risk
This systematic review aimed to investigate the effectiveness of cupping therapy on low back pain (LBP). Medline, Embase, Scopus and WANFANG databases were searched for relevant cupping RCTs on low back pain articles up to 2023. A complementary search was manually made on 27 September for update screening. Full-text English and Chinese articles on all ethnic adults with LBP of cupping management were included. Studies looking at acute low back pain only were excluded. Two independent reviewers screened and extracted data, with any disagreement resolved through consensus by a third reviewer. The methodological quality of the included studies was evaluated independently by two reviewers using an adapted tool. Change-from-baseline outcomes were treated as continuous variables and calculated according to the Cochrane Handbook. Data were extracted and pooled into the meta-analysis by Review Manager software (version 5.4, Nordic Cochrane Centre).
Eleven trials involving 921 participants were included. Five studies were assessed as being at low risk of bias, and six studies were of acceptable quality. The findings reveal:
- High-quality evidence demonstrated cupping significantly improves pain at 2-8 weeks endpoint intervention (d=1.09, 95% CI: [0.35-1.83], p=0.004).
- There was no continuous pain improvement observed at one month (d=0.11, 95% CI: [-1.02-1.23], p=0.85) and 3-6 months (d=0.39, 95% CI: [-0.09-0.87], p=0.11).
- Dry cupping did not improve pain (d=1.06, 95% CI: [-0.34, 2.45], p=0.14) compared with wet cupping (d=1.5, 95% CI: [0.39-2.6], p=0.008) at the endpoint intervention.
- There was no evidence indicating the association between pain reduction and different types of cupping (p=0.2).
- Moderate- to low-quality evidence showed that cupping did not reduce chronic low back pain (d=0.74, 95% CI: [-0.67-2.15], p=0.30) and non-specific chronic low back pain (d=0.27, 95% CI: [-1.69-2.24], p=0.78) at the endpoint intervention.
- Cupping on acupoints showed a significant improvement in pain (d=1.29, 95% CI: [0.63-1.94], p<0.01) compared with the lower back area (d=0.35, 95% CI: [-0.29-0.99], p=0.29).
- A potential association between pain reduction and different cupping locations (p=0.05) was found.
- Meta-analysis showed a significant effect on pain improvement compared to medication therapy (n=8; d=1.8 [95% CI: 1.22 – 2.39], p<0.001) and usual care (n=5; d=1.07 [95% CI: 0.21- 1.93], p=0.01).
- Two studies demonstrated that cupping significantly mediated sensory and emotional pain immediately, after 24 hours, and 2 weeks post-intervention (d= 5.49, 95% CI [4.13-6.84], p<0.001).
- Moderate evidence suggested that cupping improved disability at the 1-6 months follow-up (d=0.67, 95% CI: [0.06-1.28], p=0.03).
- There was no immediate effect observed at the 2-8 weeks endpoint (d=0.40, 95% CI: [-0.51-1.30], p=0.39).
- A high degree of heterogeneity was noted in the subgroup analysis (I2 >50%).
The authors concluded that high- to moderate-quality evidence indicates that cupping significantly improves pain and disability. The effectiveness of cupping for LBP varies based on treatment durations, cupping types, treatment locations, and LBP classifications. Cupping demonstrated a superior and sustained effect on pain reduction compared with medication and usual care. The notable heterogeneity among studies raises concerns about the certainty of these findings. Further research should be designed with a standardized cupping manipulation that specifies treatment sessions, frequency, cupping types, and treatment locations. The real therapeutic effects of cupping could be confirmed using a sham device or objective outcome measurements. Studies with at least six- to twelve-month follow-ups are needed to investigate the long-term efficacy of cupping in managing LBP.
Confused?
No need, it’s really quite simple: cupping can, according to this review, be shown to have some short-lasting effect, provided the study is flawed and does not control for placebo effects.
Surprised?
No need! There is hardly a form of so-called alternative medicine (SCAM) that does not have a similarly small effect of back pain, if tested in equally dodgy studies. This is particularly true for those treatments that can act as a theatrical placebo, e.g. acupuncture or chiropractic.
So, should a back pain sufferer try cupping?
If he/she insists, why not? But please don’t use wet cupping (which can do quite a bit of harm). Dry cupping (without injuring the skin) is arguably better (less risk, less expense, possibility of home treatment by your partner) than chiropractic, osteopathy, acupuncture, or many other SCAMs.
My conclusions – as mentioned many times previously – are as follows:
- Most SCAMs help a little with back pain (and similar conditions) because they can have a powerful placebo effect.
- Conventional medicine is also not convincingly effective for back pain.
- If you insist on SCAM, it is best to use one that is relatively harmless and inexpensive.
Representatives of six Australian professional organizations of so-called alternative medicine (SCAM) developed a survey for e-mail distribution to members. The anonymous online Qualtrics survey was based on previous surveys to identify workforce trends over time. Survey data were analyzed descriptively using Qualtrics and STATA statistical software.
Responses were recorded from 1921 participants. Respondents were predominantly female (79.7%); 71.8% were aged over 45 years. Remedial massage therapists represented 32.1% and naturopaths represented 23.7% of respondents. Highest qualifications were diplomas (37.7%), bachelor’s degrees (28.9%), and advanced diplomas (21.8%). Metropolitan locations accounted for 68.1% of practices. Solo private practice was the main practice setting (59.8%); 13.8% practiced in group private practice with SCAM practitioners; and 10.6% practiced with allied health practitioners. Approximately three quarters of respondents (73.9%) saw 0–5 new clients per week; 42.2% had 0–5 follow-up consultations per week. Collaboration rates with SCAM practitioners, other non-SCAM practitioners, and general medical practitioners (GPs) were 68.7%, 24.4%, and 9.2%, respectively. A total of 93% did not suspect an adverse event from their treatment in the past year. Businesses of 75.9% of respondents were reportedly affected by the pandemic.
The authors concluded that comparisons with previous surveys show ongoing predominance of female practitioners, an aging workforce, a high proportion of remedial massage and naturopathy practitioners, and an increasingly qualified SCAM workforce. There was little change in the very low number of adverse events suspected by practitioners, number of consultations per week, and low levels of income of most SCAM practitioners compared with the average income in Australia. Respondents collaborated at similar rates as in the past; however, more with SCAM practitioners than with GPs.
Yet another fairly useless SCAM survey to add to the endless list of similarly wasteful investigations!
If I had to extract anything potentially relevant from it, it would be just three points:
- The authors speak of an ‘increasingly qualified workforce’. The basis for this claim is that the highest qualifications were diplomas (37.7%), bachelor’s degrees (28.9%), and advanced diplomas (21.8%). Oh dear, oh dear! Anyone can issue ‘diplomas’ which are not recognised qualifications. In other words, the SCAM workforce is woefully underqualified to take charge of patients.
- Only 9% of SCAM practitioners ‘collaborated’ with GPs. By collaboration, the authors mean the very minimum of informing the GPs what type of SCAM they might be getting. Such information can be essential for avoiding harm (e.g. interactions with prescribed drugs). In other words, even the minimum of ethical and safe practice is not met in 91% of the cases.
- The fact that a total of 93% SCAM practitioners did not suspect a single adverse event from their treatment in the past year is extraordinary. It does, I fear, not demonstrate thaat SCAM id safe but that SCAM practitioners are totally oblivious to the possibility of adverse effects. In other words, they don’t inquire about adverse effects and thus don’t notice any.
Yes, these are data from Australia, and one could argue that elsewhere the situation is different. But different does not necessarily mean better. Until I see convincing evidence, I am not optimistic about the clinical practice of SCAM. Altogether, these findings do not convince me that SCAM practitioners should be let anywhere near a person who needs medical attention.
Since the introduction of their new Education Standards in March 2023, the General Chiropractic Council (GCC) has been working with chiropractic education providers to support them in implementing the changes to their curricula. Recently, the GCC have stated this:
We expect students to be taught evidence-based practice: integrating individual clinical expertise, the best available evidence from current and credible clinical research, and the values and preferences of patients. Chiropractors are important members of a patient’s healthcare team, and interprofessional approaches enable the best outcomes. Programmes that meet these Standards will teach ethical, professional care and produce competent healthcare professionals who can serve the needs of patients.
These are indeed most encouraging words!
Basically, they are saying that chiropractic education will now have to be solidly based on the principles of evidence-based medicine (EBM) as well as sound medical ethics. Let me spell out what this really means. Chiropractic courses must teach that:
- The current and credible clinical evidence suggesting that spinal manipulations, the hallmark intervention of chiropractors, are effective is weak for back pain and negative or absent for all other conditions.
- The current and credible clinical evidence suggests that spinal manipulations, the hallmark intervention of chiropractors, can cause harm which in many instances is serious.
- The current and credible clinical evidence thus suggests that the risk/benefit balance for spinal manipulations, the hallmark intervention of chiropractors, is not positive.
- Medical ethics require that competent healthcare professionals inform their patients that spinal manipulations, the hallmark intervention of chiropractors, may not generate more good than harm which is the reason why they cannot employ these therapies.
So, the end of chiropractic in the UK is looming!
Unless, of course, the GCC’s words are not really meant to be translated into action. They could be just window dressing and politically correct bullshit. But that’ s really far too far fetched – after all they come from the GENERAL CHIROPRACTIC COUNCIL, known for its excellent track record, e.g.:
- The GCC “seems to be a little self-regulatory chiropractic bubble where chiropractors regulate chiropractors.”
- A 5-year strategy for UK chiropractors: not fit for purpose
- Chiro behaving badly… is the GCC fit for purpose?
- The UK General Chiropractic Council: fit for purpose?
- Farcical Chiropractic Council: Chiropractic Patient Satisfaction and Experience
- The General Chiropractic Council “regulates chiropractors to ensure the safety of patients” … well, you could have fooled me!
- Death of a chiropractic patient prompts a reaction by the UK General Chiropractic Council
In total, 404 respondents completed the survey, of which 254 (62.9%) treated cancer patients. Most practitioners were acupuncturists and herbalists (57.1%), had (16.8 ± 9.9) years of clinical experience and see a median of 2 (1, 4) cancer patients per week. Breast cancer (61.8%) is the most common cancer type seen in SCAM clinics. Adjunctive SCAM treatments are frequently concurrent with the patient’s cancer specific treatment (39.9%), which is also reflected by the main goal of a SCAM treatment to alleviate side effects (52.4%). However, only 28.0% of the respondents are in contact with the treating oncologist. According to the respondents, pain is most effectively treated using acupuncture, while herbal medicine is best for cancer-related fatigue. SCAM practitioners mostly use certified courses (33.1%) or online databases (28.3%) but often believe that experts are more reliable to inform their practice (37.0%) than research publications (32.7%).
The authors concluded that acupuncturists and herbalists commonly treat cancer patients. Most practitioners use SCAM as an adjunct to biomedicine as supportive care and use it largely in accordance with current oncological guidelines.
You would think that the combined expertise of these institutions are capable of producing a decent survey:
- Palliative Care Unit, Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
- Northern College of Acupuncture, York YO1 6LJ, United Kingdom
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, United Kingdom
- National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Penrith NSW 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith NSW 2751, Australia
- Medical Research Institute of New Zealand, Wellington 6021, New Zealand
- Translational Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
Well, you would have been mistaken! This surely is one of the worst investigations I have seen for a while. Here are just three reasons why:
- The researchers designed an anonymous self-completion questionnaire collecting data about the participating practitioners’ demographics and clinical practice of integrative oncology. Someone should tell them that one ought to validate questionnairs before using them and that validated questionnairs exist. Unvalidated questionnairs cannot tell us much of value.
- The researchers invited SCAM practitioners in Austria, Germany, USA, Australia, and New Zealand to participate in this study. Invitations were distributed through social media and emails between October 2022 and December 2022 by professional organizations. Someone should tell them that research needs to be reproducible and surveys need to cover a representative population – both criteria that are not met here.
- The survey participants had to hold a valid license to perform acupuncture, herbal medicine, or both. That excludes all other SCAM practitioners.
Despite these serious flaws, the survey shows two findings that might be worth mentioning:
- only 28.0% of the SCAM practitioners were in contact with the treating oncologist;
- SCAM practitioners believe that “experts” are more reliable to inform their practice than research publications.
For me, these two points alone would be sufficient reason to run a mile!
The risks of chiropractic spinal manipulations (CSMs) feature regularly on my blog, not least because most chiropractors are in denial of this important issue and insist that chiropractic spinal manipulations are safe!!!. I therefore thought it might be a good idea to try and summarize the arguments they often put forward in promoting their dangerously fallacious and quasi-religious belief that CSMs are safe:
- There is not evidence to suggest that CSMs do harm. Such a statement is based on wishful thinking and ignorance motivated by the need of making a living. The evidence shows a different picture.
- There are hundreds of clinical trials that demonstrate the safety of CSMs. This argument is utterly unconvincing for at least two reasons: firstly clinical trials are far too small for identifying rare (but serious) complications; secondly, we know that clinical trials of CSM very often fail to report adverse events.
- Case reports of adverse effects are mere anecdotes and thus not reliable evidence. As there is no post-marketing surveillance system of adverse events after CSMs, case reports are, in fact, the most important and informative source of information we currently have on this subject.
- Case reports of harm by CSMs are invariably incomplete and of poor quality. Case reports are usually published by doctors who often have to rely on incomplete information. It would be up to chiropractors to publish case reports with the full details; yet chiropractors hardly ever do this.
- Case reports cannot establish cause and effect. True, but they do provide important signals which then should be investigated further. It would be up to chiropractors to do this; sadly, this is not what is happening.
- Adverse effects such as arterial dissections or strokes occur spontaneaously. True, but many have an identifiable cause, and it is our duty to find it.
- The forces applied during CSM are small and cannot cause an injury. This might be true under ideal conditions, but in clinical practice the conditions are often not ideal.
- If an arterial dissection occurs nevertheless, it is because there was a pre-existing injury. This argument is largely based on wishful thinking. Even if it were true, it would be foolish to aggravate a pre-existing injury by CSMs.
- Injuries happen only if the contra-indications of CSMs are ignored. This obviously begs the question: what are the contra-indications and how well established are they? The answer is that they are largely based on guess-work and not on systematic research. Thus chiropractors are able to claim that, once an adverse effects has occurred, the incident was due to a disregard of contra-indication and not due to the inherent risks of CSM.
- Only poorly trained chiropractors cause harm. This is evidently untrue, yet the argument provides yet another welcome escape route for those defending CSMs: if something went wrong, it must have been due to the practitioner and not the intervention!
- Chiropractors are an easy target. In my fairly extensive experience in this field, the opposite is true. Chiropractors tend to have multiple excuses and escape routes. As a consequence, they are difficult to pin down.
- Other causes, e.g. car accidents, are much more common causes of vascular injuries. Even if this were true, it does certainly not mean that CSM can be ruled out as the cause of serious harm.
- Patients who experience harm had pre-existing issues. Again, this notion is mostly based on wishful thinking and not based on sound evidence. Yet, it clearly is another popular escape route for chiropractors. And again, it is irresponsible to administer CSM if there is the possibility that pre-existing issues are present.
- The alleged harms of CSMs are merely an obsession for people who don’t really understand chiropractic. That is an old trick of someone trying to defend the indefensible. Chiropractors like to pompously claim that opponents are ignorant and only chiropractors understand the subject area. They use arrogance in an attempt to intimidate or scilence experts who disagree with them.
- Chiropractors do so much more than just CSN. True. They have ‘borrowed’ many modalities from physiotherapy and, by pointing that out, they aim at distracting from the dangers of CSMs. Yet, it is also true that practically every patient who consults a chiropractor will receive a CSM.
- Doctors are just jealous of the success of chiropractors. This fallacy is used when chiropractors run out of proper arguments. Rather than addressing the problem, they try to distract from it by claiming the opponent has ulterior motives.
- Medical treatments cause much more harm than CSM. Chiropractors are keen to mislead us into believing that NSAIDs, for instance, are much more dangerous than CSMs. The notion is largely based on one lousy article and thus not convincing. Even if it were true, it would obviously be no reason to ignore the risks of CSNs.
I am sure my list is far from complete. If you can think of further (pseudo-) arguments, please use the comments section below to let us know.
Yes, it’s the season for the ‘1o best/most/etc.’ and I don’t want to be left behind, of course. Let me therefore present to you the most noteworthy so-called alternative medicines (SCAMs) and related subjects that we discussed here in 2023.
- British politician punished for calling COVID-vaccination the “biggest crime against humanity since the holocaust” Thursday 12 January 2023, 98 Replies
- Quackademia galore: An Oxford ‘university’ starts a course in ‘veterinary chiropractic’
Tuesday 24 January 2023, 9 Replies - The ‘Lightning Process’ (LP), an effective therapy for ME? Thursday 30 March 2023, 12 Replies
- Homeopathy for cancer? Unsurprisingly, the evidence is not positive. Saturday 22 April 2023, 50 Replies
- Guess who is the new ‘HEAD OF THE ROYAL MEDICAL HOUSEHOLD’ Monday 08 May 2023, 14 Replies
- Classical homeopathy worsens the prognosis of patients infected with COVID-19. Wednesday 14 June 2023, 11 Replies
- Novak Djokovic made tennis history – doped by the ‘TAOPATCH’ device he had glued to his chest?? Monday 19 June 2023, 12 Replies
- Our struggle to publish criticism of a questionable homeopathy paper Saturday 08 July 2023, 11 Replies
- King Charles: reflexology to help women getting pregnant? Wednesday 26 July 2023, 4 Replies
- REVISITED: Australia’s National Health and Medical Research Council’s review of homeopathy Tuesday 08 August 2023, 36 Replies
- The spiritual healers who sexually harass, molest, and rape female patients Friday 11 August 2023, 7 Replies
- Pediatric care by chiropractors borders on child abuse Friday 08 September 2023, 11 Replies
- Homeopathic remedies are placebos, and the positive effects some patients experience are not due to the remedy Monday 11 September 2023, 3 Replies
- Camel urine as a treatment for cancer patients? Friday 22 September 2023, 5 Replies
- ‘Blood Electrification’: A little-known panacea – no, I am kidding, of course! Thursday 28 September 2023, 4 Replies
- Selling bleach as ‘miracle’ cure (MMS): Father and three sons are going to prison Tuesday 10 October 2023, 1 Reply
- A TCM mixture improves the prognosis of heart attacks? If it sounds too good to be true, it probably is! Sunday 29 October 2023
- Bioenergy therapies for cancer: implausible, ineffective, and an unethical waste of money
Sunday 12 November 2023, 3 Replies - The current recommendations for acupuncture by NICE Wednesday 22 November 2023, 4 Replies
- The new WHO guideline for the management of chronic low back pain. Focus: spinal manipulation Wednesday 27 December 2023, 8 Replies
Originally, I had aimed at finding the 10 most remarkable posts. As you see, I failed and listed (in chronological order a total of 20) – sorry!
Having posted well over 300 articles in 2023, I was simply unable to boil it down to just 10.
Perhaps you can help?
Please nominate your favourites.
The story about Thomas Rau made me once again look into the plethora of hair-raising nonsense that is being claimed on social media and elsewhere about live-blood analysis (LBA). LBA is a form of ‘dark field microscopy where the sample is illuminated with light that will not be collected by the objective lens and thus will not form part of the image. This generates the appearance of a dark background with bright objects on it. LBA is employed as a diagnostic method used by many practitioners of so-called alternative medicine (SCAM). The procedure is faily simple:
- a drop of blood is taken usually by a finger prick,
- it is then put on a glass plate without anticoagulation,
- the glass plate id placed on a darkfield microscope,
- the blood cells (mostly erythrocytes) are oberved,
- the SCAM practitioner can make patients watch their own blood cells on a TV screen while they are listening to his/her interpretation of the phenomena on display.
LBA is quick and simple – provided you have a dark field microscope – looks very ‘cutting edge’ to a lay person, and commands impressive fees. For all of these reasons, it is popular in the realm of SCAM.
The claims that are being made for LBA are varied and far-reaching, e.g.:
- LBA can allegedly find pleomorphic bacteria in the blood of healthy and diseased humans.
- LBA can allegedly be used to evaluate immune system status.
- LBA can allegedly diagnose diseases or predispositions to diseases such as allergies and chronic diseases, including cancer, cardiovascular disease, immunity-related disorders and many more.
LBA has a long and colorful history, e.g.:
- In the early 1900’s, Béchamp claimed that animal body fluids contained subcellular living particles (i.e., microzymas) that transformed into bacteria upon death and decay of the host (Béchamp, A. The Blood and its Third Anatomical Element. (John Ouseley Ltd, 1912)).
- Enderlein described small entities called endobionts and protits in human blood and believed that these particles underwent a complex life cycle that correlated with disease progression ( Enderlein, G. Bacteria Cyclogeny. (Verlag Walter de Gruyter, 1925)).
- In the 1950’s, Villequez proposed that human blood was infected by a latent parasite similar to bacterial L-forms.
- In the 1960/70s, Tedeschi and Pease reported that the blood of healthy and diseased individuals appeared to be continually infected with bacteria.
For a range of reasons, I am confident that LBA is hocuspocus. In the first 10 years of my career as a scientist, I was a researcher of ‘hemorhelology’, i.e. the flow properties of blood. One of the phenomena of interest in this field is that of red cell aggregation (RCA), the tendency of erythrocytes to reversibly aggregate when left still (i.e. in the absence of shear forces normally provided by the flow of blood). In the course of our research we even developed a method to quantify RCA.
Suffice to say that I think I understand the main phenomenon SCAM practitioners see when they look down their dark field microscope. They see red cells aligning in ‘rouleaux’ similar to stacks of coins. So far, so good! Where they go wrong is the interpretation of this phenomenon. It is the normal tendency of red cells to aggregate. It is not indicative of any of the conditions SCAM practitioners think it to be.
While RCA is well researched and understood, it’s re-branding under the banner of LBA has attracted almost no research at all (and this in itself should make us think: valid methods of diagnosis are invariably well-researched). The little research that did emerge fails to show that LBA is a valid diagnostic tool. Judge for yourself, here are the abstracts of the 3 recent papers on LBA that I managed to find:
BACKGROUND: Dark field microscopy according to Enderlin claims to be able to detect forthcoming or beginning cancer at an early stage through minute abnormalities in the blood. In Germany and the USA, this method is used by an increasing number of physicians and health practitioners (non-medically qualified complementary practitioners), because this easy test seems to give important information about patients’ health status.
OBJECTIVE: Can dark field microscopy reliably detect cancer?
MATERIALS AND METHODS: In the course of a prospective study on iridology, blood samples were drawn for dark field microscopy in 110 patients. A health practitioner with several years of training in the field carried out the examination without prior information about the patients.
RESULTS: Out of 12 patients with present tumor metastasis as confirmed by radiological methods (CT, MRI or ultra-sound) 3 were correctly identified. Analysis of sensitivity (0.25), specificity (0.64), positive (0.09) and negative (0.85) predictive values revealed unsatisfactory results.
CONCLUSION: Dark field micoroscopy does not seem to reliably detect the presence of cancer. Clinical use of the method can therefore not be recommended until future studies are conducted.
CONTEXT: In 1925, the German zoologist Günther Enderlein, PhD, published a concept of microbial life cycles. His observations of live blood using darkfield microscopy revealed structures and phenomena that had not yet been described. Although very little research has been conducted to explain the phenomena Dr. Enderlein observed, the diagnostic test is still used in complementary and alternative medicine.
OBJECTIVE: To test the interobserver reliability and test-retest reliability of 2 experienced darkfield specialists who had undergone comparable training in Enderlein blood analysis.
SETTING: Inpatient clinic for internal medicine and geriatrics.
METHODS: Both observers assessed 48 capillary blood samples from 24 patients with diabetes. The observers were mutually blind and assessed their findings according to a specific item randomization list that allowed observers to specify whether Enderlein structures were visible or not.
RESULTS: The interobserver reliability for the visibility of various structures was kappa = .35 (95% CI: .27-.43), the test-retest reliability was kappa = .44 (95% CI: .36-.53).
CONCLUSIONS: This pilot study indicates that Enderlein darkfield analysis is very difficult to standardize and that the reliability of the diagnostic test is low.
Although human blood is believed to be a sterile environment, recent studies suggest that pleomorphic bacteria exist in the blood of healthy humans. These studies have led to the development of “live-blood analysis,” a technique used by alternative medicine practitioners to diagnose various human conditions, including allergies, cancer, cardiovascular disease and septicemia. We show here that bacteria-like vesicles and refringent particles form in healthy human blood observed under dark-field microscopy. These structures gradually increase in number during incubation and show morphologies reminiscent of cells undergoing division. Based on lipid analysis and Western blotting, we show that the bacteria-like entities consist of membrane vesicles containing serum and exosome proteins, including albumin, fetuin-A, apolipoprotein-A1, alkaline phosphatase, TNFR1 and CD63. In contrast, the refringent particles represent protein aggregates that contain several blood proteins. 16S rDNA PCR analysis reveals the presence of bacterial DNA in incubated blood samples but also in negative controls, indicating that the amplified sequences represent contaminants. These results suggest that the bacteria-like vesicles and refringent particles observed in human blood represent non-living membrane vesicles and protein aggregates derived from blood. The phenomena observed during live-blood analysis are therefore consistent with time-dependent decay of cells and body fluids during incubation ex vivo.
So, what does all of this mean?
It means that LBA is not a valid diagnostic tool. Its use carries the serious danger of making false-positive and false-negative diagnoses. LBA has a poor reproducibility and is prone to all sorts of artefacts (including temperature, time, contaminants, method of obtaining the blood sample, etc.) that influence RCA. RCA is a normal and reversible phenomenon that determines the flow properties of blood in vivo. In itself, it is not a sign of any disease or disposition to fall ill.
In a nutshell:
LBA is an ideal tool for quacks to rip off their gullible clients.
The WHO has just released guidelines for non-surgical management of chronic primary low back pain (CPLBP). The guideline considers 37 types of interventions across five intervention classes. With the guidelines, WHO recommends non-surgical interventions to help people experiencing CPLBP. These interventions include:
- education programs that support knowledge and self-care strategies;
- exercise programs;
- some physical therapies, such as spinal manipulative therapy (SMT) and massage;
- psychological therapies, such as cognitive behavioural therapy; and
- medicines, such as non-steroidal anti-inflammatory medicines.
The guidelines also outline 14 interventions that are not recommended for most people in most contexts. These interventions should not be routinely offered, as WHO evaluation of the available evidence indicate that potential harms likely outweigh the benefits. WHO advises against interventions such as:
- lumbar braces, belts and/or supports;
- some physical therapies, such as traction;
- and some medicines, such as opioid pain killers, which can be associated with overdose and dependence.
As you probably guessed, I am particularly intrigued by the WHO’s positive recommendation for SMT. Here is what the guideline tells us about this specific topic:
Considering all adults, the guideline development group (GDG) judged overall net benefits [of spinal manipulation] across outcomes to range from trivial to moderate while, for older people the benefit was judged to be largely uncertain given the few trials and uncertainty of evidence in this group. Overall, harms were judged to be trivial to small for all adults and uncertain for older people due to lack of evidence.
The GDG commented that while rare, serious adverse events might occur with SMT, particularly in older people (e.g. fragility fracture in people with bone loss), and highlighted that appropriate training and clinical vigilance concerning potential harms are important. The GDG also acknowledged that rare serious adverse events were unlikely to be detected in trials. Some GDG members considered that the balance of benefits to harms favoured SMT due to small to moderate benefits while others felt the balance did not favour SMT, mainly due to the very low certainty evidence for some of the observed benefits.
The GDG judged the overall certainty of evidence to be very low for all adults, and very low for older people, consistent with the systematic review team’s assessment. The GDG judged that there was likely to be important uncertainty or variability among people with CPLBP with respect to their values and preferences, with GDG members noting that some people might prefer manual
therapies such as SMT, due to its “hands-on” nature, while others might not prefer such an approach.
Based on their experience and the evidence presented from the included trials which offered an average of eight treatment sessions, the GDG judged that SMT was likely to be associated with moderate costs, while acknowledging that such costs and the equity impacts from out-of-pocket costs would vary by setting.
The GDG noted that the cost-effectiveness of SMT might not be favourable when patients do not experience symptom improvements early in the treatment course. The GDG judged that in most settings, delivery of SMT would be feasible, although its acceptability was likely to vary across
health workers and people with CPLBP.
The GDG reached a consensus conditional recommendation in favour of SMT on the basis of small to moderate benefits for critical outcomes, predominantly pain and function, and the likelihood of rare adverse events.
The GDG concluded by consensus that the likely short-term benefits outweighed potential harms, and that delivery was feasible in most settings. The conditional nature of the recommendation was informed by variability in acceptability, possible moderate costs, and concerns that equity might be negatively impacted in a user-pays model of financing.
___________________________
This clearly is not a glowing endorsement or recommendation of SMT. Yet, in my view, it is still too positive. In particular, the assessment of harm is woefully deficient. Looking into the finer details, we find how the GDG assessed harms:
WHO commissioned quantitative systematic evidence syntheses of randomized controlled
trials (RCTs) to evaluate the benefits and harms (as reported in included trials) of each of the
prioritized interventions compared with no care (including trials where the effect of an
intervention could be isolated), placebo or usual care for each of the critical outcomes (refer to Table 2 for the PICO criteria for selecting evidence). Research designs other than RCTs
were not considered.
That explains a lot!
It is not possible to establish the harms of SMT (or any other therapy) on the basis of just a few RCTs, particularly because the RCTs in question often fail to report adverse events. I can be sure of this phenomenon because we investigated it via a systematic review:
Objective: To systematically review the reporting of adverse effects in clinical trials of chiropractic manipulation.
Data sources: Six databases were searched from 2000 to July 2011. Randomised clinical trials (RCTs) were considered, if they tested chiropractic manipulations against any control intervention in human patients suffering from any type of clinical condition. The selection of studies, data extraction, and validation were performed independently by two reviewers.
Results: Sixty RCTs had been published. Twenty-nine RCTs did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred. Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors.
Conclusions: Adverse effects are poorly reported in recent RCTs of chiropractic manipulations.
The GDG did not cite our review (or any other of our articles on the subject) but, as it was published in a very well-known journal, they must have been aware of it. I am afraid that this wilfull ignorance caused the WHO guideline to underestimate the level of harm of SMT. As there is no post-marketing surveillance system for SMT, a realistic assessment of the harm is far from easy and needs to include a carefully weighted summary of all the published reports (such as this one).
The GDG seems to have been aware of (some of) these problems, yet they ignored them and simply assumed (based on wishful thinking?) that the harms were small or trivial.
Why?
Even the most cursory look at the composition of the GDG, begs the question: could it be that the GDG was highjacked by chiropractors and other experts biased towards SMT?
The more I think of it, the more I feel that this might actually be the case. One committee even listed an expert, Scott Haldeman, as a ‘neurologist’ without disclosing that he foremost is a chiropractor who, for most of his professional life, has promoted SMT in one form or another.
Altogether, the WHO guideline is, in my view, a shameful example of pro-chiropractic bias and an unethical disservice to evidence-based medicine.
He came to my attention via the sad story recently featured here about patients allegedly being harmed or killed in a Swiss hospital for so-called alternative medicine (SCAM). What I then learned about the doctor in charge of this place fascinated me:
Rau states about himself (my translation):
Early on, Dr Rau focused on natural therapies, in particular homeopathy and dietary changes. The healing success of his patients proved him right, so he studied alternative healing methods with leading practitioners. These included orthomolecular medicine, Chinese and Ayurvedic medicine and European holistic medicine. With his wealth of knowledge and over 30 years of experience, Dr Rau formed his own holistic theory of healing: Swiss Biological Medicine – Dr Rau’s Biological Medicine. It is based on the principles of detoxification, nutrition, digestion and sustainable strengthening of the immune system.
Career & studies:
- Medical studies at the University of Bern
- Final medical examinations in Switzerland and the USA
- Subsequent work in rheumatology, internal and general medicine
- Member of the Swiss Medical Association FMH since 1981
- 1981 to 1992 conventional physician & medical director of a Swiss spa centre for rheumatology and rehabilitation medicine
- 1983 to 1992 Doctor at a drug rehabilitation centre
- 1992 to 2019 Establishment of the Paracelsus Clinic Lustmühle as medical director and partner
- until 2020 Head of the academic network and training organisation “Paracelsus Academy”
Rau also states this:
- 2019 mit dem Honorarprofessoren-Titel von der Europäischen Universität in Wien ausgezeichnet (2019, he was awarded the title of homorary professor at the European University in Vienna)
This puzzles me because there is no such institution as the ‘Europäische Universität in Wien’. There is a Central European University but this can hadly be it?!
Now, I am intrigued and see what the ‘honorary professor’ might have published. Sadly, there seems to be nothing on Medline except 2 interviews. In one interview, Rau explains (amongst other things) ‘live blood analysis’, a method that we have repeatedly discussed before (for instance, here and here):
Darkfield microscopy shows a lot. We take 1 drop of blood and look at it under a very large-scale magnification. The blood is life under the glass. Once it’s on the glass, there isn’t oxygen or light or heat. This is a giant stress for the blood. So we see how, over a time, the blood reacts to this stress, and how the blood cells tolerate the stress. You can see the changes. So we take a drop of blood that represents the organism and put it under stress and look at how the cells react to the stress, and then we can see the tolerance and the resistiveness of these cells. Do they have a good cell-membrane face? Do they have good energetic behavior? Do they clot together? Is there a chance for degenerative diseases? Is there a cancerous tendency in this blood? We see tendencies. And that’s what we are interested in, tendencies.
Question: If you saw a cancerous tendency, what would that look like?
Rau: Cancerous tendency is a change in the cells. They get rigid, so to say. They don’t react very well.
Question: And how long does blood live outside the body?
Rau: It can live for several days. But after 1 hour, the blood is already seriously changed. For example, a leukemia patient came to my clinic for another disease. But when we did darkfield, I found the leukemia. We saw that his white blood cells were atypical. Look at this slide—the fact that there are so many white blood cells together is absolutely unusual, and the fact that there are atypical white blood cells. This shows me that the patient has myeloid leukemia. The patient had been diagnosed as having rheumatoid lung pain, but it was absolutely not true. The real cause of his pain was an infiltration of the spinal bone by these lymphocytes.
This is, of course, complete nonsense. As I explained in my blog post, live blood analysis (LBA) is not plausible and there is no evidence to support the claims made for it. It also is by no means new; using his lately developed microscope, Antony van Leeuwenhoek observed in 1686 that living blood cells changed shape during circulation. Ever since, doctors, scientists and others have studied blood samples in this and many other ways.
New, however, is what today’s SCAM practitioners claim to be able to do with LBA. Proponents believe that the method provides information about the state of the immune system, possible vitamin deficiencies, amount of toxicity, pH and mineral imbalance, areas of concern and weaknesses, fungus and yeast infections, as well as just about everything else you can imagine.
LBA is likely to produce false-positive and false-negative diagnoses. A false-positive diagnosis is a condition which the patient does not truly have. This means she will receive treatments that are not necessary, potentially harmful and financially wasteful. A false-negative diagnosis would mean that the patient is told she is healthy, while in fact she is not. This can cost valuable time to start an effective therapy and, in extreme cases, it would hasten the death of that patient. The conclusion is thus clear: LBA is an ineffective, potentially dangerous diagnostic method for exploiting gullible consumers. My advice is to avoid practitioners who employ this technique.
And what does that say about ‘honorary professor’ Rau?
I think I let you answer that question yourself.
Some articles are just too remarkable for me to alter them in any way. This one impresses already by its title: “Ameliorative effects of homeopathic medicines in the management of different cancers“. By way of a ‘Christmas treat’, here its summary:
Homeopathy is a commonly used complementary and alternative system of medicine for the treatment of various sorts of ailments throughout the world. Homeopathic medicines are made up of potential therapeutic natural products that are primarily acknowledged for their low doses as well as extended patient survival results. Homeopathic medicines are derived from plants such as arnica (mountain herb), red onion, poison ivy, stinging nettle, and belladonna (deadly nightshade); minerals including white arsenic as well as from animals such as crushed whole bees. Homeopathic medicines are synthesized as sugar pellets to be placed under the tongue and may also be used in the form of gels, ointments, drops, tablets, and creams. Homeopathic medicines can be used to treat various disorders including migraine, depression, gastrointestinal diseases, joint pain, inflammation, different sorts of injuries, flu, arthritis as well as sciatica.
Cancer is the 2nd major reason behind global mortalities. It is revealed that developing countries around the world shoulder most of the cancer burden. According to a survey conducted in 2020, low- and middle-income countries face 70% of the total mortalities worldwide which accounts for approximately 10 million people of these countries. Homeopathic medicines ensure low-cost cancer treatment with little or no side effects on the bodies of humans and animals. Besides, it is applied as a supportive and palliative therapy in a broad range of cancer patients to enhance the body’s fight against cancer, alleviate discomfort resulting from disease or conventional treatments as well as improve the general well-being of the patients. In this chapter, our primary focus will be on the anti-cancerous effects of homeopathic medicines against different cancerous conditions in the body along with their mechanism of action.
Let me just mention a few fairly obvious points:
- Homeopathic medicines are made up of potential therapeutic natural products … REALLY? Have a look at those remedies, for instance:
- Blue (colour)
- Eclipse Totality
- Electricitas (Electricity – 80,000 volts)
- Electricitas (High Voltage Pylon)
- Green (colour)
- Halogen light
- Indigo (colour)
- Laser – red (Diode Laser Red)
- Laser Beam (2940 nm)
- LED (white) (White L(ight) E(mitting) D(iode) Light)
- LIGHT (ENERGY SAVING BULB)
- Luna (Moonlight)
- Microwave 750 MHz
- Milky Way (Essence)
- Mobile phone (Eising)
- Mobile Phone 1800MHz
- Mobile Phone 900Mhz
- Mobile Phone Mast G3
- Polaris (North star)
- Purple (Colour)
- Radiation Combination (Guild Radiation Combination)
- Rainbow (Spectrum)
- Red (colour)
- Red ( A. Wauters)
- Sol Africana
- Sol Australis (Sunlight – Australia)
- Sol Britannic (Sunlight British)
- Stonehenge (Emanation)
- Sunlight Blue (Prismatic blue from sunlight)
- Sunlight Green (Prismatic green from sunlight)
- Sunlight Orange (Prismatic orange from sunlight)
- Sunlight Purple (Prismatic purple from sunlight)
- Sunlight Red (Prismatic Red from Sunlight)
- Sunlight Yellow (Prismatic yellow from sunlight)
- Ultrasound (General)
- Ultrasound (Vaginal)
- Ultraviolet Light
- Vacuum
- Wind (South-West)
- X-ray
- Homeopathic medicines are derived from plants such as arnica (mountain herb), red onion, poison ivy, stinging nettle, and belladonna (deadly nightshade); minerals including white arsenic as well as from animals such as crushed whole bees. REALLY? Consider these remedies, for example:
- Aqua Aurum (Gold and sea water)
- Aqua Fida Vetusta (Old Faithful Water)
- Aqua Hochstein (Spring Source water from the Bavarian Forest)
- Aqua marina (Sea Water)
- Aqua nova
- Aqua Odilien
- Aqua Pura Bottled Water
- Aqua Schuasta
- Aqua Sulis (Water from Bath, Roman Spa)
- Aqua Victoria Falls
- Aqua XwMuthkwium (Musqueam Creek Water)
- Chalice Well Water
- Dead Sea Water
- Double Helix Water
- Ganga water (water from the River Ganges)
- Ganga Water (Gaumuk)
- Ganga Water (Varanasi)
- Gastein (Gastein Aqua)
- Geum Rivale (Water Avens)
- Halltal Spring Water (Water from Solbadhall in Tirol)
- Levico water (from lake in N Italy)
- Lourdes Water
- Nadana Water
- Nigari (Concentrated Japanese seawater)
- Nordenau water
- Seven Spring Head Water
- Severn Water (Source)
- Water (Guild)
- Wiesbaden Aqua (Wiesbaden Water)
- Winchelsea Water
- Zamzam aqua (Zamzam spring water [Mecca])
- Homeopathic medicines are synthesized… No, they are manufactured.
- Homeopathic medicines can be used to treat various disorders… albeit without any effect beyond placebo!
- Homeopathic medicines ensure low-cost cancer treatment with little or no side effects… and no therapeutic effect beyond placebo!
- Besides, it is applied as a supportive and palliative therapy in a broad range of cancer patients to enhance the body’s fight against cancer, alleviate discomfort resulting from disease or conventional treatments as well as improve the general well-being of the patients. This, I’m afraid, is a dangerous lie.
- …the anti-cancerous effects of homeopathic medicines… do not exist.
My conclusion:
