MD, PhD, FMedSci, FSB, FRCP, FRCPEd

medical ethics

The WDDTY is not my favourite journal – far from it. The reason for my dislike is simple: far too many of its articles are utterly misleading and a danger to public health. Take this recent one entitled ‘Paleo-type diet reversing Crohn’s and ulcerative colitis’, for instance:

START OF QUOTE
Crohn’s disease and ulcerative colitis are being reversed solely by diet—essentially a Paleo diet. The non-drug approach has been successful in 80 per cent of children who’ve been put on the special diet.

The diet—called the specific carbohydrate diet (SCD)—has been pioneered by Dr David Suskind, a gastroenterologist at Seattle Children’s Hospital. The diet excludes grains, dairy, processed foods and sugars, other than honey, and promotes natural, nutrient-rich foods, including vegetables, fruits, meats and nuts.

Children are going into complete remission after just 12 weeks on the diet, a new study has discovered. Ten children with inflammatory bowel disease (IBD)—an umbrella term for Crohn’s and ulcerative colitis—were put on the diet, and eight were completely symptom-free by the end of the study. Suskind started exploring a dietary approach to IBD because he became convinced that the standard medical treatment of steroids or other medication was inadequate. “For decades, medicine has said diet doesn’t matter, that it doesn’t impact disease. Now we know that diet does have an impact, a strong impact. It works, and now there’s evidence,” he said.

END OF QUOTE

“For decades, medicine has said diet doesn’t matter, that it doesn’t impact disease”.

Really?

In this case, I must have studied an entirely different subject all these years ago at university – I had been told it was medicine but perhaps…???…!!!

It took me some time to find the original paper – they cited a wrong reference (2017 instead of 2016). But eventually I located it. Here is its abstract:

GOAL:

To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

BACKGROUND:

IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

STUDY:

Pediatric patients with mild to moderate IBD defined by pediatric Crohn’s disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

RESULTS:

Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

CONCLUSIONS:

SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.

What does this mean?

The WDDTY report bears very little resemblance to the journal article (let alone with the title of their article or any other published research by David Suskind).

How come?

I cannot be sure, but I would not be surprised to hear that the latter was ‘egged up’ to make the former appear more interesting.

If that is so, WDDTY are (once again) guilty of misleading the public to the point of endangering lives of vulnerable patients.

SHAME ON EVERY OUTLET THAT SELLS WDDTY, I’d say.

Can intercessory prayer improve the symptoms of sick people?

Why should it? It’s utterly implausible!

Because the clinical evidence says so?

No, the current Cochrane review concluded that [the] findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.

Yet, not all seem to agree with this; and some even continue to investigate prayer as a medical therpy.

For this new study (published in EBCAM), the Iranian investigators randomly assigned 92 patients in 2 groups to receive either 40 mg of propranolol twice a day for 2 month (group “A”) or 40 mg of propranolol twice a day for 2 months with prayer (group “B”). At the beginning of study and 3 months after intervention, patients’ pain was measured using the visual analogue scale.

All patients who participate in present study were Muslim. At the beginning of study and before intervention, the mean score of pain in patients in groups A and B were 5.7 ± 1.6 and 6.5 ± 1.9, respectively. According to results of independent t test, mean score of pain intensity at the beginning of study were similar between patients in 2 groups (P > .05). Three month after intervention, mean score of pain intensity decreased in patients in both groups. At this time, the mean scores of pain intensity were 5.4 ± 1.1 and 4.2 ± 2.3 in patients in groups A and B, respectively. This difference between groups was statistically significant (P < .001).

figure

The above figure shows the pain score in patients before and after the intervention.

The authors concluded that the present study revealed that prayer can be used as a nonpharmacologic pain coping strategy in addition to pharmacologic intervention for this group of patients.

Extraordinary claims require extraordinary proof. This study is, in fact, extraordinary – but only in the sense of being extraordinarily poor, or at least it is extraordinary in its quality of reporting. For instance, all we learn in the full text article about the two treatments applied to the patient groups is this: “The prayer group participated in an 8-week, weekly, intercessory prayer program with each session lasting 45 minutes. Pain reduction was measured at baseline and after 3 months, by registered nurses who were specialist in pain management and did not know which patients were in which groups (control or intervention), using a visual analogue scale.”

Intercessory prayer is the act of praying on behalf of others. This mans that the patients receiving prayer might have been unaware of being ‘treated’. In this case, the patients could have been adequately blinded. But this is not made clear in the article.

More importantly perhaps, the authors fail to provide any numeric results. All that we are given is the above figure. It is not possible therefore to run any type of check on the data. We are simply asked to believe what the authors have written. I for one have great difficulties in doing so. All I do believe in relation to this article is that

  • the journal EBCAM is utter trash,
  • constantly publishing rubbish is unethical and a disservice to everyone,
  • prayer does not need further research of this nature,
  • and poor studies often generate false-positive findings.

‘How to convince someone when facts fail’ – this is the title of a very good and ‘must read’ article by Michael Shermer recently published in SCIENTIFIC AMERICAN. The issue is clearly relevant to numerous discussions we have on this blog. Therefore, I will repeat Shermer’s conclusions here:

If corrective facts only make matters worse, what can we do to convince people of the error of their beliefs? From my experience,

1. keep emotions out of the exchange,

2. discuss, don’t attack (no ad hominem and no ad Hitlerum),

3. listen carefully and try to articulate the other position accurately,

4. show respect,

5. acknowledge that you understand why someone might hold that opinion, and

6. try to show how changing facts does not necessarily mean changing worldviews.

These strategies may not always work to change people’s minds, but now that the nation has just been put through a political fact-check wringer, they may help reduce unnecessary divisiveness.

Wise words and good strategies! But, as Shermer himself admits, they unfortunately don’t always work. This blog and the comments made by its readers provide ample examples of failures in this respect.

By and large, I try my very best to adhere to Shermer’s principles. Yet, I do not pretend that I always succeed brilliantly – on the contrary, far too often, I lose my rag. I am not particularly proud of it, but neither am I all that deeply ashamed.

The thing is that any attempt at a respectful and constructive dialogue requires the co-operation of both sides. If the opponent is continually disrespectful, offensive, dishonest, unable to grasp even the simplest concepts, etc., I often just stop the dialogue. If that does not prevent my opponent from being a belligerent nuisance, I have been known to get impatient or even rude. TO ALL WHO I OFFENDED IN 2016, I CAN ONLY SAY THIS: THERE PROBABLY WAS A GOOD REASON FOR MY BEHAVIOUR.

I know, this is not good enough, particularly as I should set an example for others. How can I expect all the commentators on this blog to be respectful and constructive, if I too loose my temper from time to time? The answer is I cannot (by the way, this is one reason why I have passed other people’s outbursts and ,so far, published them largely uncensored; as long as I cannot fully control myself, I must not censor others with the same predicament).

So, here is my resolution for 2017:

I will continue to be provocative (this is part of the ‘raison d’etre’ of this blog) but, at the same time, I will try harder to show respect, politeness and understanding. Crucially, I am herewith asking everyone to PLEASE do likewise. Failing this, I will start censoring those sections of the comments that I consider abusive; and [I almost forgot] I will ban those commentators who repeatedly need censoring.

We had HOMEOPATHS WITHOUT BORDERS and now, I suggest, we acknowledge a similar organisation which could aptly be called CHIROPRACTORS WITHOUT SCRUPLES. This remarkable text from NATURAL NEWS explains it all, I think:

START OF QUOTE

The following chiropractors are speaking up to inform the public about the dangers of vaccines.

Dr. David Jockers, D.C.

Vaccines are one of medicine’s prized attempts to improve human performance. They use artificial laboratory derived medical technology to produce an immune response within the body in hopes it will lead to a long-term positive antibody response.

The vaccine ideology is based on the belief that people are created with inferior immune systems that are unable to keep up with the demands of the environment and need modern technology in the form of man-made vaccine formulations in order to bolster immunity.

According to the Centers for Disease Control, “The following substances are found in flu vaccines: aluminum, antibiotics, formaldehyde, human aborted fetal apparatus (dead human tissue), monosodium glutamate (MSG), and thimerosal (mercury).” Many of these same ingredients are in childhood vaccines. They are all very toxic for human physiology and have a track record for insulting the body’s immune system.

I would prefer to trust the innate ability of the body to overcome infectious microorganisms and I will fully support my body through healthy diet and lifestyle along with natural supplements and proper spinal alignment. I absolutely reject the idea that injecting a group of toxic, immune insulting chemicals into my bloodstream will improve someone’s long-term immune response.

Nancy Tarlow, D.C.

When you inject chemicals into your body that are toxic, there will be an effect. It may not be obvious at first. A child might have a fever that the doctor says is “normal”, but it isn’t. A fever or screaming could be that the brain is swelling and causing damage. The real problem is that children cannot convey to us how they feel. It’s not like an adult who can tell us that they felt great prior to a vaccination but then started having health problems.

Dr. Haroot Tovanyan, D.C.

I am a doctor of Chiropractic and I primarily work with autistic children.

Every single parent in my practice that has an autistic child has the same story. Child was born normal; child was developing normal. Child went in for their 12-month, 18-month, normal usually 24 or 36-month shots and regressed. This may be anecdotal, but when you hear it over and over and over again, there’s something to be said. These are children that have severe neurological issues. They’re not verbal; 8-10-year-old children that are still wearing diapers.

I have a quadriplegic niece in my family who received 4 shots, a total of 10 vaccines in 1 day. She was born normal. She developed normal until about a year and a half. At a year and a half she received 4 shots, 1, 2, 3, 4, and she … This was 1990 when they started doing multiple vaccines and they also quadrupled the number of shots that you’re normally receiving. She basically regressed. She’s a vegetable. I mean, she became a quadriplegic. Nowhere in nature would your child go to get exposed to let’s say 6 or 7 or 8 or 9, or in the case of my niece, 10 viruses and bacteria at the same time.

In nature that just doesn’t happen. They don’t co-exist like that. It’s not natural to put a combination of vaccines, combinations of viruses and bacteria that just don’t belong together or don’t co-exist in nature in a vial and inject it into a child and expect them to be healthy. The CDC schedule has never been tested for safety. There have never been double-blind studies. It’s never been tested for synergistic effect. They’ve refused to study un-vaccinated versus vaccinated.

END OF QUOTE

On this blog, we have discussed the issues related to chiropractic and immunisations repeatedly (for instance here, here, here and here).

In case you wonder about the origins of this odd and unethical behaviour, you best look into the history of chiropractic. D. D. Palmer, the magnetic healer who ‘invented’ chiropractic some 120 years ago, left no doubt about his profound disgust for immunisation: “It is the very height of absurdity to strive to ‘protect’ any person from smallpox and other malady by inoculating them with a filthy animal poison… No one will ever pollute the blood of any member of my family unless he cares to walk over my dead body… ” (D. D. Palmer, 1910)

D. D. Palmer’s son, B. J. Palmer  provided a more detailed explanation for chiropractors’ rejection of immunisation: “Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease… If we had one hundred cases of small-pox, I can prove to you, in one, you will find a subluxation and you will find the same condition in the other ninety-nine. I adjust one and return his function to normal… There is no contagious disease… There is no infection…The idea of poisoning healthy people with vaccine virus… is irrational. People make a great ado if exposed to a contagious disease, but they submit to being inoculated with rotten pus, which if it takes, is warranted to give them a disease” (B. J. Palmer, 1909)

We are often told that such opinions have all but died out in today’s chiropractic profession. But is this true? I see precious little evidence to assume this to be true.

Today the anti-vaxx notions of chiropractors are mostly expressed in a less abrupt, more politically correct language: The International Chiropractors Association recognizes that the use of vaccines is not without risk. The ICA supports each individual’s right to select his or her own health care and to be made aware of the possible adverse effects of vaccines upon a human body. In accordance with such principles and based upon the individual’s right to freedom of choice, the ICA is opposed to compulsory programs which infringe upon such rights. The International Chiropractors Association is supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health.

Yes, I do realise that some chiropractors now acknowledge that immunisations have been one of the most successful interventions in the history of medicine. Yet, far too many others still vehemently adhere to the gospel of the Palmers, and statements like the following abound:

Vaccines. What are we taught? That vaccines came on the scene just in time to save civilization from the ravages of infectious diseases. That vaccines are scientifically formulated to confer immunity to certain diseases; that they are safe and effective. That if we stop vaccinating, epidemics will return…And then one day you’ll be shocked to discover that … your “medical” point of view is unscientific, according to many of the world’s top researchers and scientists. That many state and national legislatures all over the world are now passing laws to exclude compulsory vaccines….

Our original blood was good enough. What a thing to say about one of the most sublime substances in the universe. Our original professional philosophy was also good enough. What a thing to say about the most evolved healing concept since we crawled out of the ocean. Perhaps we can arrive at a position of profound gratitude if we could finally appreciate the identity, the oneness, the nobility of an uncontaminated unrestricted nervous system and an inviolate bloodstream. In such a place, is not the chiropractic position on vaccines self-evident, crystal clear, and as plain as the sun in the sky?

So, the opinions by chiropractors cited above seem more the rule than the exception. NATURAL NEWS is not normally one of my favourite publications; on this occasion, however, I am thankful to the editor for alerting us to what I might call CHIROPRACTORS WITHOUT SCRUPLES.

Yes, the festive season is upon us and therefore it is high time to discuss detox (yet again). As many of us are filling their fridges to the brim, most of us prepare for some serious over-indulgence. Following alt med logic, this must prompt some counter-measures, called detox.

The range of treatments advocated by detox-fans is weird and wide (see also below):

  • various alternative diets,
  • herbal, vitamins, minerals and other ‘natural’ supplements,
  • various forms of chelation therapy,
  • electromagnetic devices,
  • colonic irrigation and enemas,
  • various forms of skin bruising,
  • cupping,
  • sauna and other means of inducing extensive sweating,
  • homeopathy,
  • ear candles,
  • foot-baths,
  • etc., etc.

I suppose it was to be expected that detox often goes with other crazy beliefs. This website, for instance, shows that it is even associated with anti-vaxx:

START OF QUOTE

Whether you believe vaccines to be harmful or not, one has to admit that all the ingredients added to vaccines cannot be good for anyone, especially children.

As David Wolfe has discussed, vaccines contain the following: sucrose, fructose, dextrose, potassium phosphate, aluminum potassium sulfate, peptone, bovine extract, formaldehyde, FD&C Yellow #6, aluminum lake dye, fetal bovine serum, sodium bicarbonate, monosodium glutamate, aluminum hydroxide, benzethonium chloride, lactose thimerosal, ammonium sulfate, formaldehyde, glutaraldehyde, bovine extract), calf serum, aluminum phosphate, aluminum hydroxyphosphate sulfate, and ethanol.

That is a long scary list and many of these things will not leave the body naturally. Thus, a gentle detox is necessary.

Detoxification Bath

Living Traditionally suggests a detoxification bath with both Zendocrine and epsom salt. Zendocrine is an essential oil mixture made up of tangerine, rosemary, geranium, juniper berry, and cilantro. Rosemary, juniper berry, and cilantro are good choices for detoxification and tangerine and geranium are purifiers.

Garlic

Garlic has been scientifically proven to treat heavy metal poisoning. Organic Lifestyle Magazine suggests consuming three cloves a day to help remove toxins.

Silica

Silica is also good for a heavy metal detox. Natural News states, “Aluminum (Al) is passed out through the urine when one supplements silica. It seems there’s little danger of taking too much, as long as adequate water is consumed and vitamin B1 and potassium levels are maintained.”

One of the best ways to get silica in your system is with the horsetail herb, rye, barley, oats, wheat, and alfalfa sprouts nuts.

Chlorella

Chlorella is one of the best detoxifying substances available. According to Dr. Mercola, “Chlorella is uniquely designed to not bind to the minerals your body naturally needs to function optimally. It does not bind to beneficial minerals like calcium, magnesium, or zinc. It’s almost as if chlorella knows which metals belong in your body and which chemicals need to be removed. Supplementing with chlorella is like unleashing a tiny army inside your body to fight the battle of removing toxins from your tissues and ushering them back outside your body where they belong.”
You can take it in supplement form or add a powdered version to your smoothie.

Probiotics

Probiotics are what is needed to put good bacteria system to rights when it has been thrown off by toxins. “They can provide assistance by decreasing the number of bad bacteria while helping to restore balance between good and bad bacteria in the gut and to keep your body functioning properly.” (LiveStrong)

Some probiotic foods include: organic yogurt, kefir, sauerkraut, kombucha, and fermented vegetables.

Omega-3

Omega 3 oils are especially good for cell repair and keeping your brain healthy. This is because of their high fat content is similar to the fats that are naturally part of cell and brain systems. (Daily Mail)

A teaspoon daily should be enough or you could take a supplement.

Cilantro

According to Natural Society, cilantro is a very gentle detoxification tool. It is also effective for removing heavy metals from the brain.
For 2-3 weeks, add a teaspoon of cilantro to your food, smoothie, or just eat it up. You can also substitute with 6-7 drops of cilantro essential oil by adding it to your bath.

END OF QUOTE

Don’t you just adore the sources quoted by the author as evidence for his/her statements?

As I said, the therapies recommended for detox are diverse. Yet, they have one important feature in co<span style=”color: #668a1d;”>mmon: they are not based on anything remotely resembling good evidence. As I stressed in my article of 2012:

The common characteristics of all of these approaches are that they are unproved. Even experts who are sympathetic to alternative medicine and AD admit: ‘while there are hundreds of randomized controlled trials on drug and alcohol detox, there are no such trials of detox programs focusing on environmental toxins … at present, “detox” is certainly more of a sales pitch than a science’. The ‘studies’ of AD that have been published are of such poor methodological quality that no conclusions can be drawn from them.

While there is a total absence of sound evidence for benefit, some of these treatments have been associated with risks which depend on the nature of the treatment and can be particularly serious with diets (malnutrition), supplements (hepatoxicity), chelation (electrolyte depletion) and colonic irrigation (perforation of the colon).

Yet detox is big business’. A recent survey, for instance, suggested that 92% of US naturopaths use some form of detox. To lay people, its principles seem to make sense and, in many of us, the desire to ‘purify’ ourselves is deep rooted. Thus detox-entrepreneurs (including Prince Charles who, several years ago, launched a ‘Detox-Tincture’ via his firm Duchy Originals) are able to exploit a gullible public.

Proponents of detox are keen to point out that ‘a modern science of ‘detoxicology’ seems to be emerging’. If there is such a thing, it should address the following, fundamental questions:

  • What are the toxins and toxicants?
  • What evidence exists that they damage our health?
  • How do we quantify them?
  • How do we diagnose that a patient requires detox?
  • Which treatments are effective in eliminating which toxins?

Currently, there is insufficient evidence to answer any of these questions. Until this situation changes, I do not think a ‘science of detox’ exists at all.

Yesterday I received an electronic Christmas card from two homeopathic institutions called ‘Homeopathic Associates and The Homeopathic College’. It read: WISHING YOU THE BEST OF HEALTH AND HAPPINESS FOR THE NEW YEAR!

Naturally I was puzzled, particularly since I had no recollection of ever having been in contact with them. The card was signed by Manfred Mueller, MA, DHM, RSHom(NA), CCH, and I decided to find out more about this man. It turns out that Manfred Mueller developed The Mueller Method or “Extra-Strength Homeopathy” to meet today’s complex chronic conditions, drug induced disorders, vaccine injuries, toxic overload, radiation-induced health problems, cancers, etc.

Now, this sounds interesting, I thought, and read on. Just a few clicks further, Mueller offers his wisdom on homeopathic cancer treatments in a lengthy article entitled ‘Is Homeopathy an Effective Cancer Treatment?

According to Mueller, the answer to his question is a clear yes. I will spare you the torture of reading the entire paper (if you have masochistic tendencies, you can read it via the link I provided above); instead, I will just copy Mueller’s conclusion:

START OF QUAOTE

Laboratory studies in vitro and in vivo show that homeopathic drugs, in addition to having the capacity to reduce the size of tumors and to induce apoptosis, can induce protective and restorative effects. Additionally homeopathic treatment has shown effects when used as a complementary therapy for the effects of conventional cancer treatment. This confirms observations from our own clinical experience as well as that of others that when suitable remedies are selected according to individual indications as well as according to pathology and to cell-line indications and administered in the appropriate doses according to the standard principles of homeopathic posology, homeopathic treatment of cancer can be a highly effective therapy for all kinds of cancers and leukemia as well as for the harmful side effects of conventional treatment. More research is needed to corroborate these clinical observations.

Homeopathy over almost two decades of its existence has developed more than four hundred remedies for cancer treatment. Only a small fraction have been subjected to scientific study so far. More homeopathic remedies need to be studied to establish if they have any significant action in cancer. Undoubtedly the next big step in homeopathic cancer research must be multiple comprehensive double-blinded, placebo-controlled, randomized clinical trials. To assess the effect of homeopathic treatment in clinical settings, volunteer adult patients who prefer to try homeopathic treatment instead of conventional therapy could be recruited, especially in cases for which no conventional therapy has been shown to be effective.

Many of the researchers conducting studies — cited here but not discussed — on the growing interest in homeopathic cancer treatment have observed that patients are driving the demand for access to homeopathic and other alternative modes of cancer treatment. So long as existing cancer treatment is fraught with danger and low efficacy, it is urgent that the research on and the provision of quality homeopathic cancer treatment be made available for those who wish to try it.

END OF QUOTE

Amazing! What could be more wrong than this?

But it’s the season of joy and love; so, let’s not go into the embarrassing details of this article. Instead, I feel like returning the curtesy of Mr Mueller’s Christmas card. Therefore, I have decided to post this open ‘Christmas card’ to him:

Dear Mr Mueller,

thank you for your card, the good wishes, and the links you provided to your websites, articles, etc. I only read the one on cancer but was impressed. It is remarkably misguided, unethical and dangerous. Crucially, it has the potential to shorten the lives of many desperate patients. I therefore urge you to desist making your opinions public or from applying them in your clinical practice. I say this not merely because I am concerned about the patients that have the misfortune to fall into your hands, but also to prevent you from getting into trouble for immoral, unethical or unlawful behaviour.

In this spirit, I wish you happiness for the New Year.

Edzard Ernst

The fact that much of chiropractic might be bogus has frequently been discussed on this blog. A recent press-release provided me with more evidence for this notion. It proudly announced a new book entitled “Beyond the Back: The Chiropractic Alternative For Conditions Beyond Back Pain”

The text claimed that shortly after the launch, the book hit #1 on the Amazon.com best seller list out of all Chiropractor books and also reached #1 for the category of Holistic Medicine.

When I checked (22/12/2016), I was not able to confirm this statement: #47 in Kindle Store > Kindle eBooks > Medical eBooks > Alternative & Holistic > Holistic Medicine, #58 in Books > Medical Books > Allied Health Professions > Chiropractic. But let’s not be petty; let’s rather see what the book has to offer.

‘Beyond the Back’ focuses on how Chiropractic care can do so much more than just alleviate back pain, the press-release says. From avoiding knee surgery to resolving athletic injuries, chiropractic care allegedly is a 100% natural health solution for a wide variety of conditions… In fact, in some cases, chiropractors can help their patients get off medications entirely and even avoid surgery, the press-release continues.

In the book itself, the authors claim that chiropractic is effective for a multitude of conditions, including asthma and colic (in fact, the authors try to give the impression that chiropractic is a veritable panacea), and that there is sound evidence for all these indications from hundreds, if not thousands of studies. The authors make it very clear – even on the book cover – that chiropractic is not an adjunct to conventional healthcare but an alternative to it; an idea, of course, that goes back to the founding fathers of chiropractic. As if this were not enough, the book also promotes diagnostic techniques such as applied kinesiology.

Some commentators on this blog have argued that the chiropractic profession is in the midst of giving up much of the nonsense upon it was originally based and to which it has clung on for more than hundred years. This book, written by 9 US authors of the new generation of chiropractors, seems to demonstrate the opposite.

On Amazon, the book currently has one single customer review: Value information and an easy read! I am a strong believer of chiropractic and this makes it easy for me to share this info with my friends ! 

This comment is apt because it makes clear that chiropractic is a belief system. We must not expect rational thoughts or facts from what, in effect, is a religion for many. I can understand this in a way: belief can be a cosy shelter from the truth; it does not require much thinking; it hardly needs any learning, no changing of minds, etc. However, belief can never be a basis for good healthcare. In my view, ‘Beyond The Back’ provides a perfect example of that.

HOMEOPATHIC REMEDIES CANNOT POSSIBLY  PLACEBOS BECAUSE THEY WORK IN ANIMALS!

How often have we heard this argument?

And how often have we pointed out that it is wrong on more than one level?

On this blog alone, we have done so here, here, here and here, for instance. But homeopaths and their followers seem to be strangely immune to facts. Presumably, they will therefore also ignore a recent paper that re-confirms what has already been said so often.

This new systematic review assessed the efficacy of homeopathy in cattle, pigs and poultry. Only peer-reviewed publications dealing with homeopathic remedies, which could possibly replace or prevent the use of antibiotics in the case of infective diseases or growth promotion in livestock were included. Search results revealed a total number of 52 trials performed within 48 publications fulfilling the predefined criteria. Twenty-eight trials were in favour of homeopathy, with 26 trials showing a significantly higher efficacy in comparison to a control group, whereas 22 showed no medicinal effect. Cure rates for the treatments with antibiotics, homeopathy or placebo varied to a high degree, while the remedy used did not seem to make a big difference. No study had been repeated under comparable conditions. Consequently, the use of homeopathy cannot claim to have sufficient prognostic validity where efficacy is concerned. When striving for high therapeutic success in treatment, the potential of homeopathy in replacing or reducing antibiotics can only be validated if evidence of efficacy is confirmed by randomised controlled trials under modified conditions.

I think this, together with the previous systematic reviews on the subject, speaks for itself, and there is little to add – except perhaps the bravely outspoken letter by Oliver Kamm in THE TIMES which alludes to the above named paper:

START OF QUOTE

Using highly diluted substances to cure ailments is a better idea than the medieval practices of bloodletting by leeches or administering hemlock as an anaesthetic. That’s the best you can say for homeopathy: it isn’t outright dangerous. As medicine, however, it’s junk. Study after study has confirmed that homeopathic remedies are inert and no more effective than either a placebo or just allowing an illness to run its course.

Now research published in the Veterinary Record concludes that there is insufficient evidence to support the use of homeopathic treatments in livestock, either, as a way to prevent or treat infectious diseases. Two scientists from the university of Kassel in Germany reviewed studies of the effectiveness of homeopathic treatments in cattle, pigs and poultry. They say the “evidence in favour of homeopathy lacks reproducibility and therefore cannot claim to have sufficient prognostic validity”.

Over 200 years, homeopaths have failed to substantiate their claims. It may seem bizarre that anyone in the 21st century could take seriously the notion of homeopathic treatments for animals. But that is to reckon without the Prince of Wales and his lifetime enthusiasm for zaniness on science, medicine, aesthetics and linguistics. He once gave a speech declaring himself proud for having been “accused once of being the enemy of the Enlightenment”. A few months ago he stunned a conference of scientists and public officials by disclosing that he uses only homeopathic remedies when treating his cattle and sheep on his country estate at Highgrove.

Prince Charles’s knowledge of science may be a joke but his contributions to public debate aren’t funny. They bestow prestige on atavistic superstitions that have no place in modern healthcare and animal welfare. NHS guidelines are clear there “is no good-quality evidence that homeopathy is effective as a treatment for any health condition”. Likewise in veterinary medicine. Out of more than 20,000 vets licensed in the UK, around 50 practise homeopathy. That is 50 too many. The same is true of the roughly 500 farmers who employ homeopathy. They can’t even claim a placebo effect as the animals are unaware of their purported medical treatment.

Yet the quacks are undaunted. The British Association of Homeopathic Veterinary Surgeons even claims success in curing dogs of cancer through homeopathy. This is nonsense — and if it persuades farmers and pet owners to forgo evidence-based treatments, it’s also wanton cruelty. It’s past time to shut these people down.”

END OF QUOTE

This meta-analysis was performed “to ascertain the effectiveness of oral aloe vera consumption on the reduction of fasting blood glucose (FBG) and hemoglobin A1c (HbA1c).”

PubMed, CINAHL, Natural Medicines Comprehensive Database, and Natural Standard databases were searched. The searches were limited to clinical trials or observational studies conducted in humans and published in English. Studies of aloe vera’s effect on FBG, HbA1c, homeostasis model assessment-estimated insulin resistance (HOMA-IR), fasting serum insulin, fructosamine, and oral glucose tolerance test (OGTT) in prediabetic and diabetic populations were examined.

Nine studies were included in the FBG parameter (n = 283); 5 of these studies included HbA1c data (n = 89). Aloe vera decreased FBG by 46.6 mg/dL (p < 0.0001) and HbA1c by 1.05% (p = 0.004). Significant reductions of both endpoints were maintained in all subgroup analyses. Additionally, the data suggested that patients with an FBG ≥200 mg/dL may see a greater benefit. A mean FBG reduction of 109.9 mg/dL was observed in this population (p ≤ 0.0001). There was evidence of publication bias with FBG but not with HbA1c.

The authors concluded that the results of this meta-analysis support the use of oral aloe vera for significantly reducing both FBG (46.6 mg/dL) and HbA1c (1.05%) in prediabetic and diabetic patients. However, given the current overall quality and relative scarcity of data, further clinical studies that are more robust and better controlled are warranted to confirm and further explore these findings.

Oh no, the results do not support the use of aloe vera at all!!

Why?

Because this ‘meta-analysis’ is of unacceptably poor quality. Here are just some of the flaws that render it totally useless, particularly for issuing advice such as above:

  • The authors included uncontrolled observational studies which make no attempt to control for non-specific effects.
  • In several studies, the use of concomitant anti-diabetic medications was allowed; therefore it is not possible to establish cause and effect by aloe vera.
  • The search strategy was woefully inadequate; for instance non-English publications were not considered.
  • There was no assessment of the scientific rigor of the included studies; this totally invalidates the reliably of the conclusions.
  • The included studies used preparations of widely different aloe vera preparations, and there is no way of knowing the does of the active ingredients.

Diabetes is a serious condition that affects millions worldwide. If some of these patients are sufficiently gullible to follow the conclusions of this paper, they might be dead within a matter of days. This makes this article one of the most dangerous papers that I have seen in the ‘peer-reviewed’ literature of alternative medicine.

Who publishes such utter and irresponsible rubbish?

You may well ask.

The journal has been discussed on this blog  before for the junk that regularly appears in its pages, and so has its editor in chief. The authors (and the reviewers) are not known to me, but one thing is for sure: they don’t know the first thing about conducting a decent systematic review/meta-analysis.

Yes, to a large extend, quacks make a living by advertising lies. A paper just published confirms our worst fears.

This survey was aimed at identifying the frequency and qualitative characteristics of marketing claims made by Canadian chiropractors, naturopaths, homeopaths and acupuncturists relating to the diagnosis and treatment of allergy and asthma.

A total of 392 chiropractic, naturopathic, homeopathic and acupuncture clinic websites were located in 10 of the largest metropolitan areas in Canada. The main outcome measures were: mention of allergy, sensitivity or asthma, claim of ability to diagnose allergy, sensitivity or asthma, claim of ability to treat allergy, sensitivity or asthma, and claim of allergy, sensitivity or asthma treatment efficacy. Tests and treatments promoted were noted as qualitative examples.

The results show that naturopath clinic websites had the highest rates of advertising at least one of diagnosis, treatment or efficacy for allergy or sensitivity (85%) and asthma (64%), followed by acupuncturists (68% and 53%, respectively), homeopaths (60% and 54%) and chiropractors (33% and 38%). Search results from Vancouver were most likely to advertise at least one of diagnosis, treatment or efficacy for allergy or sensitivity (72.5%) and asthma (62.5%), and results from London, Ontario were least likely (50% and 40%, respectively). Of the interventions advertised, few are scientifically supported; the majority lack evidence of efficacy, and some are potentially harmful.

[Legend to figure above: Percentage of alternative medicine clinic websites advertising at least one of diagnosis, treatment or efficacy for allergy/sensitivity or asthma. Presenting the data in this way demonstrates that the Canadian naturopath, homeopath and acupuncturist websites studied have >50% rates of making at least one health-related claim for both allergy/sensitivity and asthma.]

The authors concluded that the majority of alternative healthcare clinics studied advertised interventions for allergy and asthma. Many offerings are unproven. A policy response may be warranted in order to safeguard the public interest.

In the discussion section, the authors state: “These claims raise ethical issues, because evidence in support of many of the tests and treatments identified on the websites studied is lacking. For example, food-specific IgG testing was commonly advertised, despite the fact that the Canadian Society of Allergy and Clinical Immunology has recommended not to use this test due to the absence of a body of research supporting it. Live blood analysis, vega/electrodiagnostic testing, intravenous vitamin C, probiotics, homeopathic allergy remedies and several other tests and treatments offered all lack substantial scientific evidence of efficacy. Some of the proposed treatments are so absurd that they lack even the most basic scientific plausibility, such as ionic foot bath detoxification…

Perhaps most concerning is the fact that several proposed treatments for allergy, sensitivity or asthma are potentially harmful. These include intravenous hydrogen peroxide, spinal manipulation and possibly others. Furthermore, a negative effect of the use of invalid and inaccurate allergy testing is the likelihood that such testing will lead to alterations and exclusions in diets, which can subsequently result in malnutrition and other physiological problems…”

This survey originates from Canada, and one might argue that elsewhere the situation is not quite as bad. However, I would doubt it; on the contrary, I would not be surprised to learn that, in some other countries, it is even worse.

Several national regulators have, at long last, become aware of the dangers of advertising of outright quackery. Consequently, some measures are now beginning to be taken against it. I would nevertheless argue that these actions are far too slow and by no means sufficiently effective.

We easily forget that asthma, for instance, is a potentially life-threatening disease. Advertising of bogus claims is therefore  much more than a forgivable exaggeration aimed at maximising the income of alternative practitioners – it is a serious threat to public health.

We must insist that regulators protect us from such quackery and prevent the serious harm it can do.

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