risk
Norbert Hofer is the former leader of the Austrian right-wing FPÖ party who almost became Austria’s President. Currently, he is the 3rd member of the National Council. Hofer is a man full of surprises; he stated, for instance, that the Quran was more dangerous than COVID-19 during a speech held at a 2020 campaign event. As a result, he was sued for hate-speech.
Hofer’s latest coup is not political but commercial: Hofer is launching his own dietary supplement on the market. It is called “Formula Fortuna” and contains:
- L-tryptophan; a Cochrane review concluded that “a large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5‐HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia‐Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5‐HTP and tryptophan is limited at present.”
- Hydroxypropylmethylcellulose, a common delivery system.
- Rhodiola rosea extracts; human studies evaluating R. rosea did not have sufficient quality to determine whether it has properties affecting fatigue or any other condition.The U.S. Food and Drug Administration (FDA) has issued warning letters to manufacturers of R. rosea dietary supplement products unapproved as new drugs, adulterated, misbranded and in federal violation for not having proof of safety or efficacy for the advertised conditions of alleviating Raynaud syndrome, altitude sickness, depression or cancer.
- Ginseng root extract. Although ginseng has been used in traditional medicine for centuries, modern research is inconclusive about its biological effects. Preliminary clinical research indicates possible effects on memory, fatigue, menopause symptoms, and insulin response in people with mild diabetes. Out of 44 studies examined between 2005–2015, 29 showed positive, limited evidence, and 15 showed no effects. As of 2021, there is insufficient evidence to indicate that ginseng has any health effects. A 2021 review indicated that ginseng had “only trivial effects on erectile function or satisfaction with intercourse compared to placebo”. The constituents include steroid saponins known as ginsenosides, but the effects of these ginseng compounds have not been studied with high-quality clinical research as of 2021, and therefore remain unknown. As of 2019, the United States FDA and Federal Trade Commission have issued numerous warning letters to manufacturers of ginseng dietary supplements for making false claims of health or anti-disease benefits, stating that the “products are not generally recognized as safe and effective for the referenced uses” and are illegal as unauthorized “new drugs” under federal law. Concerns exist when ginseng is used chronically, potentially causing side effects such as headaches, insomnia, and digestive problems. Ginseng may have adverse effects when used with the blood thinner warfarin. Ginseng also has adverse drug reactions with phenelzine, and a potential interaction has been reported with imatinib, resulting in hepatotoxicity, and with lamotrigine. Other side effects may include anxiety, insomnia, fluctuations in blood pressure, breast pain, vaginal bleeding, nausea, or diarrhea.
- Zinc gluconate which has been used in lozenges for treating the common cold. However, controlled trials with lozenges which include zinc acetate have found it has the greatest effect on the duration of coldsInstances of anosmia (loss of smell) have been reported with intranasal use of some products containing zinc gluconate. In September 2003, Zicam faced lawsuits from users who claimed that the product, a nasal gel containing zinc gluconate and several inactive ingredients, negatively affected their sense of smell and sometimes taste. Some plaintiffs alleged experiencing a strong and very painful burning sensation when they used the product. Matrixx Initiatives, Inc., the maker of Zicam, responded that only a small number of people had experienced problems and that anosmia can be caused by the common cold itself. In January 2006, 340 lawsuits were settled for $12 million.
- Pyridoxine hydrochloride (vitamin B6) is usually well tolerated, though overdose toxicity is possible. Occasionally side effects include headache, numbness, and sleepiness. Pyridoxine overdose can cause a peripheral sensory neuropathy characterized by poor coordination, numbness, and decreased sensation to touch, temperature, and vibration.
‘Formula Fortuna’ allegedly is for lifting your mood. If I, however, tell you that you need to pay one Euro per day for the supplement, your mood might even change in the opposite direction.
What next?
I think I might design a dietary supplement against stupidity. It will not carry any of the risks of Hofer’s new invention but, I am afraid, it might be just as ineffective as Hofer’s ‘Formual Fortuna’.
Kratom (Mitragyna speciosa) belongs to the coffee family. It’s found in Southeast Asia and Africa. Traditionally, people have:
- Chewed kratom leaves.
- Made kratom tea to fight tiredness and improve productivity.
- Used kratom as medicine.
- Substituted kratom for opium.
- Used kratom during religious ceremonies.
Low doses of kratom can make you more alert, and higher doses can cause:
- Decreased pain.
- Pleasure.
- Sedation.
The mechanism of action seems to be that two of the compounds in kratom (mitragynine and 7-hydroxymitragynine) interact with opioid receptors in your brain.
Kratom is thus being promoted as a pain remedy that is safer than traditional opioids, an effective addiction withdrawal aid, and a pleasurable recreational tonic. But kratom is, in fact, a dangerous and unregulated drug that can be purchased on the Internet, a habit-forming substance that authorities say can result in opioid-like abuse and death.
The Food and Drug Administration (FDA) warned that kratom possesses the properties of an opioid, thus escalating the government’s effort to slow the usage of this alternative pain reliever. The FDA stated that the number of deaths associated with kratom use has increased. Now further concerns have emerged.
This review enumerates seven outbreaks of kratom (Mitragyna speciosa) product adulteration and contamination in the context of the United States Dietary Supplement Health and Education Act (DSHEA).
At least seven distinct episodes of kratom product contamination or adulteration are known:
- (1) krypton, a kratom product adulterated with O-desmethyltramadol that resulted in at least nine fatal poisonings;
- (2) a suspected case of kratom contamination with hydrocodone and morphine;
- (3) a case of kratom adulteration with phenylethylamine;
- (4) contamination of multiple kratom products with heavy metals;
- (5) contamination of kratom products by multiple Salmonella enterica serotypes;
- (6) exposure of federal agents raiding a synthetic cannabinoid laboratory to kratom alkaloids;
- (7) suspected kratom product adulteration with exogenous 7-hydroxymitragynine.
The authors concluded that inadequate supplement regulation contributed to multiple examples of kratom contamination and adulteration, illustrating the potential for future such episodes involving kratom and other herbal supplements.
Yes, this post is yet again about the harm chiropractors do.
No, I am not obsessed with the subject – I merely consider it to be important.
This is a case presentation of a 44-year-old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high-velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior.
The CT angiogram of the head and neck revealed bilateral vertebral artery dissection at the left V2 and right V3 segments. MRI brain confirmed an acute infarct in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus.
The authors discussed that arterial dissection accounts for about 2% of all ischemic strokes, but maybe between 8–25% in patients less than 45 years old. Vertebral artery dissection (VAD) can result from trauma from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing.
It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. Patients who have multiple chronic conditions are reporting higher use of so-called alternative medicine (SCAM), including chiropractic manipulation. Education about the association between VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, VAD symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.
Here we have a rare instance where the physicians who treated the chiro-victim were sufficiently motivated to present their findings and document them in the medical literature. Their report was published in 2021 as an abstract in conference proceedings. In other words, the report is not easy to find. Even though two years have passed, the full article does not seem to have emerged, and chances are that it will never be published.
The points I am trying to make are as follows:
- Complications after chiropractic manipulation do happen and are probably much more frequent than chiros want us to believe.
- They are only rarely reported in the medical literature because the busy clinicians who end up treating the victims do not consider this a priority and because many cases are settled in or out of court.
- Normally, it would be the ethical/moral duty of the chiros who have inflicted the damage to do the reporting.
- Yet, they seem too busy ripping off more patients by doing neck manipulations that do more harm than good.
- And then they complain that the evidence is insufficient!!!
I have featured the ‘Münster Circle‘ before. The reason why I do it again today is that we have just published a new Memorandum entitled HOMEOPATHY IN THE PHARMACY. Here is its summary which I translated into English:
Due to questionable regulations in German pharmaceutical law, homeopathic medicines can be given the status of a medicinal product without having to provide valid proof of efficacy. As medicinal products, these preparations may then only be dispensed to customers in pharmacies, which, however, creates an obligation to also supply them on request or prescription. Many pharmacies go far beyond this and advertise homeopathic medicines as a useful therapy option by advertising them prominently in the window. In addition, customers are recommended to use them, corresponding lecture events are supported, and much more. Often, homeopathic preparations are even produced according to pharmacies’ own formulations and marketed under their own name.
For pharmacists and pharmaceutical technical assistants (PTAs) to perform their important task in the proper supply of medicines to the population, they must have successfully completed a scientific study of pharmacy or state-regulated training. This is to ensure that customers are informed and properly advised about their medicines according to the current state of knowledge.
After successfully completing their training or studies, PTAs and pharmacists are undoubtedly able to recognize that homeopathic medicines cannot be effective beyond placebo. They do not have any significant content of active ingredients – if, for example, the high potencies that are considered to be particularly effective still have any active ingredients at all. Consequently, pharmacists and PTAs act against their better knowledge to the detriment of their customers if they create the impression through their actions that homeopathic medicines represent a sensible therapeutic option and customers are thereby encouraged to buy and use them.
Although homeopathics have no potential for direct harm in the absence of relevant amounts of pharmacologically active substances in the preparations, their distribution should nevertheless be viewed critically. The use of homeopathy can mean losing valuable time and delaying the start of effective therapy. It is often accompanied by criticism, even rejection of scientifically oriented medicine and public health, for example when homeopathy is presented as the antithesis to a threatening “pharmaceutical mafia”.
The Münster Circle appeals to pharmacists and PTAs to stop advertising homeopathic medicines as an effective therapeutic option, to stop producing and marketing them themselves, and to advise their customers that homeopathic preparations are not more effective than placebo. The professional organizations of pharmacists and other providers of further training are called upon to no longer offer courses on homeopathy – except for convincingly refuting the often abstruse claims of the supporters.
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I have pointed out for at least 20 years now that pharmacists have an ethical duty toward their clients. And this duty does not involve misleading them and selling them useless homeopathic remedies. On the contrary, it involves advising them on the basis of the best existing evidence.
When I started writing and talking about this, pharmacists seemed quite interested (or perhaps just amused?). They invited me to give lectures, I published an entire series of articles in the PJ, etc. Of late, they seem to be fed up with hearing this message and the invitations have well and truly stopped.
They may be frustrated with my message – but not as frustrated as I am with their inertia. In my view, it is nothing short of a scandal that homeopathic remedies and similarly bogus treatments still feature in pharmacies across the globe.
I came across an article that seems highly relevant to our recurring debates about the dangers of chiropractic. Since few of us might be readers of the Louisville Courier, I take the liberty of reproducing here a shortened version of it:
Amber Burgess, then 33, had never set foot in a chiropractor’s office when she went to Dr. Adam Fulkerson’s Heartland Family Chiropractic in Elizabethtown on May 18, 2020. In contrast, Becca Barlow, 31, had seen Dr. Leah Wright at Louisville Family Chiropractic 29 times for adjustments over three years when she went there on Jan. 7, 2019, seeking relief for “nursing mother’s neck.” Both say they will never see a chiropractor again. “That visit was my first – and last,” said Burgess, a former utility bucket-truck assembler.
In separate lawsuits, they claim they suffered strokes after chiropractic adjustments; Barlow, herself a nurse, said she realized she was having one before she even left the office and told Wright’s staff to call 911.
Citing studies on human cadavers and other research, chiropractors claim adjustments are physically incapable of causing tears to arteries that in turn cause strokes by blocking the flow of blood to the brain and other organs. In an opening statement in the trial of Barlow’s suit last March, attorney John Floyd Jr., counsel for Wright and the National Chiropractic Mutual Insurance Co., said no one has ever proved adjustments cause the tears – known as dissection – only that there is an “association” between them. “We associate the crowing of roosters with sunrise,” he told the jury. “But that doesn’t mean roosters cause the sun to come up.” Floyd also cited studies he said prove that when a patient strokes out immediately after adjustments, like Barlow, it is because they already were suffering from artery injuries when they sought treatment from their chiropractor.
Louisville attorney Brian Clare, who represents both Barlow and Burgess, previously settled two cases in Jefferson County, and has another suit pending in Warren Circuit Court. He said in an interview that “every time chiropractors perform adjustments on the neck they are playing with fire. They can go too far, too fast, turning the neck past therapeutic limits,” he said.
The jury in Barlow’s case emphatically rejected the chiropractic profession’s defenses. “We found those claims to be unbelievable,” said jury foreman Joseph Tucker, a lawyer, who noted Barlow had no symptoms before her adjustments. By a 9-3 vote, the jury awarded her $1,130,800, including $380,000 in medical expenses and $750,000 for pain and suffering.
Witnesses testified that Barlow fell off the table and vomited almost immediately after her adjustment, showing classic stroke symptoms, including vertigo, dizziness, numbness, and nausea. She lost consciousness, had to be intubated in an ambulance, then raced to Norton Brownsboro Hospital, where she underwent emergency surgery to restore the flow of blood to her arteries and save her life. Three of the four arteries in her neck had been dissected.
Burgess, in Elizabethtown, suffered a stroke in her spine that her expert, Dr. Louis Caplan, a neurology professor at Harvard University, said also was caused by her cervical manipulations. Caplan says he’s cared for more than 15,000 stroke patients over 45 years.
Fulkerson has denied liability; his lawyer, James Grohman, said he couldn’t comment because the case is pending; the trial is set for Aug. 28 in Hardin Circuit Court Caplan said in a report that Burgess’s stroke left her with partial but permanent paralysis in her arms and legs. She uses a wheelchair and walker with wheels to get around. She said she can’t work, can’t drive, and that while she can dress herself, it takes hours to get ready. She fears they will have to give up their plans to have a baby.
By any measure, strokes associated with adjustments are rare, although their incidence is disputed. The American Chiropractic Association says arteries are damaged in only one to three adjustments out of 100,000 But a 2001 report in the New England Journal of Medicine estimated dissections occur in 1 of 20,000 adjustments. And Dr. Alan Brafman, an Atlanta chiropractor, has said they occur more often than that. Brafman wrote that he’s consulted in 1,100 cases, including Barlow’s, and found in most of them, chiropractors were at fault, causing vascular damage that is “a tragic, life-altering situation for all parties involved.” Wright’s experts themselves divulged they had been retained in 200 cases, according to Clare, which he said suggests chiropractic-related strokes are more common than suspected. A survey at Stanford University in 2008 of 177 neurologists found 55 had patients who suffered strokes after seeing chiropractors, while a 2018 study in West Virginia found one in 48 chiropractors experienced such an event. Neurologists and other physicians point to a 2001 study in STROKE of 582 stroke patients that found they were five times more likely to have seen a chiropractor in the previous five days before their artery dissection than a control group without such injuries. The American Heart Association and other medical groups recommend that patients also be warned about the risks; Barlow said she never would have undergone her final manipulation if she had been informed.
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Yet again, I am impressed by the number of cases that go to court where a settlement of some sort is reached and further reporting of the incident is prevented. As a consequence, these cases are not published in the medical literature. In turn, this means that chiropractors can continue to claim that these complications do not exist or are exceedingly rare.
- The truth, however, is that NOBODY can provide accurate incidence figures.
- The truth is that, even if such complications were rare, they are devastating.
- The truth is that neck manipulations do not generate any or very little benefit.
- The truth is that their risk/benefit balance is not positive.
- The truth is that we, therefore, have an ethical duty to tell potential patients about it.
I feel that I cannot repeat my warning often enough:
AVOID CHIROPRACTORS.
THEY CAUSE MORE HARM THAN GOOD!
This happens with such a regularity that I have decided to write about it; in fact, I shall do that in the form of an ‘open letter‘ to all concerned.
Background
A person or group of persons compose a complaint about my work in which they allege that I am engaged in a decade-long vendetta specifically against their particular form of so-called alternative medicine (SCAM). This letter is sent to me, or to a publisher of my articles/books, or to my peers at the university, or to anyone else they consider appropriate. Such interventions can at times be quite entertaining or even hilariously funny, but if they occur too often, they are also mildly irritating and wasteful. Foremost, they are based on a fundamental misunderstanding that might be worth clearing up with this …
Open Letter
Dear advocate of the specific SCAM in question,
Dear professional organization of the specific SCAM in question,
I am sorry that my lecture/article/blog post/book/interview caused concern and led you to feel that I am running a long-term campaign or vendetta against the specific SCAM that you advocate. This letter is to assure you that your feeling is entirely erroneous: I am in no way targeting your specific SCAM.
If you have a look at my most recent book, for instance, you will see that, in it, I discuss a total of 202 different forms of SCAM and that – with good reason – I am highly critical of the vast majority of these methods. Imagine what it would mean to run a vendetta or campaign against all of these specific SCAMs. I would need a sizable team of co-workers involving lawyers, researchers, administrators, etc. to manage the task. I would also need plenty of funds to support the campaign, and I would most likely have more legal cases going than I have hair on my head.
The truth is that, since my retirement ~10 years ago, I do my research with no assistance whatsoever, I get no financial support or compensation for my work, and I am in contact with lawyers only when they ask me to serve as an expert witness. There simply is no evidence for the campaign that you feel does exist and you evidently misjudge my motives for criticizing your specific SCAM.
My aim is not to defame your specific SCAM or SCAM in general. I have no reason to do this. My aim is simply to inform the public responsibly and to prevent vulnerable people from getting harmed or ripped off. As I have studied the subject systematically for three decades, I feel I am competent, entitles, and duty-bound to try and do this.
I sincerely hope you are able to see the difference: you seem to think that I am destructively out to get you or your SCAM, while in truth I am constructively doing what responsible healthcare professionals (should) do.
Now that this misunderstanding has been cleared up, I thank you for reconsidering your position and stopping to claim things about me that are not true.
Best regards
Edzard Ernst
It has been reported that a young woman’s visit to a chiropractor left her unable to walk due to a torn artery.
Mariah Bond, 29, went to visit a chiropractor in the hope to get some relief from her neck pain. During the appointment, the chiropractor quickly twisted her neck from side to side. “It cracked both ways and I’d seen chiropractor videos so I thought it was normal but when I stood up I got super dizzy,” Mariah recalled. Next, Mariah started profusely vomiting and her hand began to tingle. Then she was rushed to a hospital.
It took a few hours before the doctors could find the diagnosis. “I was still throwing up constantly, it was non-stop. I couldn’t open my eyes because if I did I’d start throwing up because I was so dizzy,” Mariah said. “I was transferred via ambulance to another hospital where they did a CT scan and confirmed that I was having a stroke.”
It turned out that Mariah’s chiropractor dissected an artery in her neck which then limited the blood supply to the brain. Mariah was kept in the hospital for five days while her condition was monitored. During that time, she was left unable to walk. But slowly she did become able to rely on a zimmer frame to get around. “I couldn’t walk properly or correctly use my hands to eat, it was like I was a child. It was very weird. My brain was there but I couldn’t do it,” she stated. “My first stroke was a cerebral stroke and they were saying that I probably had a mini-stroke as I was having weird feelings in my legs. They were very confused because that wasn’t common with the stroke I had, so they said that I probably had two.”
Within a fortnight, Mariah was able to walk again but had to have physiotherapy for two months before she could return to work. After her last CT scan, she received the good news that the dissected vessel had completely healed. She said: “I was very strong-willed at the time because everyone was telling me how well I was handling this. I think my husband was more scared than I was, poor thing.”
Mariah has vowed never to visit a chiropractor again and is doing her best to raise awareness of the damage they can cause. “I was shocked because I’m so young and you don’t really hear about young people having strokes, especially from the chiropractor. I’m pretty paranoid with my neck now. I know I probably shouldn’t be but sometimes if I have a weird feeling in my head, it would probably be called PTSD, I automatically start thinking am I having a stroke? I start freaking out. I’d tell people not to go to a chiropractor. I’ve already told a million people not to do it. Just don’t go or at least don’t let them do your neck.”
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I would be surprised if this case ever got written up as a proper case report and published in a medical journal. We did a survey years ago where we found over 35 cases of severe complications after chiropractic in the UK within a period of 12 months. The most amazing result was that none of these cases had been published. In other words, under-reporting was precisely 100%.
Mariah’s case might be a true rarety, or it might be a fairly common event. It might be a most devastating occurrence, or there could be far worse events.
We simply do not know because under-reporting is huge.
Meanwhile, chiropractors – the professionals who should long have made sure that under-reporting becomes minimal or non-existent – claim that there is no evidence that strokes happen at all or regularly or often. They can do this because the medical literature seems to confirm their opinion. The only reporting system that seems to exist, the “chiropractic patient incident reporting and learning system” (CPiRLS), is for several reasons woefully inadequate and also plagued by under-reporting.
So, what advice can I possibly give to consumers in such a situation? I feel that the only thing one can recommend is to
stay well clear of chiropractors
until they finally present us with sufficient and convincing data.
Chiropractors are famous for being against COVID vaccinations and other protective measures. This recent case is an apt example.
It has been reported that the tribunal of Alberta’s regulatory body for chiropractors has ruled against Calgary chiropractor, Curtis Wall, for not wearing a mask during the pandemic. The College of Chiropractors of Alberta (CCA) sought to discipline Wall for not wearing a mask at his clinic, not observing two meters of social distancing while unmasked, not installing a plexiglass barrier in his reception area, and not requiring patients to be masked either, beginning around June 2020. In a statement issued Feb. 1, 2023, the CCA’s hearing tribunal wrote: “[T]he Hearing Tribunal has found Dr. Curtis Wall’s conduct does constitute ‘unprofessional conduct’ and their decision for penalty is forthcoming.”
Lawyer James Kitchen who represented Wall, railed against the ruling: “[T]he decision is riddled with errors of fact and law and is so poorly decided it is an embarrassment to the chiropractic profession. It is shocking the lengths the tribunal went to dismiss the evidence of Dr. Wall, three of his patients, and his four expert witnesses while blithely accepting all the evidence of the College…The decision is an egregious manifestation of pre-determined, results-oriented decision-making.”
In an interview, Kitchen said: “I set this whole case up knowing that the tribunal would likely do whatever the college and the college’s expert told him to do. I set the case up such that if the tribunal did that, they would have to make themselves look very foolish to do so. If I’m really putting my cynical hat on, I don’t know if there’s anything that surprises me, really. It should shock me the degree to which they twisted the evidence, left out the evidence. The only thing that surprises me a little bit is the lack of effort they put in to hide their bias.”
The communications manager of the CCA, Dana Myckan, commented: “Pursuant to the Health Professions Act, all Hearing Tribunal decisions are posted publicly on the CCA website. This is the extent of the information that the CCA can share on behalf of the Hearing Tribunal.”
The ruling noted that Wall initially wore a mask, but in June 2020, he “self-diagnosed as having an anxiety disorder. He believed that his self-diagnosis qualified him for a medical exemption from wearing a mask. As a result, he stopped wearing a mask when treating patients.” It added that Wall never contacted the college to let it know his condition or request an exemption, and said Wall’s son also worked at the clinic and did not wear a mask.
Kitchen said Wall could face a suspension of his practice but will appeal this ruling or any attempt to make him pay the CCA’s legal costs, which the college stated during the hearings were in excess of $200,000. Kitchen said a recent court precedent suggests the CCA will be unable to recoup costs in a ruling.
An appeal would be heard by the council of the college, which is the college’s governing body. It consists of five chiropractors elected by their peers along with five members of the public appointed by the government. Should Wall lose there, he could take his case to the Alberta Court of Appeal. Kitchen said Wall will go the distance. “I warned them that this is how I expected it to go. So he was prepared,” Kitchen said. “He’s still pretty dismayed that people could have this much evidence staring them in the face and just ignore it and follow the narrative. It’s hard for him. He’s an idealist. He’s really big on truth and people doing what’s right.”
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To all of this, I have but two questions:
- Is the CCA not also guilty of professional misconduct for calling Wall “Dr. Wall” without making it clear that he is not medically trained?
- If Wall is “big on truth”, how come he works as a chiropractor?
Homeopathic remedies are highly diluted formulations without proven clinical benefits, traditionally believed not to cause adverse events. Nonetheless, published literature reveals severe local and non-liver-related systemic side effects. This paper presents the first series on homeopathy-related severe drug-induced liver injury (DILI) from a single center.
A retrospective review of records from January 2019 to February 2022 identified 9 patients with liver injury attributed to homeopathic formulations. Competing causes were comprehensively excluded. Chemical analysis was performed on retrieved formulations using triple quadrupole gas chromatography-mass spectrometry and inductively coupled plasma atomic emission spectroscopy.
Males predominated with a median age of 54 years. The most typical clinical presentation was acute hepatitis, followed by acute on chronic liver failure. All patients developed jaundice, and ascites were notable in one-third of the patients. Five patients had underlying chronic liver disease. COVID-19 prevention was the most common indication for homeopathic use. Probable DILI was seen in 77.8%, and hepatocellular injury predominated (66.7%). Four (44.4%) patients died (3 with chronic liver disease) at a median follow-up of 194 days. Liver histopathology showed necrosis, portal and lobular neutrophilic inflammation, and eosinophilic infiltration with cholestasis. A total of 29 remedies were consumed between 9 patients, and 15 formulations were analyzed. Toxicology revealed industrial solvents, corticosteroids, antibiotics, sedatives, synthetic opioids, heavy metals, and toxic phyto-compounds, even in ‘supposed’ ultra-dilute formulations.
The authors concluded that homeopathic remedies potentially result in severe liver injury, leading to death in those with underlying liver disease. The use of mother tinctures, insufficient dilution, poor manufacturing practices, adulteration and contamination, and the presence of direct hepatotoxic herbals were the reasons for toxicity. Physicians, the public, and patients must realize that Homeopathic drugs are not ‘gentle placebos.’
Over a decade ago, we published a systematic review entitled “Adverse effects of homeopathy: a systematic review of published case reports and case series”:
Aim: The aim of this systematic review was to critically evaluate the evidence regarding the adverse effects (AEs) of homeopathy.
Method: Five electronic databases were searched to identify all relevant case reports and case series.
Results: In total, 38 primary reports met our inclusion criteria. Of those, 30 pertained to direct AEs of homeopathic remedies; and eight were related to AEs caused by the substitution of conventional medicine with homeopathy. The total number of patients who experienced AEs of homeopathy amounted to 1159. Overall, AEs ranged from mild-to-severe and included four fatalities. The most common AEs were allergic reactions and intoxications. Rhus toxidendron was the most frequently implicated homeopathic remedy.
Conclusion: Homeopathy has the potential to harm patients and consumers in both direct and indirect ways. Clinicians should be aware of its risks and advise their patients accordingly.
It caused an outcry from fans of homeopathy who claimed that one cannot insist that homeopathic remedies are ineffective because they contain no active ingredient, while also arguing that they cause severe adverse effects. In a way, they were correct: homeopathic remedies are useless even at causing adverse effects. But this applies only to remedies that are manufactured correctly and that are highly dilute. The trouble is that quality control in homeopathy often seems to be less than adequate. And this is how adverse effects can happen!
The new article from India is an important addition to the literature providing more valuable information about the risks of homeopathy. Its authors were able to do chemical analyses of some of the remedies and could thus show what the reasons for the liver injuries were. The article provides an essential caution for those who delude themselves by assuming that homeopathy is harmless. In fact, the remedies can cause severe problems. But, as we have discussed regularly on this blog, the far greater risk in homeopathy is not the remedy but the homeopath and his/her all too often incompetent advice to patients.
Wellness seems to be everywhere these days – I mean of course the term, not the state or condition. On Medline, we find in excess of 500 000 articles on wellness, just for the year 2022! Wellness is en vogue, sexy, politically correct, etc. It looks good to talk and write about it. Most importantly it is good business. A report by the Global Wellness Institute stated that in 2020 the wellness industry was valued at $4.5 trillion and continues to grow at a frightening rate.
Having studied some of the recent literature on the subject, I get the impression that, for many, wellness is foremost an excuse for waffling utter nonsense. Let me, therefore, today ask just 5 simple questions about wellness that are likely to reduce the wellness of the ‘wellness brigade’:
1.What is wellness?
It is quite evidently a sector that is unable to define itself. Here are just a few of the definitions that have been suggested. Wellness is:
- the active pursuit of activities, choices and lifestyles that lead to a state of holistic health
- the result of personal initiative, seeking a more optimal, holistic and balanced state of health and well-being across multiple dimensions
- an active process of becoming aware of and making choices towards a healthy and fulfilling life
- the state of being in good health, especially as an actively pursued goal
- a state beyond absence of illness but rather aims to optimize well-being
- the act of practicing healthy habits on a daily basis to attain better physical and mental health outcomes
- an active process through which people become aware of, and make choices toward, a more successful existence
- the optimal state of health of individuals and groups
A 2018 review revealed that there is a lack of a uniform definition of wellness and showed that there is insufficient evidence to support the clinical utility of a single particular wellness instrument.
2. How do we measure wellness?
The short answer to this question is: nobody is quite sure. There simply is no generally accepted, well-validated measure. A few domains come to mind:
- physical functioning,
- somatic symptoms, e.g. pain,
- psychological symptoms,
- social functioning,
- needs and satisfaction.
But there is no simple means to quantify wellness. If you think that I am exaggerating, consider this recent review: 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.
3. What affects wellness?
The short answer is: potentially everything. My very own wellness, for instance, deteriorates sharply, if I have to read yet another nonsensical article about it.
4. Which interventions improve wellness?
As we have seen in my previous post, this is where so-called alternative medicine (SCAM) comes in. Since there is no measure to quantify wellness, we just have to take the word of SCAM proponents for it: SCAM improves wellness!!!
It’s obvious!
Which specific SCAM?
Can I see the evidence?
Sorry, no questions allowed!
And if you dare to insist on evidence, the ‘wellness brigade’ would just give you a pitiful smile and say: wellness has to be experienced, not measured.
5. Are there risks?
Yes, of course! Here are just some of them:
- The treatments advocated for wellness almost invariably cost money.
- The treatments advocated for wellness almost invariably cause direct and indirect harm, as discussed in many of my previous posts.
- Wellness treatments tend to give the impression that one can buy wellness like an expensive piece of clothing without putting in any real effort oneself.
Considering all this, I’d like to offer my very own definition of the sector:
Wellness is a fashionable paradise for charlatans in which they are protected from scientific scrutiny and feel at liberty to bullshit to their hearts’ content.
