MD, PhD, FMedSci, FSB, FRCP, FRCPEd

pseudo-science

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On the website of THE CENTRE FOR HOMEOPATHIC EDUCATION (CHE), an organisation which claims to operate ‘in partnership with’ the MIDDLESEX UNIVERSITY LONDON, we find the most amazing promotion of quackery. Under the title of ’10 Top Homeopathic Remedies for your First Aid Kit’ they state that “we wanted to give you some top tips to put together your own remedy kit to use in first-aid situations for yourself, friends and family.”

Yes, you did read correctly: apparently, the Middlesex University is supporting a homeopathic ‘first aid’ kit. You find this unbelievable? You are not alone!

The remedies they recommend would be ideal in the 30c potency for everyday use, they claim. Here are a few of the high-lighted remedies, together with their ‘indications’:

ACONITE This remedy is great for shock…

ARNICA  This is the classic remedy for trauma… The typical arnica patient will tell you that they’re fine and avoid attention, but may well still be in shock…

ARSENICUM This is your go-to remedy for food-poisoning…

BELLADONNA …This is a great remedy for fever, sunstroke, and for a skin condition such as boils.

HEPAR SULPH Very painful and infected wounds and abscesses respond well to this remedy.

RHUS TOX …used to treat skin rashes like chicken pox and shingles.

There are many more remedies to choose from, but hopefully this will give you a good little starter kit. Also it is possible to buy a comprehensive homeopathic first-aid kit from any of the reputable homeopathic suppliers. These kits will come with instructions on how to use the remedies too.

END OF 1st QUOTE

The CHE run all sorts of courses. It’s a shame that we all missed the recent lecture Evidence based homeopathy – with Dana Ullman. But if you are in London, you might want to attend on 7/9/2016 entitled Homeopathy, Detox and Cancer – with Dr Robin Murphy ND. It will cover subjects like these:

  • The Cancer Diseases –  the cancer disease is an umbrella term for a range of conditions which primarily affects the cells and immune system first.There are many causes of this condition such as emotional shocks, toxins, drugs, trauma, radiation and severe stress, etc. In some cases the cause is genetic or not known. Aging is another factor in the development and treatment of the cancer diseases.
  • Homeopathic remedies: Cancer remedies, cancer pains, chemotherapy and radiation side effects, socks, trauma, sleep, surgery, remedies for prevention and recovery.
  • Detox therapy: Detox principles and methods, heavy metals, chemo drugs, radiation, chemicals, etc. Detox diet, superfoods, herbal tonics and natural remedies.

END OF 2nd QUOTE

Yes, not just first aid but also cancer! This is sensational (or is the term scandalous better suited?) ! Cancer, they claim, can be caused by emotional shock (they do seem to like this term!) and there are homeopathic cancer remedies (the English cancer act prohibits claims, I think). This course must be a bargain at just £30! Perhaps some London sceptics should attend?

It would be ever so easy to make fun at this – but let’s try to keep a straight face because, in fact, this is not funny at all. It seems clear to me that it would be possible to kill quite a few emergency patients following the instructions of the homeopathic first aid kit, and one would most likely hasten the death of many cancer patients following Murphy’s cancer course.

Why is the Middlesex University a ‘partner’ in such monstrosities? Presumably they get some money for it, and officials would probably claim that their ‘partnership’ does not amount to an endorsement of such dangerous quackery (interestingly, when I searched their site for ‘homeopathy’, I got “no results found”). Yet they must be aware that they are lending credibility to indefensible charlatanry and thereby risking their own reputation.

If I were the Vice Chancellor of Middlesex, I would quickly sever all links to THE CENTRE FOR HOMEOPATHIC EDUCATION and publish an apology for having been involved in such mind-boggling quackery.

When a leading paper like the FRANKFURTER ALLGEMEINE ZEITUNG (FAZ) publishes in its science pages (!!!) a long article on homeopathy, this is bound to raise some eyebrows, particularly when the article in question was written by the chair of the German Association of Homeopaths (Deutscher Zentralverein homöopathischer Ärzte) and turns out to be a completely one-sided and misleading white-wash of homeopathy. The article (entitled DIE ZEIT DES GEGENEINANDERS IST VORBEI which roughly translates into THE DAYS OF FIGHTING ARE OVER)  is in German, of course, so I will translate the conclusions for you here:

The critics [of homeopathy] … view the current insights of conventional pharmacology as some type of dogma. For them it is unthinkable that a high potency can cause a self-regulatory and thus healing effect on a sick person. Homeopathic doctors are in their eyes “liars”. Based on this single argument, the critics affirm further that therefore no positive studies can exist which prove the efficacy of homeopathy beyond placebo. After all, high potencies “contain nothing”. The big success of homeopathy is a sore point for them, because efficacious high potencies contradict their seemingly rational-materialistic world view. Research into homeopathy should be stopped, the critics say. This tune is played unisono today by critics who formerly claimed that homeopaths block the research into their therapy. The fact is: homeopathic doctors are today in favour of research, even with their own funds, whenever possible. Critics meanwhile demand a ban.

In the final analysis, homeopathic doctors do not want a fight but a co-operation of the methods. Homeopathy creates new therapeutic options for the management of acute to serious chronic diseases. In this, homeopathy is self-evidently not a panacea: the physician decides with every patient individually, whether homeopathy is to be employed as an alternative, as an adjunct, or not at all. Conventional diagnostic techniques are always part of the therapy.

END OF QUOTE

[For those readers who read German, here is the German original:

Die Kritiker … betrachten die heutigen Erkenntnisse der konventionellen Pharmakologie als eine Art Dogma. Für sie ist es undenkbar, dass eine Hochpotenz einen selbstregulativen und damit heilenden Effekt bei einem kranken Menschen auslösen kann. Homöopathische Ärzte sind in ihren Augen “Lügner”. Von diesem einen Argument ausgehend, wird dann weiter behauptet, dass es deshalb gar keine positiven Studien geben könne, die eine Wirksamkeit der Homöopathie über einen Placebo-Effekt hinaus belegen. Schließlich sei in Hochpotenzen “nichts drin”. Der große Erfolg der Homöopathie ist ihnen ein Dorn im Auge, weil wirksame Hochpotenzen ihrem vermeintlich rational-materialistischen Weltbild widersprechen. Die Erforschung der Homöopathie solle gestoppt werden, heißt es. Unisono wird diese Melodie von Kritikern heute gespielt, von ebenjenen Kritikern, die früher behaupteten, die homöopathischen Ärzte sperrten sich gegen die Erforschung ihrer Heilmethode. Fakt ist: Heute setzen sich homöopathische Ärzte für die Forschung ein, auch mit eigenen Mitteln, soweit es ihnen möglich ist. Kritiker fordern mittlerweile das Verbot.

Letztlich geht es homöopathischen Ärzten allerdings nicht um ein Gegeneinander, sondern um ein Miteinander der Methoden. Durch die Homöopathie entstehen neue Therapieoptionen bei der Behandlung von akuten bis hin zu schweren chronischen Erkrankungen. Dabei ist die ärztliche Homöopathie selbstverständlich kein Allheilmittel: Bei jedem erkrankten Patienten entscheidet der Arzt individuell, ob er die Homöopathie alternativ oder ergänzend zur konventionellen Medizin einsetzt – oder eben gar nicht. Die konventionelle Diagnostik ist stets Teil der Behandlung.]

While translating this short text, I had to smile; here are some of the reasons why:

  • ‘conventional pharmacology’ is a funny term; do homeopaths think that there also is an unconventional pharmacology?
  • ‘dogma’… who is dogmatic, conventional medicine which changes almost every month, or homeopathy which has remained essentially unchanged since 200 years?
  • ‘liars’ – yes, that’s a correct term for people who use untruths for promoting their business!
  • ‘Based on this single argument’… oh, I know quite a few more!
  • ‘doctors are today in favour of research’ – I have recently blogged about the research activity of homeopaths.
  • ‘co-operation of the methods’ – I have also blogged repeatedly about the dangerous nonsense of ‘integrative medicine’ and called it ‘one of the most colossal deceptions of healthcare today’. Hahnemann would have ex-communicated the author for this suggestion, he called homeopaths who combined the two methods ‘traitors’!!!
  • ‘new therapeutic options’… neither new nor therapeutic, I would counter; to be accepted as ‘therapeutic’, one would need a solid proof of efficacy.
  • ’employed as an alternative’ – would this be ethical?
  • ‘Conventional diagnostic techniques are always part of the therapy’… really? I was taught that diagnosis and treatment are two separate things.

There were many comments  by readers of the FAZ. Their vast majority expressed bewilderment at the idea that the chair of the German Association of Homeopaths has been given such a platform to dangerously mislead the public. I have to say that I fully agree with this view: the promotion of bogus treatments can only be a disservice to public health.

Guest post by Frank Van der Kooy

Something happened in 2008. Something, or a number of things, triggered an exponential rise in the number of rhinos being killed in South Africa. Poaching numbers remained quite low and was stable for a decade with only 13 being killed in 2007. But then suddenly it jumped to 83 in 2008 and it reached a total of 1 175 in 2015. To explain this will be difficult and it will be due to a number of factors or events coinciding in 2008. One possible contributing factor, which I will discuss here, is the growing acceptance of TCM in western countries! For example: Phynova recently advertised a new product as being the first traditional Chinese medicine (TCM) being registered in the UK. By directing customers to a separate site for more information regarding their product they ‘accidently’ linked to a site which ‘advertised’ rhino horn (this link has since been removed). Another example is a University in Australia who published a thesis in 2008, in which they described the current use of Rhino horn as a highly effective medicine, just like you would describe any other real medicine. Surely this will have an impact!

But first a bit of background, so please bear with me. There are two ‘opposing’ aspects regarding TCM that most members of the public do not seem to understand well. Not their fault, because the TCM lobby groups are spending a huge amount of effort to keep the lines between these two aspects as blurred as possible. The first aspect is the underlying pseudoscientific TCM principles; the yin and yang and the vitalistic “energy” flow through “meridians” and much more. Science has relegated this to the pseudosciences, just like bloodletting, which was seen as a cure-all hundreds of years ago. Unfortunately, the pseudoscientific TCM principles are still with us and based on these principles almost every single TCM modality works! From acupuncture to herbs to animal matter (including rhino horn) – everything is efficacious, safe and cost effective. Evidence for this is that close to a 100% of clinical trials done on TCM in China give positive results. Strange isn’t it! People in China should thus no die of any disease – they have ‘effective’ medicine for everything! This is the world of TCM in a nutshell.

The second aspect of TCM is the application of the modern scientific method to test which of the thousands of TCM modalities are really active, which ones are useless and which ones are dangerous. Decades of investigation have come up empty-handed with one or two exceptions. One notable exception is Artemisia annua which contain a single compound that is highly effective for the treatment of malaria, and once identified and intensely studied, it was taken up into conventional medicine – not the herb, but the compound. If you investigate all the plants in the world you are bound to find some compounds that can be used as medicine – it has nothing to do with TCM principles and it can most definitely not be used as evidence that the TCM principles are correct or that it based on science.

These two aspects are therefore quite different.

In the TCM world just about everything works, but it is not backed up by science. It is huge market ($170 billion) and it creates employment for many – something that make politicians smile. In the modern scientific world, almost nothing in TCM works, but it is based on science. It is however not profitable at all – you have to investigate thousands of plants in order to find one useful compound.

Many TCM practitioners and researchers are avidly trying to combine the positives of these two worlds. They focus mainly on the money and employment aspect of the TCM world and try and combine this with the modern scientific approach. They tend to focus on the one example where modern science discovered a useful compound (artemisinin) in the medicinal plant Artemisia annua, which was also coincidently used as an herb in TCM – as evidence that TCM works! Here are some examples:

“To stigmatise all traditional medicine would be unfair. After all, a Chinese medicine practitioner last year won a Nobel prize.” No, a Chinese scientist using the modern scientific method identified artemisinin after testing hundreds or even thousands of different plants.

This year, Chinese medicine practitioners will be registered in Australia. ….. Chinese herbal medicine is administered routinely in hospitals for many chronic diseases. …… This has led to recognising herbs such as Artemisia as a proven anti-malarial ……” No, the compound artemisinin is a proven anti-malarial!

There has been enormous progress in the last 20 years or so. I am sure you are familiar with the use of one of the Chinese herbs in managing resistant malaria.” No, very little progress and no, the compound artemisinin!

So this is a game that is being played with the simple intention to blur the lines between these two aspects regarding TCM – but the real reason might simply be “A new research-led Chinese medicine clinic in Sydney, better patient outcomes and the potential for Australia to tap into the $170 billion global traditional Chinese medicine market”

Prof Alan Bensoussan the director of the National Institute of Complementary Medicine (NICM) and registered in Australia as a TCM and acupuncture practitioner is a champion in blurring this line. Alan has been instrumental in lobbying the Australian regulatory agency that a long tradition of use is all you need to be able to register new products. He was also influential in establishing the Chinese medicine practitioner registry in Australia, in 2012, and thereby legitimising TCM in Australia. He has been actively chipping away at the resistance that the Australian public have against these pseudoscientific healthcare systems such as TCM – one can argue that he has done so quite successfully because they are expanding their operations into the Westmead precinct of Sydney with a new TCM clinic/hospital.

Enough background; so what does all of this have to do with Rhino horn? (and for that matter other endangered species). We have to remember that in the TCM world just about everything works and that includes rhino horn! Searching Western Sydney University’s theses portal for Xijiao (Chinese for Rhino horn) I found a thesis published in 2008 from the NICM and co-supervised by Alan; “Development of an evidence-based Chinese herbal medicine for the management of vascular dementia”

On page 45-46: “Recently, with fast developing science and technologies being applied in the pharmaceutical manufacturing area, more and more herbs or herbal mixtures have been extracted or made into medicinal injections. These have not only largely facilitated improved application to patients, but also increased the therapeutic effectiveness and accordingly reduced the therapeutic courses …… lists the most common Chinese herbal medicine injections used for the treatment of VaD. “

“Xing Nao Jing Injection (for clearing heat toxin and opening brain, removing phlegm) contains ….. Rhinoceros unicornis (Xijiao), …… Moschus berezovskii (Shexiang), …..”

“…. Xing Nao Jing injection has been widely applied in China for stroke and vascular dementia. …. After 1-month treatment intervention, they found the scores in the treatment group increased remarkably, as compared with the control group …… “

They list two endangered species; the Rhino and the Chinese forest musk deer (Moschus berezovskii). But what is truly worrying is that they don’t even mention the endangered status or at least recommend that the non-endangered substitutes, which do exist in the TCM world, should be used instead – or maybe use fingernails as a substitute? It is not discussed at all. Clearly they are stating that using these endangered animals are way more effective than western medicine (the control group) for the treatment of vascular dementia! This is deplorable to say the least. Statements like this fuels the decimation of this species. But this shows that they truly believe and support the underlying pseudoscientific principles of TCM – they have to, their ability to tap into the TCM market depends on it!

As a scientist you are entitled to discuss historic healthcare treatments such as bloodletting. But make sure to also state that this practice has been shown to be ineffective, and quite dangerous, and that modern science has since come up with many other effective treatments. If it is stated that bloodletting is currently being used and it is effective – then you will simply be promoting bloodletting! The same goes for Rhino horn and this is exactly what they have done here. But then again they live in a world where all TCM modalities are active!

How to solve this problem of growing acceptance of TCM in western countries? A simple step could be that people like Alan publicly denounce the underlying pseudoscientific TCM principles and make the ‘difficult’ switch to real science! Admittedly, he will have to part with lots of money from the CM industry and his Chinese partners, and maybe not built his new TCM hospital! But for some reason I strongly doubt that this will happen. The NICM have successfully applied a very thin, but beautiful, veneer of political correctness and modernity over the surface of complementary medicine. Anyone who cares to look underneath this veneer will find a rotten ancient pseudoscientific TCM world – in this case the promotion and the use of endangered animals.

After reading chapter two of this thesis one cannot believe that this is from an Australian University and paid for by the Australian taxpayer! The main question though: Can I directly link this thesis with the increase in rhino poaching? This will be very difficult if not impossible to do. But that is not the problem. Promoting the pseudoscientific principles of TCM in Australia expands the export market for TCM, and hence will lead to an increased need for raw materials, including the banned Rhino horn. That Rhino horn has been a banned substance since the 1980’s clearly does not seem to have any impact looking at the poaching statistics. In an unrelated paper published in 2010 the ingredients in the Xingnaojing injection is listed as “…. consisting of Chinese herbs such as Moschus, Borneol, Radix Curcumae, Fructus Gardeniae, ….” No full list is given in the paper – dare I say because it contains Rhino horn as well? The drug Ice is also banned, but if you are going to promote it at a ‘trusted’ university, then you shouldn’t be surprised that Ice production increases and more of it flows into Australia – even if it is illegal. The same goes for Rhino horn!

Last Sunday evening, the Syrian, Mohammad D., tried to enter an open air festival in Ansbach, Germany. As he had no ticket, he was barred from entering. Later he exploded his bomb in front of one of the entrances of the festival. It killed him and injured 15 others, 4 seriously.

According to a report published in German, the 27-year old suicide-bomber had been treated since about half a year in an institution in Lindau called ‘Exilio’ by alternative therapists (Heilpraktiker) who offer ‘holistic help’ for immigrants under the leadership of Gisela und Axel von Maltitz.

The German ‘Heilpraktiker’ is an oddity left over from the Third Reich. Today, a Heilpraktiker hardly needs any education or training at all. What is more, he/she can claim to practice psychotherapy without proper training in psychotherapy. The Heilpraktiker in charge of Exilio, Axel von Maltitz, for instance, calls himself ‘Primärtherapeut, Heilpraktiker, Traumatherapie and Psychotherapie.’ The debate in Germany about the usefulness or otherwise of the Heilpraktiker has recently been stimulated by the publication of a critical book on the subject and can be expected to get more intense after the events in Ansbach.

‘Exilio’ apparently has a dubious reputation in Lindau, and the local officials had stopped co-operating with this clinic already over a year ago. The therapeutic team of Exilio does not seem to include a single qualified doctor, psychologist or psychiatrist.

The treatments employed in ‘Exilio’ include such dubious methods as Rebirthing, a technique involving “specific breathing exercises which allow individuals to re-experience memories from the past and to release feelings and sentiments that are suppressed / contained within the emotional physical self.” I am not aware of good evidence to show that Rebirthing is effective for any condition.

It seems clear that the Syrian suicide-bomber was seriously disturbed; apparently he already had previously tried to commit suicide. Nobody will ever know whether the atrocity of last Sunday could have been prevented, if he had received proper psychiatric attention. With hindsight, however, it seems clear that the alternative therapies he did receive were not effective.

Acupuncture Today is a much-read online publication for people interested in acupuncture. It informs us that Chinese medicine is quite complex and can be difficult for some people to comprehend. This is because TCM is based, at least in part, on the Daoist belief that we live in a universe in which everything is interconnected. What happens to one part of the body affects every other part of the body. The mind and body are not viewed separately, but as part of an energetic system. Similarly, organs and organ systems are viewed as interconnected structures that work together to keep the body functioning.

To me, this sounds suspiciously woolly. Do they think that conventional healthcare professionals view the various body-parts as separate entities? Do they feel that conventional practitioners see the mind entirely separate from the body? Do they believe others fail to realize that what affects the brain does not affect the rest of the body? These common preconceptions have always puzzled me. Intrigued, I read on.

Elsewhere we learn that Acupuncture Today and acupuncturetoday.com are the only complete news sources in the profession and we don’t take this honor lightly. The acupuncture and Oriental medicine profession is a blend of ancient traditions, healing styles and modern therapies. We provide content that is comprehensive enough to appeal to each of the profession’s diverse groups. In addition, we provide a complete suite of additional products including newsletters, calendars and classifieds that provide our advertisers with the contextual platform they need to communicate with our readers, their customers.

Acupuncture Today seems to reflect a lot of what many acupuncturists want to hear – and thus it might provide us with an important insight into the mind-set of acupuncturists. On their website, I found an article which fascinated me:

START OF QUOTE

A more efficient method for diagnosis and treatment by remote medical dowsing has been found and used in acupuncture with great success. The procedure involves a pendulum, a picture of the patient, an anatomy book, a steel pointer, and a very thin bamboo pointer.

Being a dentist, orthodontist, acupuncturist and dowser, I like to take the liberty of treating a person affected with lockjaw or temporal-mandibular joint ailments via remote dowsing…

…When the mandible cannot open due to a spasm, the chief symptom is pain. Until energy is restored, the muscle cannot lengthen and pain cannot be eliminated. Acupuncture is a good way to correct this condition without the use of a dental appliance. Dentists specializing in treating TMJ use a computerized equipment scan (electrosonography), surface electromyography and the myomonitor to relax the muscles.

Another procedure to treat TMJ is using dowsing. At this point, I will talk about dowsing procedures and information needed to successfully carry out the procedures. Remote dowsing requires the use of the pendulum, a slender bamboo pointer, an anatomy book, a picture of the patient and a steel pointer.

To treat a TMJ patient, the picture of the patient is dowsed holding a pendulum in the right hand while the left hand uses a bamboo pointer to touch the closing and opening muscles individually in the anatomy book. The closing muscles will have good energy (as evidenced by the circular movement of the pendulum) while the lower head of the lateral pterygoid will have no energy (as evidenced by little or no movement of the pendulum). Having advance information on TMJ acupuncture points helps, but these points will have to be tested if needling will supply energy. Master Tong has suggested a point between Liver 2 and Liver 3. I find Spleen 2, a distal point related to the lower head of the lateral pterygoid, to be more effective. This can be checked by having the patient hold the point of the steel pointer so it touches Spleen 2 on the large toe.

To treat a TMJ patient, the picture of the patient is dowsed holding a pendulum in the right hand while the left hand uses a bamboo pointer to touch the closing and opening muscles individually in the anatomy book. The closing muscles will have good energy (as evidenced by the circular movement of the pendulum) while the lower head of the lateral pterygoid will have no energy (as evidenced by little or no movement of the pendulum). Having advance information on TMJ acupuncture points helps, but these points will have to be tested if needling will supply energy. Master Tong has suggested a point between Liver 2 and Liver 3. I find Spleen 2, a distal point related to the lower head of the lateral pterygoid, to be more effective. This can be checked by having the patient hold the point of the steel pointer so it touches Spleen 2 on the large toe.

By dowsing the picture of the patient with the right hand and using a bamboo pointer to touch the lower head of the pterygoid muscle in the anatomy book with the left hand, it will be evident by the circular movement of the pendulum that these muscles now have good energy. This is done before the needle is inserted. In this manner all points can be checked for ailments such as TMJ, stroke, backaches, and neck and shoulder problems before needling. When the needles are placed and after the needling procedure, energy can be checked using the pendulum. By being very accurate on the location of acupuncture points, less treatments will be needed to obtain results. Another point is Small Intestine 19, a local point which is also very effective. Good results are obtained by careful and accurate needling. Therefore, the number of visits are few…

Dowsing is a diagnostic aid that has been used for other situations and can be very helpful to acupuncturists. In conclusion, I feel that remote dowsing is a great approach to diagnosis and treatment.

END OF QUOTE

If I had not seen alternative practitioners doing this procedure with my own eyes, I might have thought the article is a hoax. Sadly, this is the ‘real world’ of alternative medicine.

I tried to find some acupuncturists who had objected to this intense nonsense, but I was not successful in this endeavour. The article was published 6 years ago (no, not on 1 April!), yet so far, nobody has objected.

I have also tried to see whether articles promoting quackery of this nature are rare exceptions in the realm of acupuncture, or whether they are regular occurrences. My impression is that the latter is the case.

What can be concluded from all this?

In a previous post about quackery in chiropractic, I have argued that the tolerance of quackery must be one of the most important hallmarks of a quack profession. As I still believe this to be true, I have to ask to which extend THE TOLERANCE OF SUCH EXTREME QUACKERY MAKES ACUPUNCTURISTS QUACKS?

[I would be most interested to have my readers’ views on this question]

A survey published in 2011 showed that one-third of Danish hospitals offered alternative therapies. In total, 38 hospitals offered acupuncture and one Eye Movement Desensitization and Reprocessing Light Therapy. The most commonly reported reason for offering CAM was “scientific evidence”.

Many readers of this blog might be amazed with both the high level of alternative medicine presence in Danish hospitals and the notion that this was due to ‘scientific evidence’. A recent article provides even more surprises about the Danish alternative medicine scene.

It revealed that 8 out of 10 Danes are interested in using some form of alternative medicine…Some 67 percent of Danes say the national healthcare system should be more open to alternative healing practices, such as homeopathy, acupuncture or chiropractic, and 60 percent would like to see these treatments covered by the public health insurance system. More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.

Charlotte Yde, the chairwoman at Sundhedsrådet, which is the umbrella organisation for alternative practitioners in Denmark, contends many Danes feel frustrated because they cannot freely discuss alternative treatment with their doctors. Alternative treatment researcher Helle Johannessen agrees that Danish doctors should openly discuss alternative medicine options with patients. “In other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark,” Johannessen told DR. “[International experience] shows that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients.”

This, it seems to me, is little more than a bonanza of fallacious thinking and misleading information.

  • The notion that popularity of a therapy has anything to do with its usefulness is a classical fallacy.
  • The notion that belief determines efficacy (More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.) or vice versa is complete nonsense.
  • The notion that many Danes … cannot freely discuss alternative treatment with their doctors is misleading: patients can discuss what they feel like with whom they feel like.
  • The notion that in other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark is also misleading: there are many European countries where LESS alternative therapies are being paid for via the public purse.
  • Finally, the notion that that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients – even if it were correct – does not mean that ALL alternative therapies are efficacious, safe, or cost-effective.

Who cares about Denmark?

Why should this be important?

Well, the Danes might care, and it is important because it provides an excellent example of how promoters of bogus treatments tend to argue – not just in Denmark, but everywhere. Unfortunately, politicians all too often fall for such fallacious notions. For them, a popular issue is a potential vote-winner. Within medical systems that are notoriously strapped for money, the looser will inevitably be optimal healthcare.

Yes, I admit it: over the years, I had formed a vague impression that homeopaths lack humour. Certainly, many comments on this blog seemed to confirm the notion. But now I changed my mind: some homeopaths are intensely funny.

Yesterday, I found a tweet which read: “NCH and homeopathy to be highlighted at the 2016 American Public Health Association’s conference in Denver”. The tweet provided a link which took me to an abstract authored by Alison Teitelbaum from the US National Center for Homeopathy (on their website, this organization tell us that they “inform legislators and work to secure homeopathy’s place in the U.S health care system while working to ensure that homeopathy is accurately represented in the media”).

The abstract in question summarized a presentation for the up-coming APHA-meeting in Denver. It is so hilariously comical that I simply have to share it with you (for those readers are homeopaths, I have added [in square brackets] a few footnotes explaining the humorous side of it):

Background: Over the last 25 years there has been a marked increase in consumer demand for information about complimentary [1] and alternative medicine, including homeopathy. Anecdotal data [2] suggest that homeopathic consumers are very satisfied with homeopathic medicines, and use them to treat acute, self-limiting conditions, however very little data exists in the published literature examining either topic [3]. Therefore, the purpose of this project was to evaluate homeopathic consumers’ use and satisfaction with homeopathic medicines.

Methods: Survey of nearly 20,000 consumers [4] who had purchased at least 1 over-the-counter (OTC) homeopathic medicine in the past 2 years.

Results: [5] More than 95% of respondents indicated they were very or extremely satisfied with the most recent OTC homeopathic medicine they had purchased and used [6]. More than 96% of respondents indicated they were very or extremely satisfied with the results of OTC homeopathic medicines that they had used in general [7]. Over 98% of respondents reported that they were very likely to purchase OTC homeopathic medicines again in the future [8]. More than 97% of respondents indicated that they were very likely to recommend homeopathic medicines to others [9]. Finally, more than 80% of respondents indicated using OTC homeopathic medicines for acute, self-limiting conditions, such as aches and pains; cold and flu symptoms; and digestive upset [10].

Conclusion: These results support anecdotal evidence [11] that homeopathic consumers are satisfied with OTC homeopathic medicines [12], and are using them to treat acute, self-limiting conditions [13]. Additional research is needed to further explore the use of OTC homeopathic medicine in the US for trends, access, and overall awareness about homeopathy [14].

[1] complimentary medicine = healthcare that costs nothing; complementary medicine = healthcare that complements real medicine; homeopathy should belong to the former category because it contains nothing.

[2] please note how ‘anecdotal data’ becomes ‘anecdotal evidence’ by the time we reach the conclusion; little does the author know that THE PLURAL OF ANECDOTE IS NOT ‘DATA’ BUT ‘ANECDOTES’!!!

[3] this statement implies that the author cannot cope with a Medline search, because there are plenty of articles on this subject.

[4] ‘nearly 20 000’ perfectly reflects the scientific rigor of this project (is it really too demanding to provide the exact figure?)

[5] how come we do not learn anything about the response rate of this survey (did ‘nearly’ everyone reply? or did ‘nearly’ everyone not reply?)?

[6] considering that only homeopathy-fans were included, this figure should be 100%!

[7] considering that only homeopathy-fans were included, this figure should be 100%!

[8] considering that only homeopathy-fans were included, this figure should be 100%!

[9] considering that only homeopathy-fans were included, this figure should be 100%!

[10] ‘more than 80%’ of an unknown rate of responders is about as much as a tin of peas. But I am nevertheless relieved that the majority used placebos merely for self-limiting conditions; the 20% who might have used it for life-threatening conditions are probably all dead – sad!

[11] see footnote number 2

[12] this is like doing a survey in a hamburger joint concluding that all consumers love to eat hamburgers.

[13] except, of course, the unknown percentage of non-responders who might all be dead.

[14] I would re-phrase this last sentence as follows: MORE SUCH PRESENTATIONS ARE NEEDED TO PROVIDE COMIC RELIEF TO OTHERWISE DRY AND BORING MEETINGS ON PUBLIC HEALTH.

Yes, I know, lately I have been neglecting my ‘ALT MED HALL OF FAME’. This is entirely my fault; there are so many candidates waiting to be admitted that, I have been hesitant as to who should be next. Today, I came across an article about Deepak Chopra and his latest book, Super Genes. It tells “how lifestyle shifts can help you reboot your health at a genetic level.” If it were just for this single sentence, he would deserve to be admitted – no, not into what you just thought, into the ‘ALT MED HALL OF FAME’, of course’.

I will save you the expense of buying his book (don’t worry, Deepak is already a multi-millionaire) by repeating what the article said about his ‘6 pillars of wellbeing’ (another cracker!!!):

DIET

• A typical modern diet is very likely to cause inflammation, which research has linked to many chronic diseases and obesity.

• To reduce inflammation, add prebiotics – substances that buffer the body from inflammation – such as oatmeal, pulpy orange juice, bran cereal and bananas to your breakfast.

• Consume probiotics – foods that contain active bacteria – once a day for gut health. These foods include active yoghurt, pickles and sauerkraut.

• Eat mindfully – eat only when you’re genuinely hungry and stop when you are full.

• Reduce snacking by eating only one measured portion in a bowl; never eat straight from a bag or packet.

STRESS

• Three factors generally lie behind the problem of chronic stress: repetition, unpredictability and a lack of control. Think of a dog barking outside your window; you don’t know when it will end and you have no way of stopping it.

• Decrease background noise and distractions at work. Also, avoid multitasking by dealing with one thing at a time.

• Leave work on time at least three times a week and don’t bring work home. Leave the office at the office.

• Avoid people who are sources of pressure and conflict. Even normal office behaviour, such as forming cliques and gossiping, is a source of stress that has the potential to be emotionally devastating.

• If you struggle to deal with negative emotions, ask your doctor about cognitive behaviour therapy.

EXERCISE

• The secret to exercise is this: keep going and don’t stop. It’s better to be active all your life at a lower level, rather than to be at a near professional-level in high school, say, and then stop completely.

• At work get up and move around once an hour and devote half your lunch break to movement, even if it’s walking around the block.

• Be in nature more: go outside for five to 10 minutes three times a day.

• Acquire more active friends and join them in their activities. Plan a shared exercise activity with your spouse or friends twice a week.

• Make leisure time more creative – think beyond TV or internet.

• Volunteer to help the needy with housecleaning, painting and repairs.

This will serve as both exercise and a morale boost.

MEDITATION

• Meditate every day for 10 minutes.

Sit with your eyes closed in a quiet place, put your attention on the tip of your nose and focus on the sensation of your breath coming in and out of your nostrils.

• Don’t look at meditation as an aid for the bad days you experience (“I’m feeling good today, so I don’t need to meditate”). It should be a lifelong practice.

• Take 10 minutes out of your lunch break to sit alone with eyes closed, preferably outside in nature.

• Notice what a relief it is to take big deep breaths when you are upset or nervous, and how ragged your breath becomes when you are anxious or stressed.

• Join an organised meditation course in your area. Search for meetup.com to find local groups that meet all around the country.

SLEEP

• Make your bedroom as dark as possible. If total darkness is impossible, wear a sleep mask.

• Drink a glass of warm almond milk, which is rich in calcium and promotes melatonin, a hormone that helps to regulate the sleep-wake cycle.

• Experiment with herbal teas associated with good sleep such as chamomile, valerian, passionflower, lavender and kava kava.

• Explore abhyanga, a self-massage technique that uses warmed sesame oil, lightly massaged into arms, legs, neck and torso (go to YouTube to see tutorials).

• Don’t ignore insomnia. In some studies sleep disorders have been associated with triggering Alzheimer’s disease and are also associated with high blood pressure.

EMOTIONS

• Take responsibility for your feelings. Wellbeing depends upon happiness, yet most people don’t really make that connection.

• Write down five specific things that make you happy and, on a daily basis, do at least one of them.

• Set a “good news policy” at meal times, whether it’s the radio station you choose to listen to or the topic of conversation around the table.

• Explore a time in your past when you were happy and learn from it, whether that means re-embracing an old hobby or getting in touch with an old friend.

• Become comfortable with delayed gratification – consider how your choices will make you feel in the future as well as today.

END OF QUOTE

My favourite website about Deepak Chopra is the one by Tom Williamson. It states that “it has been said by some that the thoughts and tweets of Deepak Chopra are indistinguishable from a set of profound sounding words put together in a random order, particularly the tweets tagged with “#cosmisconciousness”. This site aims to test that claim! Each “quote” is generated from a list of words that can be found in Deepak Chopra’s Twitter stream randomly stuck together in a sentence.” It seems to me that Deepak himself might have made ample use of this site for writing his latest book, and if you should ever run out of platitudes or empty phrases, this site will serve you well.

Deepak has published plenty of best-sellers, but he has as good as nothing to show for himself in the peer-reviewed medical literature. (When you are that famous, you obviously don’t need to bother anymore with trivia such as evidence, science and all that jazz.) This means that I had to deviate from my usual admission criteria for the “prophet of alternative medicine”, as Deepak likes to be called. But he is well worth making an exception, I am sure you agree, he is the absolute super-star!

Super-star of what?

I let you decide!

 

Homeopaths assume lots of things; one of their main claims is, for instance, that the process of repeatedly diluting a remedy and vigorously shaking it at each step – they call this potentisation – renders it more potent. This is the famous MEMORY OF WATER’ theory of homeopathy. In Hahnemann’s own words: ‘…the power of a medicine in solution is much increased by intimate mixture with a large volume of fluid…’ And elsewhere he stated that ‘as the smallest quantity of medicine naturally disturbs the organism least, we should choose the very smallest doses, provided always that they are a match for the disease… hardly any dose of the homeopathically selected remedy can be so small as not to be stronger than the natural disease…’

Hahnemann’s explanation for this extraordinary assumption (which he claimed to have observed empirically) was that his remedies do not work through any material effects but via spirit-like energies. As this sounds a little silly in the light of modern science, homeopaths have been keen to find more rational support for their theories. Thus they have developed several ‘sciency’ concepts to explain the mode of action of their highly diluted homeopathic remedies. For instance that postulated that water can form secondary structures that hold some information of the original substance (stock), even if it has long been diluted out of the remedy. Alternatively, they claimed that the shaking of the remedy generates nano-particles or silicone-particles which, in turn, are the cause of the clinical effects.

Today, I want to assume for a minute, that one of these theories is correct – they cannot all be right, of course. Homeopaths regularly show us investigations that seem to support them, even though it only needs a real expert in the particular field of science to cast serious doubt on them. I will nevertheless assume that, after potentisation, the diluent retains information via nano-particles or some other phenomenon. For the purpose of this mind-experiment, I grant homeopaths that, in this respect, they are correct. In other words, let’s for a moment assume that the ‘memory of water’ theory is correct.

As I have been more than generous, I want homeopaths to return the favour and consider what this would really mean: information has been transferred from the stock to the diluent. Does that prove anything? Does it show that homeopathy is valid?

Could the homeopaths who make this assumption be equally generous and answer the following questions, please?

  1. How does a nano-particle of coffee, for instance, affect the sleep centre in the brain to make the patient sleep? Or how does a nano-particle of the Berlin Wall or a duck liver affect anything at all in the human body? The claim that information has been retained by the diluent is no where near to an explanation of a rational mode of action, isn’t it?
  2. Most homeopathic remedies are consumed not as liquids but as ‘globuli’, i. e.  tiny little pills made of lactose. They are prepared by dropping the liquid remedy on to them. The liquid subsequently evaporates. How is it that the information retained in the liquid does not evaporate with the diluent?
  3. The diluent usually is a water-alcohol mixture which inevitably contains impurities. In fact, a liquid C12 remedy most certainly contains dimensions more impurities than stock. These impurities have, of course, also been vigorously shaken, i. e. potentised. How can we explain that their ‘potency’ has not been beefed up at each dilution step? Would this not necessitate a process where only some molecules in the diluent are agitated, while all the rest remain absolutely still? How can we explain this fantastic concept?
  4. Some stock used in homeopathy is insoluble (for instance Berlin Wall). Such stock is not diluted but its concentration in the remedy is initially lowered by a process called ‘trituration’, a process which consists in grinding the source material in another solid material, usually lactose. I have granted you that potentisation works in the way you think. But how is information transferred from one solid material to another?
  5. Everything we drink is based on water containing molecules that have been inadvertently potentised in nature a million times and therefore should have hugely powerful effects on our bodies. How is it that we experience none of these effects each time we drink?

Now, homeopaths, let me propose a deal.

If you can answer these questions satisfactorily, I will no longer doubt your memory of water theory. If you cannot do this, I think you ought to admit that all your ‘sciency’ theories about the mode of action of highly diluted homeopathic remedies are really quite silly – more silly even than Hahnemann’s idea of a ‘spirit-like’ effect.

 

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?

 

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