MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

research

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The authors of this review aimed to present an overview of the literature on physicochemical research performed on homeopathic preparations with respect to publication quality and methods used. They searched major scientific databases to find relevant publications from its origin to the end of 2015. Publications were assessed using a scoring scheme, the Manuscript Information Score (MIS). Information regarding country of origin of the research and experimental techniques used was extracted.

The authors identified 183 publications. The rate of publication in the field was 2 per year from the 1970s until 2000. Afterward, it increased to over 5.5 publications per year. The quality of publications was seen to increase sharply from 2000 onward: before 2000, only 12 (13%) publications were rated as ‘‘high quality’’ (MIS ‡7.5); 44 (48%) publications were rated as ‘‘high quality’’ after 2000.

Countries with most publications were Germany (n=42, 23%), France (n=29, 16%), India (n=27, 15%), and Italy (n=26, 14%). Techniques most frequently used were electrical impedance (26%), analytical methods (20%), spectroscopy (20%), and nuclear magnetic resonance (19%).

The authors concluded that physicochemical research into homeopathic preparations is increasing both in terms of quantity and quality of the publications.

They also announce that there will be a further paper on the subject: In part 2, we aim to identify the most interesting experimental techniques. With this, we aim to be in a position to generate meaningful hypotheses regarding a possible mode of action of homeopathic preparations.

It might be relevant to ask who the authors are and where they come from. They are Klein SD, Würtenberger S, Wolf U, Baumgartner S, and Tournier A. And their affiliations are:

  • Institute of Complementary Medicine, University of Bern, Switzerland.
  • Scientific & Regulatory Affairs, Hevert-Arzneimittel GmbH & Co. KG, Germany.
  • Society for Cancer Research, Arlesheim, Switzerland.
  • Institute of Integrative Medicine, University of Witten/Herdecke, Germany.
  • Homeopathy Research Institute (HRI), London, United Kingdom.

In other words, they are without exception proponents of homeopathy, some burdened with considerable conflicts of interest in the subject. Personally, I think it unlikely that anything meaningful will ever come of this research. But unsurprisingly, the enthusiasts beg to differ: on facebook, the HRI claimed that this new systematic review is a major step towards developing clear and testable hypotheses regarding the mode of action of homeopathy.

In a previous blog-post I have tried to explain my reservations in some detail; please allow me to repeat them here:

… 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 they 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.

HELLO HOMEOPATHS OF THIS WORLD…

SO FAR NOBODY HAS TAKEN UP MY OFFER.

BUT IT STILL STANDS!

HOW ABOUT IT?

As I have stated repeatedly, I am constantly on the look-out for positive news about alternative medicine. Usually, I find plenty – but when I scrutinise it, it tends to crumble in the type of misleading report that I often write about on this blog. Truly good research in alternative medicine is hard to find, and results that are based on rigorous science and show a positive finding are a bit like gold-dust.

But hold on, today I have something!

This systematic review was aimed at determining whether physical exercise is effective in improving cognitive function in the over 50s. The authors evaluated all randomised controlled trials of physical exercise interventions in community-dwelling adults older than 50 years with an outcome measure of cognitive function.

39 studies were included in the systematic review. Analysis of 333 dependent effect sizes from 36 studies showed that physical exercise improved cognitive function. Interventions of aerobic exercise, resistance training, multicomponent training and tai chi, all had significant point estimates. When exercise prescription was examined, a duration of 45–60 min per session and at least moderate intensity, were associated with benefits to cognition. The results of the meta-analysis were consistent and independent of the cognitive domain tested or the cognitive status of the participants.

The authors concluded that physical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that patients obtain both aerobic and resistance exercise of at least moderate intensity on as many days of the week as feasible, in line with current exercise guidelines.

But this is not alternative medicine, I hear you say.

You are right, mostly, it isn’t. There were a few RCTs of tai chi and yoga, but the majority was of conventional exercise. Moreover, most of these ‘alternative’ RCTs were less convincing than the conventional RCTs; here is one of the former category:

Community-dwelling older adults (N = 118; mean age = 62.0) were randomized to one of two groups: a Hatha yoga intervention or a stretching-strengthening control. Both groups participated in hour-long exercise classes 3×/week over the 8-week study period. All participants completed established tests of executive function including the task switching paradigm, n-back and running memory span at baseline and follow-up. Analysis of covariances showed significantly shorter reaction times on the mixed and repeat task switching trials (partial η(2) = .04, p < .05) for the Hatha yoga group. Higher accuracy was recorded on the single trials (partial η(2) = .05, p < .05), the 2-back condition of the n-back (partial η(2) = .08, p < .001), and partial recall scores (partial η(2) = .06, p < .01) of running span task.

I just wanted to be generous and felt the need to report a positive result. I guess, this just shows how devoid of rigorous research generating a positive finding alternative medicine really is.

Of course, there are many readers of this blog who are convinced that their pet therapy is supported by excellent evidence. For them, I have this challenge: if you think you have good evidence for an alternative therapy, show it to me (send it to me via the ‘contact’ option of this blog or post the link as a comment below). Please note that any evidence I would consider analysing in some detail (writing a full blog post about it) would need to be recent, peer-reviewed and rigorous.

‘Doctor’ Colleen Huber (DCH) is the US naturopath who is currently suing Britt Hermes. For me, this is enough reason to do a bit of reading and find out who DCH is and what motivates her. Here is what I found out (I added some * to the quotes [all in italics] and comments below).

DCH has an impressive presence on the Internet. One website, for instance, tells us that DCH is a Naturopathic Medical Doctor* in Tempe, Arizona. Her clinic, Nature Works Best Cancer Clinic, has had the most successful results of any clinic in the world reporting its results over the last 9 years **.

Dr. Huber authored the largest and longest study*** in medical history on sugar intake in cancer patients, which was reported in media around the world in 2014. Her other writing includes her book, Choose Your Foods Like Your Life Depends On Them ****, and she has been featured in the books America’s Best Cancer Doctors and Defeat Cancer. Dr. Huber’s academic writing has appeared in The Lancet *****, the International Journal of Cancer Research ***** and Molecular Mechanisms *****,  and other medical journals ******. Her research interests are in the use of therapeutic approaches targeting metabolic aspects of cancer…

*I am puzzled by this title. Is it an official one? I only found this, and it omits the ‘medical’: Currently, 20 states, five Canadian provinces, the District of Columbia, and the U.S. territories of Puerto Rico and the U.S. Virgin Islands have passed laws regulating naturopathic doctors. Learn more about licensure from the Association of Accredited Naturopathic Medical Colleges. It seems that Arizona is the only state where the ‘medical’ is allowed. However, don’t take this to mean that DCH went to medical school.

** ‘most successful results of any clinic in the world’? Really? Where are the comparative statistics?

*** the study had all of 317 patients and was published in an obscure, non-Medline listed journal.

**** currently ranked  #1,297,877 in Books on Amazon.

***** no such entries found on Medline.

****** sorry, but my Medline search for ‘huber colleen’ located only 2 citations, both on arthritis research conducted in an US Pfizer lab and therefore probably not from ‘our’ DCH.

Another website on or by DCH informs us that her outfit Nature Works Best is a natural cancer clinic located in Tempe, Arizona, that focuses on natural, holistic, and alternative cancer treatments. Our treatments have proved to be an effective alternative to traditional chemotherapy and radiation, which we do not use in our treatments. Rather, we have developed a natural method of treating cancers based on intravenous vitamin therapy which may include Vitamin-C, Baking Soda, and other tumor fighting agents as well as a simple food plan. *

Our team of naturopathic medical doctors have administered an estimated 31,000 IV nutrient treatments, used for all stages and types of tumors. As of July 2014, 80% of patients who completed our treatments alone went into remission, 85% of patients who completed our treatments and followed our food plan went into remission. **

* Give me a break! Vitamin-C and Baking Soda are claimed to have proved to be an effective alternative to traditional chemotherapy and radiation ? I would like to see the data before I believe this!

** Again, I would like to see the data before I believe this!

Finally, a further website proudly repeats that her academic writing has appeared in The Lancet and Cancer Strategies Journal, and other medical journals. It even presents an abstract of her published work; here it is:

Recent recommendations for the more widespread prescription of statin drugs in the U.S. have generated controversy.  Cholesterol is commonly thought to be the enemy of good health.  On the other hand, previous research has established the necessity of cholesterol in production of Vitamin D and steroid hormones, among other purposes, some of which have been shown to have anti-cancer effect.  We compare total serum cholesterol (TC) in cancer survivors vs cancer fatalities, and we assess the value of deliberately lowering TC among cancer patients.  We also examined diet in the survivors as well as those who then died of cancer.

In this original previously unpublished research, we conducted a double-blind retrospective case series, in which we looked back at data from all 255 cancer patients who came to and were treated by our clinic with either current dietary information, and/or a recent serum TC level, measured by an unaffiliated laboratory or an unaffiliated clinic over the previous seven years, comparing TC in the surviving cancer patients versus those cancer patients who died during that time.

Surviving cancer patients had 24.0 points higher mean total cholesterol than the mean for deceased cancer patients.  A number of dietary differences between cancer survivors and those who then died of cancer were also found to be notable.

Caution is advised before attempting to lower cholesterol in cancer patients with close to normal TC levels.  Those cancer patients with higher TC were more likely to survive their cancer.

I don’t know about you, but I am not impressed. Surviving cancer patients had 24.0 points higher mean total cholesterol than the mean for deceased cancer patients. Has DCH thought of the possibility that moribund patients quite simply eat less? In which case, the observed difference would be a meaningless epiphenomenon.

At this point, I stopped my reading; I now knew more than I needed to know about DCH (if you want to read more, I recommend this or this post).

As I mentioned at the beginning of this post, DCH is currently suing Britt Hermes for libel. Apart from being exceedingly stressful, such an action can also be hugely expensive.

Britt is therefore hoping to do some crowd-funding to assist her financially.

I wish my post has motivated you to donate generously.

This blog is almost entirely about critical thinking as it applies to the realm of alternative medicine, and I have written about it more often than I care to remember. For instance, in one post I concluded that criticism  in alternative medicine is directed almost exclusively towards those who are outside the realm. Criticism from the inside is as good as non-existent.

The consequences of this situation are easy to see for everyone, and they can be dramatic:

  • The journals of alternative medicine publish nothing that could be perceived to be negative for the practice of alternative medicine.
  • Self-critical thinking has no tradition and has remained an almost alien concept.
  • The very few people from the ‘inside’ who dare to criticise alternative practices are ousted and/or declared to be incompetent or worse.
  • No action is taken to initiate change.
  • The assumptions of alternative medicine remain unaltered for centuries.
  • Progress is all but absent.

But what exactly is critical thinking? The ‘Foundation of Critical Thinking‘ defines it as follows: Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness.

In an article in the Scientific American Heather butler recently provided further clarification. Here is a short extract from this most commendable paper:

START OF QUOTE

Though often confused with intelligence, critical thinking is not intelligence. Critical thinking is a collection of cognitive skills that allow us to think rationally in a goal-orientated fashion, and a disposition to use those skills when appropriate. Critical thinkers are amiable skeptics. They are flexible thinkers who require evidence to support their beliefs and recognize fallacious attempts to persuade them. Critical thinking means overcoming all sorts of cognitive biases (e.g., hindsight bias, confirmation bias).

Critical thinking predicts a wide range of life events. In a series of studies, conducted in the U.S. and abroad, my colleagues and I have found that critical thinkers experience fewer bad things in life. We asked people to complete an inventory of life events and take a critical thinking assessment (the Halpern Critical Thinking Assessment). The critical thinking assessment measures five components of critical thinking skills including verbal reasoning, argument analysis, hypothesis testing, probability and uncertainty, decision-making, and problem-solving. The inventory of negative life events captures different domains of life such as academic (e.g., I forgot about an exam), health (e.g., I contracted a sexually transmitted infection because I did not wear a condom), legal (e.g., I was arrested for driving under the influence), interpersonal (e.g., I cheated on my romantic partner who I had been with for over a year), financial (e.g., I have over $5,000 of credit card debt), etc. Repeatedly, we found that critical thinkers experience fewer negative life events. This is an important finding because there is plenty of evidence that critical thinking can be taught and improved.

Is it better to be a critical thinker or to be intelligent? My latest research pitted critical thinking and intelligence against each other to see which was associated with fewer negative life events. People who were strong on either intelligence or critical thinking experienced fewer negative events, but critical thinkers did better.

Intelligence and improving intelligence are hot topics that receive a lot of attention. It is time for critical thinking to receive a little more of that attention. Keith Stanovich wrote an entire book about What Intelligence Tests Miss. Reasoning and rationality more closely resemble what we mean when we say a person is smart than spatial skills and math ability. Furthermore, improving intelligence is difficult. Intelligence is largely determined by genetics. Critical thinking, though, can improve with training and the benefits have been shown to persist over time. Anyone can improve their critical thinking skills: Doing so, we can say with certainty, is a smart thing to do.

END OF QUOTE

We cannot learn to be intelligent, but we can learn how to think critically. If my blog helps some readers to achieve this aim, I would consider the effort worthwhile.

In 2017, Medline listed just over 1800 articles on ‘complementary alternative medicine’. If you find this number impressively high, consider that, for ‘surgery’ (a subject that has often been branded as less that active in conducting research), there were almost 18 000 Medline-listed papers.

So, the research activity in CAM is relatively small. Vis a vis the plethora of open questions, this inactivity is perhaps lamentable. What I find much more regrettable, however, is the near total lack of investigations into the ethical issues in CAM. In 2017, there were just 11 articles on Medline on ‘ethics and CAM’ (24393 articles on ‘ethics and surgery’).

One of the 11 papers that tackled the ethics directly and that was (in my opinion) one of the best is this article. Here is its concluding paragraph:

When we encounter patients who use or consider the use of complementary and/or alternative medicine, we should respect their autonomy while also fulfilling our obligations of beneficence and nonmaleficence. Physicians should become more knowledgeable about research on CAM therapies and approach discussions in an open, nonjudgmental manner to enhance patient trust. In situations where there is little risk of harm and the possibility of benefit, supporting a patient in their interest in complementary therapies can strengthen the patient-physician relationship. However, when a patient’s desire to utilize alternative therapies poses a health risk, physicians have the ethical obligation to skillfully counsel the patient toward those therapies that are medically appropriate.

I have had a long-lasting and keen interest in the ethics of CAM which resulted in the publication of many papers. Here is a selection:

Problems with ethical approval and how to fix them: lessons from three trials in rheumatoid arthritis.

‘Complementary & Alternative Medicine’ (CAM): Ethical And Policy Issues.

Pharmacists and homeopathic remedies.

No obligation to report adverse effects in British complementary and alternative medicine: evidence for double standards.

Homeopathy, a “helpful placebo” or an unethical intervention?

Advice offered by practitioners of complementary/ alternative medicine: an important ethical issue.

The ethics of British professional homoeopaths.

Evidence-based practice in British complementary and alternative medicine: double standards?

Ethics of complementary medicine: practical issues.

The ethics of chiropractic.

Reporting of ethical standards: differences between complementary and orthodox medicine journals?

Informed consent: a potential dilemma for complementary medicine.

Ethical problems arising in evidence based complementary and alternative medicine.

Complementary medicine: implications for informed consent in general practice.

Ethics and complementary and alternative medicine.

Research ethics questioned in Qigong study.

Informed consent in complementary and alternative medicine.

The ethics of complementary medicine.

For most of the time conducting this research, I felt that I was almost alone in realising the importance of this topic. And all this time, I was convinced that the subject needed more attention and recognition. Therefore, I teamed up with with the excellent ethicist Kevin Smith from the University of Dundee, and together we spent the best part of 2017 writing about it.

Our book is entitled ‘MORE HARM THAN GOOD? THE MORAL MAZE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE’ and will be published shortly by Springer.

Product Details

It is an attempt to highlight some of the most important topics in this broad and under-researched area. While working on it, I was continually struck by the fact that most of the issues we have been struggling with on this blog are, in the final analysis, ethical by nature.

My hope is that, in 2018, we will see many more high quality papers filling the almost total void of ethical perspectives on CAM. In my view, it is unquestionably an area that needs to be addressed with some urgency.

Who could resist reading an article entitled “Is Dead Vagina Syndrome Real? Plus, 4 Ways To Boost Your Libido“?

Well I couldn’t, particularly as it came from a site promisingly called ‘ALTERNATIVE DAILY’!

And I did not regret it. Here are some excerpts:

…“Dead vagina syndrome” or DVS is used to describe a woman’s over-sensitized vagina. Some people believe that regularly using a strong vibrator can cause a woman to lose feeling in her private parts. What’s worse, it’s thought that this desensitization of the nether regions makes it almost impossible for a woman to get aroused with an actual human partner. Thus, DVS is born. The theory behind the condition suggests that using a strong vibrator regularly will ultimately damage sensitive nerves around the clitoris and in the vagina…”

[Luckily, there is help – help from all natural, herbal remedies, no less. The article recommends the following cures]

Saffron

Saffron, a culinary delicacy, has a powerful libido-boosting effect. In fact, research suggests that saffron has been used traditionally as an aphrodisiac. And a little goes a long way. All you need is one or two strands to do the trick.

Maca root

Used for centuries in Asian countries, maca root has traditionally been used for male sexuality. But a study from the Department of Psychiatry, Massachusetts General Hospital has found that it may also be helpful for women in need of a sexual boost.

Nutmeg

In animal studies, nutmeg has been found to increase sexual activity in male rats. Interestingly, nutmeg has also been used traditionally as an aphrodisiac by African women and is still used today by women of all cultures. So, what’s good for men is obviously good for women too…

END OF QUOTE

Before you get all excited and start planting your own physic garden or hurry to the next health food shop, let me tell you this: I have looked into the evidence, and to call it flimsy would be the understatement of the year. There is no good reason to believe that these herbal remedies (or any other alternative therapy) can help women increase their libido.

Thankfully, the article ends on a truthful and reassuringly positive note: “most experts agree that DVS is not a real medical concern for women.”

… nor for men, I hasten to add.

 

A comprehensive review of the evidence relating to acupuncture entitled “The Acupuncture Evidence Project: A Comparative Literature Review” has just been published. The document aims to provide “an updated review of the literature with greater rigour than was possible in the past.” That sounds great! Let’s see just how rigorous the assessment is.

The review was conducted by John McDonald who no stranger to this blog; we have mentioned him here, for instance. To call him an unbiased, experienced, or expert researcher would, in my view, be more than a little optimistic.

The review was financed by the ‘Australian Acupuncture and Chinese Medicine Association Ltd.’ – call me a pessimist, but I do wonder whether this bodes well for the objectivity of the findings.

The research seems to have been assisted by a range of experts: Professor Caroline Smith, National Institute of Complementary Medicine, Western Sydney University, provided advice regarding evidence levels for assisted reproduction trials; Associate Professor Zhen Zheng, RMIT University identified the evidence levels for postoperative nausea and vomiting and post-operative pain; Dr Suzanne Cochrane, Western Sydney University; Associate Professor Chris Zaslawski, University of Technology Sydney; and Associate Professor Zhen Zheng, RMIT University provided prepublication commentary and advice. I fail to see anyone in this list who is an expert in EBM or who is even mildly critical of acupuncture and the many claims that are being made for it.

The review has not been published in a journal. This means, it has not been peer-reviewed. As we will see shortly, there is reason to doubt that it could pass the peer-review process of any serious journal.

There is an intriguing declaration of conflicts of interest: “Dr John McDonald was a co-author of three of the research papers referenced in this review. Professor Caroline Smith was a co-author of six of the research papers referenced in this review, and Associate Professor Zhen Zheng was co-author of one of the research papers in this review. There were no other conflicts of interest.” Did they all forget to mention that they earn their livelihoods through acupuncture? Or is that not a conflict?

I do love the disclaimer: “The authors and the Australian Acupuncture and Chinese Medicine Association Ltd (AACMA) give no warranty that the information contained in this publication and within any online updates available on the AACMA website are correct or complete.” I think they have a point here.

But let’s not be petty, let’s look at the actual review and how well it was done!

Systematic reviews must first formulate a precise research question, then disclose the exact methodology, reveal the results and finally discuss them critically. I am afraid, I miss almost all of these essential elements in the document in question.

The methods section includes statements which puzzle me (my comments are in bold):

  • A total of 136 systematic reviews, including 27 Cochrane systematic reviews were included in this review, along with three network meta-analyses, nine reviews of reviews and 20 other reviews. Does that indicate that non-systematic reviews were included too? Yes, it does – but only, if they reported a positive result, I presume.
  • Some of the included systematic reviews included studies which were not randomised controlled trials. In this case, they should have not been included at all, in my view.
  • … evidence from individual randomised controlled trials has been included occasionally where new high quality randomised trials may have changed the conclusions from the most recent systematic review. ‘Occasionally’ is the antithesis of systematic. This discloses the present review as being non-systematic and therefore worthless.
  • Some systematic reviews have not reported an assessment of quality of evidence of included trials, and due to time constraints, this review has not attempted to make such an assessment. Say no more!

It is almost needless to mention that the findings (presented in a host of hardly understandable tables) suggest that acupuncture is of proven or possible effectiveness/efficacy for a very wide array of conditions. It also goes without saying that there is no critical discussion, for instance, of the fact that most of the included evidence originated from China, and that it has been shown over and over again that Chinese acupuncture research never seems to produce negative results.

So, what might we conclude from all this?

I don’t know about you, but for me this new review is nothing but an orgy in deceit and wishful thinking!

Yes, I did promise to report on my participation in the ‘Goldenes Brett’ award which took place in Vienna and Hamburg on 23/11/2017. I had been asked to come to Vienna and do the laudation for the life-time achievement in producing ridiculous nonsense. This year, the award went to the ‘DEUTSCHER ZENTRALVEREIN HOMOEOPATHISCHER AERZTE’ (DZVhÄ), the German Central Society of Homoeopathic Doctors.

In my short speech, I pointed out that this group is a deserving recipient of this prestigious negative award. Founded in 1829, the DZVhÄ  is a lobby-group aimed at promoting homeopathy where and how they can. It is partly responsible for the fact that homeopathy is still highly popular in Germany, and that many German consumers seem to think that homeopathy is an evidence-based therapy.

Cornelia Bajic, the current president of this organisation stated on her website that “Homöopathie hilft bei allen Krankheiten, die keiner chirurgischen oder intensivmedizinischen Behandlung bedürfen“ (homeopathy helps with all diseases which do not need surgical or intensive care), advice that, in my view, has the potential to kill millions.

The DZVhÄ also sponsors the publication of a large range of books such as ‘Was kann die Homoeopathie bei Krebs’ (What can homeopathy do for cancer?). This should be a very short volume consisting of just one page with just one word: NOTHING. But, in fact, it provides all sorts of therapeutic claims that are not supported by evidence and might seriously harm those cancer patients who take it seriously.

But the DZVhÄ does much, much more than just promotion. For instance it organises annual ‘scientific’ conferences – I have mentioned two of them previously here, here and here. In recent years one of its main activity must have been the defamation of certain critics of homeopathy. For instance, they supported Claus Fritzsche in his activities to defame me and others. And recently, they attacked Natalie Grams for her criticism of homeopathy. Only a few days ago, Cornelia Bajic attacked doctor Gram’s new book – embarrassingly, Bajic then had to admit that she had not even read the new book!

The master-stroke of the DZVhÄ , in my opinion, was the fact that they supported the 4 homeopathic doctors who went to Liberia during the Ebola crisis wanting to treat Ebola patients with homeopathy. At the time Bajic stated that “Unsere Erfahrung aus der Behandlung anderer Epidemien in der Geschichte der Medizin lässt den Schluss zu, dass eine homöopathische Behandlung die Sterblichkeitsrate der Ebola-Patienten signifikant verringern könnte” (Our experience with other epidemics in the history of medicine allows the conclusion that homeopathic treatment might significantly reduce the mortality of Ebola patients).

As I said: the DZVhÄ are a well-deserving winner of this award!

 

For some time now, I got the impression that the research literature of alternative medicine is yielding more and more animal experiments. But impressions can of course be misleading, so I did a small statistical analysis. I went on to Medline, searched for all papers on ‘complementary/alternative medicine’, and counted the number of animal studies as well as clinical studies (including observational studies but excluding surveys) amongst the first 100 hits.

The results confirmed the above-named impression. There were:

  • 30 animal studies,
  • 12 clinical trials,
  • the rest was made up of other pre-clinical studies (mostly in-vitro studies), comments and other types of publications.

I find this dominance of animal studies surprising, particularly as I got the impression that many were odd, meaningless and not followed by adequate further research. But again, this is just an impression. Let’s see some data. Here are the first 3 papers listed:

Paper number 1

BACKGROUND:

Essential hypertension is mainly caused by endothelial dysfunction which results from nitric oxide (NO) deficiency. The present study was design to evaluate the protective effect of Bidens pilosa ethylene acetate extract (Bp) on L-NAME induced hypertension and oxidative stress in rats.

METHODS:

Male Wistar rats were used to induce hypertension by the administration of L-NAME (a non-pecific nitric oxide inhibitor) (50 mg/kg/day). The others groups were receiving concomitantly L-NAME plus Bp extract (75 and 150 mg/kg/day) or losartan (25 mg/kg/day). All the treatments were given orally for 4 weeks. At the end of the treatment, the hemodynamic parameters were recorded using the direct cannulation method. The effects of the extract on lipid profile, kidney and liver functions as well as oxidative stress markers were evaluated by colorimetric method. Results were expressed as the mean ± SEM. The difference between the groups was compared using one-way analysis of variance (ANOVA) followed by the Duncan’s post hoc test.

RESULTS:

Animals receiving L-NAME presented high blood pressure, normal heart rate and lipid profile as well as NO depletion, liver and kidney injuries and oxidative stress. The concomitant treatment with L-NAME and Bp or losartan succeeded to prevent the raised of blood pressure and all the other injuries without affecting the heart rate.

CONCLUSION:

These results confirm the antihypertensive effects of Bidens pilosa and highlight its protective properties in L-NAME model of hypertension in rat, probably due to the presence of Quercetin 3,3 ‘-dimethyl ether 7-0-β-D-glucopyranoside.

Paper number 2

BACKGROUND:

Oxidative stress has a pivotal role in the pathogenesis and development of diabetic peripheral neuropathy (DPN), the most common and debilitating complications of diabetes mellitus. There is accumulating evidence that Juglans regia L. (GRL) leaf extract, a rich source of phenolic components, has hypoglycemic and antioxidative properties. This study aimed to determine the protective effects of Juglans regia L. leaf extract against streptozotocin-induced diabetic neuropathy in rat.

METHODS:

The DPN rat model was generated by intraperitoneal injection of a single 55 mg/kg dose of streptozotocin (STZ). A subset of the STZ-induced diabetic rats intragastically administered with GRL leaf extract (200 mg/kg/day) before or after the onset of neuropathy, whereas other diabetic rats received only isotonic saline as the same volume of GRL leaf extract. To evaluate the effects of GRL leaf extract on the diabetic neuropathy various parameters, including histopathology and immunohistochemistry of apoptotic and inflammatory factors were assessed along with nociceptive and biochemical assessments.

RESULTS:

Degeneration of the sciatic nerves which was detected in the STZ-diabetic rats attenuated after GRL leaf extract administration. Greater caspase-3, COX-2, and iNOS expression could be detected in the STZ-diabetic rats, which were significantly attenuated after GRL leaf extract administration. Also, attenuation of lipid peroxidation and nociceptive response along with improved antioxidant status in the sciatic nerve of diabetic rats were detected after GRL leaf extract administration. In other word, GRL leaf extract ameliorated the behavioral and structural indices of diabetic neuropathy even after the onset of neuropathy, in addition to blood sugar reduction.

CONCLUSION:

Our results suggest that GRL leaf extract exert preventive and curative effects against STZ-induced diabetic neuropathy in rats which might be due to its antioxidant, anti-inflammatory, and antiapoptotic properties.

Paper number 3

BACKGROUND:

Many people still experience pain and inflammation regardless of the available drugs for treatments. In addition, the available drugs have many side effects, which necessitated a quest for new drugs from several sources in which medicinal plants are the major one. This study evaluated the analgesic and anti- inflammatory activity of the solvent fractions of Moringa stenopetala in rodent models of pain and inflammation.

METHODS:

Successive soxhlet and maceration were used as methods of extractions using solvents of increasing polarity; chloroform, methanol and water. Swiss albino mice models were used in radiant tail flick latency, acetic acid induced writhing and carrageenan induced paw edema to assess the analgesic and anti-inflammatory activities. The test groups received different doses (100 mg/kg, 200 mg/kg and 400 mg/kg) of the three fractions (chloroform, methanol and aqueous). The positive control groups received morphine (20 mg/kg) or aspirin (100 mg/kg or 150 mg/kg) based on the respective models. The negative control groups received the 10 ml/kg of vehicles (distilled water or 2% Tween 80).

RESULTS:

In all models, the chloroform fraction had protections only at a dose of 400 mg/kg. However, the methanol and aqueous fraction at all doses have shown significant central and peripheral analgesic activities with a comparable result to the standards. The aqueous and methanol fractions significantly reduced carrageenan induced inflammation in a dose dependent manner, in which the highest reduction of inflammation was observed in aqueous fraction at 400 mg/kg.

CONCLUSION:

This study provided evidence on the traditionally claimed uses of the plant in pain and inflammatory diseases, and Moringa stenopetala could be potential source for development of new analgesic and anti-inflammatory drugs.

END OF QUOTE

I may be wrong, but I have my doubts that these papers are useful (and there are many that are far worse than these 3. Take for instance this one that I blogged about previously). Animal studies could clearly be helpful, but they have to fulfil certain conditions.

Medline is currently littered with dubious animal experiments which never seem to be followed up with further research. Without subsequent research verifying whether the effects observed in animals might have any meaning for treating humans, such studies are, I think, in danger of being a waste of animals, money and time. It is my impression – one that would be difficult to back up by hard data – that most of these dubious animal studies are never followed by further research. If true, this would render them meaningless and arguably unethical.

Yet I am not an expert in pre-clinical research and would be most interested to hear your opinion on this matter.

It has been announced that Susan and Henry Samueli have given US$ 200 million to medical research at the University of California, Irvine (UCI). Surely this is a generous and most laudable gift! How could anyone doubt it?

As with any gift, one ought to ask what precisely it is for. If someone made a donation to research aimed at showing that climate change is a hoax, that white supremacy is justified, or that Brexit is going to give Brits their country back, I doubt that it would be a commendable thing. My point is that research must always be aimed at finding the truth and discovering facts. Research that is guided by creed, belief or misinformation is bound to be counter-productive, and a donation to such activities is likely to be detrimental.

Back to the Samuelis! The story goes that Susan once had a cold, took a homeopathic remedy, and subsequently the cold went away. Ever since, the two Samuelis have been supporters not just of homeopathy but all sorts of other alternative therapies. I have previously called this strikingly common phenomenon an ‘epiphany‘. And the Samuelis’ latest gift is clearly aimed at promoting alternative medicine in the US. We only need to look at what their other major donation in this area has achieved, and we can guess what is now going to happen at UCI. David Gorski has eloquently written about the UCI donation, and I will therefore not repeat the whole, sad story.

Instead I want to briefly comment on what, in my view, should happen, if a wealthy benefactor donates a large sum of money to medical research. How can one maximise the effects of such a donation? Which areas of research should one consider? I think the concept of prior probability can be put to good use in such a situation. If I were the donor, I would convene a panel of recognised experts and let them advise me where there are the greatest chances of generating important breakthroughs. If one followed this path, alternative medicine would not appear anywhere near the top preferences, I dare to predict.

But often, like in the case of the Samuelis, the donors have concrete ideas about the area of research they want to invest in. So, what could be done with a large sum in the field of alternative medicine? I believe that plenty of good could come it. All one needs to do is to make absolutely sure that a few safeguards are in place:

  • believers in alternative medicine must be kept out of any decisions processes;
  • people with a solid background in science and a track-record in critical thinking must be put in charge;
  • the influence of the donor on the direction of the research must be minimised as much as possible;
  • a research agenda must be defined that is meaningful and productive (this could include research into the risks of alternative therapies, the ethical standards in alternative medicine, the fallacious thinking of promoters of alternative medicine, the educational deficits of alternative practitioners, the wide-spread misinformation of the public about alternative medicine, etc., etc.)

Under all circumstances, one needs to avoid that the many pseudo-scientists who populate the field of alternative or integrative medicine get appointed. This, I fear, will not be an easy task. They will say that one needs experts who know all about the subtleties of acupuncture, homeopathy, energy-healing etc. But such notions are merely smoke-screens aimed at getting the believers into key positions. My advice is to vet all candidates using my concept of the ‘trustworthiness index’.

How can I be so sure? Because I have been there, and I have seen it all. I have researched this area for 25 years and published more about it than any of the untrustworthy believers. During this time I trained about 90 co-workers, and I have witnessed one thing over and over again: someone who starts out as a believer, will hardly ever become a decent scientist and therefore never produce any worthwhile research; but a good scientist will always be able to acquire the necessary knowledge in this or that alternative therapy to conduct rigorous and meaningful research.

So, how should the UCI spend the $ 200 million? Apparently the bulk of the money will be to appoint 15 faculty chairs across medicine, nursing, pharmacy and population health disciplines. They envisage that these posts will go to people with expertise in integrative medicine. This sounds extremely ominous to me. If this project is to be successful, these posts should go to scientists who are sceptical about alternative medicine and their main remit should be to rigorously test hypotheses. Remember: testing a hypothesis means trying everything to show that it is wrong. Only when all attempts to do so have failed can one assume that perhaps the hypothesis was correct.

My experience tells me that experts in integrative medicine are quite simply intellectually and emotionally incapable of making serious attempts showing that their beliefs are wrong. If the UCI does, in fact, appoint people with expertise in integrative medicine, it is, I fear, unavoidable that we will see:

  • research that fails to address relevant questions;
  • research that is of low quality;
  • promotion masquerading as research;
  • more and more misleading findings of the type we regularly discuss on this blog;
  • a further boost of the fallacious concept of integrative medicine;
  • a watering down of evidence-based medicine;
  • irreversible damage to the reputation of the UCI.

In a nutshell, instead of making progress, we will take decisive steps back towards the dark ages.

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