MD, PhD, FMedSci, FSB, FRCP, FRCPEd

medical ethics

I am sure this  FDA press-release will interest many readers (we reported about this case before):

The U.S. Food and Drug Administration announced today that its laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label. The agency is warning consumers that homeopathic teething tablets containing belladonna pose an unnecessary risk to infants and children and urges consumers not to use these products.

In light of these findings, the FDA contacted Standard Homeopathic Company in Los Angeles, the manufacturer of Hyland’s homeopathic teething products, regarding a recall of its homeopathic teething tablet products labeled as containing belladonna, in order to protect consumers from inconsistent levels of belladonna. At this time, the company has not agreed to conduct a recall. The FDA recommends that consumers stop using these products marketed by Hyland’s immediately and dispose of any in their possession. In November 2016, Raritan Pharmaceuticals (East Brunswick, New Jersey) recalled three belladonna-containing homeopathic products, two of which were marketed by CVS.

“The body’s response to belladonna in children under two years of age is unpredictable and puts them at unnecessary risk,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. ”We recommend that parents and caregivers not give these homeopathic teething tablets to children and seek advice from their health care professional for safe alternatives.”

Homeopathic teething products have not been evaluated or approved by the FDA for safety or effectiveness. The agency is unaware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children. In September 2016, the FDA warned against the use of these products after receiving adverse event reports.

Consumers should seek medical care immediately if their child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation after using homeopathic teething products.

The FDA encourages health care professionals and consumers to report adverse events or quality problems experienced with the use of homeopathic teething products to the FDA’s MedWatch Adverse Event Reporting program:

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The Agency is also responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

END OF PRESS RELEASE

Well, this will be irritating to many homeopathy-fans, not least to our friend Dana Ullman. He likes to publish articles alleging that the US authorities have recently taken to being ever so unfair to the homeopathic industry. I commented recently on his paper entitled “Extreme Bias in FTC’s Ruling on Homeopathic Medicine” where he displays the well-known biases and ignorance of his trade in exemplary fashion, including the often firm anti-vaccination stance of homeopaths. Dana can also not resist claiming that ‘the Swiss government’s “Health Technology Assessment” on homeopathic medicine is much more comprehensive than any previous governmental report written on this subject to date’ and – how could it be otherwise? – is sufficient proof that homeopathy works.

In case you believe in what Ullman says, you ought to read the intriguing evidence about Ullman after being called as an expert witness in an US class action. On this occasion, the judge stated:

The Defendant presented the testimony of Gregory Dana Ullman who is a homeopathic practitioner. He outlined the theory of homeopathic treatment and presented his opinion as to the value and effectiveness of homeopathic remedies. The Court found Mr. Ullman’s testimony to be not credible. Mr. Ullman’s bias in favor of homeopathy and against conventional medicine was readily apparent from his testimony. He admitted that he was not an impartial expert but rather is a passionate advocate of homeopathy. He posted on Twitter that he views conventional medicine as witchcraft. He opined that conventional medical science cannot be trusted.
[…]
Mr. Ullman’s testimony was unhelpful in understanding the purported efficacy of the ingredients of SnoreStop to reduce the symptoms of snoring. Although he is familiar with the theory of homeopathic treatment, his opinions regarding its effectiveness was unsupported and biased. The Court gave no weight to his testimony.(Rosendez v. Green Pharmaceuticals)

Say no more!

Mike Cummings recently stated on this blog “I’m not into blog banter.” Is he perhaps referring to some ‘alternative facts’? The truth seems to be that he blogs happily, regularly and – I am sad to say – disgracefully. This is a quote from his new post about the discussions regarding an acupuncture trial which was in the press a few days ago, (and also has been discussed on this blog):

START OF QUOTE

So there has been a big response to this paper press released by BMJ on behalf of the journal Acupuncture in Medicine. The response has been influenced by the usual characters – retired professors who are professional bloggers and vocal critics of anything in the realm of complementary medicine. They thrive on oiling up and flexing their EBM muscles for a baying mob of fellow sceptics (see my ‘stereotypical mental image’ here). Their target in this instant is a relatively small trial on acupuncture for infantile colic.[1] Deserving of being press released by virtue of being the largest to date in the field, but by no means because it gave a definitive answer to the question of the efficacy of acupuncture in the condition. We need to wait for an SR where the data from the 4 trials to date can be combined. On this occasion I had the pleasure of joining a short segment on the Today programme on BBC Radio 4 led by John Humphreys. My protagonist was the ever-amusing David Colquhoun (DC), who spent his short air-time complaining that the journal was even allowed to be published in the first place. You can learn all about DC care of Wikipedia – he seems to have a surprisingly long write up for someone whose profession career was devoted to single ion channels, perhaps because a significant section of the page is devoted to his activities as a quack-busting blogger. So why would BBC Radio 4 invite a retired basic scientist and professional sceptic blogger to be interviewed alongside one of the journal editors – a clinician with expertise in acupuncture (WMA)? At no point was it made manifest that only one of the two had ever been in a position to try to help parents with a baby that they think cries excessively. Of course there are a lot of potential causes of excessive crying, but I am sure DC would agree that it is unlikely to be attributable to a single ion channel…

END OF QUOTE

I encourage everyone to read Cummings post in full; it’s full of surprises. Here I just want to comment very briefly why I find his post disgraceful (the Cummings quotes are in bold followed by my comments):

….usual characters….. Disrespectful to the point of being derogatory, in my view

….retired professors….. Not true, non-retired professionals commented as well

….professional bloggers…. Meaning people who earn their income by blogging? Certainly not true!

….vocal critics of anything in the realm of complementary medicine…. Critic not of ‘anything’ but merely of things that are false or misleading like the trial in question

….a baying mob of fellow sceptics…. Unquestionably meant to be insulting and arguably libelous

….Deserving of being press released by virtue of being the largest to date in the field…. Large is not necessarily a virtue that merits a press-release, particularly, if it is not matched with quality

….We need to wait for an SR where the data from the 4 trials to date can be combined…. More than doubtful that we ‘need to wait’. The 4 trials in question are all very weak and therefore cannot provide a firm answer via a systematic review

….the ever-amusing David Colquhoun…. Derogatory to the extreme

….why would BBC Radio 4 invite a retired basic scientist and professional sceptic blogger…. The answer could be because he understands science and has vast experience exposing false claims

….only one of the two had ever been in a position to try to help parents with a baby that they think cries excessively…. This does not necessarily mean that such a person understands science, and Cummings might even be an example for this

….is unlikely to be attributable to a single ion channel…. Even Cummings’ attempts at humour are quite appalling.

 

The comments of Dr Mike Cummings MB ChB Dip Med Ac, I am afraid, befit an ill-educated acupuncturist who feels personally hurt because his views have been challenged and who is not quite bright enough to have a rational discussion about his favourite subject, particularly with someone who has a superior grasp of the issues at hand (which are clearly not ‘how to stick a needle in a baby’). However, Cummings is not a simple acupuncturist; he happens to be a member of the medical profession, a medical director of the British Medical Acupuncture Society and (as he seems keen to point out) a journal editor. With these credentials, he should, in my view, be able to argue a bit more intelligently, truthfully and a lot more gracefully.

Sad, really!

One could almost think he wants to give acupuncture a bad name!!!

Acupuncture is often recommended as a treatment for shoulder pain, but its effectiveness is far from proven. A new study has just been published; but does it change this uncertainty?

A total of 227 patients with subacromial pain syndrome were recruited to this RCT. The patients were allocated to three groups who received either A) group exercise, B) group exercise plus acupuncture or C) group exercise plus electro-acupuncture. The primary outcome measure was the Oxford Shoulder Score. Follow-up was post treatment, and at 6 and 12 months. Data were analysed on intention-to-treat principles with imputation of missing values.

Treatment groups were similar at baseline. All treatment groups demonstrated improvements over time. Between-group estimates were, however, small and non-significant.

The authors concluded that neither acupuncture nor electro-acupuncture were found to be more beneficial than exercise alone in the treatment of subacromial pain syndrome. 

Well, that was to be expected!… I hear the rationalists amongst us exclaim.

Actually, I am not so sure.

One could easily have expected that the acupuncture groups (B and C) show a significant advantage over group A.

Why?

Because acupuncture is a ‘theatrical placebo’, a ritual that impresses patients and thus impacts on results, particularly on subjective outcomes like pain. If the results had shown a benefit for acupuncture + exercise (groups B and C) versus exercise alone (group A), what would we have made of it? Acupuncture fans would surely have claimed that it is evidence confirming acupuncture’s effectiveness. Sceptics, on the other hand, would have rightly insisted that it demonstrates nothing of the sort – it merely confirms that placebo effects can affect clinical outcomes such as pain.

As it turned out, however, this trial results happened to indicate that these placebo-effects can be so small that they fail to reach the level of statistical significance.

I think there is one noteworthy message here: RCTs with such a design (no adequate control for placebo effects) can easily generate false-positive results (in this case, this did not happen, but it was nevertheless a possible outcome). Such studies are popular but utterly useless: they don’t advance our knowledge one single iota. If that is so, we should not waste our resources on them because, in the final analysis, this is not ethical. In other words, we must stop funding research that has little or no chance of advancing our knowledge.

First she promoted vaginal steam baths and now Gwyneth Paltrow claims that putting a ball of jade (which you can order from her online-business, if you happen to have the cash) in their vaginas is good for women.

Yes, I kid you not; this is what she states on her website:

The strictly guarded secret of Chinese royalty in antiquity—queens and concubines used them to stay in shape for emperors—jade eggs harness the power of energy work, crystal healing, and a Kegel-like physical practice. Fans say regular use increases chi, orgasms, vaginal muscle tone, hormonal balance, and feminine energy in general. Shiva Rose has been practicing with them for about seven years, and raves about the results; we tried them, too, and were so convinced we put them into the goop shop. Jade eggs’ power to cleanse and clear make them ideal for detox…

But if you think that Gwyneth is somehow fixated on her feminine parts, you are probably mistaken. She is much more versatile than that and seems to employ her vagina merely for drumming up publicity for her business. If you browse her site, you find no end of baffling, vagina-unrelated wonders and purchasable products from the world of alternative medicine.

Here are just two further examples.

Flower  remedies

A flower essence is a bioenergetic preparation. Through the use of sunlight and water, we are able to capture the energy of a flower and use it for healing purposes: A freshly harvested flower is placed on the surface of water for a specific length of time and exposed to sunlight, resulting in the vibrational imprint of the flower in water. The flower essence is then used as an energetic remedy, with each flower having its own range of unique therapeutic benefits.

Vibrational imprint?

Unique therapeutic benefit?

Pull the other one! The truth about (Bach) flower remedies is much simpler: they are expensive placebos.

A method for getting rid of the parasites we allegedly all suffer from

…an eight-day, mono-diet goat-milk cleanse—accompanied by a specific vermifuge made of anti-parasitic herbs—is the most successful treatment. Parasites primarily live in the mucus lining of the gut system, where they feed on nutrients before they enter the body. Think of the goat milk as bait—parasites come out of the gut lining to drink the milk, which they love, but they also consume the vermifuge, which will eventually eradicate them. On top of being highly effective, this method is a much more gentle medicine than bombarding them—and your body—with a harsh drug.

Are they for real?

This is pure and potentially very dangerous, unethical nonsense!

Oh sorry – I forgot: we now must call it differently now: we are obviously dealing with Gwyeneth’s ‘alternative facts’.

We all know that alternative medicine is currently popular, and much of the evidence suggested that this is mostly because mostly people in the midst of their lives are using it. This may be so, but it is about to change; it stands to reason that these ‘baby boomers’ are getting older, and therefore the typical user of alternative medicine is or will soon be an elderly person. In addition, the ‘oldies’ (I am one of them) are likely to be multi-morbid and therefore have more reason to try everything that is on offer.

Not convinced? But that is roughly is what this website seems to suggest:

START OF QUOTE

Geriatric population is more susceptible to chronic diseases such as heart problems, joint disorders and others. Therefore, this population group needs regular use of the medicines to prevent the disease conditions. The use of complementary and alternative medicines is increasing among the geriatric population globally due to the fact that CAMs decreases the risk of adverse reactions and drug interactions.

Complementary and alternative medicines include products such as dietary medicine and herbal medicine products. These medicines can be used for the management of both communicable (i.e. tuberculosis, hantavirus and others) and non communicable diseases (i.e. chronic kidney disease, cardiovascular and others) in geriatric population. These medicines (i.e. CAM) treat the patients by healing therapies which is not based on principles of conventional medicine.

Geographically, North America is considered as the largest market of geriatric complementary and alternative medicines owing to high use of CAMs in this region. For example, Health and Retirement Study conducted one survey which concluded that around 85% of the geriatric population in North America reported the use of complementary and alternative medicines. Thus, high use of CAM modalities will establish healthy platform to develop the growth of geriatric complementary and alternative medicines market.

Europe is the second largest market of geriatric complementary and alternative medicines. The growth is mainly attributed to the increasing aging population coupled with rising use of complementary and alternative medicines in Europe. According to European Commission (Eurostat) report published in 2013, around 17.8% of the European population were aged 65 years and above. The organization has also stated that aging population is expected to increase at high rate in coming year in Europe. In addition, Asia-Pacific is the emerging market for geriatric complementary and alternative medicines market because of rising interest of key companies to expand their presence in Asia Pacific.

Key companies operating in the market for geriatric complementary and alternative medicines include Geriatric & Medical Companies, Inc., Merck Sharp & Dohme Corporation. Geri-Care pharmaceuticals, UAS Laboratories.

END OF QUOTE

I know, this text includes several glaring errors. But the main claim that alternative medicine is fast becoming a thing for the elderly might well be true. This, of course, has implications for marketing, research, etc. For us on this blog it means that we need to find better ways to get through to people who are no spring chickens any longer.

The elderly have special needs and can be vulnerable in several ways. When they are ill, they need efficacious treatments. By and large, this excludes alternative therapies. The elderly may also be more susceptible to the risks of alternative medicine. Moreover, they are often not that affluent and might need to watch their expenses. Making them spend large amounts of cash on treatments that are ineffective is therefore a particularly unethical.

I think that messages like these might convince some elderly people to stop putting unreasonable hope in, and wasting their time/money on bogus therapies. But I am very keen to hear from my readers about further ideas how to curb the boom of alternative medicine in this age group.

Whenever a level-headed person discloses that a specific alternative therapy is not based on good evidence, you can bet your last shirt that a proponent of the said treatment responds by claiming that conventional medicine is not much better.

There are several variations to this theme. Today I want to focus on just one of them, namely the counter-claim that, only a short while ago, conventional medicine was not much better than the said alternative therapy (the implication is that it must be unfair to demand evidence from alternative medicine, while accepting a similar state of affairs in conventional medicine). The argument has recently been formulated by one commentator on this blog as follows:

“Trepanation, leeches for UTI’s, and bloodletting are all historical treatments of medical doctors…It’s hypocritical… to impute mainstream chiropractice to the profession’s beginnings and yet not admit that medicine’s founding and evolution was inbued with consistently scientific rigor.”

Sadly, some people seem to be convinced by such words, and this is why they are being repeated ad nauseam by interested parties. Yet the argument is fallacious for a range of reasons.

  • Firstly, it is based on the classical ‘tu quoque’ fallacy (appeal to hypocrisy).
  • Secondly – unless we happen to be historians – it is not the healthcare of the past that is relevant to our discussions. The question cannot be what this or that group of clinicians used to do; the question is HOW DO THEY TREAT THEIR PATIENTS TODAY?

As soon as we focus on this issue, it is impossible to deny that conventional medicine has made lots of progress and moved light years away from treatments such as trepanation, leeches, bloodletting and many others.

Why?

Why did we make such huge progress?

Because research showed that many of the traditional treatments were ineffective, unsafe and/or implausible (thus demonstrating that hundreds of years of experience – which alternative therapists rate so very highly – is of more than dubious value), and because we consequently developed and tested new therapies and subsequently used those treatments that passed these tests and were proven to do more good than harm.

By contrast, in the last decades, centuries and millennia, homeopathy, chiropractic, acupuncture, paranormal healing etc. did make no (or very little) progress. So much so that Hahnemann, for instance, would pass any exam for  homeopathy today. (If you disagree with this statement, please post a list of those treatments that have been given up by alternative therapists in the last 100 years or so.) Come to think of it, it is a hallmark of alternative medicine that it does not progress in the way conventional medicine does. It is almost completely static, a fact, that renders it akin to a dogma or a cult.

But why? Why is there no real progress in alternative medicine?

Don’t tell me that there is no research, research funding, etc. There are now hundreds of studies of homeopathy or chiropractic, thousands of acupuncture, and dozens of paranormal healing, for instance. The trouble is not the paucity of such research but its findings! The totality of the evidence in each of these areas fails to show that the therapy in question is efficacious.

And there we have, I think, another hallmark of alternative medicine: it is an area where research is only acted upon, if its findings are in line with the preconceptions and aspirations of its proponents.

I find this interesting!

It means, amongst other things, that research into alternative medicine tends not to be used for finding the truth or establishing new knowledge; it is mainly employed for the promotion of the therapy in question, regardless of what the truth about it might be (this would disqualify this exercise from being research and qualify it as PSEUDO-RESEARCH). If the research findings are such that they cannot be used for promotion, they are simply ignored or defamed as inadequate.

You probably guessed: this is the headline of a new WDDTY articleWDDTY tell us that they provide “information on complimentary therapies and alternative medicines” (I don’t want to sound snobbish, but I have my doubts about people who don’t even know how to spell their subject area). As the actual article in question (on vitamin C for cancer, a subject we have discussed on this blog before here and here) is quite short, I might as well show you its full beauty:

START OF QUOTE

High-dose vitamin C does kill cancer—but only when it’s given intravenously. It’s now just a few steps away from being approved as a safe and effective cancer treatment alongside chemotherapy and radiation.

Although researchers have tested the vitamin as a cancer therapy many times, they almost always concluded that it was ineffective—but they were guaranteeing failure by giving it orally to patients.

When it’s given intravenously, it bypasses the gut and goes directly into the bloodstream—where concentrations of the vitamin are up to 500 times higher than when it’s taken orally—and targets cancer cells, say researchers at the University of Iowa.

The therapy is now going through the approval process, and could soon be available as an alternative to chemotherapy or radiation, the two conventional cancer treatments.

It’s been proved to be effective in animal studies, and phase 1 trials have demonstrated that it’s safe and well-tolerated.

Now doctors at the university are starting to use it on patients with pancreatic cancer and lung cancer, and are measuring their progress against other patients who will continue to be given chemotherapy or radiation.

Biologist Garry Buettner, who works at the university, has worked out just why vitamin C is so effective: the vitamin breaks down quickly in the body, and generates hydrogen peroxide that kills cancer cells. “Cancer cells are much less efficient in removing hydrogen peroxide than normal cells, so cancer cells are much more prone to damage and death from a high amount of hydrogen peroxide”, he explained. “This explains how very, very high levels of vitamin C do not affect normal tissue, but can be damaging to tumour tissue.”

END OF QUOTE

According to the author, these amazing claims are based on one single source: a Medline-listed article with the following abstract:

Ascorbate (AscH) functions as a versatile reducing agent. At pharmacological doses (P-AscH; [plasma AscH] ≥≈20mM), achievable through intravenous delivery, oxidation of P-AscH can produce a high flux of H2O2 in tumors. Catalase is the major enzyme for detoxifying high concentrations of H2O2. We hypothesize that sensitivity of tumor cells to P-AscH compared to normal cells is due to their lower capacity to metabolize H2O2. Rate constants for removal of H2O2 (kcell) and catalase activities were determined for 15 tumor and 10 normal cell lines of various tissue types. A differential in the capacity of cells to remove H2O2 was revealed, with the average kcell for normal cells being twice that of tumor cells. The ED50 (50% clonogenic survival) of P-AscH correlated directly with kcell and catalase activity. Catalase activity could present a promising indicator of which tumors may respond to P-AscH.

The author of the WDDTY article is Bryan Hubbard. I did not know this man but soon learnt that he is actually the co-founder of WDDTY. He may not know how to spell ‘complementary medicine’ but he certainly has a lot of fantasy! His latest drivel on vitamin C for cancer seems to prove it. He seems to have the ability to extrapolate from the truth to a point where it becomes unrecognisable. The claims he makes in his article in question certainly are in no way supported by the evidence he provided as his source.

This could be trivial; yet sadly, it isn’t: WDDTY is read by many members of the unsuspecting public. Some of them might have cancer or know someone who has cancer. These desperate patients are likely to believe what is published in WDDTY and might be tempted to act upon it. In other words, the totally misleading articles by Hubbard put lives at risk – and that I cannot find trivial!

What doctors don’t tell you is not what WDDTY suggest; doctors don’t tell you that vitamin C reverses cancer because it is not true. In view of this and other evidence, perhaps the acronym WDDTY is not the best for this publication? Could I perhaps suggest to ‘Hubbard and Co’ another abbreviation? How about MIFUC (MisInformation From Unethical Columnists)?

[yes, I know, I was tempted to chose another noun for the ‘C’, but I resisted!]

Homeopaths have, since about 200 years, insisted that their remedies are efficacious treatments for infectious diseases. As evidence for this notion, they often produce epidemiological data showing that a group of infected patients treated homeopathically had better results than another group treated conventionally. While potentially interesting, such findings never constitute proof, because the two groups might not have been comparable and many other factors could have determined the observed outcome. In fact, these stories are prime examples for the need of rigorously controlled trials when testing the efficacy of medical treatments.

Homeopaths are invariably unable to provide more compelling evidence for their claims. Instead, they repeat, since 200 years, their assumptions over and over again. Are they not aware, I ask myself, that the repetition of a lie does not create a truth?

What their repetition of lies sometimes does create, unfortunately, is some impact on a political level. This website explains it fairly well:

The Public Health Ministry (of Thailand) is thinking of implementing alternative therapy homeopathy in all districts of Sing Buri this year, after a report that it could boost the human’s body immunity to fight dengue fever, an inspector-general at the ministry said.

Homeopathic medicines had been given to Sing Buri volunteer students from kindergarten to lower-secondary level in a 2012-13 trial and it yielded satisfactory results, said Dr Jakkriss Bhumisawasdi, director of the Inspector-General Region for Bureau of Inspection and Evaluation.

The number of dengue fever cases in Sing Buri have gone down, taking its rankings from No 67 in the country (with one death) in 2011 to No 76 in 2012. As there was a nationwide dengue fever outbreak in 2013, Sing Buri reported the country’s lowest prevalence at 44.95 per 100,000 population.

Jakkriss said “homeopathy” was safe and low-cost and had been used in various countries including the United Kingdom, France, Italy, Switzerland, Belgium, the United States, Australia, India and Malaysia.

Pilot project

Next, the system of medicine would be implemented in Region 4 Bureau’s seven other provinces: Nakhon Nayok, Nonthaburi, Pathum Thani, Ayutthaya, Lop Buri, Sara Buri and Ang Thong. If this one district per province pilot project went well, they would consider implementing it across the country, he said.

Sing Buri Hospital paediatrician Dr Wali Suwatthika said the preparation involved dissolving Eupatorium herbal pills in drinking water. Each child would be given 3cc of this tasteless water every three months. The trial, which began in July 2012, covered 4,250 children in Muang district and only four of them developed mild dengue fever in one year, while seven out of the district’s 2,856 remaining kids who didn’t get the medicine had dengue fever, in a more severe condition.

Thailand reported 150,934 dengue fever patients last year, double the previous year’s number, and 133 deaths. As there is no vaccine for dengue fever, the Public Health Ministry used a combination of several measures, including the eradication of mosquito larva incubation grounds and a campaign for people to install mosquito nets.

END OF QUOTE

So, where is the evidence that homeopathy does anything at all for Dengue patients? The 2012-13 trial referred to above has, as far as I can see, not been published. This probably means that it was not a publishable study at all. The only study available on Medline is this one:

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

END OF QUOTE

The bottom line is simple and depressing: the totality of the best available evidence fails to show that homeopathy is efficacious for Dengue fever (or any other infectious disease). It is irresponsible to claim otherwise.

Trump says he never mocked a disabled journalist.

YET THE WHOLE WORLD SAW HIM DO IT!

UK Brexit politicians such as Boris Johnson claim they never promised £ 350 million per week of EU funds for the NHS.

BUT WE ALL SAW THE PICTURES OF THE CAMPAIGN BUS!

These are just two of the numerous, obvious and highly significant lies that we have been told in recent months. In fact, we have heard so many lies recently that some of us seem to be getting used to them. We even have a new term for the phenomenon: the ‘post-truth society’.

Personally I don’t like the word at all: it seems to reflect a tacit acceptance of lies and their legitimisation.

I find it dangerous to put up with falsehoods in that way. And I think the truth is far too valuable to abandon it without a fight. I will therefore continue to call a lie a lie!

And, by Jove, in alternative medicine, we have no shortage of them:

  • Homeopaths claiming to be able to treat any condition with their ‘high potency remedies’.
  • Chiropractors who claim that spinal manipulation improves health.
  • Healers who state that their paranormal healing affects symptoms.
  • Alternative practitioners who claim that they treat the root cause of diseases.
  • Naturopaths who pretend they can treat childhood conditions.
  • Acupuncturists who say that rebalancing yin and yang affects health.
  • Alternative practitioners who insist they can detox our bodies.
  • Politicians who claim that TCM save lives.
  • Slapping therapists who say they can cure diabetes.
  • Journalists who publish that Paleo-diet can cure inflammatory bowel diseases.
  • Entrepreneurs who promote their unproven products as diabetes cures.
  • Academics who teach homeopathy to medical students.
  • Homeopaths who claim that their remedies are effective alternatives for vaccinations.

Do I need to go on?

These are not ‘post-truths’ – these are just lies, pure and simple.

We must not be lulled into complacency or false tolerance. Lies are lies, and they are wrong and unethical. In many instances they can even kill. To ignore or accept a steady stream of lies is not a solution; on the contrary, it can easily become part of the problem.

So, let’s continue to call them by their proper name – no matter whether they originate from the dizzy heights of world politics or the low lands of quackery.

At a recent conference in Montréal (October 2016), the WFC (World Federation of Chiropractic) and the ACC (Association of Chiropractic Colleges) reached a consensus on education. Consequently, recommendations were produced that offer 12 key ‘take away messages’. I take the liberty of reproducing these statements entitled ‘Training Tomorrow’s Spine Care Experts’ (the square brackets were inserted by me and refer to brief comments I made below).

START OF QUOTE

1. Chiropractic educational institutions have a  responsibility to equip students with the skills and  attributes necessary to become future spinal health care experts. This includes a commitment to astute diagnostic ability, a comprehensive knowledge of spine-related disorders [1], appreciation for the contributions of other health professionals and a commitment to collaborative, patient-centered and evidence-informed care [2].

2. Technological advances [3] provide an opportunity for the chiropractic profession to enhance, evolve and standardize core education and practice. This is relevant to the teaching of chiropractic skills, sharing of learning resources and assessment of performance. Emerging technologies that support the development of clinically-competent practitioners should be embedded within chiropractic programs.

3. The teaching and learning of specialized manual assessment and treatment skills should remain a key distinguishing element of chiropractic curricula.

4. Surveys of the public have a demonstrated a desire for consistency in the provision of chiropractic services. Such consistency need not compromise the identities of individual institutions but will cultivate public trust and cultural authority [4].

5. Globally consistent educational and practice standards will facilitate international portability [5] and promote greater health equity in the delivery of spine care.

6. Chiropractic programs should espouse innovation and leadership in the context of ethical [6], sustainable business [7] practices.

7. Chiropractic educational curricula should reflect current evidence [8] and high quality guidelines [9], and be subjected to regular review to ensure that students are prepared to work in collaborative health care environments.

8. The training of tomorrow’ s spine care experts should incorporate current best practices in education.

9. Interdisciplinary collaboration and strategic partnerships present opportunities to position chiropractors as leaders [10] and integral team players in global spine care.

10. Chiropractic educational institutions should champion the integration of evidence informed clinical practice [11], including clinical practice guidelines, in order to optimize patient outcomes. This will in turn foster principles of lifelong learning and willingness to adapt practice methods in the light of emerging evidence [12].

11. Students, faculty, staff and administrators must all contribute to a learning environment that fosters cultural diversity, critical thinking [13], academic responsibility and scholarly activity.

12. Resources should be dedicated to embed and promote educational research activity in all chiropractic institutions.

END OF QUOTE

And here are my brief comments:

[1] Some chiropractors believe that all or most human conditions are ‘spine-related disorders’. We would need a clear statement here whether the WFC/ACC do support or reject this notion and what conditions we are actually talking about.

[2] ‘Evidence-informed’??? I have come across this term before; it is used more and more by quacks of all types. It is clearly not synonymous with ‘evidence-based’, but aims at providing a veneer of respectability by creation an association with EBM. In concrete terms, asthma, for instance, might, in the eyes of some chiropractors, be an evidence-informed indication for chiropractic. In other words, ‘evidence-informed’ is merely a card blanch for promoting all sorts of nonsense.

[3] It would be good to know which technical advances they are thinking of.

[4] Public trust is best cultivated by demonstrating that chiropractic is doing more good than harm; by itself, this point sounds a bit like PR for maximising income. Sorry, I am not sure what they mean by ‘cultural authority’ – chiropractic as a cult?

[5] ‘International portability’ – nice term, but what does it mean?

[6] I get the impression that many chiropractors do not know what is meant by the term ‘ethics’.

[7] But they certainly know much about business!

[8] That is, I think, the most relevant statement in the entire text – see below.

[9] Like those by NICE which no longer recommend chiropractic for back pain? No? They are not ‘high quality’? I see, only those that recommend chiropractic fulfil this criterion!

[10] Chiropractors as leaders? Really? With their (largely ineffective) manipulations as the main contribution to the field? You have to be a chiropractor to find this realistic, I guess.

[11] Again ‘evidence-informed’ instead of ‘evidence-based’ – who are they trying to kid?

[12] The evidence that has been emerging since many years is that chiropractic manipulations fail to generate more good than harm.

[13] In the past, I got the impression that critical thinking and chiropractic are a bit like fire and water.

MY CONCLUSION FROM ALL THIS

What we have here is, in my view, little more than a mixture between politically correct drivel and wishful thinking. If chiropractors truly want chiropractic educational curricula to “reflect current evidence”, they need to teach the following main tenets:

  • Chiropractic manipulations have not been shown to be effective for any of the conditions they are currently used for.
  • Other forms of treatment are invariably preferable.
  • Subluxation, as defined by chiropractors, is a myth.
  • Spine-related disorders, as taught in many chiropractic colleges, are a myth.
  • ‘Evidence-informed’ is a term that has no meaning; the proper word is ‘evidence-based’ – and evidence-based chiropractic is a contradiction in terms.

Finally, chiropractors need to be aware of the fact that any curriculum for future clinicians must include the core elements of critical assessment and medical ethics. The two combined would automatically discontinue the worst excesses of chiropractic abuse, such as the promotion of bogus claims or the financial exploitation of the public.

But, of course, none of this is ever going to happen! Why? Because it would mean teaching students that they need to find a different profession. And this is why I feel that statements like the above are politically correct drivel which can serve only one purpose: to distract everyone from the fundamental problems in that profession.

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