MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

politics

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I am sure that most of us have had enough of the endless discussions, information and foremost disinformation about Brexit; we truly had to endure them ad nauseam. And here I come with a post about the very subject.

Have I lost my senses?

Bear with me and find out for yourself.

There has been little mention of alternative medicine in the debates about last week’s referendum. For the Remain campaigners, there was perhaps no reason to go into this divisive topic because, in their view, all would stay as it is. And the ‘Brexiters’ obviously had other things on their minds. It seemed almost as though they were too busy inventing new lies on a daily basis. To me, it seems fairly obvious though that, in the realm of alternative medicine, quite a lot could change after disastrous vote to leave the EU .

My main fears are twofold;

  1. Politicians who are short-sighted enough to campaign for Brexit might also be sufficiently stupid to go for unproven medicine. This fear seems to be confirmed by Nigel Farage who once claimed that BIG HARMA was lobbying in Brussels to put alternative medicine producers out of business. But we should take that with a pinch of salt, of course; anything this man says is hardly worth taking any notice of, in my view.
  2. Consumers who are gullible enough to believe the false arguments of the Brexiters might also be sufficiently naïve to believe the fallacies and falsehoods of alternative medicine promoters.

So, are there reasonable predictions as to how Brexit might impact on the alternative medicine scene in Britain? I searched for some evidence on this question and was surprised how little there was to be found.

Dr Jan Knight from Knight Scientific, a medical research company, was quoted saying: “A lot of the complementary/alternative medicine lobby are rubbing their hands because they think they’ll be able to do anything, but I don’t think the regulations will change.”

The excellent QUACKOMETER published an entire article on the subject which is well worth reading and essentially agrees with this view. Here are its conclusions: “EU laws about alternative medicine are not that great in number. The UK is free to choose who it licenses as a medical practitioner. It can allow chiropractors and osteopaths to have statutory regulation and does so. It can fund any such treatment publicly if it so wished without EU interference. It can police the sale of products on the High Street by funding Trading Standards and training them (but it chooses not to.) The UK government can come up with its own schemes to register herbalists and homeopaths and in doing so misleads the public about them. In short, it is possible to suggest that the UK governments do indeed exercise sovereignty over how alternative medicine manifests itself, how well the public is protected and how much public money is spent on it. Leaving the EU is not going to make much difference that way. Although I do suspect that staying might indeed over the years steadily increase the level of regulation around the matter. Successive UK governments have not done a lot. The EU just a little more.”

Perhaps the regulatory framework might not change a lot. But what about the prevalence of alternative medicine usage? It seems difficult to predict in which direction it will go. The reason is that I see influences in both directions.

FACTORS THAT COULD INCREASE THE USE OF ALTERNATIVE MEDICINE

The Brexiters managed to style themselves as the anti-establishment. It is obvious that much of alternative medicine understands itself as an anti-establishment movement within healthcare. This means there could be a natural affinity between the two. On second thought, however, I think we can reject this possibility. The reason is that the Brexiters’ anti-establishment stance was nothing but a campaign ploy; in truth it is as genuine as a 4£ note.

What is much more real, in my view, is the well-documented inability of the Brexiters to correctly interpret the evidence (one could put this more simply by pointing out their ability to twist and turn the truth such that it suits their aims). These are qualities which I have often observed in promoters of alternative medicine, and it is this type of affinity that eventually might stimulate a general upwards trend of alternative medicine in the UK.

In a similar vein, we have to account for the influence of our future king. Prince Charles clearly has an alternative bee under his bonnet. Once we are outside the EU, it is likely that his influence on health politicians and other decision makers will be felt more powerfully. The Prince of Wales might even revive the ‘Smallwood Report’ which he commissioned to convince politicians that money could be saved by using more alternative therapies in the NHS. Charles and his views usually generate bewilderment on the EU-level, while here in the UK we still have many who take him seriously. His influence in a post-Brexit Britain is likely to be strengthened and will therefore be a factor that has the potential to boost alternative medicine in the UK.

FACTORS THAT COULD DECREASE THE USE OF ALTERNATIVE MEDICINE

It has been reported that our suicidal move out of the EU has led to a contraction of wealth in Britain which is bigger than anything seen since 1921. Apparently, £ 120 billion have been wiped off the value of the stock market within just a few hours. To assume that this will hit only those who are rich enough to own shares, is more than naïve. It will hit all Brits and might even drive us into another recession.

Such developments are, of course, most unwelcome but nevertheless important in relation to alternative medicine usage. Those who employ alternative treatments usually pay for them out of their own pocket. Alternative medicine has always been a bit of a luxury item for those who had more money than sense. The consequence is that financially hard times are almost automatically associated with a reduction of alternative medicine use.

CONCLUSION

All of this is, of course, akin to an exercise in reading tea leafs. But if I am correct, we will now see a significant decrease in the demand for alternative medicine in the ‘Disunited Kingdom’. Once the financial misery is over – and that could take many years – Prince Charles and other ‘irrationalists’ might succeed in bringing about a moderate increase in the use of unproven treatments.

The ACUPUNCTURE NOW FOUNDATION (ANF) have recently published a document that is worth drawing your attention to. But first I should perhaps explain who the ANF are. They state that “The Acupuncture Now Foundation (ANF) was founded in 2014 by a diverse group of people from around the world who were concerned about common misunderstandings regarding acupuncture and wanted to help acupuncture reach its full potential. Our goal is to become recognized as a leader in the collection and dissemination of unbiased and authoritative information about all aspects of the practice of acupuncture.”

This, I have to admit, sounds like music to my ears! So, I studied the document in some detail – and the music quickly turned into musac.

The document which they call a ‘white paper’ promises ‘a review of the research’. Reading even just the very first sentence, my initial enthusiasm turned into bewilderment: “It is now widely accepted across health care disciplines throughout the world that acupuncture can be effective in treating such painful conditions as migraine headaches, and low back, neck and knee pain, as well as a range of painful musculoskeletal conditions.” Any review of research that starts with such a deeply uncritical and overtly promotional statement, must be peculiar (quite apart from the fact that the ANF do not seem to appreciate that back and neck pain are musculoskeletal by nature).

As I read on, my amazement grew into bewilderment. Allow me to present a few further statements from this review (together with a link to the article provided by the ANF in support and a very brief comment by myself) which I found more than a little over-optimistic, far-fetched or plainly wrong:

Male fertility, especially sperm production and motility, has also been shown to improve with acupuncture. In a recent animal study, electro-acupuncture was found to enhance germ cell proliferation. This action is believed to facilitate the recovery of sperm production (spermatogenesis) and may restore normal semen parameters in subfertile patients.

The article supplied as evidence for this statement refers to an animal experiment using a model where sperm are exposed to heat. This has almost no bearing on the clinical situation in humans and does not lend itself to any clinical conclusions regarding the treatment of sub-fertile men.

In a recent meta-analysis, researchers concluded that the efficacy of acupuncture as a stand-alone therapy was comparable to antidepressants in improving clinical response and alleviating symptom severity of major depressive disorder (MDD). Also, acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of post-traumatic stress disorder (PTSD). The incidence of adverse events with acupuncture was significantly lower than antidepressants.

The review provided as evidence is wide open to bias; it was criticised thus: “the authors’ findings did not reflect the evidence presented and limitations in study numbers, sample sizes and study pooling, particularly in some subgroup analyses, suggested that the conclusions are not reliable”. Moreover, we need to know that by no means all reviews of the subject confirm this positive conclusion, for instance, thisthis, or this one; all of the latter reviews are more up-to-date than the one provided by ANF. Crucially, a Cochrane review concluded that “the evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture”.

“A randomized controlled trial of acupuncture and counseling for patients presenting with depression, after having consulted their general practitioner in primary care, showed that both interventions were associated with significantly reduced depression at three months when compared to usual care alone.”

We have discussed the trial in question on this blog. It follows the infamous ‘A+B versus B’ design which cannot possibly produce a negative result.

Now, please re-read the first paragraph of this post; but be careful not to fall off your chair laughing.

There would be more (much more) to criticise in the ANF report but, I think, these examples are ENOUGH!

Let me finish by quoting from the ANF’s view on the future as cited in their new ‘white paper’: “Looking ahead, it is clear that acupuncture is poised to make significant inroads into conventional medicine. It has the potential to become a part of every hospital’s standard of care and, in fact, this is already starting to take place not only in the U.S., but internationally. The treatment is a cost-effective and safe method of relieving pain in emergency rooms, during in-patient stays and after surgery. It can lessen post-operative nausea, constipation and urinary difficulties, and have a positive impact on conditions like hypertension, anxiety and insomnia…

Driven by popular demand and a growing body of scientific evidence, acupuncture is beginning to be taken seriously by mainstream conventional medicine, which is incorporating it into holistic health programs for the good of patients and the future of health care. In order for this transition to take place most effectively, misunderstandings about acupuncture need to be addressed. We hope this white paper has helped to clarify some of those misunderstandings and encourage anyone with questions to contact the Acupuncture Now Foundation.”

My question is short and simple: IGNORANCE OR FRAUD?

 

Britt Marie Hermes is a most remarkable woman. She is an ex-naturopath who has the courage to speak out against all that is wrong with naturopathy. On her website she writes:

I used to be a naturopathic doctor. For 3 years, I practiced naturopathic medicine, licensed in Washington and Arizona. I earned my degree at Bastyr University and then completed a one-year naturopathic residency in a private clinic. I stayed at this clinic until I moved to Tucson.

Naturopathic medicine is not what I was led to believe. I discovered that the profession functions as a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric with many ineffective and dangerous practices.

I left the profession of naturopathic medicine to pursue an education in biomedical research. Since my departure, I have been working to understand my former biases within naturopathic medicine. I am now exploring the ethics and evidence, or lack thereof, of naturopathic education and practice. I hope I can convey the message that naturopathy must be highly scrutinized, as its proponents have a seemingly on-going history of deceit, exploitation, and medical fraud.

Her articles are a rich source of fascinating material about naturopathy, and I warmly recommend you read her criticisms; you will not find better-informed comments easily. Recently, she went one step further and started a petition against US naturopaths’ plight to call themselves ‘doctors’. It seems that this was one step too far for the mighty ‘BIG NATUROPATHY’.

Forbes Magazine reported that, on May 26th, 5 days after Hermes launched her petition, the AANP retaliated [the AANP is the leading naturopaths’ organization in the U.S., the American Association of Naturopathic Physicians]. The subject line of an email sent to all AANP membership:  “AANP Needs Your Help – Stop Britt’s Change.org Petition.”

“We need your help to stop this petition… This petition violates these [Change.org] policies:

  • Breaks the law – this is defamatory and libelous content
  • Impersonates others;  Britt Marie Hermes is not from the United States
  • Terms of service – does not abide by the law or respect the rights of others

Naturopaths found Britt Marie so threatening that they started a website entitled ‘BRITT MARIE HERMES FACT CHECK. Here they indulge in blatant character assassination:

Britt Marie Hermes Fact Check was established to provide an unbiased analysis of the claims that Britt Marie Hermes (Britt Marie Deegan) has made, and is making, about Naturopathic Medicine, its educational system, and its practitioners. For the past year she promoted herself as an expert on Naturopathic Medicine, having left the profession because of her unsuccessful time as a practitioner. It’s clear that she has an agenda against the profession while claiming to be an expert. She has consistently lied, and left out important facts when discussing aspects of the Naturopathic Medicine, its educational system and its practitioners. Accusations have been made that she is being paid by the pharmaceutical industry, although they haven’t been substantiated. What is clear, is that she was unsuccessful during her short time as a practitioner and now has an agenda against the profession.

This looks suspiciously like the dirt some alternative medicine fans have been throwing at me, I thought, and I asked Britt Marie (who I once had the pleasure of meeting in person) to comment – and she very kindly did:

I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the American Association of Naturopathic Pediatrics.

I was making decent money at my practices in Seattle and Tucson. By all accounts, I was a successful naturopathic doctor. My bosses at the Tucson clinic had even asked me if I were interested in becoming their business partner!

I walked away from my practice because my boss was committing a federal crime by importing and administering a non-FDA approved medication to his cancer patients. I decided to leave naturopathic medicine for good after a former president of the American Association of Naturopathic Physicians urged me not to report my boss’s criminal activity to the authorities.

These wounds still hurt. I lost dozens of friends. I lost eight years of my life. I lost my livelihood. The ND degree does not have any value in the academic community. It is a tarnish on my permanent record. It would have been in my financial interest to move to another practice and continue being a “successful” naturopath.

The problem with naturopaths is that they measure success by how much money one collects from patients, yet they fail to understand that naturopathic services are quackery. So by their logic, being a successful naturopath is dependent upon profiting by fooling patients and fooling oneself. If others want to describe me as an unsuccessful naturopath, then the term “success” has no useful meaning.

I am not employed to write about anything in particular about naturopathic medicine or with any particular tone. I am an independent blogger who wants to share my insights. I created my own opinions on naturopathic medicine by looking at the profession critically. This kind of task is fundamental to the scientific process that I only learned after leaving naturopathy and engaging with the academic community.

Naturopaths want to be recognized as primary care physicians in the U.S. and Canada. This is a big deal, and we all should be skeptical. This profession is claiming to have established a comprehensive medical education that trains competent medical practitioners, who somehow predominately rely upon unproven methods at best and debunked ones at worst.

Naturopaths essentially want to be allowed to take shortcuts in medical training. Instead of attending medical school, naturopaths attend naturopathic programs with low acceptance standards and faculty who are not qualified to teach medical topics. Instead of passing a standardized and peer-reviewed medical licensing exam, naturopaths have created their own secretive licensing exam that tests on homeopathy and other dubious treatments. What little real medical standards that seem to be tested on the exam have been botched, like the one question in which a child is gasping for air and the correct answer on how to treat is to give a homeopathic remedy.

Naturopaths have called me a liar, but have been unable to identify any specific fabrications. They say I am omitting facts and evidence, but they cannot show what information I allegedly missed. It seems that for naturopaths the only way to deal with legitimate criticism, is to undermine my integrity.

My blog harbors no hidden agenda. I write to prevent students from being duped into thinking they are being adequately trained as a primary care physicians in naturopathic programs. I write to protect patients from the poorly trained practitioners that these programs produce. I write because I have seen both worlds, and the naturopathic one is terrifying.

To this, I have nothing to add – except a big THANK YOU to Britt Marie for her courage, honesty and tenacity.

I have previously reported about the issue of homeopathy on the NHS in Liverpool here. Since then, the NHS Liverpool Clinical Commissioning Group (CCG) has conducted a consultation on whether to continue funding. Personally, I think such polls are a daft waste of resources.

Why?

I will explain in a moment; first read the (slightly shortened) summary:

In November 2015, NHS Liverpool CCG Governing Body stated a preference to decommission the homeopathy service and commenced the consultation exercise with the intent to ascertain how the public felt about it. This report was written by the Centre for Public Health, Liverpool John Moores University, and includes independent analysis of the consultation activities.

The consultation ran from 13th November – 22nd December 2015. The two main methods used were 1) a survey available online and in paper format. It was completed by 743 individual respondents and, of those who provided a valid postcode, 68% (323 individuals) lived within the Liverpool CCG area, 2) a small consultation event held on 4th December 2015 facilitated by Liverpool John Moores University. The event was attended by 29 individuals, the majority of whom were patients and staff from the Liverpool Medical Homeopathic Service. Eighteen of the participants at this event resided in Liverpool.

Two thirds of survey respondents (66%; 380 respondents) said they would never use homeopathy services in the future. The reasons for this included the lack of evidence and scientific basis of homeopathy; negative personal experiences of homeopathy; and believing it was an inappropriate use of NHS funding. Those who would be likely to use it in the future (28%) felt they wanted to be able to choose an alternative to conventional medicine; felt it was value for money for the NHS; appreciated the time, care and holistic consultation; and discussed their own positive experiences. Sixty six per cent of survey respondents (111) who had used homeopathy in the past reported an excellent or good experience. Those who reported a positive experience (66%) felt that homeopathy had improved their health where conventional medicine had not, and participants valued that the homeopathic practitioner had treated their emotional as well as their physical needs. Those who reported a below average or poor experience (31%) felt homeopathy had not improved their medical condition and some felt they had been misled and had not been told the remedy contained no active ingredients.

At the consultation event, the majority of the 29 participants were homeopathy service users and they described a positive experience of homeopathy and the ability to choose ‘holistic’ and non-pharmaceutical treatment. Participants also questioned what services they could use if they were unable to access homeopathy on the NHS and were concerned and angry about the service potentially being decommissioned. A small number of participants at this event agreed with the view that there is a lack of evidence regarding efficacy and felt it was an inappropriate use of NHS funds that would be better spent on other, more effective services.

Of the survey respondents, 73% (541 individuals) chose the option to stop funding all homeopathy services; when including only Liverpool residents in the analysis this decreased to 64%.  Twenty three per cent of survey respondents (170 individuals) wanted to continue to fund homeopathy services in Liverpool (either at current levels or to increase the budget); when only including Liverpool residents this proportion increased slightly to 30%. At the end of the consultation event the participants in the room (29 individuals) were asked to vote on their preferred funding option; twenty two participants (76%) wanted to continue the service and increase the maximum funding limit; three participants (14%) wanted to stay with the current situation and three participants (10%) wanted to stop funding the service.

There was some tension in what those in the consultation saw as acceptable and appropriate evidence about the effectiveness of homeopathy. Many participants in the survey and at the event reported their positive experience or anecdotal evidence as “proof” that homeopathy is effective.  There was a low understanding about how scientific research is conducted or evaluated. The NHS try to base funding decisions on rigorous, high-quality, unbiased, peer-reviewed research, however, the CCG is required to account of all evidence, including patient experience, when funding or discontinuing services.

Across the survey and the consultation event there was some confusion about what types of treatment come under the heading of “homeopathy”, with participants making reference to a range of herbal remedies and supplements. Iscador (a mistletoe extract) may be, in some cases, provided as a complementary treatment for patients with cancer, however, this is not a homeopathic remedy. There was also discussion (in the event and in the survey responses) about other herbal remedies and supplements.

END OF SUMMARY

So, why do I not think highly about exercises of this kind?

In general, surveys are tricky and often very dodgy research tools. Particularly in alternative medicine, they are as popular as they are useless. The potential problems arise from the way the methodology is often applied. For instance, sampling is crucial. If, like in the present case, no rigorous sampling techniques are applied, the results will inevitably be unreliable in reflecting the views of a population.

The findings of the survey above could easily be little more than a reflection of which camp had a better PR. Homeopaths usually are very good on such occasions at persuading others for homeopathy. In this case, the results show that, despite their best efforts, the overall vote was not positive for homeopathy. What we don’t know is whether this is a reflection on the ‘will of the people’. It could be that the public is much more against funding nonsense than this poll suggests.

I would also argue that letting people vote about the availability of medical interventions is nonsensical. The value of healthcare technologies is not determined by such ‘beauty contests’; the value depends on the scientific evidence, and that is not readily evaluated by non-experts. Imagine: next we might vote for or against bone-marrow transplants; who has the expertise to cast such a vote?

Oh yes, and the ‘small consultation’ – what was that supposed to be. Probably just an exercise in political correctness. Nobody in their right mind can have expected any meaningful insight coming from it.

Finally, I dispute that ‘patients’ experience’ is the same as ‘evidence’, as the summary above seems to claim. This is just nonsense. evidence is something entirely different from experience.

But politicians will disregard all this. They will say ‘the public has decided’ and will stop funding homeopathy on the NHS in Liverpool. More by coincidence than by design, this survey went into the right direction. Now one can only hope that the rest of the country will follow suit – on evidence, not on dodgy pseudo-evidence from surveys.

We tend to trust charities; many of us donate to charities; we think highly of the work they do and the advice they issue. And why shouldn’t we? After all, a ‘charity’ is ‘an institution or organization set up to provide help, money, etc, to those in need’. Not a hint at anything remotely sinister here – charities are good!

Except, of course, those that are not so good!

By ‘not so good’ I mean charities that misinform the public to a point where they might even endanger our health, well-being and savings. Yes, I am speaking of those charities that promote unproven or disproven alternative therapies – and unfortunately, there are many of those around today.

Our recent letter in the SUNDAY TIMES, tried to alert the public to this problem and to the fact that the UK regulator seems to be failing to do much about it. A Charity Commission spokesman, in turn, replied that his organisation had received the letter and would respond formally to it:

“The Commission is required to register organisations as charities which are established for exclusively charitable purposes for the public benefit,” he said. “Charitable purposes for the advancement of health include conventional methods as well as complementary, alternative or holistic methods which are concerned with healing mind, body and spirit in the alleviation of symptoms and the cure of illness. Those organisations dealing with complementary and alternative medicines must be able to demonstrate that they are capable of promoting health otherwise they will not be for the public benefit.

“The Commission is the registrar and regulator of charities however it is not the authority in the efficacy of any and every non-traditional medical treatment. These are issues of substantial debate with a variety of opinions. Each case is considered on its merits based on the evidence available. To be charitable there needs to be sufficient evidence of the efficacy of the method to be used. The Commission must further be assured that any potential harm that might be said to arise does not outweigh the benefit identified by the method.

“The Commission expects charities to provide information that is factually accurate with legitimate evidence.” 

But is the information provided by all charities factually accurate?

Take, for instance, YES TO LIFE! Have a good look and then decide for yourself.

On their website they state: “We provide support, information and financial assistance to those with cancer seeking to pursue approaches that are currently unavailable on the NHS. We also run a series of educational seminars and workshops which are aimed at the general public who want to know more and practitioners working with people who have cancer.”

The website informs us about many alternative therapies and directly or indirectly promote them for the curative or supportive treatment of cancer. I have chosen 5 of them and copied the respective summaries as published by YES TO LIFE. My main selection criterion was having done some research myself on the modality in question. Here are the 5 cancer treatments which I selected; the text from YES TO LIFE is in bold, and that of my published research is in normal print with a link to the published paper:

CARCTOL

Carctol is a relatively inexpensive product, specifically formulated to assist cells with damaged respiration, it is also a powerful antioxidant that targets free radicals, the cause of much cellular damage. It also acts to detoxify the system.

The claim that Carctol is of any benefit to cancer patients is not supported by scientific evidence.

LAETRILE

Often given intravenously as part of a programme of Metabolic Therapy, Laetrile is a non-toxic extract of apricot kernels. The claimed mechanism of action that is broken down by enzymes found in cancer cells. Hydrogen cyanide, one of the products of this reaction then has a local toxic effect on the cells.

The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.

MISTLETOE

Mistletoe therapy was developed as an adjunct to cancer treatment in Switzerland in 1917-20, in the collaboration between Dr I Wegman MD and Dr Rudolf Steiner PhD (1861-1925). Mistletoe extracts are typically administered by subcutaneous injection, often over many years. Mistletoe treatment improves quality of life, supports patients during recommended conventional cancer treatments and some studies show survival benefit. It is safe and has no adverse interactions with conventional cancer treatments.

None of the methodologically stronger trials exhibited efficacy in terms of quality of life, survival or other outcome measures. Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy.

UKRAIN

A type of low toxicity chemotherapy derived from a combination of two known cytotoxic drugs that are of little use individually, as the doses required for effective anticancer action are too high to be tolerated. However the combination is effective at far lower doses, with few side effects.

The data from randomised clinical trials suggest Ukrain to have potential as an anticancer drug. However, numerous caveats prevent a positive conclusion, and independent rigorous studies are urgently needed. [To judge the validity of this last treatment, I also recommend reading a previous post of mine.]

Finally, it might be informative to see who the individuals behind YES TO LIFE are. I invite you to have a look at their list of medical advisors which, I think, speaks for itself. It includes, for instance, Dr Michael Dixon of whom we have heard before on this blog, for instance, here, here and here.

Say no more!

In 2008, I published a paper entitled ‘CHIROPRACTIC, A CRITICAL EVALUATION’ where I reviewed most aspects of this subject, including the historical context. Here is the passage about the history of chiropractic. I believe it is relevant to much of the current discussions about the value or otherwise of chiropractic.

The history of chiropractic is “rooted in quasi-mystical concepts.”  Bone-setters of various types are part of the folk medicine of most cultures, and bone-setting also formed the basis on which chiropractic developed.

The birthday of chiropractic is said to be September 18, 1895. On this day, D.D. Palmer manipulated the spine of a deaf janitor by the name of Harvey Lillard, allegedly curing him of his deafness. Palmer’s second patient, a man suffering from heart disease, was also cured. About one year later, Palmer opened the first school of chiropractic. There is evidence to suggest that D.D. Palmer had learned manipulative techniques from Andrew Taylor Still, the founder of osteopathy. He combined the skills of a bone-setter with the background of a magnetic healer and claimed that “chiropractic was not evolved from medicine or any other method, except that of magnetic.” He coined the term “innate intelligence” (or “innate”) for the assumed “energy” or “vital force,” which, according to the magnetic healers of that time, enables the body to heal itself. The “innate” defies quantification. “Chiropractic is based on a metaphysical epistemology that is not amenable to positivist research or experiment.”

The “innate” is said to regulate all body functions but, in the presence of “vertebral subluxation,” it cannot function adequately. Chiropractors therefore developed spinal manipulations to correct such subluxations,  which, in their view, block the flow of the “innate.” Chiropractic is “a system of healing based on the premise that the body requires unobstructed flow through the nervous system of innate intelligence.” Anyone who did not believe in the “innate” or in “subluxations” was said to have no legitimate role in chiropractic.

“Innate intelligence” evolved as a theological concept, the representative of Universal Intelligence ( = God) within each person. D.D. Palmer was convinced he had discovered a natural law that pertained to human health in the most general terms. Originally, manipulation was not a technique for treating spinal or musculoskeletal problems, it was a cure for all human illness: “95% of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints.” Early chiropractic pamphlets hardly mention back pain or neck pain, but assert that, “chiropractic could address ailments such as insanity, sexual dysfunction, measles and influenza.” D.D. Palmer was convinced that he had “created a science of principles that has existed as long as the vertebra.” Chiropractors envision man as a microcosm of the universe where “innate intelligence” determines human health as much as “universal intelligence” governs the cosmos; the discovery of the “innate intelligence” represents a discovery of the first order, “a reflection of a critical law that God used to govern natural phenomena.”

Early chiropractic displayed many characteristics of a religion. Both D.D. Palmer and his son, B.J. Palmer, seriously considered establishing  chiropractic as a religion. Chiropractic “incorporated vitalistic concepts of an innate intelligence with religious concepts of universal intelligence,” which substituted for science. D.D. Palmer declared that he had discovered the answer to the timeworn question, “What is life?” and added that chiropractic made “this stage of existence much more efficient in its preparation for the next step – the life beyond.”

Most early and many of today’s chiropractors agree: “Men do not cure. It is that inherent power (derived from the creator) that causes wounds to heal, or a part to be repaired. The Creator…uses the chiropractor as a tool…chiropractic philosophy is truly the missing link between Religion or Power of the various religions.” Today, some chiropractors continue to relate the “innate” to God. Others, however, warn not to “dwindle or dwarf chiropractic by making a religion out of a technique.”

Initially, the success of chiropractic was considerable. By 1925, more than 80 chiropractic schools had been established in the United States. Most were “diploma mills” offering an “easy way to make money,” and many “were at one another’s throats.” Chiropractors believed they had established their own form of science, which emphasized observation rather than experimentation, a vitalistic rather than mechanistic philosophy, and a mutually supportive rather than antagonist relationship between science and religion. The gap between conventional medicine and chiropractic thus widened “from a fissure into a canyon.” The rivalry was not confined to conventional  medicine; “many osteopaths asserted that chiropractic was a bastardized version of osteopathy.”

Rather than arguing over issues such as efficacy, education, or professional authority, the American Medical Association insisted that all competent health care providers must have adequate knowledge of the essential subjects such as anatomy, physiology, pathology, chemistry, and bacteriology. By that token, the American Medical Association claimed, chiropractors were not fit for practice. Some “martyrs,” including D.D. Palmer himself, went to jail for practicing medicine without a licence.

Chiropractors countered that doctors were merely defending their patch for obvious financial reasons (ironically, chiropractors today often earn more than conventional doctors), that orthodox science was morally corrupt and lacked open-mindedness. They attacked the “germo-anti-toxins-vaxiradi-electro-microbioslush death producers” and promised a medicine “destined to the grandest and greatest of this or any age.”

Eventually, the escalating battle against the medical establishment was won in “the trial of the century.” In 1987, sections of the U.S. medical establishment were found “guilty of conspiracy against chiropractors,” a decision which was upheld by the U.S. Supreme Court in 1990. In other countries, similar legal battles were fought, usually with similar outcomes. Only rarely did they not result in the defeat of the “establishment:” In 1990, a Japanese Ministry of Health report found that chiropractic is “not based on the knowledge of human anatomy but subjective and unscientific.”

These victories came at the price of “taming” and “medicalizing” chiropractic. In turn, this formed the basis of a conflict within the chiropractic profession – the dispute between “mixers” and “straights” – a conflict which continues to the present day.

The “straights” religiously adhere to D.D. Palmer’s notions of the “innate intelligence” and view subluxation as the sole cause and manipulation as the sole cure of all human disease. They do not mix any non-chiropractic techniques into their therapeutic repertoire, dismiss physical examination (beyond searching for subluxations) and think medical diagnosis is irrelevant for chiropractic. The “mixers” are somewhat more open to science and conventional medicine, use treatments other than spinal manipulation, and tend to see chiropractors as back pain specialists. Father and son Palmer warned that the “mixers” were “polluting and diluting the sacred teachings” of chiropractic. Many chiropractors agreed that the mixers were “bringing discredit to the chiropractic.”

The “straights” are now in the minority but nevertheless exert an important influence. They have, for instance, recently achieved election victories within the British General Chiropractic Council. Today, two different chiropractic professions exist side by sided “one that wishes to preserve the non-empirical, non-positivist, vitalist foundations (the straights) and the other that wishes to be reckoned as medical physicians and wishes to utilize the techniques and mechanistic viewpoint of orthodox medicine (the mixers).” The International Chiropractic Association represents the “straights” and the American Chiropractic Association the “mixers.”

(for references, see the original article)

It has been reported in most newspapers that Prince Charles has proposed a solution to the problem of antibiotic over-use in animals and humans. He told an international gathering of scientists and government officials in London that he treats his own cows and sheep with homeopathy. Many people reacted with dismay. I, however, plead for more understanding of this thoroughly good-willed man.

In fact, I intend to go one step further.

We have often heard that he is a considerate and caring man. We ought to give him the benefit of the doubt. I have tried therefore to empathise with his situation, put myself into his shoes and repeat the considerations that made him say what he said. My empathy went so far that I tried to re-live and formulate his thoughts in the first person singular (or should I have used the ‘Royal We’?). The result is the following little monologue where I categorised the considerations under 7 headings.

THE OCCASION

I wonder why they invited me to give a speech. True, I am a farmer at heart and I know all about husbandry, but I have no real expertise in the field of antibiotics.

Perhaps it is an occasion to tell them a bit about homeopathy. Yes, that subject would surely fascinate the audience!

THE INTELLECTUAL ENVIRONMENT

They tell me that the conference will be packed with very bright people. That sort of thing always makes me a bit self-conscious. Perhaps I should decline the invitation after all? Sometimes, I have the impression that people make fun at me.

No, I must not think like that – after all, I have had a very expensive education too, and I know my stuff.

THE ISSUE

Homeopathy is such a wonderful subject. I must try to win them over and make them appreciate its beauty. These experts should realize that homeopathy is the future.

I have heard rumours that some blinkered scientists doubt that homeopathy works. But my advisors tell me that it is best to ignore this sort of thing. And my advisors know their stuff even better than I.

POTENTIAL IMPACT

This conference is going to have a very high impact. The press will be there. It will be reported across the world. And government’s chief medical officer, Dame Sally Davies (why can we not have more holistic doctors in position like these; I must remember to discuss this with Michael Dixon asap); she once called homeopathy ‘rubbish’ – enough to throw her in the Tower!

Mustn’t think like that! On the contrary, I will make sure they all get the message. I will bowl them over! The press will surely be on my side. This will be a victory for homeopathy.

THE RISKS

Mother might be upset; she does not like me to stick my neck out like that…goes on about constitutional role and such trivia…she thinks we should not put our nose into things that are none of our business. And the Royal PR team will not like it either. They do what they can to distract from the image of ‘THE MEDDLING PRINCE’ might think that my speech is a hindrance to their efforts. I better don’t tell anyone in advance about this, they might try to stop me.

But now I feel quite unstoppable.

THE SPEECH

This is what I will tell them about homeopathy: “It was one of the reasons I converted my farming operation to an organic – or agro-ecological – system over 30 years ago and why we have been successfully using homeopathic – yes, homeopathic – treatments for my cattle and sheep as part of a programme to reduce the use of antibiotics.” I think this will convince everyone. Who needs science when there is powerful rhetoric like this?

LAST DOUBTS

What if it does not go well? They will not dare to contradict me, I am the future King, for heaven’s sake! Even if they disagree, they will not show it. They just don’t have the guts. And anyway, I will not take questions, I never do enter into any debate on homeopathy. It is simply too tedious to argue with people who do not understand the issues involved.

It is decided – I’ll do it. I’ll do it for homeopathy and for the good of mankind. If they then chose to misunderstand me, that’s their problem, and my people will issue a statement for the press saying “Homeopathy is used on a case-by-case basis at Home Farm, in combination with more conventional medicine, to minimise dependence on antibiotics.”

 

*In case you are a lawyer hired by HRH to check out this post: it is pure satire through and through, there is not a factual sentence here; if you want to sue me, please find another reason.

On their website, the American Chiropractic Association (ACA) recently updated its members on their lobbying activities aimed at having US chiropractors recognised as primary care physicians. The president of the ACA posted the following letter to ACA members:

Last February the ACA House of Delegates passed a formal resolution directing ACA to make achieving full physician status in Medicare a top priority of the association.

For much of this past year, ACA’s staff and key volunteers have been laying the groundwork to achieve just that — quietly spending time building key support on Capitol Hill for this important legislative change. As you know, our progress advanced to the point where we were able on Oct. 27 to publically launch our grassroots campaign centered on the widespread circulation of our National Medicare Equality Petition.

Since the launch of our campaign, through very public and transparent means, ACA has received the support of various organizations and individuals within the profession. These supporters fully understand the importance of eliminating any and all provider discrimination by CMS. Further they fully understand and agree with the soundness of the strategic and tactical decisions we have made and continue to make an effort to achieve the desired reformation in Medicare.

Towards building a unified consensus within the profession for our objectives and plans to accomplish them, we have engaged in prolonged discussions, mostly via the Chiropractic Summit Steering Committee and Roundtable process that includes ACA, COCSA, ACC, ICA, NBCE, FCLB and CCE. Throughout this process we have provided for them written legal opinions and analyses relative to the precise legislative language needed to achieve the full-physician status we seek. We have outlined our strategy numerous times; have shared our materials and updates with any group wishing to review them; and have repeatedly urged state chiropractic associations, chiropractic colleges, corporate partners and individual DCs to join with us and enthusiastically support this reformation campaign.

While there was high consensus on the objective of Medicare reform during the Summit Roundtable process, there was much discussion surrounding the proposed legislative language. Specifically, whether or not “detection and correction of subluxation of the spine through manual manipulation” would need to be eliminated and replaced with language simply designating DCs as physician level providers on the same level as MDs and DOs who report/bill services to Medicare based on their individual state laws.

ACA is of the opinion that nothing less than removal of the “subluxation” language in the definition of physician section will accomplish our objectives. Historically, the facts are that this language has proven to be the major barrier within HHS and CMS when we advocated for regulatory remedies expanding our reimbursement and coverage for the full range of services provided by a DC. ACA (and our profession) has expended massive resources over the past decade or longer to no avail through regulatory channels (HHS, CMS). Based on these experiences, the only reasonable recourse to eliminate 40+ years of Medicare discrimination is through a thoughtful profession-wide legislative effort.

During the Roundtable discussions, compromise language was reached placing the current “subluxation language” into the preamble of a proposed law stating that DCs must continue to have the ability to detect and correct subluxations of the spine for Medicare beneficiaries. Six of seven Summit Roundtable organizations voted in favor of this language that was offered by the Association of Chiropractic Colleges.

ACA`s intent on removing the “subluxation” reference in the Social Security Administrative statute is in no way an attempt to quash our ability to perform those services that so many of the Medicare population need and deserve. Rather, the ultimate goal of this historic effort is to gain the privilege to manage our Medicare patients within state scopes of practice and allow reimbursement for all those services that the Medicare beneficiaries are currently forced to pay out of pocket. ACA supports fully our continued ability to correct subluxations through appropriate active care and, in fact, achieve coverage for manipulation of all areas, not simply limited to the spine.

Expanding Medicare scope reimbursement will allow our profession to practice contemporary chiropractic and to potentially increase utilization of our services to the ever-increasing aging population. Expansion and reformation will also place DCs in a position to participate in alternative payment models, quality healthcare initiatives, community health centers, hospitals and other integrated settings which are vital to professional growth.

In conclusion, should you as an HOD member be questioned on our intent you should be able to answer unequivocally that ACA supports the right to manage our patients as dictated by our training and competencies based on state scopes of practice. Further, we support those who wish to provide necessary active subluxation care for the Medicare population. Please support this initiative and let’s join together to encourage your state association, colleges and universities, corporate partners, patients and individual DCs to become true partners in order to make this a success for our patients and for our grand profession.

A list of talking points will be distributed in the coming days.

Sincerely, Tony Hamm, DC President, ACA

Do I read this correctly?

The term subluxation is a hindrance to business. Therefore chiros need to do something about it. Never mind that the principle of subluxation as used in the realm of chiropractic is nonsense!

This might throw an entirely different light on those chiros who want to get rid of the term ‘subluxation’.

And what about chiros as primary care physicians?

Recently Dave Newell posted on this blog: “chiropractors in the UK … are primary care clinicians”. I objected and he insisted to be correct because “Primary Care is defined as a clinician that is the first port of call for patients seeking help.” Frank Odds then countered: “This business of “primary care provider” is becoming enervating! Edzard has now spelt out the meaning of the term as defined by Wikipedia. You are quite right that a dentist is a primary care provider: people go to a dentist when they have symptoms affecting their mouth in general — more often their teeth and gums in particular. They know that’s what dentists deal with. A general practitioner is a primary care provider: people go to a GP when they have symptoms anywhere. They know that’s what GPs deal with. A chiropractor is indeed a primary care provider: of chiropractic. ”

I think that primary care physicians are doctors who are capable of handling everything or at least most of what primary care may present to them. Chiros do not fulfil this criterion, I think.

I would be interested what you feel on this important issue.

Germany is, as we all know, the home of homeopathy. Here it has an unbroken popularity, plenty of high level support and embarrassingly little opposition. The argument that homeopathy has repeatedly been shown to merely rely on placebo effects seems to count for nothing in Germany.

Perhaps this is going to change now. On January 30, a group of experts from all walks of life have met in Freiburg to discuss ways of informing the public responsibly and countering the plethora of misinformation that Germans are regularly exposed to on the subject of homeopathy. They founded the ‘Information Network Homeopathy’ and decided on a range of actions.

No doubt, some will ask where does their financial support come from? And no doubt, some will claim that we are on the payroll of ‘Big Pharma’. The truth is that we have no funding; everyone gives his/her own time free of charge and pays for his/her own expenses etc. And why? Because we believe in progress and feel strongly that it is time to improve healthcare by relegating homeopathy to the history books.

One of the first fruits of the network’s endeavours is the Freiburger Erklärung zur Homöopathie’, the ‘Freiburg Declaration on Homeopathy’. I have the permission to reproduce the document here in full (the translation is mine):

HOMEOPATHY IS NEITHER NATUROPATHY NOR MEDICINE

Despite the support of politicians and the silence of those who should know better, homeopathy has remained a method which is in clear opposition to the proven basics of science. The members and supporter of the ‘Information Network Homeopathy’ view homeopathy as a stubbornly surviving belief system, which cannot be accepted as part of naturopathy nor medicine. The information network is an association of physicians, pharmacists, veterinarians, biologists, scientists and other critics of homeopathy who are united in their aim to disclose this fact more openly and make the public more aware of it.

NO SPECIAL STATUS FOR HOMEOPATHY

During the more than 200 years of its existence, homeopathy has not managed to demonstrate its specific effectiveness. Homeopathy only survives because it has been granted special status in the German healthcare system which is, in the opinion of the experts of the network, unjustified. Drugs have to prove their effectiveness according to objective criteria, but homeopathics are exempt from this obligation. We oppose such double standards in medicine.

Homeopathy has also not managed to demonstrate a plausible mode of action. Instead its proponents pretend that there are uncertainties which need to be clarified. We oppose such notions vehemently. Homeopathy is not an unconventional method that requires further scientific study. Its basis consists of long disproven theories such as the ‘law of similars’, ‘vital force’ or ‘potentisation by dilution’.

SELF-DECEPTION OF PATIENT AND THERAPIST

We do not dispute the therapeutic effects of a homeopathic treatment. But they are unrelated to the specific homeopathic remedy. The perceived effectiveness of homeopathics is due to suggestion and auto-suggestion of the patient and the therapist. The mechanisms of such (self-) deceit are multi-fold but well-known and researched. Symptomatic improvements caused by context-effects must not be causally associated with the homeopathic remedy. We assume that many physicians and alternative practitioners using homeopathy are unaware of the existence and multitude of such mechanisms and are acting in good faith. This, however, does not alter the fact that their conclusions are wrong and thus potentially harmful.

MEDICINE AND SCIENCE

We do not claim that the scientific method which we uphold can currently research and explain everything. However, it enables us to explain that homeopathy cannot explain itself. The scientific method shows the best way we have for differentiating effective from ineffective treatments. A popular belief in therapeutic claims nourished by politicians and journalists can never be a guide for medical activities.

AIM OF THIS DECLARATION

Our criticism is not aimed at needy patients or practising homeopathic clinicians; it is aimed at the school of homeopathy and the healthcare institutions which could have long recognised the nonsensical nature of homeopathy, but have chosen not to interfere. We ask the players within our science-based healthcare system to finally reject homeopathy and other pseudoscientific methods and to return to what should be self-evident: scientifically validated, fair and generally reproducible rules promoting top-quality medicine for he benefit of the patient.

Authors:

Dr.-Ing. Norbert Aust, Initiator Informationsnetzwerk Homöopathie

Dr. med. Natalie Grams, Leiterin Informationsnetzwerk Homöopathie

Amardeo Sarma, GWUP Vorsitzender und Fellow von CSI (Committee for Skeptical Inquiry)

Signatories:

Edzard Ernst, Emeritus Professor, Universität Exeter, UK

Prof. Dr. Rudolf Happle, Verfasser der Marburger Erklärung zur Homöopathie

Prof. Dr. Wolfgang Hell, Vorsitzender des Wissenschaftsrates der GWUP

Prof. Norbert Schmacke, Institut für Public Health und Pflegeforschung, Universität Bremen

Dr. rer. nat. Christian Weymayr, freier Medizinjournalist

Natural Pharmacy Business reported that the UK homeopathic pharmacy, Helios, has just launched 5 new combination remedies. Nothing exciting about that, you might say. But wait, these products have licences from the UK regulator and are thus allowed to make therapeutic claims. A spokesperson for Helios was quoted as stating about the new products that ‘…we can actually say what they do, making it easier for customers to recommend or choose what is needed.’

A closer look at the Helios website reveals more details. The 5 remedies are described as follows:

1) Helios Injury 30c – Arnica, Rhus tox and Ruta grav are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of pains and minor trauma associated with minor injuries, bruises, strains and sprains as well as minor emotional trauma associated with the above. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency.

2) Helios Sleep 30c – Avena sativa, Coffea, Passiflora and Valarian are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of temporary sleep disturbances wherever you are. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency. This product is not recommended for children under 18, please call us for advice for use in children.

3) Helios ABC 30c  – Aconite, Belladonna and Chamomilla are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of minor feverish illness and/or minor earache in children up to 12 years and for symptoms associated with teething in infants or toddlers. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency. Remedies for babies may be dissolved in half a teaspoon of previously boiled, cooled water.

4) Helios Stress Relief 30c –  Aconite, Arg nit and Arsenicum are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of symptoms associated with mild stress. The remedy comes in lactose free, organic sucrose pills in our easy to use 4gm single dose dispenser in 30c potency. This product is not recommended for children under 18, please call us for advice for use in children.

5) Helios Hay Fever 30c –  Allium cepa, Euphrasia and Sabadilla are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of Hay Fever. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency.

So, now they are entitled to tell us what these remedies actually do!!!

Interesting!

Interesting, because what they do tell us is actually not true. If you look critically at the evidence, you are inevitably going to arrive at entirely different verdicts about the effectiveness of these remedies: THEY ACTUALLY DO NOTHING!

(No, buying them does something to you bank balance, but that’s all)

Consumers are being seriously ripped off and misled here to believe that these homeopathics might actually be needed in cases of illness: THE TRUTH IS THAT THERE IS NO CONDITION FOR WHICH THEY HAVE BEEN PROVEN TO BE EFFECTIVE!

Why did the regulator grant them a licence and allow them to make such claims?

Perhaps someone from the MHRA has the kindness to enlighten us.

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