MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

gullible consumer

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This is a question most clinicians must have asked themselves. The interest of patients in this area is enormous, and many do seek advice from their doctor, nurse, pharmacist, midwife etc. In a typical scenario, a patient might plug up her courage (yes, for many it does take courage) and ask:

What about therapy xy for my condition? My friend suffers from the same problem, and she says the treatment works very well.

The way I see it, there are essentially 4 options for formulating a reply:

1.       Uncompromisingly negative

2.       Evidence-based

3.       Open-minded

4.       Uncritically promotional

Let me explain and address these 4 options in turn.

1.       Uncompromisingly negative

I know that it can be tempting to be wholly dismissive and simply state that all alternative medicine is rubbish; if it were any good, it would have been adopted by conventional medicine. Therefore, alternative medicine is never an alternative; it is by definition implausible, ineffective and often dangerous.

Even if all of this were true, the uncompromisingly negative approach is not helpful, in my experience. Patients need and deserve some empathy and understanding of their position. If we brusque them, they feel insulted and go elsewhere. Not only would we then lose a patient, but we would run a high risk of exposing her to a practitioner who promotes quackery. The disservice seems obvious.

2.       Evidence-based

Clinicians might consider their patient’s question and reply to it by explaining what the current best available evidence tells us about the therapy in question. This can be done with empathy and compassion. For instance (if that is true), the clinician can explain that the treatment in question lacks a scientific basis, that it has nevertheless been tested in clinical trials which sadly do not show that it works. Crucially, the clinician should subsequently explain what effective treatments do exist and discuss a viable treatment plan with the patient.

The problem with this approach is that many, if not most conventional clinicians are fairly clueless about the evidence as it relates to the plethora of alternative therapies. Therefore, an honest discussion around the current best evidence is often difficult or impossible.

3.       Open-minded

This is the approach many clinicians today use as a default position. They basically tell their patient that there is not a lot of evidence for the treatment in question. However, it seems harmless, and therefore – if the patient is really keen on going down this route – why not? This type of response is, I fear, given regardless of the therapy in question and it largely ignores the evidence – some alternative treatments do work, some don’t, some are fairly safe, some aren’t.

Condoning alternative medicine in this way gives the impression of being ‘open-minded’ and ‘patient-centred’. It has the considerable advantage that it does not require any hard work, such as informing oneself about the current best evidence. It’s disadvantage is that it neither correct nor ethical.

4.       Uncritically promotional

Many clinicians go even one decisive step further. Under the banner of ‘integrative medicine’, they openly recommend using ‘the best of both worlds’ as being ‘holistic’, ’empathetic’, ‘patient-centred’, etc. By this, they usually mean employing as many unproven or disproven treatments as alternative medicine has to offer.

This approach gives the impression of being ‘modern’ and in tune with the wishes of patients. Its disadvantages are, however, obvious. Introducing bogus treatments into clinical routine can only render it less effective, more expensive, and less safe. Integrative medicine is therefore not in the best interest of patients and arguably unethical.

Conclusion

So, how should we advise patients on alternative medicine? I know what I would say and probably most of my readers can guess. But I do not want to prejudge the issue; I prefer to hear your views, please.

A cognitive bias known as the Dunning-Kruger Effect has, I think, considerable relevance in alternative medicine. The effect means that, the less you know, the less able you are to recognize how little you know, and the less likely you are to recognize your limitations. Consequently, your confidence in yourself is inflated and you believe you are more competent than your opponent. Expressed differently:

  • Incompetence prevents the recognition of incompetence.
  • Too stupid to doubt.

Even though the phenomenon of illusory superiority is today attributed to David Dunning and Justin Kruger, many others before them have alluded to the phenomenon:

Image result for dunning kruger effect

The relevance of the Dunning Kruger Effect to alternative medicine seems obvious, I think. Here we are confronted with all sorts of practitioners who believe they know it all, can treat any condition, alleviate the ‘root cause’ of all ills, etc., etc. Many of my previous posts on this blog have dealt with aspects of this problem. And with unfailing regularity, the discussions brought some individuals badly affected by the Dunning-Kruger Effect to the fore. Typically, they go on and on and on… consumed by their inflated confidence and trapped by their incompetence to realise their incompetence. And typically, they find an audience who is gullible enough to applaud them.

They often remind me of a cartoon I once saw:

The little graph below explains it all quite neatly:

Image result for dunning kruger effect

The novice lacks knowledge but, as he acquires a modicum of (pseudo-)knowledge, he gets a boost of confidence. An experienced person has enough knowledge to know that he knows very little; therefore his confidence is relatively low. When experience and knowledge combine to become wisdom, confidence grows and we might be talking to a real expert. Oddly, in terms of confidence, the novice can score higher than even the wisest expert.

To some extent, this simple graph even explains the popularity of many forms of quackery: they are being promoted by people who know very little but are bursting with confidence. And it is this high level of confidence that tends to impress the gullible public who then eagerly adopt the quackery.

Where the graph is somewhat misleading, I think, is where it might give the impression that there is an automatic and necessary transition from novice to expert (from left to right on the X-axis). In many individuals, this development does occur but, sadly, in many others it does not. The evangelical believers in alternative medicine, I fear, usually belong to the latter, sad category.

If I am correct, the Dunning Kruger Effect can therefore partly explain 1) the inflated confidence of proponents of alternative medicine, as well as 2) the current popularity of quackery.

We should not have to repeat this! But, as it is currently topical and certainly true, let me tell you again:

DETOX IS BUNK!

After the season of gluttony, it seems that half the population has fallen victim to the legion of alternative practitioners and entrepreneurs who claim that their particular form of quackery is ideally suited for detoxifying the body – and, sure enough, rid their clients of money instead of poisons. I have pointed out again and again why detox, as promoted in alternative medicine. is bogus and occasionally even harmful – see for instance here, here and here. And years ago, I published a review of the evidence on ‘alternative detox’ (AD); it concluded that “the principles of AD make no sense from a scientific perspective and there is no clinical evidence to support them. The promotion of AD treatments provides income for some entrepreneurs but has the potential to cause harm to patients and consumers. In alternative medicine, simplistic but incorrect concepts such as AD abound. All therapeutic claims should be scientifically tested before being advertised-and AD cannot be an exception.”

But I have, of course, many readers who do not trust a word I am putting on paper. So, please don’t take it from me, take it from others; read for example this recent article: 

Detox diets are popular dieting strategies that claim to facilitate toxin elimination and weight loss, thereby promoting health and well-being. The present review examines whether detox diets are necessary, what they involve, whether they are effective and whether they present any dangers. Although the detox industry is booming, there is very little clinical evidence to support the use of these diets. A handful of clinical studies have shown that commercial detox diets enhance liver detoxification and eliminate persistent organic pollutants from the body, although these studies are hampered by flawed methodologies and small sample sizes. There is preliminary evidence to suggest that certain foods such as coriander, nori and olestra have detoxification properties, although the majority of these studies have been performed in animals. To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans. This is an area that deserves attention so that consumers can be informed of the potential benefits and risks of detox programmes.

To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans. I think that says enough; and it applies not just to detox diets, it applies to all detox methods promoted in alternative medicine.

DETOX IS BUNK!

Save your hard-earned money for stuff that is proven to work.

Electrohomeopathy is a version of homeopathy few people know about. Allow me to explain:

Cesare Mattei (1809–1896), an Italian count, was interested in homeopathy. Mattei believed that fermented plants gave off ‘electrical’ energy that could be used to cure illness. He also believed that every illness had a cure provided in the vegetable kingdom by God. He began to develop his system from 1849. The large bottles are labelled ”Red”, ”Green”, “White”, “Yellow” and “Blue” so the actual ingredients remained a secret. Ointments were made up with ingredients from the small and large bottles. The vial labelled “Canceroso 5” was used for bruises, cancers, chilblains, hair loss, skin diseases and varicose veins, among other conditions. Although dismissed by the medical profession as quackery, Mattei’s system was popular. It formed part of the treatment at St Saviour’s Cancer Hospital in London from 1873.

Wikipedia offers more informing us that:

“… Mattei, a nobleman living in a castle in the vicinity of Bologna studied natural science, anatomy, physiology, pathology, chemistry and botany. He ultimately focused on the supposed therapeutic power of “electricity” in botanical extracts. Mattei made bold, unsupported claims for the efficacy of his treatments, including the claim that his treatments offered a nonsurgical alternative to cancer. His treatment regimens were met with scepticism by mainstream medicine:

The electrohomeopathic system is an invention of Count Mattei who prates of “red”, “blue”, and “green” electricity, a theory that, in spite of its utter idiocy, has attracted a considerable following and earned a large fortune for its chief promoter.

Notwithstanding criticisms, including a challenge by the British medical establishment to the claimed success of his cancer treatments,  electrohomeopathy (or Matteism, as it was sometimes known at the time) had adherents in Germany, France, the USA and the UK by the beginning of the 20th century; electrohomeopathy had been the subject of approximately 100 publications and there were three journals dedicated to it.

Remedies are derived from what are said to be the active micro nutrients or mineral salts of certain plants. One contemporary account of the process of producing electrohomeopathic remedies was as follows:

As to the nature of his remedies we learn … that … they are manufactured from certain herbs, and that the directions for the preparation of the necessary dilutions are given in the ordinary jargon of homeopathy. The globules and liquids, however, are “instinct with a potent, vital, electrical force, which enables them to work wonders”. This process of “fixing the electrical principle” is carried on in the secret central chamber of a Neo-Moorish castle which Count Mattei has built for himself in the Bolognese Apennines… The “red electricity” and “white electricity” supposed to be “fixed” in these “vegetable compounds” are in their very nomenclature and suggestion poor and miserable fictions.

According to Mattei’s own ideas however, every disease originates in the change of blood or of the lymphatic system or both, and remedies can therefore be mainly divided into two broad categories to be used in response to the dominant affected system. Mattei wrote that having obtained plant extracts, he was “able to determine in the liquid vegetable electricity”. Allied to his theories and therapies were elements of Chinese medicine, of medical humours, of apparent Brownianism, as well as modified versions of Samuel Hahnemann‘s homeopathic principles. Electrohomeopathy has some associations with Spagyric medicine, a holistic medical philosophy claimed to be the practical application of alchemy in medical treatment, so that the principle of modern electrohomeopathy is that disease is typically multi-organic in cause or effect and therefore requires holistic treatment that is at once both complex and natural.”

END OF QUOTE

If one would assume that electrohomeopathy is nothing more than a bizarre and long-forgotten chapter in the colourful history of homeopathy, one would be mistaken; it is still used and promoted by enthusiasts who continue to make bold claims. This article, for instance, informs us that:

  • Electro Homeopathic remedies tone up the brain and the nerves through which overall body processes are controlled and strengthen the digestion process.
  • The tablets provide food for the red blood cells and provide nourishment for the white corpuscles of the lymph and the blood.
  • They provide the useful elements to the plasma of the blood and provide required nutrients for the cells of which tissues are made.
  • They enhance the eviction through the skin and other modes and unnecessary substances which disturb the function and health of the body.
  • They cure the diseases and are helpful to the patients who use them.
  • They are curative as well as palliatives.
  • They are helpful in curing the serious diseases whether it is acute or chronic, non-surgical or surgical, for women, men, and children. They provide 100 percent cure.
  • They cure diseases such as tuberculosis, cancer, fistula, and cancer. They can cure these diseases without operation.
  • They cure all type of infectious diseases with certainty and are also helpful in prophylactics in the epidemics.

This article also provides even more specific claims:

Here are the 5 best Electro Homeopathic medicines for curing kidney stones –

  • Berberis Vulgaris – is the best medicine for left-sided kidney stones
  • Cantharis Vesicatoria– is one of the best medicine for kidney stones with burning in urine
  • Lycopodium – is the best remedy for right-sided kidney stones
  • Sarsaparilla – is the best medicine for kidney stones with white sand in urine
  • Benzoic Acid – is best homeopathic medicine for renal calculi…

The aforesaid homeopathic medicines for kidney stones have been found to be very effective in getting these stones out of the system. It does not mean that only these medicines are used.

What all of this highlights yet again is this, I think:

  • There are many seriously deluded people out there who are totally ignorant of medicine, healthcare and science.
  • To a desperate patient, these quacks can seem reasonable in their pretence of medical competence.
  • Loons make very specific health claims (even about very serious conditions), thus endangering the lives of the many gullible people who believe them.
  • Even though this has been known and well-documented for many years, t here seems to be nobody stopping the deluded pretenders in their tracks; the public therefore remains largely unprotected from their fraudulent and harmful acts.
  • In particular, the allegedly more reasonable end of the ‘alt med community’ does nothing to limit the harm done by such charlatans – on the contrary, whether knowingly or not, groups such as doctors of ‘integrative medicine’ lend significant support to them.

Placentophagy is the act of eating the placenta after childbirth. It seems to be advocated widely. But why would anyone even think of doing such a weird thing?

According to Wikipedia, the placenta contains high levels of prostaglandin. Prostaglandin stimulates involution (an inward curvature or penetration, or, a shrinking or return to a former size) of the uterus. The placenta also contains small amounts of oxytocin which eases birth stress and causes the smooth muscles around the mammary cells to contract and eject milk.

Wiki also tells us that human placenta has also been an ingredient in some traditional Chinese medicines, including using dried human placenta, known as “Ziheche” (simplified Chinese: 紫河车; traditional Chinese: 紫河車; pinyin: Zǐhéchē), to treat wasting diseases, infertility, impotence and other conditions. Most recently, the Center for Disease Control published a report of a newborn infected with Group B Streptococcus (GBS) bacteria likely after the mother ingested placenta capsules. Consequently, the CDC said that placenta capsule ingestion should be avoided and to educate mothers interested in placenta encapsulation about the potential risks. A recent publication advised that physicians should discourage placentophagy because it is potentially harmful with no documented benefit.

The benefits of placentophagy are, according to many proponents of this therapy, considerable. This website, for instance, claims the following effects:

START OF QUOTE

BALANCE HORMONES
When  a woman births the placenta, she loses the many useful hormones contained in it that were produced during pregnancy.  It can take months for the body to balance these hormones again. Taking placenta pills helps reintroduce these hormones into the mother’s body  in small doses, until her body resumes its natural hormonal balance.

DECREASE THE INCIDENCE OF POSTPARTUM DEPRESSION
Iron-deficiency in postpartum women can lead to fatigue, and may be a contributing factor to depressive symptoms. The placenta is extremely rich in natural iron and can be a valuable and natural resource to replenish the mother’s lost iron supply.  It is also rich in naturally-produced B6 which is often used to combat depression.  Many mothers find the combination of these substances in placenta encapsulation to be helpful in improving their post-birth emotional experience.

INCREASE ENERGY & FACILITATE FASTER HEALING
The placenta contains hormones and nutrients that have been found to increase energy and promote healing.  It is also rich in naturally-produced iron and protein, which can help replenish the mother’s nutrients following childbirth.

LESSEN POSTPARTUM BLEEDING
Historically, midwives have utilized a small portion of the placenta to control postpartum bleeding during and after childbirth.  Placenta pills contain these same hormones and can lessen bleeding and help promote uterine healing.

PROMOTE HEALTHY BREAST MILK PRODUCTION
The  placenta contains Human Placental Lactogen and Prolactin, which help prepare the mammary glands and stimulate milk production.  These are often beneficial in successful breastfeeding of a new infant.

END OF QUOTE

As we all know, bogus claims abound in alternative medicine; the question, as always is: are they true?

There have been no studies of whether placentophagy provides hormonal effects in humans, Wiki claims. But this last statement is no longer true. The first human trial of placentophagy has just been published. The objective of this study was to investigate whether salivary hormone concentrations of women ingesting their own encapsulated placenta during the early postpartum differed from those of women consuming a placebo.

Randomly assigned participants (N=27) were given a supplement containing either their dehydrated and homogenized placenta (n=12), or placebo (n=15). Saliva samples were collected during late pregnancy and early postpartum. Samples of participants’ processed placenta, and the encapsulated placebo, were also collected. Hormone analyses were conducted on all samples utilizing liquid chromatography-tandem mass spectrometry.

The results show that there were no significant differences in salivary hormone concentrations between the placenta and placebo groups post-supplementation that did not exist pre-supplementation. There were, however, significant dose-response relationships between the concentration of all 15 detected hormones in the placenta capsules and corresponding salivary hormone measures in placenta group participants not seen in the placebo group. The higher salivary concentrations of these hormones in the placenta group reflects the higher concentrations of these hormones in the placenta supplements, compared to the placebo.

In a second paper on the same trial, the authors assessed the maternal mood, bonding, and fatigue via validated scales across 4 time points during late pregnancy and early postpartum.

The results show no significant main effects related to maternal mood, bonding, or fatigue between placenta and placebo group participants. However, examination of individual time points suggested that some measures had specific time-related differences between placenta and placebo groups that may warrant future exploration. Though statistical significance should not be interpreted in these cases, the authors did find some evidence of a decrease in depressive symptoms within the placenta group but not the placebo group, and reduced fatigue in placenta group participants at the end of the study compared to the placebo group.

The authors concluded that no robust differences in postpartum maternal mood, bonding, or fatigue were detected between the placenta and placebo groups. This finding may be especially important for women considering maternal placentophagy as a ‘natural’ (i.e., non-pharmacological) means of preventing or treating blues/depression. Given the study limitations, these findings should be interpreted as preliminary. Small, time-related improvements in maternal mood and lower fatigue post-supplementation among placenta group participants may warrant further research.

Will this largely negative evidence stop enthusiasts of placentophagy making therapeutic claims?

I very much doubt it!

 

The British press recently reported that a retired bank manager (John Lawler, aged 80) died after visiting a chiropractor in York. This tragic case was published in multiple articles, most recently in THE SUN. Personally, I find this regrettable – not the fact that the press warns consumers of chiropractic, but the tone and content of the articles.

Let me explain this by citing the one in THE SUN of today. Here is the critical bit that concerns me:

Ezvard Ernst, Emeritus Professor of Complementary Medicine at Exeter University, published a study showing at least 26 people had died as a result. He said: “The evidence is not in favour of chiropractic treatments. Nobody knows how many have suffered severe complications or died.” Edvard Ernst, Professor of Complementary Medicine, says many have suffered complications or died from chiropractors treatments… A study from Exeter University shows at least 26 people have died as a result of treatment.

And what is wrong with this?

The answer is lots:

  • My first name is consistently misspelled (a triviality, I agree).
  • I am once named as Emeritus Professor and once as Professor of Complementary Medicine. The latter is wrong (another triviality, perhaps, but some of my more demented critics have regularly accused me of carrying wrong titles)
  • The mention of 26 deaths after chiropractic treatments is problematic and arguably misleading (see below).
  • Our ‘study’ was not a study but a systematic review (another triviality?).

Now you probably think I am being pedantic, but I feel that the article is regrettable not so much by what it says but by what it fails to say. To understand this better, I will below copy my emails to the journalist who asked for help in researching this article.

  • My email of 17/10 answering all 7 of the journalist’s specific questions:
  • 1. Why are you sceptical of chiropractic?
  • I have researched the subject for more than 2 decades, and I know that the evidence is not in favour of chiropractic
  • 2. How many people do you believe have died in Britain as a result of being treated by a chiropractor? If it’s not possible to say, can you estimate?
  • nobody knows how many patients have suffered severe complications or deaths. there is no system to monitor such events that is comparable to the post-marketing surveillance of conventional medicine. we did some research and found that the under-reporting of cases of severe complications was close to 100% in the UK.
  • 3. What is so dangerous about chiropractic? Is there a particular physical treatment than endangers life?
  • manipulations that involve rotation and over-extension of the upper spine can lead to a vertebral artery breaking up. this causes a stroke which sometimes is fatal.
  • 4. Is the industry well regulated?
  • UK chiropractors are regulated by the General Chiropractic Council. it is debatable whether they are fit for purpose (see here:http://edzardernst.com/2015/02/the-uk-general-chiropractic-council-fit-for-purpose/)
  • 5. Should we be suspicious of claims that chiropractic can cure things like IBS and autism?
  • such claims are not based on good evidence and therefore misleading and unethical. sadly, however, they are prevalent.
  • 6. Who trains chiropractors?
  • there are numerous colleges that specialise in that activity.
  • 7. Is it true Prince Charles is to blame for the rise in popularity/prominence of chiropractic?
  • I am not sure. certainly he has been promoting all sorts of unproven treatments for decades.
  • My email of 18/10 answering 3 further specific questions
  • 1. Would you actively discourage anyone from being treated by a chiropractor?
    yes, anyone I feel responsible for
    2. Are older people particularly at risk or could one wrong move affect anyone?
    older people are at higher risk of bone fractures and might also have more brittle arteries prone to dissection
    3. If someone has, say, a bad back or stiff neck what treatment would you recommend instead of chiropractic?
    I realise every case is different, but you are sceptical of all complementary treatments (as I understand it) so what would you suggest instead?
    I would normally consider therapeutic exercises and recommend seeing a good physio.
  • 3. My email of 23/10 replying to his request for specific UK cases
  • the only thing I can offer is this 2001 paper
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297923/
  • where we discovered 35 cases seen by UK neurologists within the preceding year. the truly amazing finding here was that NONE of them had been reported anywhere before. this means under-reporting was exactly 100%.

END OF QUOTES
I think that makes it quite obvious that much relevant information never made it into the final article. I also know that several other experts provided even more information than I did which never appeared.

The most important issues, I think, are firstly the lack of a monitoring system for adverse events, secondly the level of under-reporting and thirdly the 50% rate of mild to moderate adverse-effects. Without making these issues amply clear, lay readers cannot possibly make any sense of the 26 deaths. More importantly, chiropractors will now be able to respond by claiming: 26 deaths compare very favourably with the millions of fatalities caused by conventional medicine. In the end, the message that will remain in the heads of many consumers is this: CONVENTIONAL MEDICINE IS MUCH MORE DANGEROUS THAN CHIROPRACTIC!!! (The 1st comment making this erroneous point has already been published: Don’t be stupid Andy. You wanna discuss how many deaths occur due to medication side effects and drug interactions? There is a reason chiros have the lowest malpractice rates.)

Don’t get me wrong, I am not accusing the author of the SUN-article. For all I know, he has filed a very thoughtful and complete piece. It might have been shortened by the editor who may also have been the one adding the picture of the US starlet with her silicone boobs. But I am accusing THE SUN of missing a chance to publish something that might have had the chance of being a meaningful contribution to public health.

Perhaps you still think this is all quite trivial. Yet, after having experienced this sort of thing dozens, if not hundreds of times, I disagree.

I have often remarked on the fact that, in alternative medicine, more surveys get published than in any other medical field. Typically these surveys are not just useless but overtly counter-productive:

  • they tend to be of very poor quality;
  • their results are not generalizable and thus meaningless;
  • they show that a sizable proportion of the population uses alternative therapies, pay out of their own pocket for them, and are satisfied with them;
  • the authors then state that it must be unfair that only the affluent can benefit from alternative medicine;
  • eventually, the conclusion is reached that alternative medicine should be paid for by the healthcare system and be free for all at the point of usage.

Therefore, I find that it is a waste of time to even read surveys of alternative medicine usage. But every now and then, one does come along that is worth discussing – like this one, for instance.

The survey evaluated dietary supplements (DS) usage by US adults aged ≥60 y to characterize the use of DSs, determine the motivations for use, and examine the associations between the use of DSs and selected demographic, lifestyle, and health characteristics. Data from 3469 older adults aged ≥60 y from the 2011-2014 NHANES were analyzed. DSs used in the past 30 d were ascertained via an interviewer-administered questionnaire in participants’ homes. The prevalence of overall DS use and specific types of DSs were estimated. The number of DSs reported and the frequency, duration, and motivation(s) for use were assessed. Logistic regression models were constructed to examine the association between DS use and selected characteristics.

Seventy percent of older adults reported using ≥1 DS in the past 30 d; 54% of users took 1 or 2 products, and 29% reported taking ≥4 products. The most frequently reported products were multivitamin or mineral (MVM) (39%), vitamin D only (26%), and omega-3 fatty acids (22%). Women used DSs almost twice as often as men. Those not reporting prescription medications were less likely to take a DS than those reporting ≥3 prescription medications. The most frequently reported motivation for DS use was to improve overall health (41%).

The authors concluded that the use of DSs among older adults continues to be high in the United States, with 29% of users regularly taking ≥4 DSs, and there is a high concurrent usage of them with prescription medications.

I find these data impressive – but not in a positive sense, I hasten to add.

The level of DS use in the US is staggering. Considering that 90% (my estimate) of the supplements are completely useless, the amount of money that is being wasted is huge. Even more concerning is the frequency of drug interactions that are being provoked by DS-intake.

And what’s the solution?

Obviously, it is better information for consumers (which is easier said than done – but I am trying my best!).

We have repeatedly discussed on this blog the fact that many alternative practitioners are advising their patients against vaccinations, e. g.:

There is little doubt that this phenomenon contributes to low immunisation rates. This, in turn, is a contributing factor to outbreaks of measles and other infectious diseases. The website of the European Centre for Disease Prevention and Control has recently published data on measles outbreaks in Europe:

Bulgaria: There is an increase by three cases since 21 July 2017. Since the beginning of 2017 and as of 16 July, Bulgaria reported 166 cases. During the same time period in 2016 Bulgaria reported one case.

France: On 27 July 2017 media quoting the French Minister of Health reported the death of a 16-year-old unvaccinated girl. She had fallen sick in Nice and died on 27 June 2017 in Marseille.

Germany: There is an increase by four cases since the last report on 21 July 2017. Since the beginning of 2017 and as of 26 July, Germany reported 801 cases. During the same time period in 2016 Germany reported 187 cases.

Italy: There is an increase by 170 cases since 21 July 2017. Since the beginning of 2017 and as of 25 July, Italy reported 3 842 cases, including three deaths. Among the cases, 271 are healthcare workers. The median age is 27 years, 89% of the cases were not vaccinated and 6% received only one dose of vaccine.

Romania: There is an increase by 229 cases, including one additional death, since 21 July 2017. Since 1 January 2016 and as of 21 July 2017, Romania reported 8 246 cases, including 32 deaths. Cases are either laboratory-confirmed or have an epidemiological link to a laboratory-confirmed case. Infants and young children are the most affected groups. Timis, in the western part of the country closest to the border with Serbia, is the most affected district with 1 215 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage.

Spain: There is an increase by seven cases since 14 July 2017. Since the beginning of 2017 and as of 25 July, Spain reported 145  measles cases.

United Kingdom: Public Health Wales reported two additional cases related to the outbreak in Newport and Torfaen, bringing the total to ten cases related to this outbreak. In England and Wales there is an increase by 76 cases since 21 July 2017. Since the beginning of 2017 and as of 23 July 2017, England and Wales reported 922 cases. In the same time period in 2016, they reported 946 cases.

In addition to the updates listed above ECDC produces a monthly measles and rubella monitoring report with surveillance data provided by the member states through TESSy. The last report was published on 11 July 2017 with data up to 31 May 2017.

Measles outbreaks continue to occur in EU/EEA countries. There is a risk of spread and sustained transmission in areas with susceptible populations. The national vaccination coverage remains less than 95% for the second dose of MMR in the majority of EU/EEA countries. The progress towards elimination of measles in the WHO European Region is assessed by the European Regional Verification Commission for Measles and Rubella Elimination (RVC). Member States of the WHO European Region are making steady progress towards the elimination of measles. At the fifth meeting of the RVC for Measles and Rubella in October 2016, of 53 countries in the WHO European Region, 24 (15 of which are in the EU/EEA) were declared to have reached the elimination goal for measles, and 13 countries (nine in the EU/EEA) were deemed to have interrupted endemic transmission for between 12 and 36 months, meaning they are on their way to achieving the elimination goal. However, six EU/EEA countries were judged to still have endemic transmission: Belgium, France, Germany, Italy, Poland and Romania. More information on strain sequences would allow further insight into the epidemiological investigation.

All EU/EEA countries report measles cases on a monthly basis to ECDC and these data are published every month. Since 10 March 2017, ECDC has been reporting measles outbreaks in Europe on a weekly basis and monitoring worldwide outbreaks on a monthly basis through epidemic intelligence activities. ECDC published a rapid risk assessment on 6 March.

END OF QUOTE

Personally, I believe that it is high time to stop the rhetoric and actions of the anti-vaccination movements. This includes educating alternative practitioners and their patients. If necessary, we need regulation that prohibits their dangerous and unethical activities.

An article by Rabbi Yair Hoffman for the Five Towns Jewish Times caught my eye. Here are a few excerpts:

“I am sorry, Mrs. Ploni, but the muscle testing we performed on you indicates that your compatibility with your spouse is a 1 out of a possible 10 on the scale.”

“Your son being around his father is bad for his energy levels. You should seek to minimize it.”

“Your husband was born normal, but something happened to his energy levels on account of the vaccinations he received as a child. It is not really his fault, but he is not good for you.”

Welcome to the world of Applied Kinesiology (AK) or health Kinesiology… Incredibly, there are people who now base most of their life decisions on something called “muscle testing.” Practitioners believe or state that the body’s energy levels can reveal remarkable information, from when a bride should get married to whether the next Kinesiology appointment should be in one week or two weeks. Prices for a 45 minute appointment can range from $125 to $250 a session. One doctor who is familiar with people who engage in such pursuits remarked, “You have no idea how many inroads this craziness has made in our community.”

… AK (applied kinesiology) is system that evaluates structural, chemical, and mental aspects of health by using “manual muscle testing (MMT)” along with other conventional diagnostic methods. The belief of AK adherents is that every organ dysfunction is accompanied by a weakness in a specific corresponding muscle… Treatments include joint manipulation and mobilization, myofascial, cranial and meridian therapies, clinical nutrition, and dietary counselling. A manual muscle test is conducted by having the patient resist using the target muscle or muscle group while the practitioner applies force the other way. A smooth response is called a “strong muscle” and a response that was not appropriate is called a “weak response.” Like some Ouiji board out of the 1970’s, Applied Kinesiology is used to ask “Yes or No” questions about issues ranging from what type of Parnassa courses one should be taking, to what Torah music tapes one should listen to, to whether a therapist is worthwhile to see or not.

“They take everything with such seriousness – they look at it as if it is Torah from Sinai,” remarked one person familiar with such patients. One spouse of an AK patient was shocked to hear that a diagnosis was made concerning himself through the muscle testing of his wife – without the practitioner having ever met him… And the lines at the office of the AK practitioner are long. One husband holds a crying baby for three hours, while his wife attends a 45 minute session. Why so long? The AK practitioner let other patients ahead – because of emergency needs…

END OF EXCERPTS

The article  is a reminder how much nonsense happens in the name of alternative medicine. AK is one of the modalities that is exemplary:

  • it is utterly implausible;
  • there is no good evidence that it works.

The only systematic review of AK was published in 2008 by a team known to be strongly in favour of alternative medicine. It included 22 relevant studies. Their methodology was poor. The authors concluded that there is insufficient evidence for diagnostic accuracy within kinesiology, the validity of muscle response and the effectiveness of kinesiology for any condition. 

Some AK fans might now say: absence of evidence is not evidence of absence!!! There is no evidence that AK does not work, and therefore we should give it the benefit of the doubt and use it.

This, of course, is absolute BS! Firstly, the onus is on those who claim that AK works to prove their assumption. Secondly, in responsible healthcare, we are obliged to employ those modalities for which the evidence is positive, while avoiding those for which the evidence fails to be positive.

 

Isn’t it wonderful when your long-held views are confirmed by someone with influence?

This, of course, is a rhetorical question – I can tell you: it is wonderful!

Matthew Stanbrook, MD PhD recently published an editorial in CMAJ which I find delightful; let me present you a few quotes from it:

The multibillion-dollar market for “natural” health products has flourished under lax government regulations. These regulations have enabled manufacturers to exploit the public’s difficulty in distinguishing nonprescription drugs, with scientifically proven therapeutic benefits, from herbal or homeopathic preparations and supplements that often make similar health claims with little or no evidence and are frequently grounded in unscientific belief systems about health and disease…

In pharmacies, supermarkets and convenience stores, natural health products are displayed side by side with nonprescription drugs. Both tout their approval by Health Canada as an implicit endorsement of efficacy and safety on package labels that make similar health claims. However, although nonprescription drugs and their therapeutic claims require scientific evidence that is carefully scrutinized by Health Canada, natural health products have a separate regulatory system that typically imposes such minimal requirements that it is effectively a rubber stamp. Unlike nonprescription drugs, if a problem arises with a natural health product, Health Canada has little or no authority to compel any changes to its manufacture, labelling or sale.

…Risk is often difficult to perceive accurately without direct evidence. For example, under the proposed framework, Health Canada would continue to classify most homeopathic preparations as low-risk products and, thus, exempt from scientific review. Recently, a homeopathic product sold in the United States that claimed to relieve teething pain in infants and supposedly contained a very dilute extract from the belladonna plant was associated with several deaths of infants who manifested classic signs of anticholinergic poisoning…

…If consumers are unable to separate products with no scientific proof behind them from products supported by evidence, then we need to separate them in stores. Natural health products should be pulled from the shelves where they are mixed with nonprescription drug products and confined to their own separate section, away from any signage implying a therapeutic use.

The double standard perpetuated by both regulators and retailers that enables the deception of unsuspecting Canadians must end. Alternative medicines with claims based on alternative facts do not deserve an alternative, easy regulatory road to market — at the very least, they need to be moved to an alternative shelf.

END OF QUOTES

This, of course, is Canada. But elsewhere progress is also being made.The Australian reported about plans in Australia whereby pharmacies would be banned from selling useless and possibly dangerous homoeopathic remedies. The Australian last year ­revealed a review of pharmacy regulation, headed by Stephen King from the Productivity ­Commission, identified a potential conflict of interest in pharmacists selling vitamins, for example, that may not have a significant ­evidence base, alongside more stringently regulated and government-subsidised medicines. In its interim report, the review panel was “concerned that the sale of complementary medicines alongside other medicines may mislead consumers”. It therefore concludes that “complementary medicines should be held in a separate area within community pharmacies, where customers can easily access a pharmacist for appropriate advice.”

“To avoid potential harm, or the confusion between the efficacies of different types of medicines, pharmacists need to be easily ­accessible to give needed advice when consumers choose a complementary or pharmacy-only medicine,” the review panel said. It was scathing of homo­eopathy and the perception of legitimacy given to those so-called remedies sold in pharmacies. “The only defence put to the panel regarding homoeopathy was that it was harmless and able to be used as a placebo in certain circumstances,” the review panel noted. “The panel does not believe that this argument is sufficient to justify the continued sale of these products in pharmacies …”

AUSTRALIAN JOURNAL OF PHARMACY (AJP) noted that the interim report of the Review of Pharmacy Remuneration and Regulation states that “there are unacceptable risks where community pharmacies are allowed to sell homeopathic products”.

In 2015 Pharmaceutical Society of Australia (PSA) said it did not support the sale of homeopathy in pharmacy. “Our position is that pharmacists must use their professional judgement to prevent the supply of products with evidence of no effect,” PSA president Joe Demarte said at the time. Ian Carr, of Saxby’s Pharmacy in Taree, NSW, and Friends of Science in Medicine member, told the AJP that “in terms of homeopathic products being recommended not to be sold by PBS-approved pharmacies, I one hundred per cent heartily agree with that finding. “I love saying that I believe homeopathy works. But it has never been shown to work better than placebo. There are many things that will work as well as placebo, but it’s not ethical to be selling them as a cure or treatment for something. I would have a bit more time for it if there was a plausible theory behind it, but its basis is entirely implausible – it pushes all the buttons for being a pseudoscience, so I agree it has no place in Australian pharmacy. However, I am at a bit of a loss to understand why they haven’t carried some of that logic over into the comments on complementary medicines generally.”

Mr Carr also told the AJP that “If one conceives of complementary medicines as being vitamins and minerals, that’s one thing. But the marketing of those items has become so diffuse and so wide that on most of these CM shelves we have traditional medicines, we’ve got herbal medicines, we’ve got items that are basically just marketing formulas for certain conditions. The evidence behind most of these things is very very slim, and we still have the possibility of health fraudsters just marching in and taking advantage of the lack of regulation in the industry.”

So, Canada and Australia are making progress in protecting consumers from bogus healthcare products and from pharmacists selling them.

Hurray!!!

When, I ask myself, are the UK, the US and other countries following suit?

 

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