Many proponents of alternative medicine seem somewhat suspicious of research; they have obviously understood that it might not produce the positive result they had hoped for; after all, good research tests hypotheses and does not necessarily confirm beliefs. At the same time, they are often tempted to conduct research: this is perceived as being good for the image and, provided the findings are positive, also good for business.
Therefore they seem to be tirelessly looking for a study design that cannot ‘fail’, i.e. one that avoids the risk of negative results but looks respectable enough to be accepted by ‘the establishment’. For these enthusiasts, I have good news: here is the study design that cannot fail.
It is perhaps best outlined as a concrete example; for reasons that will become clear very shortly, I have chosen reflexology as a treatment of diabetic neuropathy, but you can, of course, replace both the treatment and the condition as it suits your needs. Here is the outline:
- recruit a group of patients suffering from diabetic neuropathy – say 58, that will do nicely,
- randomly allocate them to two groups,
- the experimental group receives regular treatments by a motivated reflexologist,
- the controls get no such therapy,
- both groups also receive conventional treatments for their neuropathy,
- the follow-up is 6 months,
- the following outcome measures are used: pain reduction, glycemic control, nerve conductivity, and thermal and vibration sensitivities,
- the results show that the reflexology group experience more improvements in all outcome measures than those of control subjects,
- your conclusion: This study exhibited the efficient utility of reflexology therapy integrated with conventional medicines in managing diabetic neuropathy.
This method is fool-proof, trust me, I have seen it often enough being tested, and never has it generated disappointment. It cannot fail because it follows the notorious A+B versus B design (I know, I have mentioned this several times before on this blog, but it is really important, I think): both patient groups receive the essential mainstream treatment, and the experimental group receives a useless but pleasant alternative treatment in addition. The alternative treatment involves touch, time, compassion, empathy, expectations, etc. All of these elements will inevitably have positive effects, and they can even be used to increase the patients’ compliance with the conventional treatments that is being applied in parallel. Thus all outcome measures will be better in the experimental compared to the control group.
The overall effect is pure magic: even an utterly ineffective treatment will appear as being effective – the perfect method for producing false-positive results.
And now we hopefully all understand why this study design is so very popular in alternative medicine. It looks solid – after all, it’s an RCT!!! – and it thus convinces even mildly critical experts of the notion that the useless treatment is something worth while. Consequently the useless treatment will become accepted as ‘evidence-based’, will be used more widely and perhaps even reimbursed from the public purse. Business will be thriving!
And why did I employ reflexology for diabetic neuropathy? Is that example not a far-fetched? Not a bit! I used it because it describes precisely a study that has just been published. Of course, I could also have taken the chiropractic trial from my last post, or dozens of other studies following the A+B versus B design – it is so brilliantly suited for misleading us all.
A recent article by Frank King (DC, ND) caught my eye. In it, he praises homeopathy in glowing terms. First I was not sure whether he is pulling my leg; then I decided he was entirely serious. Am I mistaken?
Here is the crucial passage for you to decide:
Even though the founder of homeopathy lived more than 200 years ago, he wrote about genetics. Samuel Hahnemann, MD, not only emphasized the importance of natural healing methods, he also recognized the influence of genetics in some types of illnesses.
Hahnemann used the term miasm to refer to the source of chronic diseases. He recognized several miasms, such as psora (meaning “itch”), syphilis, tuberculosis, gonorrhea, and cancer. In addition to recognizing and naming these miasms, he developed homeopathic remedies to address and correct them.
When your patient treatment protocols reach a plateau with chiropractic and nutritional support, consider turning to the constitutional homeopathic remedies, miasms, and detoxification formulas. Toxins inhibit the body’s ability to heal by interfering with the normal nerve pathways.
For example: Due to the steady growth in heavy-metal exposure modern civilization has experienced since the Industrial Revolution, mercury could be considered a modern miasm. Animal studies indicate that mercury’s negative effects can carry through to future generations, just as some of the other miasms do.
Mercurius is homeopathically prepared mercury to help address the symptoms of mercury toxicity, which can manifest as slow thought processes, chilliness, weak digestion, sore throat, and night sweats.
This is just one of the more than 1,300 Homeopathic Pharmacopoeia of the United States ingredients recognized by the FDA.
Homeopathy can be the perfect complement to chiropractic care. It can correct the energetics (including the genetics) of the deepest areas of the body, mind, and emotions, where the hands of the chiropractor can’t reach.
In case you don’t know much about homeopathy, it is true that Hahnemann believed in ‘miasms’, i.e. noxious vapours as the cause of a disposition to certain diseases. Even by Hahnemann’s standards, it turned out to be one of his more crazy ideas. To claim that, by believing in miasms, he foresaw the science of genetics is more than a little far-fetched.
In case you are not sure what toxins do in our body, rest assured that only chiropractors believe they inhibit the body’s ability to heal by interfering with the normal nerve pathways.
And in case you think you suffer from slow thought processes, chilliness, weak digestion, sore throat, and night sweats and thus feel like rushing to the next pharmacy to buy some Mercurius, don’t! This would not eliminate any mercury from your body, it would just eliminate cash from your pocket (in that sense, homeopathy might indeed occasionally reach where the hands of the chiropractor can’t reach).
One can say a lot about alternative medicine, I think, but nobody can deny that it regularly provides us with perfect (unintentional) comedy.
I am sure that many of my readers have sleepless night because they cannot think of a fitting Christmas present for their alternative therapist. I have given this increasingly acute problem some thought and come up with a few handy suggestions.
FOR THE REFLEXOLOGIST
Reflexologists believe that our organs are represented on the sole of our feet. By exerting pressure on locations which correspond to specific organs, they seek to influence the function of these organs. What the reflexologist therefore needs is an insole for her shoes that is deeply cushioned so that these sensitive points are well protected from unwanted exposure to strain. Without this protection, the reflexologist’s health might be in danger; imagine her crossing the street and inadvertently putting pressure on the liver or heart area. This would stimulate these organs and the unsuspecting therapist might suffer tachycardia or her liver might go into over-drive and metabolize drugs like warfarin way too fast, thus leaving her prone to suffer a blood clot.
FOR THE CHIROPRACTOR
Chiropractic was invented about 120 years ago when D.D. Palmer adjusted a subluxation in the neck of a deaf janitor who could then hear again. Chiropractors have ever since claimed that their adjustments free vital nerves that have been blocked by spinal subluxations. I suggest to give them a textbook of anatomy; there they can read up how the inner ear is connected to the brain via nerves which do not even pass via the spine but remain safely in the skull. I am sure the chiropractor will appreciate this news; it will make her think and she might even start doubting whether the rest of the gospel of Mr Palmer is correct.
FOR THE CRANIO-SACRAL THERAPIST
I suggest to give this practitioner an integral helmet for Christmas. Cranio-sacral therapy is based on the idea that the bones of the skull move ever so slightly and that these movements have a profound influence on our health. If that is true, the head of the therapist is in urgent need of complete protection from outside interference of any kind. Even a slight touch from a friend or spouse could have unforeseeable consequences. If she does not already have one, she needs a motorcycle-helmet and must wear it at all times.
FOR THE HOMEOPATH
Homeopaths dilute their remedies endlessly and are convinced that this process which they call ‘potentiation’ renders their remedies not weaker but stronger. The most treasured remedies contain nothing at all. To make a homeopath truly happy, one therefore should give her a nicely wrapped box that contains nothing. Make sure that the box once contained something really nice; like this it will have a powerful memory of its past content which is what homeopaths are after. I am sure she will be overwhelmed by this generosity and enjoy the present for years to come.
FOR THE REIKI MASTER
Reiki is the art of channelling healing energy via the hands of the therapist into a patient’s body. Reiki masters are unusually skilled and have energy-filled hands. When they are not in action, their energy would leak uselessly from their hand; and when they need it for their good work, they may have run empty. This disastrous situation would lead to the ineffectiveness of the otherwise useful intervention. I think that a fully insulated pair of gloves could prevent this situation. My suggestion therefore is to give the Reiki master a pair of solid skiing gloves which have been fitted with insulating material and to advise the master to wear them when not doing her healing.
FOR THE TRADITIONAL CHINESE ACUPUNCTURIST
By far the most common serious complication of acupuncture is a pneumothorax; it happens when an acupuncture needle punctures a lung and means that the patient is in a spot of trouble. If the acupuncturist happens to insert needles on both sides of the thorax, both lungs can be punctured, and then the patient is in a lot of trouble. As anyone can call herself an acupuncturist, some seem to have no idea where the lungs are and are blissfully unaware that their needles can penetrate into vital organs. I think the ideal gift for such acupuncturists might be an atlas of anatomy where they can see with their own eyes what damage a little misplaced needle can cause.
FOR THE HERBALIST
Herbalists tend to promote the idea that, because herbal extracts are natural, they are necessarily safe. The most fitting present for such a therapist might be a textbook of toxicology. There she will find that some of the most powerful poisons come from the plant kingdom. It might not be an insight that she likes, but it just could save some patients from getting hurt.
FOR THE COLONIC IRRIGATIONIST
Colonic irrigation involves pouring lots of water into the part of the body where the sun doesn’t shine in order to detoxify the patient. As the notion of such ‘detox’ is entirely bonkers, I suggest that these therapists could diversify into more serious areas of medicine. Give them a tin of instant coffee for Christmas, and they will be able to claim to treat cancer. Coffee-enemas are a popular alternative treatment for cancer, and I am sure the therapist will be thankful for this opportunity to enlarge her business.
This list could be extended, of course, but I think I will stop here and give my readers the occasion to contribute their own suggestions; surely your ideas are better than mine. So, please put them into your short comments below.
One of the perks of researching alternative medicine and writing a blog about it is that one rarely runs out of good laughs. In perfect accordance with ERNST’S LAW, I have recently been entertained, amused, even thrilled by a flurry of ad hominem attacks most of which are true knee-slappers. I would like to take this occasion to thank my assailants for their fantasy and tenacity. Most days, these ad hominem attacks really do make my day.
I can only hope they will continue to make my days a little more joyous. My fear, however, is that they might, one day, run out of material. Even today, their claims are somewhat repetitive:
- I am not qualified
- I only speak tosh
- I do not understand science
- I never did any ‘real’ research
- Exeter Uni fired me
- I have been caught red-handed (not quite sure at what)
- I am on BIG PHARMA’s payroll
- I faked my research papers
Come on, you feeble-minded fantasists must be able to do better! Isn’t it time to bring something new?
Yes, I know, innovation is not an easy task. The best ad hominem attacks are, of course, always based on a kernel of truth. In that respect, the ones that have been repeated ad nauseam are sadly wanting. Therefore I have decided to provide all would-be attackers with some true and relevant facts from my life. These should enable them to invent further myths and use them as ammunition against me.
Sounds like fun? Here we go:
Both my grandfather and my father were both doctors
This part of my family history could be spun in all sorts of intriguing ways. For instance, one could make up a nice story about how I, even as a child, was brain-washed to defend the medical profession at all cost from the onslaught of non-medical healers.
Our family physician was a prominent homeopath
Ahhhh, did he perhaps mistreat me and start me off on my crusade against homeopathy? Surely, there must be a nice ad hominem attack in here!
I studied psychology at Munich but did not finish it
Did I give up psychology because I discovered a manic obsession or other character flaw deeply hidden in my soul?
I then studied medicine (also in Munich) and made a MD thesis in the area of blood clotting
No doubt this is pure invention. Where are the proofs of my qualifications? Are the data in my thesis real or invented?
My 1st job as a junior doctor was in a homeopathic hospital in Munich
Yes, but why did I leave? Surely they found out about me and fired me.
I had hands on training in several forms of alternative medicine, including homeopathy
Easy to say, but where are the proofs?
I moved to London where I worked in St George’s Hospital conducting research in blood rheology
Another invention? Where are the published papers to document this?
I went back to Munich university where I continued this line of research and was awarded a PhD
Another thesis? Again with dodgy data? Where can one see this document?
I became Professor Rehabilitation Medicine first at Hannover Medical School and later in Vienna
How did that happen? Did I perhaps bribe the appointment panels?
In 1993, I was appointed to the Chair in Complementary Medicine at Exeter university
Yes, we all know that; but why did I not direct my efforts towards promoting alternative medicine?
In Exeter, together with a team of ~20 colleagues, we published > 1000 papers on alternative medicine, more than anyone else in that field
Impossible! This number clearly shows that many of these articles are fakes or plagiaries.
My H-Index is currently >80
Same as above.
In 2012, I became Emeritus Professor of the University of Exeter
Isn’t ’emeritus’ the Latin word for ‘dishonourable discharge’?
I HOPE I CAN RELY ON ALL OF MY AD HOMINEM ATTACKERS TO USE THIS INFORMATION AND RENDER THE ASSAULTS MORE DIVERSE, REAL AND INTERESTING.
To write an AT FAP seems far from easy. The reason for this is simple: the reality of alternative medicine is often more fantastic than what our fantasy can make up. I hope you give it a try nevertheless and send me your stories. Here are AT FAPs 10, 11 and 12.
AT FAP No 10 (by Edzard Ernst)
IMPORTANT NEW ARTICLE IN ‘SOS’
A little-known but nevertheless important monthly journal called ‘Snake-Oil Salesman’ (SOS) has just published a remarkable article which, I think, deserves a mention here. The paper entitled HOW TO BE SUCCESSFUL IN HARD TIMES – A ROAD-MAP TO HEALTH AND WEALTH was authored by the chief executive of ‘Dutchy Originals Herbal Tinctures’ (DOHT) but the grapevine has it that Prince Charles had important input as well. The article explains that, during recessions, snake-oil salesmen are the ones who suffer most. People are just not educated enough to realise the importance of snake oil to public health and wealth, the paper stated. The sale figures for Dutchy Originals Herbal Detox Tincture, for instance, have been declining steadily ever since the world financial crisis started. And that during a time when people need our products most, the SOS-paper stressed. In view of this dire situation, the experts at DOHT have conducted a multi-facetted research project funded by HRH with the aim of designing an effective strategy that will boost sale figures of any snake-oil product, even during hard times. The main part of the SOS-article goes into the strategy point by point. Here I take the liberty of listing from the executive summary the main landmarks on the road to snake-oil success:
- snake-oil is natural and natural means good, effective and foremost safe
- synthetic medicines have none of these qualities, on the contrary, they are amongst the leading causes of death in most countries
- snake-oils have stood the test of time; they were used much before today’s pharmaceuticals were even invented; in other words, they have been field tested for hundreds of years on millions of patients, and that is certainly more important than a few clinical trials
- snake-oils are thus supported by thousands of anecdotes and satisfied customers
- highly respected pharmacies like Boots sell snake-oil and some are even available on the NHS
- famous people, politicians and other pillars of society regularly use snake-oil; some even have a Royal warrant!
- several Nobel-prize winners endorse snake-oil
- compared to some modern drugs, snake-oil is cheap
- snake-oil is not just for one or two conditions, it is a ‘cure all’
- snake-oil is holistic, i.e. it takes care not just of your physical symptoms, like conventional drugs might do, it also increases wellness on the emotional and spiritual levels
- snake-oil is in tune with the current emphasis on patient choice in health care
The SOS-article concludes with the advice for snake-oil manufacturers to employ the above-listed elements for an effective sales-strategy wisely. Do not use all you ammunition at once, writes the paper states, if you adapt a small selection of them carefully to optimally suit your product, you will be able to sell your snake-oil well, and your customers will be delighted forthwith. It really is a win/win situation.
AT FAP No 11 (by Edzard Ernst)
THE ‘NO BRAIN DRAIN’
At a recent meeting of the ‘International Medical Research Standard Panel’ (IMRSP), a governance body of major research funding bodies across the globe aimed at watching over, as well as increasing the quality of medical research, members surprised the world of science: in an official statement, they expressed their pleasure with and approval of alternative medicine.
The panel had commissioned an investigation into the impact on research standards of the plethora of alternative medicine research groups (AMRGs). The investigators applied powerful statistical methods and demonstrated an unexpected but consistent effect: In regions where particularly many AMRGs had emerged, the quality of mainstream medical research seemed to improve; there was even something akin to a dose-effect relationship: the more AMRGs, the larger the improvement in quality.
The panel concluded that alternative medicine seems to attract those researchers who are “perhaps not the brightest buttons in the drawer”, as they elegantly put it. This ‘no brain drain’, they argued, has the effect that the less gifted scientists are drawn away from mainstream research which, in turn, means that the quality of mainstream science increases. A spokesman said: “we are pleased that so many AMRGs are emerging these days and hope the trend continues for the benefit of real medicine”.
AT FAP No 12 (submitted by ‘stopthequacks’)
Homeopathy successfully treats heart attack
As part of the intensive on-going research effort in the School of Homeopathy Education and Denialism (Shed) in our garden we’re delighted to report another success for homeopathy.
One of our leading researchers Del Usional was investigating homeopathic preparations of mains voltage alternating current. In these highly technical and detailed scientific experiments Del first cut the end off a kettle lead and removed the shielding from the live and neutral wires. He then plugged in the cable and put the exposed copper ends into some fresh tap water in a clean jam jar.
This resulted in Del being thrown backwards and landing on the lawnmower and suffering a cardiac arrest. Luckily a colleague witnessed this and called the paramedics. However, with great presence of mind, he began to succus and dilute the water that remained in the jar. The paramedics arrived and despite defibrillating Del were having no success, the race was on. !0, 20, 30C and Del was still in problems, chest compressions and oxygen were doing nothing. Finally 200C, we’d need a really potent remedy for this situation.
Just as the paramedics shocked Del again some of the 200C Alt Curr preparation was dripped on Del’s lips. Instantly he coughed and opened his eyes. He made a full recovery and the burns on his hands were successfully treated with homeopathic preparations (after skin grafting).
This clear and unequivocal result shows the power of homeopathy. The sceptics may well say we “don’t know” that it wasn’t quantum nano-bollock particles of copper from the wire rather than the electricity itself. But that’s just stupid – like cures like so it couldn’t be the copper, it is obviously the memory of the electricity in the water that had the effect.
We offered some of this highly potent medicine to the paramedic crew but they mysteriously declined, we can only assume they are in the pay of big Pharma.