MD, PhD, FMedSci, FSB, FRCP, FRCPEd

risk

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On this blog, I have discussed the lamentable quality of TCM products before (e. g. here, here and here). In a nutshell, far too high percentages of them are contaminated with toxic substances or adulterated with prescription drugs. It is no question: these deficits put many consumers at risk. Equally, there is no question that the problem has been known for decades.

For the Chinese exporters, such issues are a great embarrassment, not least because TCM-products are amongst the most profitable of all the Chinese exports. In the past, Chinese officials have tried to ignore or suppress the subject as much as possible. I presume they fear that their profits might be endangered by being open about the dubious quality of their TCM-exports.

Recently, however, I came across a website where unusually frank and honest statements of Chinese officials appeared about TCM-products. Here is the quote:

China is to unroll the fourth national survey of traditional Chinese medicine (TCM) resources to ensure a better development of the industry, said a senior health official…

With the public need for TCM therapies growing, the number of medicine resources has decreased and people have turned to the cultivated ones. However, due to a lack of standards, the cultivated TCM resources are sometimes less effective or even unsafe for human use, said Wang Guoqiang, director of the State Administration of TCM, at a TCM seminar held in Kunming, Yunnan Province in southwest China.

There is a pressing need to protect TCM resources, Wang said. “I’ve heard people saying that medicine quality will spell doom for the TCM industry, which I must admit, is no exaggeration,” he said.

The survey has been piloted in 922 counties in 31 provinces in China since 2011. According to its official website, it will draw a clear picture of the variety, distribution, storage and growth trends of TCM resources, including herbs, animals, minerals and synthetic materials.

TCM includes a range of traditional medical practices originating in China. It includes such treatments as herbal medicine, acupuncture, massage (tuina), exercise (qigong) and dietary therapy.

Although well accepted in the mainstream of medical care throughout East Asia, TCM is considered an alternative medical system in much of the western world and has been a source of controversy. A milestone in the recognition of TCM came when Chinese pharmaceutical chemist Tu Youyou won a Nobel Prize in 2015 for her discovery of Artemisinin, a medicinal herb, to help treat malaria.

END OF QUOTE

Surely, these are remarkable, perhaps even unprecedented statements by Chinese officials:

…cultivated TCM resources are sometimes less effective or even unsafe for human use…

…medicine quality will spell doom for the TCM industry…

Let’s hope that, after such words, there will be appropriate actions… finally.

The UK petition to ban homeopathy for animals has so far achieved well over 3 000 signatures. Remarkably, it also prompted a reaction from the Faculty of Homeopathy which I reproduce here in full:

Response to petition calling on the RCVS to ban homeopathy

Homeopathy has a long history of being used successfully in veterinary practice for both domestic and farm animals. The EU recommends its use in its regulations on organic farms and is funding research into veterinary homeopathy as a way of reducing antibiotic use in livestock. It is nonsense to suggest that responsible pet owners and farmers are unable to distinguish between effective and ineffective medicines; they continue to use homeopathy because they see its benefits.

Membership of the Faculty of  Homeopathy (VetMFHom) is bestowed on qualified veterinary surgeons who have completed a minimum of three years study of homeopathy and after a rigorous examination procedure. It differentiates the qualified veterinary homeopath from an unlicensed healer.

In a statement, the Royal College of Veterinary Surgeons said “… homeopathy is currently accepted by society and recognised by UK medicines legislation, and does not, in itself, cause harm to animals”. Before going on to say it could see no justification for banning veterinary surgeons from practising homeopathy.

In an age when antibiotic resistance is such an important issue, veterinary surgeons and farmers who have found they can limit the use of these drugs by using homeopathy should be applauded and not attacked.


Peter Gregory
BVSc MRCVS VetFFHom
Veterinary Dean, Faculty of Homeopathy

 

Such sentiments resonate with those of the UK’s most influential supporter of homeopathy, Prince Charles. Speaking at a global leaders summit on antimicrobial resistance, Prince Charles  recently warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries at The Royal Society in London. “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”

It seems that both Prince Charles and Peter Gregory believe that homeopathy can be employed to reduce the use of antibiotics in animals. So, let’s analyse this hypothesis a little closer.

The way I see it, the belief must be based on one of two assumptions:

  1. Homeopathic remedies are effective in treating or preventing bacterial infections.
  2. If farmers administer homeopathic remedies to their life-stock, they are less likely to administer unnecessary antibiotics.

Assumption No 1 can be rejected without much further debate; there is no evidence whatsoever that homeopathic remedies have antibiotic efficacy. In fact, the consensus today is that highly diluted homeopathic remedies are pure placebos.

Assumption No 2, however, might be more plausible and therefore deserves further scrutiny.  If we do not tell the farmers nor the vets that homeopathic remedies are placebos, if, in other words, we mislead them to think they are efficacious medicines, they might give them to their animals instead of antibiotics. Consequently, the usage of antibiotics in animals would decrease. This strategy sounds plausible but, on second thought, it has many serious drawbacks:

  1. The truth has a high value in itself which we would disregard at our peril.
  2. One might not be able to keep the truth from the farmers and even less able to hide it from vets.
  3. If we mislead farmers and vets, we must also mislead the rest of the population; this means lots of people might start using homeopathic placebos even for serious conditions.
  4. Misleading farmers, vets and the rest of the population is clearly unethical.
  5. Misleading farmers and vets in this way might not be necessary; if there is abuse of antibiotics in farming, we ought to tackle this phenomenon directly.
  6. Misleading farmers and vets might be dangerous for at least two reasons: firstly, animals who truly need antibiotics would not receive adequate treatment; secondly, farmers and vets might eventually become convinced that homeopathy is efficacious and would therefore use it in all sorts of situations, even for serious diseases of humans.

Whichever way I twist and turn the assumption No 2, I fail to arrive at anything remotely sensible. But this leaves me with a huge problem: I would have to conclude that both the Veterinary Dean, Faculty of Homeopathy and the heir to the throne are bonkers… and, surely, this cannot be right either!!!

 

Some homeopaths advise parents not to vaccinate their kids and use homeopathic vaccinations or ‘homeo-prophylaxis’ instead. Despite the fact that it has long been clear that this approach is not effective and even dangerous, some homeopathic pharmacies have been selling the remedies used for that purpose. In the UK, Helios has been at the forefront of this dubious trade. But, a few days ago, they have changed their ways.

Here is a screenshot of the results of a search for the word ‘vaccine’, with the ‘remedies’ that were subsequently removed highlighted:

Helios vaccine remedies 1

Click the image to enlarge.

This is undoubtedly a step in the right direction. The question I ask myself is WHY DID HELIOS MAKE THIS CHANGE? Was it because they had to? Or was it because they saw the light and realised that the evidence did not support the remedies in question?

If it was the latter motivation, we will soon know – because, in that case, they will surely do the same with the entire rest of their remedies.

Why?

BECAUSE THERE IS NOT GOOD EVIDENCE THAT ANY HIGHLY DILUTED HOMEOPATHIC REMEDY IS MORE THAN A PLACEBO.

You have to excuse me, if I keep coming back to this theme: so-called ‘alternative cancer cures’ are truly dangerous. I have tried to explain this already many times, for instance here, here and here. And it is by no means just alternative therapists who make a living of such quackery. Sadly qualified medical doctors are often involved as well. As to prove my point, here is a tragic story that broke yesterday:

Former Miss New Hampshire, Rachel Petz Dowd, lost her battle with cancer on Sunday 12 June 2016 — a battle she fought publicly through personal writings in a blog in hopes of helping others on a similar journey toward healing. The singer/songwriter and mother of three from Auburn died about a month after traveling to Mexico for an aggressive form of alternative cancer treatment. She turned 47 last week. Dowd was diagnosed with stage 2 triple negative breast cancer in May 2014. The diagnosis led her to create a blog called “Rachel’s Healing” to document what she hoped would be a journey back to health. “I hope my readers can gain something from my journey and that they find their own personal way to combat this disease impacting too many women today,” she wrote. Dowd used the blog to share her experiences with traditional and natural medicine during her cancer fight.

On 5/3/16 Mrs Dowd wrote on her blog: “Well after some careful consideration and looking at different clinics and hospitals we’ve made a decision. Will be going to the CMN Hospital on the Yuma, Arizona border*. For 28 days of treatments. It’s not a day clinic but a full hospital servicing over the past 30 years. There’s a special wing dedicated to alternative cancer care and the treatment list is impressive.  Many treatments that are not available in this country. We feel this would be the best course of care daily for 28 days and then at the end of the 4 weeks I intend my immune system to be back on-line. I will be doing a stem cell boost of my bone marrow the last week. I know of a women, Shannon Knight, from The Truth About Cancer documentary, who had stage 4 metastasized into locations of her bones and her lungs and she came out of there completely cured. Her oncologist said it was nothing short of a miracle, but she said no it was just clean hard work!  She said no it was just clean the hard, aggressive treatments that only attack cancer, boost and prime your immune system, become a whole, healthy being once again:) It is possible and I am planning on being one of the exceptions like Shannon!”

  • The hospital is across the US border in Mexico; it is run by medically qualified personnel.

The hospital [“CMN Hospital’s facility is only 14 blocks away once you cross the border to begin your alternative cancer treatment”] has a website where they tell a somewhat confusing story about their treatment plans; here is a short but telling excerpt:

CMN’s protocols are individualized and comprehensive. You will benefit from oxidative therapies, IV minerals selenium and bicarbonate IV vitamins such as vitamin B-17 and IV vitamin C. Far infrared and others including MAHT, Cold Laser Therapy, Hyperbaric Oxygen Therapy and Ozone Therapy are a daily part of your protocol. Ultraviolet Blood Irradiation is effective in destroying pathogens in your blood and slows the growth of cancer cell growth. CMN’s Stem cell therapy and Dendritic cell therapy are just two of the advanced cancer treatments applied to patients.”

And here is what they say about three therapies as examples of treatments that have discussed before on this blog: vitamin C, Laetrile and Essiac.

IV Vitamin C If large amounts of vitamin C are presented to cancer cells, large amounts will be absorbed. In these unusually large concentrations, the antioxidant vitamin C will start behaving as a pro-oxidant as it interacts with intracellular copper and iron. This chemical interaction produces small amounts of hydrogen peroxide. Because cancer cells are relatively low in an intracellular anti-oxidant enzyme called catalase, the high dose vitamin C induction of peroxide will continue to build up until it eventually lyses the cancer cell from the inside out!

IV Vitamin B17 / Laetrile Also known as amygdaline, Vitamin B-17 is a molecule made up of four parts: -2 parts Glucose -1 part Benzaldahyde-1 part Hydrogen Cyanide. Laetrile is found in at least 1200 different plants, including apricots, peaches, apple seeds, lentils, cashews, brown rice, millet, and alfalfa. Commercial preparations of laetrile are obtained from the kernels of apricots, peaches and bitter almonds. The body requires an enzyme called beta-glucosidase in order to process laetrile and release the cyanide. Studies have shown that cancer cells contain more of this enzyme than normal cells, which allows for a higher release of cyanide at tumor sites. Another enzyme known as rhodanese is important in this process. Normal healthy cells contain rhodanese which protects them from the activated cyanide. Most cancer cells are deficient in this enzyme, leaving them vulnerable to the poison. Tumor destruction begins once the cyanide is released within the malignancies, meaning laetrile therapy is selectively toxic to cancer cells while remaining non-toxic to normal cells.

Essiac Tea / Order Original Essiac Tea Essiac, given its name by Rene Caisse (“caisse” spelt backwards), consists of four main herbs that grow in the wilderness of Ontario, Canada. The original formula is believed to have its roots from the native Canadian Ojibway Indians. The four main herbs that make up Essiac are Burdock Root, Slippery Elm Inner Bark, Sheep Sorrel and Indian Rhubarb Root. Essiac tea helps release toxins that build up in fat and tissues into the blood stream where they can be filtered and excreted by the liver and kidneys.  Cleaning the body of toxins and impurities frees up the immune system to focus on killing cancer cells and protecting the body.

 

I think I will abstain from further comments, firstly because I want to avoid getting sued by these people and secondly because it seems all too depressingly obvious.

AROMATHERAPY is one of the most popular alternative therapies. The experience is usually pleasant enough, but what are the risks? None!!! At least this is what the therapists would claim. But is this true? Perhaps not. According to a recent press-release, the risks might be considerable.

Officials with the Tennessee Poison Control Center (TPC) are warning that they are seeing an increasing number of toxic exposures, mostly involving children, to essential oils used in aromatherapy. The TPC says the number of essential oil exposures doubled between 2011 and 2015, and 80 percent of those cases involved children. The primary route of poisoning is by ingestion, but also occurs with excessive or inappropriate application to the skin. Children are at risk because their skin easily absorbs oils and because they may try to ingest essential oils from the container.

“Tea tree oil is commonly cited, and most of those cases are accidental ingestions by children.” said Justin Loden, PharmD, certified specialist in Poison Information (CSPI) at TPC. Most essential oils have a pleasant smell but bitter taste, so children easily choke on them and aspirate the oil to their lungs, Loden said.

Several essential oils such as camphor, clove, lavender, eucalyptus, thyme, tea tree, and wintergreen oils are highly toxic. All of the oils produce oral and throat irritation, nausea, and vomiting when ingested. Most essential oils either produce central nervous system (CNS) stimulation, which results in agitation, hallucinations, delirium, and seizures or CNS depression, which results in lethargy and coma. Other toxic effects include painless chemical burns, hypotension, acute respiratory distress syndrome, acute liver failure, severe metabolic acidosis, and cerebral edema depending on which essential oil is in question.

Tennessee Poison Center Tips for using essential oils

  • Safely using and storing essential oils is extremely important
  • Use essential oil products ONLY for their intended purpose.
  • Use only the amount stated on the label/guide.
  • Do not swallow an essential oil unless the label says to do so.
  • Do not use a product on the skin unless the label says to do so.
  • Do not leave the product out (i.e. as a pesticide) unless the label says to do so.
  • If you have bottles of essential oils at home, keep them locked up, out of sight and reach of children and pet at all times. Children act fast, so do poisons.

Many will think that this is alarmist – but I don’t. In fact, in 2012, I published a systematic review aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. No, it was not funded by ‘BIG PHARMA’ but by THE ROYAL COLLEGE OF PHYSICIANS, LONDON.

Five electronic databases were searched to identify all relevant case reports and case series. Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects.

At the time, we concluded that aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.

I might add – before the therapists start making comments – that, yes, aromatherapy is still dimensions safer than many conventional treatments. But remember: the value of a therapy is not determined by its safety but by the risk/benefit balance! And what are the proven benefits of aromatherapy, I ask you.

Many cancer patients use some form of alternative therapy. Most of them combine it with conventional oncological treatments which begs the important question whether the two can interact.

The aim of this new investigation was firstly to assess prevalence of interactions between alternative medicines (AMs) and drugs for comorbidities from a large survey on melanoma patients and secondly to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers in Germany were asked to complete a standardized questionnaire including questions about their AM-use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and AMs was evaluated for their potential of interaction.

1089 questionnaires were eligible for evaluation. From these, 61.6 % of patients reported taking drugs regularly from which 34.4 % used biological-based AMs. Risk evaluation for interaction was possible for 180 AM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2 % at risk of interaction of their co-consumption of conventional drugs and AMs. Almost all patients using Chinese herbs were at risk (88.6 %).

The authors concluded that with a high rate of AM usage at risk of interactions between AMs and drugs taken for comorbidities, implementation of a regular assessment of AM usage and drugs for comorbidities is mandatory in cancer care.

On this blog, I have mentioned this problem repeatedly. For instance, I reported about a survey of 1,500 members of the German non-medically trained practitioner (NMP) associations. Its results showed that the treatments employed by NMPs were heterogeneous. Homeopathy was used by 45% of the NMPs, and 10% believed it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets were used by more than 10% of the NMPs. None of the treatments were discussed with the respective physician on a regular basis. The authors concluded from these findings that many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies.

One problem regarding herb-drug interactions is that we currently have to rely more on speculations than on facts. The only exception is the issue of interactions with St John’s Wort (SJW). Some time ago, I reported on this blog about a study assessing how often SJW is prescribed with medications that interact dangerously with it. The researchers conducted a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey. Twenty-eight percent of SJW visits involved a drug that has a potentially dangerous interaction with SJW. These included selective serotonin reuptake inhibitors, benzodiazepines, warfarin, statins, verapamil, digoxin, and oral contraceptives. The authors concluded that SJW is frequently used in potentially dangerous combinations. Physicians should be aware of these common interactions and warn patients appropriately.

My conclusion at the time is as true and important today: physicians ought to know about the potential of herbal remedies to interact with drugs but, considering the frequency of self-prescription of such treatments, raising  consumers’ awareness of the risks associated with herbal medicines is at least as important.

I must have stated this a thousand times – but I will do it again: A HOMEOPATHIC REMEDY MIGHT BE HARMLESS, BUT MANY HOMEOPATHS AREN’T!

As to prove my point, US homeopaths are about to host a conference where it is made quite obvious. The National Center for Homeopathy (NHC) is a non-profit organization in the US dedicated to “promoting health through homeopathy by advancing the use and practice of homeopathy.” The NCH is also the host organization for the Joint American Homeopathic Conference (JAHC). This event offers an afternoon of homeopathic learning for those interested in understanding more about the use of homeopathy on 9 April this year.

“We host a conference every year for practitioners and serious students but we also know there are a lot of people who’d like to learn more about homeopathy. So we created this special afternoon for interested beginners called Homeopathy Academy for Moms Live! Though we find moms and dads increasingly interested in using homeopathic remedies for their families, we created this event for all novice users,” explains NCH Executive Director Alison Teitelbaum. “People are interested in homeopathy because it’s safe, has no side effects, is inexpensive and, best of all, natural.”

Interested attendees to the introductory workshop receive:

1. Two 2-hour workshops taught by renowned homeopathic instructors that are guaranteed to increase your understanding, skill level, and confidence in using homeopathy at home for yourself and your family
2. Access to our one-of-a-kind holistic Marketplace – where close to 40 exhibitors and vendors will be showcasing and selling their natural, holistic, and homeopathic products and services.

Pre-registration rate of $35 is available until March 23 and then $50 thereafter.

A few clicks away, I found a NHC website which might disclose more clearly what the moms are about to be taught. Here are a few highlights:

Based on a thorough review of the literature, I believe strongly that the decreased incidence of these serious diseases is linked to improved sanitation and hygiene as well as to the introduction of vaccinations.  However, I am deeply concerned about the catastrophic rise of chronic diseases like asthma, autism, and behavioral disorders. Much more research into the possible relationship between vaccinations and these epidemic problems needs to be done.

At present, there is little data to support or reject any such association.

If your state permits exemption to vaccination, you may decide to withhold vaccinations from your child based on the simple philosophical decision that you do not wish to inject foreign bacterial/viral matter into your healthy child. Given that the infectious diseases for which people get vaccinated are exceedingly rare in the U.S., it is unlikely that your child would suffer the consequences of one of them. Be aware, however, that in some cities it is becoming routine to remove unvaccinated children from schools whenever there is a child with an infectious disease for which the majority are vaccinated. In the case of chickenpox, this could result in a child being removed from school two or four weeks a year, without recourse….

Do not accept the bland reassurances of health professionals or public health authorities that your child will be safe if vaccinated. There is no question that vaccines have the potential to undermine immune function in some children who receive them. Many vaccine investigators agree that the increase in asthma, diabetes, autism, and some autoimmune diseases is directly attributed to vaccine use in children. Educate yourself about disease incidence, vaccine effectiveness, and vaccine adverse effects before you agree to any vaccinations…

Don’t be bullied by the medical profession. Do make a decision and try not to let it plague you–move on and enjoy your baby! Also, don’t forget that if you are breastfeeding, your baby will get a lot of immunity from you and it would be unnecessary to vaccinate quite so early in their life…

All vaccines are artificial disease products, accompanied with preservatives of varying potential toxicity. Their introduction into the body is a serious proposition…

NOW, WHO FEELS LIKE PERPETUATING THE MYTH OF HOMEOPATHY BEING HARMLESS?

I get comments of this nature all the time, sometimes by the dozen per day. As the argument is so very common, let me ONCE AGAIN explain what is wrong with it. Here are 10 very simple points for those who find it hard to understand the issue.

  1. My expertise is in alternative medicine and not in pharmacology. I know many pharmacologists who are competent to criticise aspects of pharmacotherapy and do so regularly. I do NOT consider myself competent to comment on pharmacotherapy.
  2. The fact that some things are not perfect in one area of health care (e. g. pharmacotherapy) does certainly not mean that one is not allowed to criticise shortcomings in other areas (e. g. homeopathy).
  3. As far as I can tell, it is not pharmaceuticals that ‘kill 100k a year’, but the issue is more complex: a sizable proportion of this tragic total is due to medical errors, for instance.
  4. The 100k figure seems to refer to the US where the vast majority of the population take pharmaceuticals but only about 2% of the population ever try homeopathy.
  5. Nobody seems to dispute that pharmaceuticals have beneficial effects beyond placebo; the general consensus regarding highly diluted homeopathics is that they have no effects beyond placebo.
  6. To judge the value of a therapy, it is naïve and dangerously misleading to consider just its risks. If we did that, aromatherapy would be preferable to surgery, reflexology would be better than chemotherapy and OF COURSE homeopathy would be better than pharmacotherapy. And if we then implemented this ‘wisdom’ into routine practice, we would hasten the deaths of millions.
  7. Any reasonable judgement of the value of any therapy must account for its documented risks in relation to its documented benefits. In other words, we must always try to weigh the two against each other and do a risk/benefit analysis.
  8. If a therapy is associated with finite risks and no benefits, its risk/benefit balance cannot possibly be positive. Where the benefit is non-existent or doubtful, even relatively small risks will inevitably tilt this balance in to the negative.
  9. This is precisely the situation that applies to homeopathy: its benefits beyond placebo are doubtful and its risks are fairly well documented.
  10. This means that homeopathy cannot be considered to be a therapy that is fit for purpose.

Cervical spine manipulation (CSM) is a popular manipulative therapy employed by chiropractors, osteopaths, physiotherapists and other healthcare professionals. It remains controversial because its benefits are in doubt and its safety is questionable. CSM carries the risk of serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke.

Chinese physicians recently reported a rare case of a ‘locked-in syndrome’ (LIS) due to bi-lateral VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after receiving treatment with CSM. Although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnoea at 4 hours after admission. He was diagnosed with LIS. Cervical and brain computed tomography angiography revealed bi-lateral VADs. Aorto-cranial digital subtraction angiography showed a vertebro-basilar thrombosis which was blocking the left vertebral artery, and a stenosis of right vertebral artery. The patient underwent emergency arterial embolectomy; subsequently he was treated with antiplatelet therapy and supportive therapy in an intensive care unit and later in a general ward. After 27 days, the patient’s physical function gradually improved. At discharge, he still had a neurological deficit with muscle strength grade 3/5 and hyperreflexia of the limbs.

The authors concluded that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to CSM have pre-existing craniocervical artery dissection.

Informed consent is an ethical imperative with any treatment. There is good evidence to suggest that few clinicians using CSM obtain informed consent from their patients before starting their treatment. This is undoubtedly a serious violation of medical ethics.

So, why do they not obtain informed consent?

To answer this question, we need to consider what informed consent would mean. It would mean, I think, conveying the following points to the patient in a way that he or she can understand them:

  1. the treatment I am suggesting can, in rare cases, cause very serious problems,
  2. there is little good evidence to suggest that it will ease your condition,
  3. there are other therapies that might be more effective.

Who would give his or her consent after receiving such information?

I suspect it would be very few patients indeed!

AND THAT’S THE REASON, I FEAR, WHY MANY CLINICIANS USING CSM PREFER TO BEHAVE UNETHICALLY AND FORGET ABOUT INFORMED CONSENT.

Non-validated diagnostic methods, like those in abundant use in alternative medicine, run an unacceptably high risk of producing false positive or false negative diagnoses. The former would be a diagnosis that the patient is, in fact, not suffering from; this enables the charlatan to get rich on treating something that is not even there. The latter would be missing an illness that might even kill the patient. Thus both scenarios are unquestionably harmful.

It is now 21 years ago that I published a review of alternative diagnostic techniques entitled ‘WHICH CRAFT IS WITCHCRAFT?’. Here is the abstract:

The prevalence of complementary medicine in most industrialised countries is impressive and increasing. Discussions of the topic often focus on therapeutic approaches and neglect diagnostic methods specific for complementary medicine. The paper summarises the data available on such “alternative” diagnostics. Scientific evaluations of these are scant, and most techniques have never been properly validated. The ones that have can be demonstrated to be not reproducible, sensitive, or specific. The ones that have not should be regarded as such until shown otherwise by rigorous testing. Therefore it seems that “alternative” diagnostic methods may seriously threaten the safety and health of patients submitted to them. Orthodox doctors should be aware of the problem and inform their patients accordingly.

Exactly 15 years after the publication of this paper, PRINCE CHARLES published his book ‘HARMONY‘ where is covers amongst many other topic also the subject of alternative diagnostics. This is what he tells us about them:

I have also learn from leading experts how we can understand a great deal about the causes of ill health through more traditional methods of diagnosis – for example, through examination of the iris, ears, tongue, feet and pulse, very much the basis of the Indian Ayurvedic system. This is not to say that modern diagnostic techniques do not have a role, but let us not forget what we can gain by using the knowledge and wisdom accumulated over thousands of years by pioneers who did not have access to today’s technology. In fact, an over-reliance can often mean that the subtle signs of imbalance revealed by the examination of the eyes, pulse and tongue are totally missed. Including the fruits of such knowledge, gleaned over 8 000 years of studying the relationship of the human body to the rest of Nature and to the Universe, can but only provide an extra, valuable resource to doctors as they seek to make a full diagnosis. Why persist in denying the immense value of such accumulated wisdom when it can tell us so much about the whole person – mind, body and spirit? Employing the best of the ancient and modern in a truly integrated way is another example of harmony and balance at work.

Charles is talking here about iridology, amongst other methods. Iridologists try to diagnose disease or susceptibility to disease by analysing the colour pattern of a patient’s iris. It happens to be a technique that has repeatedly been put to the test. In 1999, I published a systematic review of the evidence and concluded that the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.

Given that the evidence for alternative diagnostic techniques is either negative or absent, why does the heir to the throne advocate using them? Does he not know that he has considerable influence and endangers the health of those who believe him? Why does he call this nonsense valuable? The answer probably is that he does not know better.

There is nothing wrong with Charles’ ignorance, of course. He is not a medic (if he were, his quackery might get him struck off the register!) and does not need to know such things! But, if he is ignorant about certain technicalities, should he write about them? At the very least, when giving such concrete medical advice about diagnostic methods, should he not recruit the expertise of people who do know about such matters?

In Charles’ defence, I should mention that apparently he did ask several physicians for help with his book. Two of those who he acknowledged in HARMONY have been mentioned on this blog before: Mosaraf Ali and Michael Dixon.

I MIGHT BE MISTAKEN, BUT IT SEEMS TO ME THAT CHARLES IS NOT JUST IGNORANT ABOUT MEDICINE BUT ALSO ABOUT THE ART OF CHOOSING EXPERTS.

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