MD, PhD, FMedSci, FSB, FRCP, FRCPEd

politics

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The Committees of Advertising Practice (CAP) write and maintain the UK Advertising Codes, which are administered by the Advertising Standards Authority. On their website, the CAP recently published an updated advertising code for naturopathy. As we have regularly discussed the fact that the public is being frequently misled in this area, I consider the code important in the context of this blog. I therefore take the liberty of repeating it here – not least in the hope that this helps preventing misinformation in the future [the numbers in square brackets refer to me footnotes below].

START OF QUOTE

What is Naturopathy?

Naturopathy is a holistic [1] approach to healthcare that uses a combination of one or more different disciplines (for example herbal medicine or hydrotherapy) and a healthy lifestyle [2] in order to gain and maintain a healthy body [3].

What claims are likely to be acceptable?

The promotion of a healthy [4] lifestyle is likely to acceptable as are claims that go no further than those commonly accepted for healthy [4] eating, sleeping well, taking exercise and the like.

What claims are likely to be problematic?

The ASA and CAP have not yet been provided with evidence which demonstrates that Naturopathy can be used to treat medical conditions (Rule 12.1).  Therefore, any claims that go beyond accepted claims for a healthy [4] lifestyle are likely to be problematic [5] unless they are supported by a robust body of evidence.  In 2013, the ASA ruled against claims on a marketer’s website which said that Naturopathy could be used to treat acute and chronic illness and disease because the marketer had not provided any evidence in support of their claims (CNM The College of Naturopathic Medicine Ltd, 13 March 2013).

What about serious medical conditions?

Claims to offer treatment on conditions for which medical supervision should be sought [6] are likely to be considered to discourage essential treatment unless that treatment is carried out under the supervision of a suitably qualified health professional (Rule 12.2).

END OF QUOTE

Naturopathy has been the subject of my posts before – see for instance here, here, here, here and here. Naturopathy can be dangerous to the point where it can kill the patient – see for instance here and here. Therefore it is important that advertising gets regulated. To make it very clear: the above statement by the CAP is, in my view, a step in the right direction, and I encourage alternative practitioners to look up the equivalent CAP documents for their specific therapy.

Having said that, I still feel the need to make a few comments:

  1. It is misleading to call naturopathy ‘holistic’. This is often factually incorrect and also gives the impression that conventional medicine is not holistic – see also here.
  2. Are we sure that all lifestyles promoted by naturopaths are, in fact, healthy?
  3. Maintaining a healthy body is naturopathy speak for DISEASE PREVENTION. Who decides what is effective prevention? On what evidence? How come many naturopaths are against the most effective means of prevention of all times – vaccination?
  4. Who decides what is ‘healthy’? On what evidence?
  5. Why ‘problematic’? Are they not wrong or bogus or false or fraudulent or criminal?
  6. Are there conditions for which medical supervision should not be sought? Which are they?

The ‘CHRONICLE OF CHIROPRACTIC’ recently reported on the relentless battle within the chiropractic profession about the issue of ‘subluxation’. Here is (slightly abbreviated) what this publication had to say:

START OF QUOTE

Calling subluxation based chiropractors “unacceptable creatures” chiropractic researcher Keith H Charlton DC, MPhil, MPainMed, PhD, FICC, recently stated “. . . that it is no longer scientifically acceptable for any responsible chiropractic clinician to ever use the word subluxation except as theory . . .” Charlton made the comment to members of the Chiropractic Research Alliance a group of subluxation deniers who routinely disparage the concept of subluxation.

Charlton is a well known “Subluxation Denier” and frequently attacks subluxation based chiropractors in his peer reviewed research papers and on Facebook groups. According to Charlton in a paper published in the journal Chiropractic and Osteopathy: “The dogma of subluxation is perhaps the greatest single barrier to professional development for chiropractors. It skews the practice of the art in directions that bring ridicule from the scientific community and uncertainty among the public.”

On January 5, 2017 Charlton further stated: “We need NOW in 2017 and beyond to get rid of the quacks that do us so much harm. They need to be treated personally and professionally as utterly unacceptable creatures to be shunned and opposed at every turn. Time to get going on cleaning out the trash. And that includes all signs, websites, literature, handouts and speech of staff and chiropractors.”

…Charlton has testified against subluxation based chiropractors in regulatory board actions and appears to revel in it.

In his most recent pronouncement Charlton states that he is okay with subluxation as a “regional spine shape distortion” and asserts that this is a CBP subluxation. This contention is common with subluxation deniers who are willing to accept an orthopedic definition of subluxation absent the neurological component.

…Charlton states he uses the following techniques on his website:

  • Applied Kinesiology
  • Diversified
  • Motion Palpation
  • Sacro-Occipital Technique
  • Activator
  • Logan Basic

When this self-declared scientist was confronted with his use of Applied Kinesiology and these other techniques his response was essentially that he is engaging in a “bait and switch” and that he just has those on his website to get patients who are looking for those things. Charlton lists 21 “research papers” on his curriculum vitae though they are all simply commentaries or reviews not original clinical research. The majority of these opinion pieces are attacks on subluxation and the chiropractors who focus on it.

END OF QUOTE

What does this tell us?

  • It seems to me that the ‘anti-subluxation’ movement with in the chiropractic profession is by no means winning the battle against the ‘hard-core subluxationists’.
  • Chiropractors cannot resist the temptation to use ad hominem attacks instead of factual arguments. I suppose this is because the latter are in short supply.
  • The ‘anti-subluxationists’ present themselves as the evidence-based side of the chiropractic spectrum. This impression might well be erroneous. Giving up the myth of subluxation obviously does not necessarily mean abandoning other forms of quackery.

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.

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.

The boom of alternative medicine in the US – and consequently in the rest of the developed world – is intimately connected with a NHI centre now called NCCIH (National Center for Complementary and Integrative Health). It was founded in the early 1990s because some politicians were bent on promoting quackery. Initially the institution had modest funding but, after more political interference, it had ample cash to pursue all sorts of activities, including sponsoring research into alternative therapies at US universities. A most interesting video summarising the history of the NCCIH can be seen here.

No other institution in the world had more funds for research into alternative medicine than the NCCIH, and it soon became the envy of alt med researchers globally. I have been invited by the NCCHI on several occasions and invariably was impressed by their apparent affluence. While we Europeans usually had to do our research on a shoe-string, our American colleagues seemed to be ‘rolling in it’.

I was often far less impressed with the research they sponsored. Not only it was invariably eye-wateringly expensive, but also its quality seemed often dismal. Sometimes, I even got the impression that research was used as a means of mainstreaming quackery for the unsuspecting American – and consequently world-wide – public.

An example of this mainstreaming is an article in JAMA published yesterday. Here is a short but telling excerpt:

Researchers led by Richard L. Nahin, PhD, MPH, lead epidemiologist at the NIH’s National Center for Complementary and Integrative Health (NCCIH), examined efficacy and safety evidence in 105 randomized controlled trials (RCTs) conducted between January 1966 and March 2016. The review—geared toward primary care physicians as part of the journal’s Symposium on Pain Medicine—focused on popular complementary approaches to common pain conditions.

Unlike a typical systematic review that assigns quality values to the studies, the investigators conducted a narrative review, in which they simply looked at the number of positive and negative trials. “If there were more positives than negatives then we generally felt the approach had some value,” Nahin explained. “If there were more negatives, we generally felt the approach had less value.” Trials that were conducted outside of the United States were excluded from the review.

Based on a “preponderance” of positive vs negative trials, complementary approaches that may offer pain relief include acupuncture and yoga for back pain; acupuncture and tai chi for osteoarthritis of the knee; massage therapy for neck pain; and relaxation techniques for severe headaches and migraine. Several other techniques had weaker evidence, according to the qualitative assessments, for specific pain conditions (see “Selected Complementary Health Approaches for Pain”). The treatments were generally safe, with no serious adverse events reported.

To me, this looks that NCCIH has now managed to persuade even the editors of JAMA to white-wash their dodgy science. The review referred to here is a paper we discussed some time ago on this blog. I then stated about it the following:

Reading the article carefully, it is impossible not to get troubled. Here are a few points that concern me most:

  • the safety of a therapy cannot be evaluated on the basis of data from RCTs (particularly as it has been shown repeatedly that trials of alternative therapies often fail to report adverse effects); much larger samples are needed for that; any statements about safety in the aims of the paper are therefore misplaced;
  • the authors talk about efficacy but seem to mean effectiveness;
  • the authors only included RCTs from the US which must result in a skewed and incomplete picture;
  • the article is from the National Center for Complementary and Integrative Health which is part of the NIH but which has been criticised repeatedly for being biased in favour of alternative medicine;
  • not all of the authors seem to be NIH staff, and I cannot find a declaration of conflicts of interest;
  • the discussion of the paper totally lacks any critical thinking;
  • there is no assessment of the quality of the trials included in this review.

My last point is by far the most important. A summary of this nature that fails to take into account the numerous limitations of the primary data is, I think, as good as worthless. As I know most of the RCTs included in the analyses, I predict that the overall picture generated by this review would have changed substantially, if the risks of bias in the primary studies had been accounted for.

I find it puzzling that the ‘lead epidemiologist at the NIH’s National Center for Complementary and Integrative Health’ would publish such dubious research. Why does he do it? If you have watched the video mentioned above, you are inclined to think that it might be because of political interference.

However, I suggest another, in a way much more damming reason or contributing factor: the NCCIH has so long indulged in such poor science that even its top people have forgotten what good science looks like. I know this is a bold hypothesis; so, let me try to support it with some data.

Several years ago, my team together with several other researches have looked at the NCCIH-sponsored research systematically according to 4 different subject areas. Here are the conclusions of our articles reporting the findings:

ACUPUNCTURE

Seven RCTs had a low risk of bias. Numerous methodological shortcomings were identified. Many NCCAM-funded RCTs of acupuncture have important limitations. These findings might improve future studies of acupuncture and could be considered in the ongoing debate regarding NCCAM-funding. [Focus on Alternative and Complementary Therapies Volume 17(1) March 2012 15–21]

HERBAL MEDICINE

This independent assessment revealed a plethora of serious concerns related to NCCAM studies of herbal medicine. [Perfusion 2011; 24: 89-102]

ENERGY MEDICINE

In conclusion, the NCCAM-funded RCTs of energy medicine are prime examples of misguided investments into research. In our opinion, NCCAM should not be funding poor-quality studies of implausible practices. The impact of any future studies of energy medicine would be negligible or even detrimental. [Focus on Alternative and Complementary Therapies Volume 16(2) June 2011 106–109 ]

CHIROPRACTIC

In conclusion, our review demonstrates that several RCTs of chiropractic have been funded by the NCCAM. It raises numerous concerns in relation to these studies; in particular, it suggests that many of these studies are seriously flawed. [https://www.ncbi.nlm.nih.gov/pubmed/21207089]

I think I can rest my case and urge you to watch the video mentioned above.

The Scotsman reported that David Tredinnick, the somewhat feeble-minded Tory MP for Bosworth, has been at it again. Apparently he said that many of his constituents are only alive today because they have been treated with alternative medicine.

Tredennick recently urged ministers to spend more NHS money on alternative therapies such as homeopathy and acupuncture to treat patients. It seems to me that, for him and other quackery promoters, evidence and science are issues beyond comprehension. Mr Tredinnick also disclosed the fact that he received acupuncture at a Chinese medical clinic just before the Commons debate on cancer strategy – a regular treatment he credits with keeping him healthy.

Tredennick told his fellow MPs: “I was talking there to practitioners about what they are able to do for cancer patients, and there is actually a very long list of types of cancer that can be treated using traditional Chinese herbal medicine.“ One, cervical cancer, two, non-Hodkins lymphoma, three, HIV, four, colon cancer, five… six, breast cancer, seven, prostate cancer. And so the list goes on. “I have in my constituency several constituents who I believe are alive today because they have used Chinese medicine.“ And the reason for that is what it does is it strengthens your system, and it strengthens the immune system, and it is very effective after cancer treatment. It deals with particular symptoms.”

This is by no means the first outburst of quackery-promotion by the Right Honourable Gentleman. I have a whole selection of quotes from him which I sometimes use for amusing my audience during public lectures. Because amusing he is; Tredennick seems to be utterly devoid of rational thought when it comes to the subject of alternative medicine, and often his statements make for comedy gold. This time, however, he might be sailing closer to the wind than he perhaps realizes: Under English law, it is an offence to claim that any treatment can cure cancer, I believe.

We all had to learn to laugh about unethical and dangerous nonsense the ‘Tredennicks of this world’ regularly claim about alternative medicine. Laughing is the only solution for coping with such idiocy, I am afrid. If we don’t laugh, we have to consider taking it seriously – and this is a truly frightening prospect, particularly considering that this guy actually sits in parliament and has the power to influence our lives.

WARNING: THIS POST IS NOT ABOUT ALTERNATIVE MEDICINE

My first ever scientific paper, a spin-off from my MD thesis, was published exactly 40 years ago. Since then, I have written many more articles. Readers of this blog might think that they are all on alternative medicine, but that is not the case. My most cited paper is (I think) one which combined my research in haemorheology with that in epidemiology. Yet, I would not consider it to be my most important article.

So, what is my most important publication?

It is one that relates to the history of medicine.

How come?

In 1990, I was appointed as chair of Rehabilitation Medicine at the University of Vienna. On the occasion of the official opening of the new 2000-bed university hospital in Vienna, I was asked to say a few words and thought that a review of the history of my department might be a fitting subject. But I was wrong. What I discovered while researching it turned out to be totally unfitting for the event; in fact, it contributed to my decision to leave Vienna in 1993. I did, however, summarize my findings in an article – and it is this paper that I consider my most important publication. Here is its abstract:

Misguided by the notion that the decline of the German race would be prevented by purifying “Aryan blood” and eliminating foreign, particularly Jewish, influences, the Nazis evicted all Jews from universities within their growing empire during the Third Reich. The Medical Faculty of Vienna suffered more than any other European faculty from “race hygiene.” Within weeks of the Nazi annexation of Austria in 1938, 153 of the Faculty’s 197 members were dismissed. By far the most frequent reason for dismissal was Jewish origin. Most victims managed to emigrate, many died in concentration camps, and others committed suicide. The “cleansing” process encountered little resistance, and the vacant posts were quickly filled with persons known not for their medical expertise but for their political trustworthiness. It was in this climate that medical atrocities could be committed. After the collapse of the Third Reich, most members of the Faculty were burdened with a Nazi past. Most remained in office, and those who had to leave were reinstituted swiftly. The Jews evicted in 1938 were discouraged from returning. These events have significantly–and with long-lasting effects–damaged the quality of a once-leading medical school. This story needs to be told to honor its victims and to fortify us so that history does not repeat itself.

As I pointed out in my memoir, it “was not published until 1995, by which time I was no longer at the University of Vienna but had left Austria and gone joyfully back to the U.K. to take up my post at the University of Exeter. When the paper was published, it had a considerable impact and important consequences. On the one hand, I received a torrent of hate-mail and threats, and was even accused by the more sensationalistic elements of the Austrian press of having stolen considerable amounts of money from my department at the University of Vienna – an entirely fabricated story, of course, and so ridiculous that I couldn’t even take it seriously enough to instigate legal action.”

So, what else happened as a consequence of the paper?

The answer is ‘lots’.

The Nazi-dean of the medical faculty in 1938, Eduard Pernkopf,  became the author of one of the world’s best anatomical atlas. Here is a short excerpt from a website on Pernkopf and his work which outlines some of the consequences of my paper:

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Following Dr. Edzard Ernst’s, revelations in the Annals of Internal Medicine (1995) about the source of Pernkopf’s “models,” Yad Vashem (the Holocaust Authority in Israel) requested that the Universities of Vienna and Insbruck conduct an independent inquiry to determine who the subjects in Pernkopf’s Atlas were and how they died. The request from Yad Vashem was initially denied; but the issue did not end. The following year, a letter by Dr. Seidelman and Dr. Howard Israel, an oral surgeon at Columbia University published in JAMA (November, 1996) in which they stated: “The abuses of medicine perpetrated during the Hitler regime pervaded the entire medical profession of the Third Reich including the academic elite. One legacy of the tragic era endures today through the continued publication of a critically acclaimed atlas, Pernkopf Anatomy…” Their letter prompted a report by the New York Times (1996).

In 1997, Alfred Ebenbauer, the rector of the University of Vienna, wrote to JAMA indicating that an investigation had been initiated and that preliminary findings indicated that the anatomy department had indeed, routinely received corpses of executed persons, among them renowned dissidents, and “brain preparations derived from children under the euthanasia program in psychiatric institutes were still stored there…” For the first time, he acknowledged publicly systematic suppression and even denial of the university’s Nazi past and its failure to conduct relevant investigations. Ebenbauer explained that this attitude had changed because of ‘‘increasing pressure from abroad’’ and a new political atmosphere in Austria (Ethics and Access…Pernkopf atlas, Bulletin of the Medical Library Association 2001; Hildebrandt, 2006).

Penkopf_Atlas Human Anatomy_neck-shoulderThe final report of University of Vienna investigation found that at least 1,377 bodies of executed victims (guillotined or shot by the Gestapo at a rifle range); about 7,000 bodies of fetuses and children; and “8 victims of Jewish origin” had been received by the Anatomy Institute. A statement for users of Pernkop’s Atlas sent out by the U of V to all libraries states: “it is therefore within the individual user’s ethical responsibility to decide whether and in which way he wishes to use this book.” (Hildebrandt, 2006). Hildebrandt states: “the influx of bodies from executions increased so much during the NS [Nazi] regime that the rooms of the anatomy institute were sometimes overfilled and executions had to be postponed because of this.” However, she notes that the true numbers are not known because of incomplete documentation.

Howard M. Spiro, M.D., director of Yale’s Program for Humanities in Medicine and professor of internal medicine, was among the noted speakers at the convocation in Vienna marking (1998) the 60th anniversary of the dismissal of Jewish faculty members from the Vienna Medical School. In his address The Silence of Words, Dr. Spiro said, “the things that we avoid and don’t talk about are the matters that mean the most to us. The shame that has no vent in words makes other organs weep.” Dr. Spiro acknowledged that current officials of the University of Vienna are attempting to recover information that has either been hidden or destroyed and trying to locate former faculty who were interned and exiled. “There is a new generation that has taken over, and they are not afraid to look into these atrocities.”

It is now understood that many of the incredibly detailed illustrations in Pernkopf’s atlas depicted the bodies of victims of Nazi terror.

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Why do I bring this up again today?

For two reasons: firstly, I have been invited to give two lecture about these events in recent weeks. Secondly and much more importantly, we seem to live in times when the threat of fascism in several countries has again become worrisomely acute, and I think reminding people of my conclusion drawn in 1995 might not be a bad idea:

This story needs to be told to honor its victims and to fortify us so that history does not repeat itself.

On this blog, we have repeatedly discussed the issues around para-normal or spiritual healing practices. In one of these posts I concluded that these treatments are:

  1. utterly implausible
  2. not supported by good clinical evidence.

What follows seems as simple as it is indisputable: energy healing is nonsense and does not merit further research.

Yet both research and – more importantly – the practice of spiritual healing continue, not only in the developed world but even more so in poor and under-developed countries.

Traditional healers, known in Rwanda as Abarangi or Abacwezi claim to use their spiritual powers to heal sick patients. Recently, they urged their government to acknowledge them through proper regulation. Jean-Bosco Kajongi, the leader of the healers in Rwanda, said Abahereza are like doctors who have been selected by angels. “Umuhereza is someone who gets power from God to treat different diseases but particularly demonic possession such as ‘Amahembe’ and ‘Imandwa’. Sometimes, doctors detect something in the body, do surgery but find nothing. But Abarangi can identify the disease beforehand and heal it. Thus, we want to have legal personality and work with modern doctors because what we cure, they cannot even see it. Therefore, mortality rate would decrease.”

Abahereza claim to have God-given powers to heal any disease, provided that the patient has belief in their powers. Claudine Uwamahoro, a resident of Rulindo district is one of them. “Last year, I was transferred to Kanombe Military Hospital to have my leg cut off after they diagnosed me with cancer. Abarangi told me it was not cancer but rather ‘Imandwa.’ They treated me but I didn’t get healed immediately because I had not yet heeded God’s commandment because they do not use any medicines but only requires you to obey God and respect his commandments.  Now my leg has been healed… Like Jesus came to save us so that we don’t perish, Umurangi also came so that we do not die of diseases that normal medicines cannot treat.”

Another patient agrees: “In 1983, I played football but later, Imandwa disabled me and my legs were paralyzed. I went to various hospitals and was given an assortment of medicines but they could not help. I always had fever; Doctors treated me but could not identify what kind of disease it really was. I even went to traditional healers but they didn’t have a solution. Pastors and priests prayed for me but in vain. Sorcerers also tried but failed. I was possessed by Imandwa and I was cured by Umurangi from Kirehe District. I believe that they have the power from God and when you respect their conditions, they treat and cure you completely.”

According to Alexia Mukahirwa, another witness, Umurangi is very powerful. “I was sick for 16 years. I went to different places and met many doctors. Some told me I had blood infection, others said it was stomach and intestinal infections. I consumed numberless medicines that never helped until I saw the power of Abarangi and believed them. Some people said that I had HIV/AIDS but it was not true. I only weighed 42 kilograms but now I have 68. Abarangi are powerful and may God bless them.”

James Mugabo, who is an “Umuhereza” or priest, said: “Before colonialism, people had their way of treating illness. But we have abandoned everything yet we should not.” The Director General of clinical services in the Ministry of Health responded by stating: “The law and policy are being drafted and will help us to know who does what kind of medicine and their identity. From that, we will know where to localize Abarangi in traditional or alternative.”

Hearing such things, we might smile and think ‘that’s Rwanda – this would not happen in developed countries’. But sadly, it does! These things happen everywhere. I know of healing ceremonies in the UK and the US that are embarrassingly similar to the ones in Rwanda – remember, for instance, the scenes seen on TV where Donald Trump was blessed by some evangelicals to receive the ability to win the election? And now they will probably claim that it worked!

Nothing to do with alternative medicine, you say? Perhaps this website on ‘spiritual homeopathy’ is more relevant then:

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What is spiritual homeopathy? It is based on the principle that “like cures like” and “wounds heal wounds” — the underlying wisdom of support groups. A Biblical story which illustrates this principle takes place on the ancient shepherding people’s journey through the desert. When they grew impatient and complained bitterly to Moses, God sent venomous snakes to bite the people. Many died. When the people confessed their sin, God told Moses to put a bronze snake on a pole. Those who were bitten and focused on the bronze snake did not die; they looked and lived.

Many years later Jesus said of his mission, “As Moses lifted up the serpent in the desert, so the Chosen One must be lifted up, so that everyone who believes on the Chosen One might have eternal life.” Jesus’ disciple Peter wrote, “By Christ’s wounds you are healed.” In “The Angel that Troubled the Waters,” Thornton Wilder wrote: “Without your wound where would your power be? … In love’s service only the wounded can serve.”

As the Thanksgiving and Christmas season approaches, spiritual homeopathy offers healing to all – because the Babe in the Manger is also the Wounded Healer

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I think I rest my case.

 

 

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