A special issue of Medical Care has just been published; it was sponsored by the Veterans Health Administration’s Office of Patient Centered Care and Cultural Transformation. A press release made the following statement about it:
Complementary and alternative medicine therapies are increasingly available, used, and appreciated by military patients, according to Drs Taylor and Elwy. They cite statistics showing that CAM programs are now offered at nearly 90 percent of VA medical facilities. Use CAM modalities by veterans and active military personnel is as at least as high as in the general population.
If you smell a bit of the old ad populum fallacy here, you may be right. But let’s look at the actual contents of the special issue. The most interesting article is about a study testing acupuncture for posttraumatic stress disorder (PTSD).
Fifty-five service members meeting research diagnostic criteria for PTSD were randomized to usual PTSD care (UPC) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone. Outcomes were assessed at baseline and 4, 8, and 12 weeks postrandomization. The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist (PCL) and the Clinician-administered PTSD Scale (CAPS) from baseline to 12-week follow-up between the two treatment groups. Secondary outcomes were depression, pain severity, and mental and physical health functioning. Mixed model regression and t test analyses were applied to the data.
The results show that the mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC. Acupuncture was also associated with significantly greater improvements in depression, pain, and physical and mental health functioning. Pre-post effect-sizes for these outcomes were large and robust.
The authors conclude from these data that acupuncture was effective for reducing PTSD symptoms. Limitations included small sample size and inability to parse specific treatment mechanisms. Larger multisite trials with longer follow-up, comparisons to standard PTSD treatments, and assessments of treatment acceptability are needed. Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment.
What shall we make of this?
I know I must sound like a broken record to some, but I have strong reservations that the interpretation provided here is correct. One does not even need to be a ‘devil’s advocate’ to point out that the observed outcomes may have nothing at all to do with acupuncture per se. A much more rational interpretation of the findings would be that the 8 times 60 minutes of TLC and attention have positive effects on the subjective symptoms of soldiers suffering from PTSD. No needles required for this to happen; and no mystical chi, meridians, life forces etc.
It would, of course, have been quite easy to design the study such that the extra attention is controlled for. But the investigators evidently did not want to do that. They seemed to have the desire to conduct a study where the outcome was clear even before the first patient had been recruited. That some if not most experts would call this poor science or even unethical may not have been their primary concern.
The question I ask myself is, why did the authors of this study fail to express the painfully obvious fact that the results are most likely unrelated to acupuncture? Is it because, in military circles, Occam’s razor is not on the curriculum? Is it because critical thinking has gone out of fashion ( – no, it is not even critical thinking to point out something that is more than obvious)? Is it then because, in the present climate, it is ‘politically’ correct to introduce a bit of ‘holistic touchy feely’ stuff into military medicine?
I would love to hear what my readers think.
Biopuncture is a therapy whereby specific locations are injected with biological products. The majority of the products are derived from plants. Most of these injections are given into the skin or into muscles. Products commonly used in Biopuncture are, for example, arnica, echinacea, nux vomica and chamomile. Arnica is used for muscle pain, nux vomica is injected for digestive problems, echinacea is used to increase the natural defense system of the body. Biopuncturists always inject cocktails of natural products. Lymphomyosot is used for lymphatic drainage, Traumeel for inflammations and sports injuries, Spascupreel for muscular cramps. Injections with antiflogistics, hyaluronic acid, blood platelets, blood, procaine, ozon, cortisone or vitamin B are not considered as Biopuncture…
How can such a small dose influence your body and stimulate healing? Scientists don’t have the final proof yet, but they postulate that these injections are working through the stimulation of the immune system (which is in fact your defense system). Let’s compare it with a vaccination. When you receive a tetanus vaccination, only small amounts of a particular product are necessary to stimulate the immune system against lockjaw. In other words, just a few injections can protect your body for years…
An important issue in Biopuncture is the detoxification of the body. It literally means “cleaning the body” from all the toxins that have accumulated: for example from the environment (air pollution, smoking), from bad nutrition, or from medication (e.g., antibiotics and steroids you’ve taken). These toxins can block your defense system. Some injections work specifically on the liver and others on the kidneys. Cleaning up the lymphatic system with Lymphomyosot is considered very important in Biopuncture. It is like taking the leaves out of the gutter. The down side of such an approach is that old symptoms (which have been suppressed earlier on) may come to the surface again. But that is sometimes part of the healing strategy of the body…
That sounds strange, to say the least. But remember: strange treatments might still work! The question is therefore: IS BIOPUNCTURE AN EFFECTIVE THERAPY? If you ask it to Dr Oz, the answer would be a resounding YES – but let’s not ask Oz, let’s try to find some reliable evidence instead. In my quest to locate such evidence, I came across claims like these.
Examples of some acute conditions we treat with biopuncture:
- Knee and ankle sprains
- Muscle sprains- quadriceps, hamstring, adductors, rotator cuff
Examples of some chronic conditions we treat with biopuncture:
- Achilles tendinitis
- Tennis elbow
- Chronic arthritis of the knee, hip, shoulder
- Back pain
- Myofascial pains
- Irritable bowel syndrome
- TMJ syndrome
Somehow I had the feeling that this was more than a little too optimistic, and I decided to conduct a rudimentary Medline search. The results were sobering indeed: not a single clinical trial seems to be available that supports any of the claims that are being made for biopuncture.
So, what should we conclude? I don’t know about you, but to me it seems that biopuncture is quackery at its purest.
Rigorous research into the effectiveness of a therapy should tell us the truth about the ability of this therapy to treat patients suffering from a given condition — perhaps not one single study, but the totality of the evidence (as evaluated in systematic reviews) should achieve this aim. Yet, in the realm of alternative medicine (and probably not just in this field), such reviews are often highly contradictory.
A concrete example might explain what I mean.
There are numerous systematic reviews assessing the effectiveness of acupuncture for fibromyalgia syndrome (FMS). It is safe to assume that the authors of these reviews have all conducted comprehensive searches of the literature in order to locate all the published studies on this subject. Subsequently, they have evaluated the scientific rigor of these trials and summarised their findings. Finally they have condensed all of this into an article which arrives at a certain conclusion about the value of the therapy in question. Understanding this process (outlined here only very briefly), one would expect that all the numerous reviews draw conclusions which are, if not identical, at least very similar.
However, the disturbing fact is that they are not remotely similar. Here are two which, in fact, are so different that one could assume they have evaluated a set of totally different primary studies (which, of course, they have not).
One recent (2014) review concluded that acupuncture for FMS has a positive effect, and acupuncture combined with western medicine can strengthen the curative effect.
Another recent review concluded that a small analgesic effect of acupuncture was present, which, however, was not clearly distinguishable from bias. Thus, acupuncture cannot be recommended for the management of FMS.
How can this be?
By contrast to most systematic reviews of conventional medicine, systematic reviews of alternative therapies are almost invariably based on a small number of primary studies (in the above case, the total number was only 7 !). The quality of these trials is often low (all reviews therefore end with the somewhat meaningless conclusion that more and better studies are needed).
So, the situation with primary studies of alternative therapies for inclusion into systematic reviews usually is as follows:
- the number of trials is low
- the quality of trials is even lower
- the results are not uniform
- the majority of the poor quality trials show a positive result (bias tends to generate false positive findings)
- the few rigorous trials yield a negative result
Unfortunately this means that the authors of systematic reviews summarising such confusing evidence often seem to feel at liberty to project their own pre-conceived ideas into their overall conclusion about the effectiveness of the treatment. Often the researchers are in favour of the therapy in question – in fact, this usually is precisely the attitude that motivated them to conduct a review in the first place. In other words, the frequently murky state of the evidence (as outlined above) can serve as a welcome invitation for personal bias to do its effect in skewing the overall conclusion. The final result is that the readers of such systematic reviews are being misled.
Authors who are biased in favour of the treatment will tend to stress that the majority of the trials are positive. Therefore the overall verdict has to be positive as well, in their view. The fact that most trials are flawed does not usually bother them all that much (I suspect that many fail to comprehend the effects of bias on the study results); they merely add to their conclusions that “more and better trials are needed” and believe that this meek little remark is sufficient evidence for their ability to critically analyse the data.
Authors who are not biased and have the necessary skills for critical assessment, on the other hand, will insist that most trials are flawed and therefore their results must be categorised as unreliable. They will also emphasise the fact that there are a few reliable studies and clearly point out that these are negative. Thus their overall conclusion must be negative as well.
In the end, enthusiasts will conclude that the treatment in question is at least promising, if not recommendable, while real scientists will rightly state that the available data are too flimsy to demonstrate the effectiveness of the therapy; as it is wrong to recommend unproven treatments, they will not recommend the treatment for routine use.
The difference between the two might just seem marginal – but, in fact, it is huge: IT IS THE DIFFERENCE BETWEEN MISLEADING PEOPLE AND GIVING RESPONSIBLE ADVICE; THE DIFFERENCE BETWEEN VIOLATING AND ADHERING TO ETHICAL STANDARDS.
One of the problems regularly encountered when evaluating the effectiveness of chiropractic spinal manipulation is that there are numerous chiropractic spinal manipulative techniques and clinical trials rarely provide an exact means of differentiating between them. Faced with a negative studies, chiropractors might therefore argue that the result was negative because the wrong techniques were used; therefore they might insist that it does not reflect chiropractic in a wider sense. Others claim that even a substantial body of negative evidence does not apply to chiropractic as a whole because there is a multitude of techniques that have not yet been properly tested. It seems as though the chiropractic profession wants the cake and eat it.
Amongst the most commonly used is the ‘DIVERSIFIED TECHNIQUE’ (DT) which has been described as follows: Like many chiropractic and osteopathic manipulative techniques, Diversified is characterized by a high velocity low amplitude thrust. Diversified is considered the most generic chiropractic manipulative technique and is differentiated from other techniques in that its objective is to restore proper movement and alignment of spine and joint dysfunction.
Also widely used is a technique called ‘FLEXION DISTRACTION’ (FD) which involves the use of a specialized table that gently distracts or stretches the spine and which allows the chiropractor to isolate the area of disc involvement while slightly flexing the spine in a pumping rhythm.
The ‘ACTIVATOR TECHNIQUE’ (AT) seems a little less popular; it involves having the patient lie in a prone position and comparing the functional leg lengths. Often one leg will seem to be shorter than the other. The chiropractor then carries out a series of muscle tests such as having the patient move their arms in a certain position in order to activate the muscles attached to specific vertebrae. If the leg lengths are not the same, that is taken as a sign that the problem is located at that vertebra. The chiropractor treats problems found in this way moving progressively along the spine in the direction from the feet towards the head. The activator is a small handheld spring-loaded instrument which delivers a small impulse to the spine. It was found to give off no more than 0.3 J of kinetic energy in a 3-millisecond pulse. The aim is to produce enough force to move the vertebrae but not enough to cause injury.
There is limited research comparing the effectiveness of these and the many other techniques used by chiropractors, and the few studies that are available are usually less than rigorous and their findings are thus unreliable. A first step in researching this rather messy area would be to determine which techniques are most frequently employed.
The aim of this new investigation was to do just that, namely to provide insight into which treatment approaches are used most frequently by Australian chiropractors to treat spinal musculoskeletal conditions.
A questionnaire was sent online to the members of the two main Australian chiropractic associations in 2013. The participants were asked to provide information on treatment choices for specific spinal musculoskeletal conditions.
A total of 280 responses were received. DT was the first choice of treatment for most of the included conditions. DT was used significantly less in 4 conditions: cervical disc syndrome with radiculopathy and cervical central stenosis were more likely to be treated with AT. FD was used almost as much as DT in the treatment of lumbar disc syndrome with radiculopathy and lumbar central stenosis. More experienced Australian chiropractors use more AT and soft tissue therapy and less DT compared to their less experienced chiropractors. The majority of the responding chiropractors also used ancillary procedures such as soft tissue techniques and exercise prescription in the treatment of spinal musculoskeletal conditions.
The authors concluded that this survey provides information on commonly used treatment choices to the chiropractic profession. Treatment choices changed based on the region of disorder and whether neurological symptoms were present rather than with specific diagnoses. Diversified technique was the most commonly used spinal manipulative therapy, however, ancillary procedures such as soft tissue techniques and exercise prescription were also commonly utilised. This information may help direct future studies into the efficacy of chiropractic treatment for spinal musculoskeletal disorders.
I am a little less optimistic that this information will help to direct future research. Critical readers might have noticed that the above definitions of two commonly used techniques are rather vague, particularly that of DT.
Why is that so? The answer seems to be that even chiropractors are at a loss coming up with a good definition of their most-used therapeutic techniques. I looked hard for a more precise definition but the best I could find was this: Diversified is characterized by the manual delivery of a high velocity low amplitude thrust to restricted joints of the spine and the extremities. This is known as an adjustment and is performed by hand. Virtually all joints of the body can be adjusted to help restore proper range of motion and function. Initially a functional and manual assessment of each joint’s range and quality of motion will establish the location and degree of joint dysfunction. The patient will then be positioned depending on the region being adjusted when a specific, quick impulse will be delivered through the line of the joint in question. The direction, speed, depth and angles that are used are the product of years of experience, practice and a thorough understanding of spinal mechanics. Often a characteristic ‘crack’ or ‘pop’ may be heard during the process. This is perfectly normal and is nothing to worry about. It is also not a guide as to the value or effectiveness of the adjustment.
This means that the DT is not a single method but a hotchpotch of techniques; this assumption is also confirmed by the following quote: The diversified technique is a technique used by chiropractors that is composed of all other techniques. It is the most commonly used technique and primarily focuses on spinal adjustments to restore function to vertebral and spinal problems.
What does that mean for research into chiropractic spinal manipulation? It means, I think, that even if we manage to define that a study was to test the effectiveness of one named chiropractic technique, such as DT, the chiropractors doing the treatments would most likely do what they believe is required for each individual patient.
There is, of course, nothing wrong with that approach; it is used in many other area of health care as well. In such cases, we need to view the treatment as something like a ‘black box'; we test the effectiveness of the black box without attempting to define its exact contents, and we trust that the clinicians in the trial are well-trained to use the optimal mix of techniques as needed for each individual patient.
I would assume that, in most studies available to date, this is precisely what already has been implemented. It is simply not reasonable to assume that a trial the trialists regularly instructed the chiropractors not to use the optimal treatments.
What does that mean for the interpretation of the existing trial evidence? It means, I think, that we should interpret it on face value. The clinical evidence for chiropractic treatment of most conditions fails to be convincingly positive. Chiropractors often counter that such negative findings fail to take into account that chiropractors use numerous different techniques. This argument is not valid because we must assume that in each trial the optimal techniques were administered.
In other words, the chiropractic attempt to have the cake and eat it has failed.
‘Healing, hype or harm? A critical analysis of complementary or alternative medicine’ is the title of a book that I edited and that was published in 2008. Its publication date coincided with that of ‘Trick or Treatment?’ and therefore the former was almost completely over-shadowed by the latter. Consequently few people know about it. This is a shame, I think, and this post is dedicated to encouraging my readers to have a look at ‘Healing, hype or harm?’
One reviewer commented on Amazon about this book as follows: Vital and informative text that should be read by everyone alongside Ben Goldacre’s ‘Bad Science’ and Singh and Ernt’s ‘Trick or Treatment’. Everyone should be able to made informed choices about the treatments that are peddled to the desperate and gullible. As Tim Minchin famously said ‘What do you call Alternative Medicine that has been proved to work? . . . Medicine!’
This is high praise indeed! But I should not omit the fact that others have commented that they were appalled by our book and found it “disappointing and unsettling”. This does not surprise me in the least; after all, alternative medicine has always been a divisive subject.
The book was written by a total of 17 authors and covers many important aspects of alternative medicine. Some of its most famous contributors are Michael Baum, Gustav Born, David Colquhoun, James Randi and Nick Ross. Some of the most important subjects include:
As already mentioned, our book is already 6 years old; however, this does not mean that it is now out-dated. The subject areas were chosen such that it will be timely for a long time to come. Nor does this book reflect one single point of view; as it was written by over a dozen different experts with vastly different backgrounds, it offers an entire spectrum of views and attitudes. It is, in a word, a book that stimulates critical thinking and thoughtful analysis.
I sincerely think you should have a look at it… and, in case you think I am hoping to maximise my income by telling you all this: all the revenues from this book go to charity.
Have you ever wondered why homeopathic remedies cost relatively much money? The less they contain, the more expensive they seem to be. The typical homeopathic remedy contains not a single molecule of what it says on the bottle, yet it can cost quite a lot. Why?
The reason is, of course, that these remedies are ‘potentized’ – meaning that the starting material is diluted and subsequently ‘succussed’. The latter term describes the process of vigorously shaking the remedy at each dilution step. Succussion is essential for transferring the life-energy from one dilution to the next, homeopaths insist. The most commonly used OTC remedies are in the ‘C30′ potency. This means that some pharmacist had to do 30 dilutions 1: 100, and each time he or she made a new dilution, he or she had to do the vigorous shaking as well.
Homeopaths are still debating as to how often and how hard the remedy needs to be shaken for the optimal transference of the life-energy; Hahnemann did it by banging the vial on his bible. Meanwhile, inventive manufacturers have developed machines that can manage the succussions semi-automatically. But even then, the process needs to be supervised, and all of this takes time and costs money, of course.
And now you understand why these remedies cannot be as cheap as to reflect the total absence of an active molecule!
And perhaps you also understand why some pharmacists might get truly fed-up doing the dilution/succession knowing that they might as well just put distilled water in the final vial – nobody on this planet could possibly ever tell the difference! I have always imagined that many of them throw the homeopathic rule book in the bin and forget about this tedious procedure.
Actually, I have more than imagined this.
Since I have been giving lectures on homeopathy on a fairly regular basis, I have encountered several pharmacists who told me of their frustration when they had to manufacture homeopathic remedies. Over the years, I met three of them who told me that they became so annoyed with the whole thing that they did precisely what I hinted at above: they just skipped all the dilution and succession and decided to dispense distilled water. Apparently nobody ever noticed.
These are, of course, just stories which people have told me. They may not even be true. I have no evidence whatsoever to substantiate them. But now, an ex-employee of an US homeopathic manufacturer has gone one step further. He published a short report of the time when he worked in the homeopathic industry. His account is so unique that I took the liberty of re-publishing it here:
I have worked at a homeopathic manufacturing plant. Yes, there is always a starting material, however sometimes it can get really shady. Homeopathics are regulated by the FDA under CFR 211, so if you make stuff up (like lie about having a starting material), and they find out about it, you’re in big trouble.
For most herbals, the actual herb is purchased, then tested to make sure it’s the right variety. This can mean TLC (thin layer chromatography), which is what I was responsible for doing when I worked there. A lot of times we got in a different species of the herb, but used it anyway.
Sometimes a pathogenic starting material is used – in that case, we contacted out to a third party micro lab that keep strains in a controlled environment. We paid the micro guy a contract fee to do the dilutions himself which ended up being about $3500 because only he was licensed to deal with pathogens. We made 200 30 mL units out of that which sold for less than $1200 total. Such a waste.
Sometimes a material of animal origin is used. If it’s something weird, like bovine trachea, there really isn’t a good method to test it, so we kind of took the supplier’s word for it. Pretty shady.
One time we needed to do an extraction of “morning dew”, so we went outside in the morning, shook some water off of some weeds, weighed it, then did the dilution.
My favorite story is this one: We needed to do a dilution of uranium 200X. Problem, is you can’t get uranium (unless you’re Doc Brown), so we went to Hanford (this was a looong time ago) carrying a vial of water. When we got there and did a tour (the plant manager knew what we were going to do), we took the vial and held it up against a glass wall that was a close as we could get to the cooling chamber. That became our “1X” dilution. We went back to our lab and diluted it to 200X, in ethanol. We had a lot left over, and because it’s illegal in WA to dump large quantities of ethanol down the drain, we needed a disposal service. Unfortunately, when we tried to explain that it was a 200X dilution (and that there wasn’t even a single atom of uranium in there to begin with), they still wouldn’t take it, because it said “uranium” on the label. So we took a shovel and buried in the back of the plant, and never told anyone.
I told you his story was unique. Did I promise too much?
After the usually challenging acute therapy is behind them, cancer patients are often desperate to find a therapy that might improve their wellbeing. At that stage they may suffer from a wide range of symptoms which can seriously limit their quality of life. Any treatment that can be shown to restore them to their normal mental and physical health would be more than welcome.
Most homeopaths believe that their remedies can do just that, particularly if they are tailored not to the disease but to the individual patient. Sadly, the evidence that this might be so is almost non-existent. Now, a new trial has become available; it was conducted by Jennifer Poole, a chartered psychologist and registered homeopath, and researcher and teacher at Nemeton Research Foundation, Romsey.
The aim of this study was to explore the benefits of a three-month course of individualised homeopathy (IH) for survivors of cancer. Fifteen survivors of any type of cancer were recruited from a walk-in cancer support centre. Conventional treatment had to have taken place within the last three years. Patients saw a homeopath who prescribed IH. After three months of IH, they scored their total, physical and emotional wellbeing using the Functional Assessment of Chronic Illness Therapy for Cancer (FACIT-G). The results show that 11 of the 14 women had statistically positive outcomes for emotional, physical and total wellbeing.
The conclusions of the author are clear: Findings support previous research, suggesting CAM or IH could be beneficial for survivors of cancer.
This article was published in the NURSING TIMES, and the editor added a footnote informing us that “This article has been double-blind “.
I find this surprising. A decent peer-review should have picked up the point that a study of that nature cannot possibly produce results which tell us anything about the benefits of IH. The reasons for this are fairly obvious:
- there was no control group,
- therefore the observed outcomes are most likely due to 1) natural history, 2) placebo, 3) regression towards the mean and 4) social desirability; it seems most unlikely that IH had anything to do with the result
- the sample size was tiny,
- the patients elected to receive IH which means that had high expectations of a positive outcome,
- only subjective outcome measures were used,
- there is no good previous research suggesting that IH benefits cancer patients.
On the last point, a recent systematic review showed that the studies available on this topic had mixed results either showing a significantly greater improvement in QOL in the intervention group compared to the control group, or no significant difference between groups. The authors concluded that there existed significant gaps in the evidence base for the effectiveness of CAM on QOL in cancer survivors. Further work in this field needs to adopt more rigorous methodology to help support cancer survivors to actively embrace self-management and effective CAMs, without recommending inappropriate interventions which are of no proven benefit.
All this new study might tell us is that IH did not seem to harm these patients – but even this finding is not certain; to be sure, we would need to include many more patients. Any conclusions about the effectiveness of IH are totally unwarranted. But are there ANY generalizable conclusions that can be drawn from this article? Yes, I can think of a few:
- Some cancer patients can be persuaded to try the most implausible treatments.
- Some journals will publish any rubbish.
- Some peer-reviewers fail to spot the most obvious defects.
- Some ‘researchers’ haven’t got a clue.
- The attempts of misleading us about the value of homeopathy are incessant.
One might argue that this whole story is too trivial for words; who cares what dodgy science is published in the NURSING TIMES? But I think it does matter – not so much because of this one silly article itself, but because similarly poor research with similarly ridiculous conclusions is currently published almost every day. Subsequently it is presented to the public as meaningful science heralding important advances in medicine. It matters because this constant drip of bogus research eventually influences public opinion and determines far-reaching health care decisions.
Many proponents of alternative medicine seem somewhat suspicious of research; they have obviously understood that it might not produce the positive result they had hoped for; after all, good research tests hypotheses and does not necessarily confirm beliefs. At the same time, they are often tempted to conduct research: this is perceived as being good for the image and, provided the findings are positive, also good for business.
Therefore they seem to be tirelessly looking for a study design that cannot ‘fail’, i.e. one that avoids the risk of negative results but looks respectable enough to be accepted by ‘the establishment’. For these enthusiasts, I have good news: here is the study design that cannot fail.
It is perhaps best outlined as a concrete example; for reasons that will become clear very shortly, I have chosen reflexology as a treatment of diabetic neuropathy, but you can, of course, replace both the treatment and the condition as it suits your needs. Here is the outline:
- recruit a group of patients suffering from diabetic neuropathy – say 58, that will do nicely,
- randomly allocate them to two groups,
- the experimental group receives regular treatments by a motivated reflexologist,
- the controls get no such therapy,
- both groups also receive conventional treatments for their neuropathy,
- the follow-up is 6 months,
- the following outcome measures are used: pain reduction, glycemic control, nerve conductivity, and thermal and vibration sensitivities,
- the results show that the reflexology group experience more improvements in all outcome measures than those of control subjects,
- your conclusion: This study exhibited the efficient utility of reflexology therapy integrated with conventional medicines in managing diabetic neuropathy.
This method is fool-proof, trust me, I have seen it often enough being tested, and never has it generated disappointment. It cannot fail because it follows the notorious A+B versus B design (I know, I have mentioned this several times before on this blog, but it is really important, I think): both patient groups receive the essential mainstream treatment, and the experimental group receives a useless but pleasant alternative treatment in addition. The alternative treatment involves touch, time, compassion, empathy, expectations, etc. All of these elements will inevitably have positive effects, and they can even be used to increase the patients’ compliance with the conventional treatments that is being applied in parallel. Thus all outcome measures will be better in the experimental compared to the control group.
The overall effect is pure magic: even an utterly ineffective treatment will appear as being effective – the perfect method for producing false-positive results.
And now we hopefully all understand why this study design is so very popular in alternative medicine. It looks solid – after all, it’s an RCT!!! – and it thus convinces even mildly critical experts of the notion that the useless treatment is something worth while. Consequently the useless treatment will become accepted as ‘evidence-based’, will be used more widely and perhaps even reimbursed from the public purse. Business will be thriving!
And why did I employ reflexology for diabetic neuropathy? Is that example not a far-fetched? Not a bit! I used it because it describes precisely a study that has just been published. Of course, I could also have taken the chiropractic trial from my last post, or dozens of other studies following the A+B versus B design – it is so brilliantly suited for misleading us all.
A recent article by Frank King (DC, ND) caught my eye. In it, he praises homeopathy in glowing terms. First I was not sure whether he is pulling my leg; then I decided he was entirely serious. Am I mistaken?
Here is the crucial passage for you to decide:
Even though the founder of homeopathy lived more than 200 years ago, he wrote about genetics. Samuel Hahnemann, MD, not only emphasized the importance of natural healing methods, he also recognized the influence of genetics in some types of illnesses.
Hahnemann used the term miasm to refer to the source of chronic diseases. He recognized several miasms, such as psora (meaning “itch”), syphilis, tuberculosis, gonorrhea, and cancer. In addition to recognizing and naming these miasms, he developed homeopathic remedies to address and correct them.
When your patient treatment protocols reach a plateau with chiropractic and nutritional support, consider turning to the constitutional homeopathic remedies, miasms, and detoxification formulas. Toxins inhibit the body’s ability to heal by interfering with the normal nerve pathways.
For example: Due to the steady growth in heavy-metal exposure modern civilization has experienced since the Industrial Revolution, mercury could be considered a modern miasm. Animal studies indicate that mercury’s negative effects can carry through to future generations, just as some of the other miasms do.
Mercurius is homeopathically prepared mercury to help address the symptoms of mercury toxicity, which can manifest as slow thought processes, chilliness, weak digestion, sore throat, and night sweats.
This is just one of the more than 1,300 Homeopathic Pharmacopoeia of the United States ingredients recognized by the FDA.
Homeopathy can be the perfect complement to chiropractic care. It can correct the energetics (including the genetics) of the deepest areas of the body, mind, and emotions, where the hands of the chiropractor can’t reach.
In case you don’t know much about homeopathy, it is true that Hahnemann believed in ‘miasms’, i.e. noxious vapours as the cause of a disposition to certain diseases. Even by Hahnemann’s standards, it turned out to be one of his more crazy ideas. To claim that, by believing in miasms, he foresaw the science of genetics is more than a little far-fetched.
In case you are not sure what toxins do in our body, rest assured that only chiropractors believe they inhibit the body’s ability to heal by interfering with the normal nerve pathways.
And in case you think you suffer from slow thought processes, chilliness, weak digestion, sore throat, and night sweats and thus feel like rushing to the next pharmacy to buy some Mercurius, don’t! This would not eliminate any mercury from your body, it would just eliminate cash from your pocket (in that sense, homeopathy might indeed occasionally reach where the hands of the chiropractor can’t reach).
One can say a lot about alternative medicine, I think, but nobody can deny that it regularly provides us with perfect (unintentional) comedy.
Kinesiology tape is all the rage. Its proponents claim that it increases cutaneous stimulation, which facilitates motor unit firing, and consequently improves functional performance. But is this just clever marketing, wishful thinking or is it true? To find out, we need reliable data.
The current trial results are sparse, confusing and contradictory. A recent systematic review indicated that kinesiology tape may have limited potential to reduce pain in individuals with musculoskeletal injury; however, depending on the conditions, the reduction in pain may not be clinically meaningful. Kinesiology tape application did not reduce specific pain measures related to musculoskeletal injury above and beyond other modalities compared in the context of included articles.
The authors concluded that kinesiology tape may be used in conjunction with or in place of more traditional therapies, and further research that employs controlled measures compared with kinesiology tape is needed to evaluate efficacy.
This need for further research has just been met by Korean investigators who conducted a study testing the true effects of KinTape by a deceptive, randomized, clinical trial.
Thirty healthy participants performed isokinetic testing of three taping conditions: true facilitative KinTape, sham KinTape, and no KinTape. The participants were blindfolded during the evaluation. Under the pretense of applying adhesive muscle sensors, KinTape was applied to their quadriceps in the first two conditions. Normalized peak torque, normalized total work, and time to peak torque were measured at two angular speeds (60°/s and 180°/s) and analyzed with one-way repeated measures ANOVA.
Participants were successfully deceived and they were ignorant about KinTape. No significant differences were found between normalized peak torque, normalized total work, and time to peak torque at 60°/s or 180°/s (p = 0.31-0.99) between three taping conditions. The results showed that KinTape did not facilitate muscle performance in generating higher peak torque, yielding a greater total work, or inducing an earlier onset of peak torque.
The authors concluded that previously reported muscle facilitatory effects using KinTape may be attributed to placebo effects.
The claims that are being made for kinesiology taping are truly extraordinary; just consider what this website is trying to tell us:
Kinesiology tape is a breakthrough new method for treating athletic sprains, strains and sports injuries. You may have seen Olympic and celebrity athletes wearing multicolored tape on their arms, legs, shoulders and back. This type of athletic tape is a revolutionary therapeutic elastic style of support that works in multiple ways to improve health and circulation in ways that traditional athletic tapes can’t compare. Not only does this new type of athletic tape help support and heal muscles, but it also provides faster, more thorough healing by aiding with blood circulation throughout the body.
Many athletes who have switched to using this new type of athletic tape report a wide variety of benefits including improved neuromuscular movement and circulation, pain relief and more. In addition to its many medical uses, Kinesiology tape is also used to help prevent injuries and manage pain and swelling, such as from edema. Unlike regular athletic taping, using elastic tape allows you the freedom of motion without restricting muscles or blood flow. By allowing the muscles a larger degree of movement, the body is able to heal itself more quickly and fully than before.
Whenever I read such over-enthusiastic promotion that is not based on evidence but on keen salesmanship, my alarm-bells start ringing and I see parallels to the worst type of alternative medicine hype. In fact, kinesiology tapes have all the hallmarks of alternative medicine and its promoters have, as far as I can see, all the characteristics of quacks. The motto seems to be: LET’S EARN SOME MONEY FAST AND IGNORE THE SCIENCE WHILE WE CAN.