that toxin compared with a control group of volunteers who did not receive the detox.

But such studies are not available. Why? Do the marketing men believe in their own claims? Maybe they feel that profits and evidence are like fire and water? Or possibly the thetans have an aversion to science?

If you think that the Purif, Narconon or any other form of alternative detox eliminates toxins, you might be mistaken. Most clients have lost some money, many have lost their ability to think straight, some may even have lost their lives. But there is no reliable evidence that they have actually lost any toxins.

END OF MY 2012 ARTICLE

In 2012, I found no evidence to suggest that NARCONON works. Now, I looked again and found this article reporting a non-randomised, controlled study:

“In 2004, Narconon International developed a multi-module, universal prevention curriculum for high school ages based on drug abuse etiology, program quality management data, prevention theory and best practices. We review the curriculum and its rationale and test its ability to change drug use behavior, perceptions of risk/benefits, and general knowledge. After informed parental consent, approximately 1000 Oklahoma and Hawai’i high school students completed a modified Center for Substance Abuse Prevention (CSAP) Participant Outcome Measures for Discretionary Programs survey at three testing points: baseline, one month later, and six month follow-up. Schools assigned to experimental conditions scheduled the Narconon curriculum between the baseline and one-month follow-up test; schools in control conditions received drug education after the six-month follow-up. Student responses were analyzed controlling for baseline differences using analysis of covariance. At six month follow-up, youths who received the Narconon drug education curriculum showed reduced drug use compared with controls across all drug categories tested. The strongest effects were seen in all tobacco products and cigarette frequency followed by marijuana. There were also significant reductions measured for alcohol and amphetamines. The program also produced changes in knowledge, attitudes and perception of risk. The eight-module Narconon curriculum has thorough grounding in substance abuse etiology and prevention theory. Incorporating several historically successful prevention strategies this curriculum reduced drug use among youths.”

The question arises: would I send anyone to the NARCONON programme?

My answer is NO!

Not because the trial is lousy (which it is) and not because the programme is too expensive (which it is); I would not send anyone to any institution that has even the slightest links to Scientology.

 

Currently, over 50 000 000 websites promote alternative medicine, and consumers are bombarded with information not just via the Internet, but also via newspapers, magazines and other sources. This has the potential of needlessly separating them from their cash or even seriously harming their health. As there is little that protects us from greedy entrepreneurs and over-enthusiastic therapists, we should think about protecting ourselves. Here I will provide five simple tips that may fortify you against fake news in the realm of alternative medicine.

Imagine you read somewhere that the condition you are affected by is curable (or at least improvable) by THERAPY XY. It is only natural that you are exited by this news. Before you now rush to the next health shop or alternative medicine centre, it is worth asking yourself the following questions:

  • Is the claim plausible? As a rule of thumb, it is fair to say that, if it sounds too good to be true, it probably is too good to be true. Not so long ago, UK newspapers reported that a herbal mixture called ‘CARCTOL’ had been discovered to be an efficacious and safe cancer cure (before that, it was Essiac, shark cartilage, Laetrile and many more). I only needed a minimal amount of research to find that the claim had no basis in fact. Come to think of it, it is not plausible that any alternative therapy will ever emerge as a miracle cure for any condition, particularly a serious disease like cancer. It is also not plausible that a herbal mixture would ever prove to be a cure for a wide range of different cancers. The very idea of such ‘cures’ is a contradiction in terms. If an alternative therapy ever did turn out to be efficacious, it would become mainstream even before the clinical tests to prove its efficacy are fully concluded. The notion of an alternative cure presumes that conventional scientists and clinicians reject a treatment simply because it originated from the realm of alternative medicine. There is no precedent that this has ever occurred, and I am sure it will never happen in future.
  • What is the evidence for the claim? In the case of CARCTOL, the claim was based on a UK doctor apparently observing that, in several patients, tumours had been melting like butter in the sun after they took this herbal mixture. One particularly irresponsible headline read: “I’ve seen herbal remedy make tumours disappear, says respected cancer doctor.” This, however, is no evidence but mere anecdotes, and we confuse the two at our peril. Remember: the plural of anecdote is anecdotes, not evidence. With anecdotes, we can never be sure about cause and effect. Therapeutic claims must be based on good evidence, e.g. controlled clinical trials.
  • Who is behind the claim? In the UK, the CARCTOL claim emerged around 2004 and originated mainly from Dr Rosy Daniel. In the above newspaper article, she was called ‘a respected cancer doctor’. Personally, I do NOT ‘respect’  someone who makes claims of this nature without having good evidence. And a ‘cancer doctor’ is usually understood to be an oncologist; to the best of my knowledge, Dr Daniel is NOT an oncologist. In fact, she now calls herself a ‘Lifestyle and Integrative Medicine Consultant’. Faced with an important new health claim, one should always check who is behind it. Check out whether this person is reputable and free of conflicts of interest. An affiliation to a reputable university is usually more convincing than being a director of your own private heath centre.
  • Where was the claim published? The CARCTOL story had been published in newspapers – and nowhere else! Even today, there is only one Medline-listed publication on the subject. It is my own review of the evidence which, in 2004, concluded that “The claim that Carctol is of any benefit to cancer patients is not supported by scientific evidence.”   *** If important new therapeutic claims like ‘therapy xy cures cancer’ are reported in the popular media, you should always check where they were first published (or simply dismiss it without researching it). It is unthinkable that such an important claim is not made first in a proper, peer-reviewed article in a good medical journal. Go on ‘Medline’, conduct a quick search and find out whether the new findings have been published. If the claim does not come from peer-reviewed journals, forget about it. If it has been published in any journal that has alternative, complementary, integrative or similar terms in its name, take it with a good pinch of salt.
  • Is there money involved? In the case of CARCTOL, the costs were high. I was called once by a woman who had read my article telling me that she was pursued by the doctor who had treated her husband. Tragically, the man had nevertheless died of his cancer, and the widow was now pursued for £8 000 which she understandably was reluctant to pay. Many new treatments are expensive. So, high costs are not necessarily suspicious. Still, I advise you to be extra cautious in situations where there is the potential for someone to make a fast buck. Financial exploitation is sadly rife in the realm of alternative medicine.

A similar checklist originates from a team of experts. Researchers from Uganda, Kenya, Rwanda, Norway, and England, worked to identify the most important ideas a person would need to grasp thinking critically about health claims. They came up with excellent points:

  1. Just because a treatment is popular or old does not mean it’s beneficial or safe.
  2. New, brand-name, or more expensive treatments may not be better than older ones.
  3. Treatments usually come with both harms and benefits.
  4. Beware of conflicts of interest — they can lead to misleading claims about treatments.
  5. Personal experiences, expert opinions, and anecdotes aren’t a reliable basis for assessing the effects of most treatments.
  6. Instead, health claims should be based on high-quality, randomized controlled trials.

Alternative medicine can easily turn into a jungle or even a nightmare. Before you fall for any dubious claim that THERAPY XY is good for you, please go through the simple sets of questions above. This might protect you from getting ripped off or – more importantly – from getting harmed.

 

*** After this article had been published, I received letters from layers threatening me with legal action unless I withdrew the paper. I decided to ignore them, and no legal action followed.

Since more than 20 years, I have been writing about the risks of alternative therapies. One of my first papers on this issue was published in 1995 and focussed on acupuncture. Here is its abstract:

The use of acupuncture is widespread. The procedure is often claimed to be totally, or at least reasonably, safe. The published evidence regarding its potential risks is reviewed. The repeated and/or inappropriate use of an acupuncture needle carries the risk of infections. Amongst others, AIDS and hepatitis have been transmitted. Acupuncture needles may also traumatise tissues and organs. Pneumothorax is the most frequent complication caused in this way. Finally, needles may break and fragments can be dislodged into distant organs. A serious and more general concern related to the safety of acupuncture is the competence of the therapist, whether or not medically qualified. The “philosophy” of acupuncture is not in line with orthodox diagnostic skills; therefore acupuncturists can be dangerously unconcerned with diagnostic categories. Thus indirect risks might add significantly to the direct risks of acupuncture. It is concluded that the true risk of acupuncture cannot be estimated. Whatever its extent, it could and probably should be lowered by enforcing educational and clinical standards.

My reason for banging on about the potential harms (direct and indirect risks) of alternative medicine is fairly obvious: I want to alert healthcare professionals and consumers to the fact that these treatments may not be as harmless as they are usually advertised to be. Yet, I have often be called an alarmist fear-monger. In my view, nothing could be further from the truth.

Thinking about fear-mongering, I began to ask myself whether those who regularly accuse me are the ones guilty of the deed. Are alternative practitioners fear-mongers? Surely not all of them, but some clearly are. Here are a few of the strategies they use for their fear-mongering.

NON-EXISTING DIAGNOSES

Perhaps the most obvious way to instil fear into people is to tell them that they are affected by a disease or condition they do not have. Many alternative practitioners do exactly that!

  • A chiropractor might tell you that you have a subluxation in your spine.
  • A naturopath would inform you that your body is full of toxins.
  • An acupuncturist will tell you that your life energy is blocked.
  • A homeopath might warn you that your vital force is too low.

These diagnoses have one thing in common: they do not exist. They are figments of the therapist’s imagination. And they have another thing in common: the abnormalities need to be corrected, and – surprise, surprise – the very therapy that the practitioner specialises in happens to be just the ticket for that purpose.

  • The chiropractor will tell you that a simple spinal adjustment will solve the problem.
  • The naturopath will inform you that a bit of detox will eliminate the toxins.
  • The acupuncturist will tell you that his needles will de-block your chi.
  • The homeopath will persuade you that he can find the exact remedy to revive your vital force.

And there we have the third thing these diagnoses have in common: they are all treatable, will all result in a nice bill, and will all improve the cash-flow of the therapist.

MEDICALIZING TRIVIALITIES

But often, it is not even necessary for an alternative therapist to completely invent a diagnosis. Patients usually consult an alternative practitioner with some sort of symptom – frequently with what one might call a medical triviality that does not need any treatment at all but can be dealt with differently, for instance, by issuing some life-style advice or just simple re-assurance that nothing major is amiss. But for the fear-monger, this is not enough. He feels the need to administer his therapy, and for that purpose he needs to medicalize trivialities :

  • A low mood thus becomes a clinical depression.
  • A sore back is turned into a nasty lumbago.
  • A tummy upset morphs into a dangerous gastritis.
  • Abdominal unrest is diagnosed to be a leaky gut syndrome.
  • A food aversion turns into a food intolerance, etc., etc.

The common denominator is again the fact that fear is instilled into the patient. And again, a useless therapy is administered, if at all possible in the form of a lengthy series of treatments. This, of course, generates significant benefit – not therapeutic, but financial!

DEMONIZING CONVENTIONAL MEDICINE

But there is always the risk that the patient is wiser than expected. She might be so scared learning of her condition that she decides to see her doctor. That would mean a loss of income which has to be avoided! The trick to achieve this is usually not difficult: conventional healthcare professionals must be demonized.

  • They are not treating the root cause of the problem.
  • They are in the pocket of BIG PHARMA.
  • They prescribe medicines with terrible side-effects.
  • They have no idea about holism.
  • They never have enough time to listen, etc., etc.

I know, some of these criticisms are not entirely incorrect (for instance, many conventional medicines do have serious side-effects but, as I try to point out ad nauseam, we need to consider their risk/benefit balance). But that is hardly the point here; the point is to scare the patient off conventional medicine. Only a person who is convinced that the ‘medical mafia’ is out to get her, will prove to be a loyal customer of all things alternative.

DISEASE PREVENTION

And a loyal customer is someone who comes not just once or twice but regularly, ideally from cradle to grave. The way to achieve this ultimate stimulus of the practitioners cash flow is to convince the patient that she needs regular treatments, even when she feels perfectly alright. The magic word here is PREVENTION! The masters here are the chiropractors, I guess; they promote what they call ‘maintenance care’, i.e. the regular treatment of healthy individuals to keep their spines subluxation-free. It goes without saying that maintenance care is a money-making scam.

The strategy requires two little lies, but that’s forgivable considering the good cause, boosting the income of the practitioner:

  1. Conventional doctors don’t do prevention.
  2. The alternative treatment is an effective preventative.

The first statement can be shown to be an obvious lie. All we know about effective disease prevention today comes from conventional medicine and science; nothing originates from the realm of alternative medicine. Remarkably, the most efficacious preventative measure of all times, immunisation, is frequently defamed and neglected by alternative practitioners.

The second statement is a necessary lie; how else would a patient agree to pay regularly for the practitioner’s services? I am not aware of any alternative therapy that can effectively prevent any disease.

CONCLUSIONS

  • Some alternative practitioners regularly instil fear into consumers.
  • Several strategies are being used for this purpose.
  • They have the aim of maximising the therapists’ income.
  • Fear-mongering is unethical and despicable.
  • Pointing out that a certain therapy might fail to generate more good than harm is not fear-mongering.

I am sure you always wanted to know what animal chiropractic is all about!

This website explains it quite well:

START OF QUOTES

…Animal chiropractic (veterinary spinal manipulative therapy) focuses on the preservation and health/wellness of the neuro-musculo-skeletal system. Chiropractic is the science that is centered around the relationship between the spine and the nervous system. The spine is your body’s foundation and the nervous system, including your brain, spinal cord and nerves, controls your entire body. They must work together harmoniously to improve one’s general health and their ability heal. If the systems are not functioning to their highest potential you may experience changes in digestion, heart and lung function, reproduction and most evidently musculature. When adjacent joints are in an abnormal position, called a subluxation, the nervous system and all that it controls will be negatively impacted. If these subluxations are not corrected, they can result in prolonged inappropriate stimulation of nerves. This could result in reduced function internally, musculo-skeletal dysfunction and pain.

Spinal manipulation is the art of restoring full and pain free range of motion to joints and can greatly benefit an animal after they have experienced subluxations. The veterinarian will use their hands to palpate joints both statically and in motion. By doing this, they can determine where the animal is experiencing decreased motion or misaligned joints. Once identified, an adjustment can be performed. An adjustment or spinal manipulation is a gentle, specific, quick and low force thrust that will be applied at an angle specific to the different areas of motion in the spine and extremities. Only a certified animal chiropractor will understand the complexity involved in adjustments and can best assess if an animal can benefit from chiropractic care.

Many animals can benefit from this alternative therapy. If you notice that your animal has a particularly sensitive spot somewhere on their body, is walking or trotting differently and or not performing to the same ability they have previously, they may be a candidate for a chiropractic assessment. However, an animal does not need to be sick or injured to benefit from chiropractic care. Animals in good health or ones used for sporting activities are also prime candidates for chiropractic care. By maintaining your pet’s proper spinal alignment and mobility they will attain optimal function of muscles, nerves and tissues that support the joints. When the body can move freely your pet will experience improved mobility, stance and flexibility, which can evolve into improved agility, endurance and overall performance. Finally, many people have never considered that chiropractic care can also benefit their animal by boosting their immune response. It can aid in providing a healthier metabolism and a vibrant nervous system which all facilitate your animal’s natural ability to heal themselves from within. Chiropractic care can enhance the quality of your pet’s life ensuring many active and healthy years to come.

…during veterinary school I began the process of researching how to become an animal chiropractor or veterinary spinal manipulative therapist. As I researched further, I noticed that this specialized profession has grown. It became apparent that one should be certified by either the College of Animal Chiropractors or American Veterinary Chiropractic Association to practice on animals…  It was surprising to find out that there are only four programs in the USA and Canada that are approved by both organizations. The courses consisted of over 200 hours of intensive study and hands on learning followed by certification testing…

END OF QUOTE

Yes, I did shorten the quote a bit but, rest assured, I did not cut out a single word about the efficacy of animal chiropractic. Even if I had wanted to, I couldn’t: there is no mention of it in the article.

I wonder why!

Looking into Medline, I found several reports related to the subject:

  • One study suggested an association between chiropractic findings in the lumbar vertebrae and urinary incontinence and retention in dogs.
  • A case report highlighted the potential benefits of combining traditional medical management with chiropractic treatment and physical therapy techniques for management of severe acute-onset torticollis in a giraffe.
  • A review explained that there is limited evidence supporting the effectiveness of spinal mobilization and manipulation in animals.
  • An observational study suggested that chiropractic manipulations elicit slight but significant changes in thoracolumbar and pelvic kinematics.
  • A comparative study measured the spinal mechanical nociceptive thresholds in 38 horses, and showed that they increased by 27, 12 and 8% in the chiropractic, massage and phenylbutazone groups, respectively.

… and that was basically it. Not a single study to suggest that chiropractic is effective for specific conditions of animals.

Frustrated, I went on the site of the ‘College of Animal Chiropractic’; surely there I would find the evidence I was looking for. They offer lots of platitudes and this largely nonsensical statement:

“When a joint become restricted in its range of motion(hypomobile or ‘locked-up’), through trauma, repetitive injury, degenerative changes, or structural stresses, the surrounding tissues are affected. This, in turn, further affects the joints ability to move freely and sensitive structures are activated causing the area to be sensitive or painful. Nerves are the communication links between all tissues in the body to the brain and spinal cord; when joint dysfunction is present, messages to other areas are also affected, which can lead to pain, weakness, reduced function, and compensatory changes. Animal chiropractic focuses on the restoration of movement and the promotion of heath by restoring normal joint mechanics and soft-tissue function, thus, normalizing neurological patterns that facilitate healing . The main tool an animal chiropractor uses to restore joint motion is called an “adjustment”, or veterinary spinal manipulation. This gentle, specialized, manual skill, involves the application of a quick, low-force maneuver that is directed to a specific area of a joint at a specific angle. A certified animal chiropractor understands these joint angles intimately and can best asses if an animal can benefit from chiropractic care, and, is the only professional who is qualified to adjust your pet.”

But no evidence!

By now I was desperate. My last hope was the ‘American Veterinary Chiropractic Association’. All I found there, however, was this: the “American Veterinary Chiropractic Association (AVCA) is a professional membership group promoting animal chiropractic to professionals and the public, and acting as the certifying agency for doctors who have undergone post-graduate animal chiropractic training.”

Not a jot of evidence!

The assumption that animal chiropractic is effective seems to rely on the evidence from human studies…

… and we all know how solid that body of evidence is!

My conclusion from all this: chiropractors treating animals and those treating humans have one important characteristic in common.

THEY HAPPILY PROMOTE BOGUS TREATMENTS.

How often have I pointed out that most studies of chiropractic (and other alternative therapies) are overtly unethical because they fail to report adverse events? And if you think this is merely my opinion, you are mistaken. This new analysis by a team of chiropractors aimed to describe the extent of adverse events reporting in published RCTs of Spinal Manipulative Therapy (SMT), and to determine whether the quality of reporting has improved since publication of the 2010 Consolidated Standards Of Reporting Trials (CONSORT) statement.

The Physiotherapy Evidence Database and the Cochrane Central Register of Controlled Trials were searched for RCTs involving SMT. Domains of interest included classifications of adverse events, completeness of adverse events reporting, nomenclature used to describe the events, methodological quality of the study, and details of the publishing journal. Data were analysed using descriptive statistics. Frequencies and proportions of trials reporting on each of the specified domains above were calculated. Differences in proportions between pre- and post-CONSORT trials were calculated with 95% confidence intervals using standard methods, and statistical comparisons were analysed using tests for equality of proportions with continuity correction.

Of 7,398 records identified in the electronic searches, 368 articles were eligible for inclusion in this review. Adverse events were reported in 140 (38.0%) articles. There was a significant increase in the reporting of adverse events post-CONSORT (p=.001). There were two major adverse events reported (0.3%). Only 22 articles (15.7%) reported on adverse events in the abstract. There were no differences in reporting of adverse events post-CONSORT for any of the chosen parameters.

The authors concluded that although there has been an increase in reporting adverse events since the introduction of the 2010 CONSORT guidelines, the current level should be seen as inadequate and unacceptable. We recommend that authors adhere to the CONSORT statement when reporting adverse events associated with RCTs that involve SMT.

We conducted a very similar analysis back in 2012. Specifically, we evaluated all 60 RCTs of chiropractic SMT published between 2000 and 2011 and found that 29 of them did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred (which I find hard to believe since reliable data show that about 50% of patients experience adverse effects after consulting a chiropractor). Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors. Our conclusion was that adverse effects are poorly reported in recent RCTs of chiropractic manipulations.

The new paper suggests that the situation has improved a little, yet it is still wholly unacceptable. To conduct a clinical trial and fail to mention adverse effects is not, as the authors of the new article suggest, against current guidelines; it is a clear and flagrant violation of medical ethics. I blame the authors of such papers, the reviewers and the journal editors for behaving dishonourably and urge them to get their act together.

The effects of such non-reporting are obvious: anyone looking at the evidence (for instance via systematic reviews) will get a false-positive impression of the safety of SMT. Consequently, chiropractors are able to claim that very few adverse effects have been reported in the literature, therefore our hallmark therapy SMT is demonstrably safe. Those who claim otherwise are quite simply alarmist.

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