MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

quackery

It’s again the season for nine lessons, I suppose. So, on the occasion of Christmas Eve, let me rephrase the nine lessons I once gave (with my tongue firmly lodged in my cheek) to those who want to make a pseudo-scientific career in so-called alternative medicine (SCAM) research.

  1. Throw yourself into qualitative research. For instance, focus groups are a safe bet. They are not difficult to do: you gather 5 -10 people, let them express their opinions, record them, extract from the diversity of views what you recognize as your own opinion and call it a ‘common theme’, and write the whole thing up, and – BINGO! – you have a publication. The beauty of this approach is manifold:
    • you can repeat this exercise ad nauseam until your publication list is of respectable length;
    • there are plenty of SCAM journals that will publish your articles;
    • you can manipulate your findings at will;
    • you will never produce a paper that displeases the likes of King Charles;
    • you might even increase your chances of obtaining funding for future research.
  1. Conduct surveys. They are very popular and highly respected/publishable projects in SCAM. Do not get deterred by the fact that thousands of similar investigations are already available. If, for instance, there already is one describing the SCAM usage by leg-amputated policemen in North Devon, you can conduct a survey of leg-amputated policemen in North Devon with a medical history of diabetes. As long as you conclude that your participants used a lot of SCAMs, were very satisfied with it, did not experience any adverse effects, thought it was value for money, and would recommend it to their neighbour, you have secured another publication in a SCAM journal.
  2. In case this does not appeal to you, how about taking a sociological, anthropological or psychological approach? How about studying, for example, the differences in worldviews, the different belief systems, the different ways of knowing, the different concepts about illness, the different expectations, the unique spiritual dimensions, the amazing views on holism – all in different cultures, settings or countries? Invariably, you must, of course, conclude that one truth is at least as good as the next. This will make you popular with all the post-modernists who use SCAM as a playground for enlarging their publication lists. This approach also has the advantage to allow you to travel extensively and generally have a good time.
  3. If, eventually, your boss demands that you start doing what (in his narrow mind) constitutes ‘real science’, do not despair! There are plenty of possibilities to remain true to your pseudo-scientific principles. Study the safety of your favourite SCAM with a survey of its users. You simply evaluate their experiences and opinions regarding adverse effects. But be careful, you are on thin ice here; you don’t want to upset anyone by generating alarming findings. Make sure your sample is small enough for a false negative result, and that all participants are well-pleased with their SCAM. This might be merely a question of selecting your patients wisely. The main thing is that your conclusions do not reveal any risks.
  4. If your boss insists you tackle the daunting issue of SCAM’s efficacy, you must find patients who happened to have recovered spectacularly well from a life-threatening disease after receiving your favourite form of SCAM. Once you have identified such a person, you detail her experience and publish this as a ‘case report’. It requires a little skill to brush over the fact that the patient also had lots of conventional treatments, or that her diagnosis was never properly verified. As a pseudo-scientist, you will have to learn how to discretely make such details vanish so that, in the final paper, they are no longer recognisable.
  5. Your boss might eventually point out that case reports are not really very conclusive. The antidote to this argument is simple: you do a large case series along the same lines. Here you can even show off your excellent statistical skills by calculating the statistical significance of the difference between the severity of the condition before the treatment and the one after it. As long as this reveals marked improvements, ignores all the many other factors involved in the outcome and concludes that these changes are the result of the treatment, all should be tickety-boo.
  6. Your boss might one day insist you conduct what he narrow-mindedly calls a ‘proper’ study; in other words, you might be forced to bite the bullet and learn how to do an RCT. As your particular SCAM is not really effective, this could lead to serious embarrassment in the form of a negative result, something that must be avoided at all costs. I, therefore, recommend you join for a few months a research group that has a proven track record in doing RCTs of utterly useless treatments without ever failing to conclude that it is highly effective. In other words, join a member of my ALTERNATIVE MEDICINE HALL OF FAME. They will teach you how to incorporate all the right design features into your study without the slightest risk of generating a negative result. A particularly popular solution is to conduct a ‘pragmatic’ trial that never fails to produce anything but cheerfully positive findings.
  7. But even the most cunningly designed study of your SCAM might one day deliver a negative result. In such a case, I recommend taking your data and running as many different statistical tests as you can find; chances are that one of them will produce something vaguely positive. If even this method fails (and it hardly ever does), you can always focus your paper on the fact that, in your study, not a single patient died. Who would be able to dispute that this is a positive outcome?
  8. Now that you have grown into an experienced pseudo-scientist who has published several misleading papers, you may want to publish irrefutable evidence of your SCAM. For this purpose run the same RCT over again, and again, and again. Eventually, you want a meta-analysis of all RCTs ever published (see examples here and here). As you are the only person who conducted studies on the SCAM in question, this should be quite easy: you pool the data of all your dodgy trials and, bob’s your uncle: a nice little summary of the totality of the data that shows beyond doubt that your SCAM works and is safe.

The purpose of this review was to

  • identify and map the available evidence regarding the effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions;
  • identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use.

Two reviewers independently screened and selected the studies, extracted key findings and assessed the methodological quality of included papers. A descriptive synthesis of reported findings was undertaken using a level-of-evidence approach.

Eighty-seven articles were included. Their methodological quality varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with

  • adolescent idiopathic scoliosis (AIS),
  • asthma,
  • attention deficit hyperactivity disorder (ADHD),
  • autism spectrum disorder (ASD),
  • back/neck pain,
  • breastfeeding difficulties,
  • cerebral palsy (CP),
  • dysfunctional voiding,
  • excessive crying,
  • headaches,
  • infantile colic,
  • kinetic imbalances due to suboccipital strain (KISS),
  • nocturnal enuresis,
  • otitis media,
  • torticollis,
  • plagiocephaly.

The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported in systematic reviews of randomised controlled trials and other lower-quality studies. There was strong to very strong evidence for ‘no significant effect’ of spinal manipulation for managing

  • asthma (pulmonary function),
  • headache,
  • nocturnal enuresis.

There was inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition.

The authors concluded that, whilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis of the collective findings does not provide support for spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.

Perhaps the most important findings of this review relate to safety. They confirm (yet again) that there is only limited reporting of adverse events in this body of research. Six reviews, eight RCTs and five other studies made no mention of adverse events or harms associated with spinal manipulation. This, in my view, amounts to scientific misconduct. Four systematic reviews focused specifically on adverse events and harms. They revealed that adverse events ranged from mild to severe and even death.

In terms of therapeutic benefit, the review confirms the findings from the previous research, e.g.:

  • Green et al (Green S, McDonald S, Murano M, Miyoung C, Brennan S. Systematic review of spinal manipulation in children: review prepared by Cochrane Australia for Safer Care Victoria. Melbourne, Victoria: Victorian Government 2019. p. 1–67.) explored the effectiveness and safety of spinal manipulation and showed that spinal manipulation should – due to a lack of evidence and potential risk of harm – be recommended as a treatment of headache, asthma, otitis media, cerebral palsy, hyperactivity disorders or torticollis.
  • Cote et al showed that evidence is lacking to support the use of spinal manipulation to treat non-musculoskeletal disorders.

In terms of risk/benefit balance, the conclusion could thus not be clearer: no matter whether chiropractors, osteopaths, physiotherapists, or any other healthcare professionals propose to manipulate the spine of your child, DON’T LET THEM DO IT!

The year 2022 is drawing to a close, and I am reminded of my ‘WORST PAPER OF 2022 COMPETITION’. As a prize, I am offering the winner (that is the lead author of the winning paper) one of my books that best fits his/her subject. I am sure this will overjoy him or her. I hope to identify about 10 candidates for the prize, and towards the end of the year, I let my readers decide democratically on who should be the winner. In this spirit of democratic voting, let me suggest to you entry No 10 entitled ‘Conventional Homeopathic Medicine and Its Relevance to Modern Medicine‘. Here is the unadulterated abstract:

Context: Homeopathic medicine can be explained as a symptoms-based method of treatment, and it can act as an alternative treatment strategy against allopathy by focusing on the symptoms of illness, as opposed to causative agents as allopathic medicine does. Also, homeopathic medicines are extracted from nature rather than being chemically synthesized as western drugs are.

Objective: The review intended to briefly describe the concept of homeopathic medicine, its emergence from a historical point of view, and its broader healing properties, providing examples of key homeopathic drugs and comparing them to modern medicines.

Design: The research team performed a narrative review by searching databases like Pubmed, Google Scholar, and other national search engines. The search used the keywords homeopathic medicine, alternate medicine, materia medica, allium cepa, Zingiber officinale, penicillium, Agaricus muscaria, Botulinum toxin.

Setting: Dr. D.Y. Patil Homoeopathic Medical College and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune.

Results: This review highlights the rich sources homoeopathic drugs and their corelation with modern medicine. The current review focuses on the significance of the Homeopathic Materia Medica and on notable remedies in homeopathy that align with allopathy in addressing different pathological conditions, including treatments that the two types of medicine have in in common and that are effective in homeopathy.

Conclusions: Many studies are being conducted to prove the mechanism of action of homoeopathic medicines. Droplet Evaporating Method (DEM), Raman, UltraViolet-Visible (UV-VIS) spectroscopy and Transmission Electron Microscopy (TEM) are commonly used methods to characterize homeopathic medicines at ultra-low concentration and many such studies will surely indicate how homoeopathic medicines act. Such research results may subsequently lead to the betterment of treatment procedures and the integration of homeopathic principles into mainstream medical practices.

I find it quite an ‘achievement’ to put so much nonsense into such a short abstract. My ‘favorite’ statement is this one: “many such studies will surely indicate how homoeopathic medicines act.” Since he published this paper, the first author has done another article; it is entitled “Breast Abscess Healing with Homoeopathy: A Case Report” and would be a further contender for my award.

But let’s not give him an unfair chance to win the competition!

 

PS

The next time I post about this will be about deciding on this year’s winner. So, you might want to give it some consideration.

The INDY and many other news outlets reported that the British Tory MP, Andrew Bridgen, has called on prime minister Rishi Sunak to suspend mRNA covid vaccines after alleging they are “not safe, not effective and not necessary”.

During Wednesday’s PMQs (13 December), Bridgen stated that “since the rollout in the UK of the BioNTech-Pfizer mRNA vaccine, we have had almost half a million reports of adverse effects from the public”, a message he later reiterated on Twitter.

Posting a snippet from his debate, Bridgen tweeted: “Almost half a million yellow card reports of adverse effects following administration of the Biotech Pfizer mRNA vaccine in the UK alone! Answers are desperately needed. #completelyunprecedented”.

Bridgen also claimed that a leading figure in the British Heart Foundation is suppressing evidence that the Covid vaccines cause heart damage, even sending non-disclosure agreements to his research team.

Facebook flagged his post with a notice urging users to ensure that they share “reliable information.” It included two links to “continue sharing” or “get vaccine info.”

The scandals Bridgen has been involved in seem too numerous to mention (e.g. violation of parliamentary standards, homophobic remarks, antisemitic statements). Here is just one of the most recent:

Leicestershire MP has been ordered to pay £800,000 and been evicted from his five bedroom home by a judge following a legal dispute involving the family vegetable business. It is currently unknown where Andrew Bridgen, Conservative MP for North West Leicestershire, lives after being given final deadline of August 24 to vacate the premises in Coleorton, near Coalville.

The 57-year-old was branded “dishonest” by a High Court judge in March – who ruled that Bridgen “lied” under oath. Judge Brian Rawlings said he was so dishonest that nothing he said about the dispute with AB Produce, a vegetable and potato supplier based in Measham, could be taken at face value.

Bridgen was also said to have behaved in an “abusive”, “arrogant” and “aggressive” way during the dispute, in which he has spent years suing the firm. A later judgment in June, reported by the Times on Sunday, forced the MP to vacate the £1.5 million-valued property owned by AB Produce that he has lived in since 2015…

For a fact check on Bridgeon’s vaccine claims, see here. And below are a few reactions from Twitter users to Bridgen’s Covid proctophsia:

First a High Court judge says Tory MP, Andrew Bridgen, lied under oath, then he evicts him from his home and orders him to pay £800,000 now Facebook flags his posts as Covid misinformation. How’s your week going?

Andrew Bridgen MP now promoting Dr David Cartland, a man who aligns himself with claims that Freemasons rule the world; that Covid doesn’t exist; and that medical doctors who don’t share his views should be executed (screenshots H/T

Andrew Bridgen MP now promoting Dr David Cartland, a man who aligns himself with claims that Freemasons rule the world; that Covid doesn’t exist; and that medical doctors who don’t share his views should be executed.

This Andrew Bridgen? ‘A Conservative MP lied under oath, behaved in an abusive, arrogant and aggressive way, and was so dishonest that his claims about a multimillion-pound family dispute could not be taken at face value, a high court judge has ruled.’

Proper tinfoil-hat stuff from Andrew Bridgen, suggesting Covid vaccines are unsafe, misrepresenting data, and implying some sort of conspiracy between ‘Big Pharma’ and MHRA.

Our ‘Memorandum Integrative Medicine‘ seems to be causing ripples. A German website that claims to aim at informing consumers objectively posted a rebuttal. Here is my translation (together with comments by myself inserted via reference numbers in brackets and added below):

With drastic words and narrow-mindedness bordering on ideology (1), the Münster Circle, an association of opponents to complementary therapies such as homeopathy (2), takes issue with the treatment concept of integrative medicine in a memorandum (3). By integrative medicine physicians understand the combination of doctor-led medicine and doctor-led complementary medicine to a meaningful total concept with the goal of reducing side effects and to treating patients individually and optimally (4). Integrative medicine focuses primarily on chronic diseases, where conventional acute medicine often reaches its limits (5)In the memorandum of the Münsteraner Kreis, general practitioner Dr. Claudia Novak criticizes integrative medicine as “guru-like self-dramatization” (6) by physicians and therapists, which undermines evidence-based medicine and leads to a deterioration in patient care. She is joined by Prof. Dr. Edzard Ernst, Professor Emeritus of Alternative Medicine, who has changed from Paul to Saul with regard to homeopathy (7) and is leading a veritable media campaign against proponents of treatment procedures that have not been able to prove their evidence in randomized placebo-controlled studies (8). The professor ignores the fact that this involves a large number of drugs that are used as a matter of course in everyday medicine (9) – for example, beta-blockers or other cardiological drugs (10). “Like the devil fears the holy water” (11), the Münsteraner Kreis seems to fear the concept of integrative medicine (12). The vehemence coupled with fear with which they warn against the treatment concept makes one sit up and take notice (13). “As an experienced gynecologist who has successfully worked with biological medicine as an adjunct in his practice for decades, I can only shake my head at such narrow-mindedness”, points out Fred-Holger Ludwig, MD (14). Science does not set limits for itself, but the plurality of methods is immanent (15). “Why doesn’t Prof. Ernst actually give up his professorial title for alternative medicine? That would have to be the logical consequence of its overloud criticism of established treatment concepts from homeopathy to to integrative medicine”, questions Dr. Ludwig (16).

The concept of integrative medicine is about infiltrating alternative procedures into medicine, claim the critics of the concept, without mentioning that many naturopathic procedures have been used for centuries with good results (17) and that healthcare research gives them top marks (18). “Incidentally, the scientists among the representatives of the Münster Circle should know that it is difficult to capture individualized treatment concepts with the standardized procedures of randomized, placebo-controlled studies (19). Anyone who declares the highest level of evidence to be the criterion for approval makes medicine impossible and deprives patients in oncology or with rare diseases, for example, of chances of successful treatment (20). Even there, drugs are used that cannot be based on high evidence, tested in placebo-controlled studies, because the number of cases is too low (21),” notes Dr. Ludwig .

  1. Ideology? Evidence is not ideology, in my view.
  2. We are an association of multidisciplinary experts advocating a level playing field with sound evidence in all areas of healthcare.
  3. The actual memorandum is not linked in this text; does the author not want his readers to form the own opinion?
  4. In our memorandum, we offer various definitions of integrative medicine (IM), none of which is remotely similar to this one.
  5. No, IM is usually being promoted in a much wider sense.
  6. This term does not appear in our memorandum.
  7. I am not aware that I changed from Paul to Saul with regard to homeopathy; I know that I was led mostly by the evidence.
  8. I feel flattered but don’t think that my humble work is a ‘media campaign’.
  9. True, I do not pretend to understand all areas of medicine and tend to be silent in the ones that I lack up-to-date expertise.
  10. Is he really saying that beta-blockers are not evidence-based?
  11. The holy water comparison from a homeopath, who arguably makes a living from dishing out ‘holy water’, made me laugh!
  12. It is most revealing, I think, that he thinks our motivation is fear.
  13. Splendid!
  14. FHL is the author of the article, and it is thus charmingly naive that he cites himself in this way
  15. I somehow doubt that he understands what he is expressing here.
  16. I find this rather a bizarre idea but I’ll think about it.
  17. Argumentum ad traditionem.
  18. Those that get ‘top marks’ belong to evidence-based medicine and not to IM.
  19. Here the author reveals that he does not understand the RCT methodology and even fails to know the trial evidence on homeopathy – RCTs of individualised homeopathy are possible and have been published (e.g. this one).
  20. If he really believes this, I fear for his patients.
  21. Pity that he does not provide an example.

To understand FHL better, it is worth knowing that he claims to treat cancer patients with conventional and homeopathic medicine. He states that this approach reduces side effects – without providing evidence, of course.

Altogether, FHL does not dispute a single fact or argument from our memorandum. In fact, I get the impression that he never actually read it. To me, it feels as though he merely read an article ABOUT the document. In any case, his critique is revealing and important, in my view. It demonstrates that there are no good arguments to defend IM.

So, thank you FHL!

Like traditional acupuncture, “cosmetic acupuncture” involves the insertion of needles into the skin. Also called facial rejuvenation acupuncture, cosmetic acupuncture is believed to stimulate collagen and therefore reduce the look of wrinkles. They also claim that cosmetic acupuncture rejuvenates your skin by improving your overall energy and is a great addition to your overall wellness routine – at least, this is what enthusiasts want us to believe.

No surprise then that many consumers give cosmetic acupuncture a try. But what, if after paying for a session, you don’t notice any difference? What, if you even look worse than before?

Impossible?

Not at all! One of the few studies on the subject showed that about half of the clients complained of blotchiness and hyperpigmented spots.

Cosmetic acupuncturists are well prepared for this argument and claim that the treatment will take longer to show any results: “Most cosmetic acupuncture treatments are meant to be taken in a series, generally in a group of 10,” says DiLibero. “The effects of acupuncture are cumulative, so follow-up appointments are recommended.”

And what does the evidence tell us about the effectiveness of cosmetic acupuncture?

One study showed “promising results as a therapy for facial elasticity”. Another one “showed clinical potential for facial wrinkles and laxity.”

That’s great!

No, it isn’t; the studies were published in 3rd class journals and did not even have control groups. Sorry, but I don’t call this evidence. In fact, the type of study that merits the term has not emerged. In other words, cosmetic acupuncture is a swindle!

But at least cosmetic acupuncture is not harmful.

Wrong!

  1. It will cost you a lot of money because the therapist will persuade you that you need 10 treatment sessions or more.
  2. It can cause blotchiness and hyperpigmented spots, as mentioned above.
  3. It has been reported to cause extensive facial sclerosing lipogranulomatosis.

So, you want to improve your looks?

I am not sure what therapies work for this purpose. But I do know that cosmetic acupuncture isn’t one of them.

Psychics make big promises. Here is just one example:

All the questions that you’re longing to find the answers to are now just a Reading away.Want to know when you’ll find love? Just ask. Want to know which way your career is heading? Just say the word. Want to know what opportunities are around the corner for you? Just go ahead and find out.

At The Circle, you’ll have access to the very best Psychic Readers in the country at your fingertips, whenever you need to understand your life better. With regular Psychic Readings, you will experience better love lives, stronger relationships, more successful careers, and much more personal fulfillment.

The Circle is the UK’s most trusted Psychic Reading service, and for very good reason. Since 1997 we’ve performed millions of Readings and have helped many customers like you on their life journey.

How come then that a psychic could not predict the following?

The US Attorney’s Office has announced that Michael Paul Guzman, 42, was sentenced to 38 months in prison, and Samantha Stevens, 51, was sentenced to 30 months in prison by U.S. District Judge Darrin P. Gayles for orchestrating a fortune-telling fraud scheme and money laundering.

According to court documents, Stevens was portraying herself as a psychic/fortune teller in 2012 when she met a victim in Miami. Stevens gained the victim’s trust and convinced her that a curse had been placed on her and her family. Stevens claimed she needed to perform rituals on large sums of money in order to lift the curse. Failure to do so—the victim was led to believe—would result in harm to her and her family.

Stevens and Guzman spent the victim’s money on vehicles, property, and casino gambling. The relationship between Stevens and the victim lasted several years. During this time, the victim was persuaded to give up more than $3 million. The scheme came to an end in 2016 when Stevens cut off communication with the victim after she no longer could pay for the rituals. Once Stevens severed the relationship, the victim contacted federal law enforcement.

Stevens argued in court that the ceremonies she performed were an expression of her religion and the client “received exactly what she bargained for.”

_______________________________

This is not the first time self-proclaimed psychics have been sentenced to prison in Florida. In 2020, a woman and her daughter were sentenced for “defrauding two victims with their spiritual scams” and in 2019, a woman was reportedly sentenced to more than three years in prison for a “fortune telling” fraud scheme.  In 2014, a South Florida woman who claimed to be a psychic with the ability to positively influence terminal cancer was sentenced to three years and nine months in prison.

Didier Raoult, the French scientist who became well-known for his controversial stance on hydroxychloroquine for treating COVID-19, has featured on this blog before (see here, here, and here). Less well-known is the fact that he has attracted controversy before. In 2006, Raoult and 4 co-authors were banned for one year from publishing in the journals of the American Society for Microbiology (ASM), after a reviewer for Infection and Immunity discovered that four figures from the revised manuscript of a paper about a mouse model for typhus were identical to figures from the originally submitted manuscript, even though they were supposed to represent a different experiment. In response, Raoult “resigned from the editorial board of two other ASM journals, canceled his membership in the American Academy of Microbiology, ASM’s honorific leadership group, and banned his lab from submitting to ASM journals”. In response to Science covering the story in 2012, he stated that, “I did not manage the paper and did not even check the last version”. The paper was subsequently published in a different journal.

Now, the publisher PLOS is marking nearly 50 articles by Didier Raoult, with expressions of concern while it investigates potential research ethics violations in the work. PLOS has been looking into more than 100 articles by Raoult and determined that the issues in 49 of the papers, including reuse of ethics approval reference numbers, warrant expressions of concern while the publisher continues its inquiry.

In August of 2021, Elisabeth Bik wrote on her blog about a series of 17 articles from IHU-Méditerranée Infection that described different studies involving homeless people in Marseille over a decade, but all listed the same institutional ethics approval number. Bik and other commenters on PubPeer have identified ethical concerns in many other papers, including others in large groups of papers with the same ethical approval numbers. Subsequently, Bik has received harassment and legal threats from Raoult.

David Knutson, senior manager of communications for PLOS, sent ‘Retraction Watch’ this statement:

PLOS is issuing interim Expressions of Concerns for 49 articles that are linked to researchers affiliated with IHU-Méditerranée Infection (Marseille, France) and/or the Aix-Marseille University, as part of an ongoing case that involves more than 100 articles in total. Many of the papers in this case include controversial scientist Didier Raoult as a co-author.

Several whistleblowers raised concerns about articles from this institute, including that several ethics approval reference numbers have been reused in many articles. Our investigation, which has been ongoing for more than a year, confirmed ethics approval reuse and also uncovered other issues including:

  • highly prolific authorship (a rate that would equate to nearly 1 article every 3 days for one or more individuals), which calls into question whether PLOS’ authorship criteria have been met
  • undeclared COIs with pharmaceutical companies

To date, PLOS has completed a detailed initial assessment of 108 articles in total and concluded that 49 warrant an interim Expression of Concern due to the nature of the concerns identified. We’ll be following up with the authors of all articles of concern in accordance with COPE guidance and PLOS policies, but we anticipate it will require at least another year to complete this work.

Raoult is a coauthor on 48 of the 49 papers in question. This summer, Raoult retired as director of IHU-Méditerranée Infection, the hospital and research institution in Marseille that he had overseen since 2011, following an inspection by the French National Agency for the Safety of Medicines and Health Products (ANSM) that found “serious shortcomings and non-compliances with the regulations for research involving the human person” at IHU-Méditerranée Infection and another Marseille hospital. ANSM imposed sanctions on IHU-Méditerranée Infection, including suspending a research study and placing any new research involving people under supervision, and called for a criminal investigation. Other regulators have also urged Marseille’s prosecutor to investigate “serious malfunctions” at the research institution.

Pierre-Edouard Fournier, the new director of IHU-Méditerranée Infection, issued a statement on September 7th that said he had “ensured that all clinical trials in progress relating to research involving the human person (RIPH) were suspended pending the regularization of the situation.” Also in September, the American Society for Microbiology placed expressions of concern on 6 of Raoult’s papers in two of its journals, citing “a ‘scientific misconduct investigation’ by the University of Aix Marseille,” where the researcher also has an affiliation.

___________________________

Christian Lehman predicted on my blog that ” If Covid19 settles in the long-term, he [Raoult] will not be able to escape a minutely detailed autopsy of his statements and his actions. And the result will be devastating.” It seems he was correct.

 

Onion water seems to be all the rage these days. Advocates claim that it is a natural cold and flu remedy that can help the body heal faster and kick symptoms like coughing and congestion. And many consumers who feel threatened by flu, COVID, and various respiratory infections believe them.

But what on earth is onion water? It is precisely what it sounds like: onion immersed in water. Preparation starts with cutting up raw red or yellow onions, placing them into a bowl, and adding water. The fresh onion and water mixture should then soak for about 12 hours. After that, the onion water is ready for consumption.

Besides being a recipe for bad breath, can onion water actually relieve any symptoms, or help the body heal from infections?

A review of the evidence concluded that “effect of onion and its constituents on oxidative stress, inflammatory and immune system were shown indicating their therapeutic value in treatment of various diseases associated with oxidative stress, inflammation, and immune-dysregulation.”

This may sound encouraging but the review was based mostly on pre-clinical evidence, and the question, therefore, remains: are there any good trial data?

Another recent review included clinical trials (where available) and concluded that “possible bronchodilatory and preventive effects of onion and Qt on asthma and other obstructive respiratory diseases. The effects of the plant and its constituents on lung cancer, lung infections, and allergic disorders were also reported both in experimental and clinical studies. However, before preparing drugs based on A. cepa and its constituents for clinical practice, further standard clinical trials are needed to be performed.”

In other words, compelling trial evidence that preparations from onion are effective against viral infections does not exist.

And what about homeopathy?

Homeopaths frequently use potentised onion as a remedy for conditions that cause eyes to water (because ‘like cures like’). Is there any sound evidence that homeopathic onion remedies are better than a placebo? You probably guessed: the answer is NO!

So, no good evidence for onion, potentised onion, onion water, or any other preparations of onion. My advice, therefore, is to continue using your onions in the kitchen rather than in the medicine cabinet.

Osteopathy is currently regulated in 12 European countries: Cyprus, Denmark, Finland, France, Iceland, Italy, Liechtenstein, Luxembourg, Malta, Portugal, Switzerland, and the UK. Other countries such as Belgium and Norway have not fully regulated it. In Austria, osteopathy is not recognized or regulated. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a Europe-based survey, whereby an updated profile of osteopaths not only provides new data for Austria but also allows comparisons with other European countries.

A voluntary, online-based, closed-ended survey was distributed across Austria in the period between April and August 2020. The original English OPERA questionnaire, composed of 52 questions in seven sections, was translated into German and adapted to the Austrian situation. Recruitment was performed through social media and an e-based campaign.

The survey was completed by 338 individuals (response rate ~26%), of which 239 (71%) were female. The median age of the responders was 40–49 years. Almost all had preliminary healthcare training, mainly in physiotherapy (72%). The majority of respondents were self-employed (88%) and working as sole practitioners (54%). The median number of consultations per week was 21–25 and the majority of respondents scheduled 46–60 minutes for each consultation (69%).

The most commonly used diagnostic techniques were: palpation of position/structure, palpation of tenderness, and visual inspection. The most commonly used treatment techniques were cranial, visceral, and articulatory/mobilization techniques. The majority of patients estimated by respondents consulted an osteopath for musculoskeletal complaints mainly localized in the lumbar and cervical region. Although the majority of respondents experienced a strong osteopathic identity, only a small proportion (17%) advertise themselves exclusively as osteopaths.

The authors concluded that this study represents the first published document to determine the characteristics of the osteopathic practitioners in Austria using large, national data. It provides new information on where, how, and by whom osteopathic care is delivered. The information provided may contribute to the evidence used by stakeholders and policy makers for the future regulation of the profession in Austria.

This paper reveals several findings that are, I think, noteworthy:

  • Visceral osteopathy was used often or very often by 84% of the osteopaths.
  • Muscle energy techniques were used often or very often by 53% of the osteopaths.
  • Techniques applied to the breasts were used by 59% of the osteopaths.
  • Vaginal techniques were used by 49% of the osteopaths.
  • Rectal techniques were used by 39% of the osteopaths.
  • “Taping/kinesiology tape” was used by 40% of osteopaths.
  • Applied kinesiology was used by 17% of osteopaths and was by far the most-used diagnostic approach.

Perhaps the most worrying finding of the entire paper is summarized in this sentence: “Informed consent for oral techniques was requested only by 10.4% of respondents, and for genital and rectal techniques by 21.0% and 18.3% respectively.”

I am lost for words!

I fail to understand what meaningful medical purpose the fingers of an osteopath are supposed to have in a patient’s vagina or rectum. Surely, putting them there is a gross violation of medical ethics.

Considering these points, I find it impossible not to conclude that far too many Austrian osteopaths practice treatments that are implausible, unproven, potentially harmful, unethical, and illegal. If patients had the courage to take action, many of these charlatans would probably spend some time in jail.

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