MD, PhD, FMedSci, FSB, FRCP, FRCPEd

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Here is a third excerpt from my new book A SCIENTIST IN WONDERLAND. It describes the thinking behind the research strategy my team and I adopted and the main arguments for and against it.

After roughly one year of preparatory work, everything seemed to be in place for our research to start in earnest. Around this time, I was asked to write a “mission statement” for my new research unit, which had by then been given the official title of the Department of Complementary Medicine. “A very British thing”, a friend explained when I enquired what a mission statement might be. “Just put on paper what your unit stands for.” I gave it some thought and formulated our mission as clearly and concisely as I could:

  • To conduct rigorous, inter-disciplinary and international collaborative research into the efficacy, safety and cost of complementary medicine.
  • To further analytical thinking in this area.

People reading my mission statement tended to be slightly puzzled by the inclusion of “analytical thinking” as a specific, separate item, but even after two decades, I am still pleased that I added it. The fostering of critical analysis is vital to any scientific endeavour, and perhaps particularly so in a field that, until now, has been so accustomed to special pleading and so sheltered from objective evaluation.

While studying medicine, I had not been well instructed in critical thinking. It was only later that I had realized how vulnerable health care can be without it. In Vienna, we had managed to smuggle the subject onto the medical curriculum. In Exeter, I soon discovered how woefully uncritical the attitude towards alternative medicine frequently was. This phenomenon was noticeable not just when reading the popular press or when talking to lay people but also, and perhaps even more worryingly, it was equally obvious in discussions with health care professionals. This lack of critical thinking, I felt, had the potential to hinder progress or even to cause significant harm. Particularly during the later years of my time in Exeter, the theme of critical analysis would dominate my work.

My peers were happy with the mission statement, and most rational thinkers who saw it thought it was ambitious but sound. However, in many alternative medicine enthusiasts it aroused suspicion; they seemed dismayed and felt that it was misguided. Some offered the opinion that alternative medicine should not be scientifically scrutinized at all. Others believed that my work should be directed much more at promoting alternative medicine rather than questioning it. Some argued that a professor of complementary medicine should be unabashedly sympathetic towards those working in this area, and that this attitude should be specifically articulated in any mission statement. Yet others argued that the mission statement should focus primarily on sociological or psychological issues rather than medical questions.

I listened patiently and politely to everyone who wanted to comment. I discussed, re-evaluated, re-discussed and reconsidered my position. But whichever way I looked at it, I couldn’t escape the conclusion that the arguments of my critics were at best unconvincing or irrelevant, and at worst they were down-right misleading—and I became determined to show why.

I was not a politician, nor was I a propagandist or an ideologue: I was simply a scientist, and as such my role was not to further the ambitions of interested parties but to determine the true value of alternative medicine. Patients and consumers have an absolute right to know the truth about the value of the treatments they frequently use, and the obligation of a researcher is to determine truth. That required a rigorous medical research agenda which would steer us clear of the post-modernist approach advocated by so many who tried to influence me and my growing team of investigators.

Over the years, my resolve to stay on this straight and narrow path of objective medical research has provoked endless criticism. Indeed, the potential for conflict had been there from the outset, when, at that very first lecture for alternative practitioners, I had been publicly challenged: “How did they dare to appoint a doctor to this chair?” Now that I had realized that this tension existed, I had to decide how to deal with it in my professional capacity.

Initially I made a conscious effort to avoid discord, not because I lacked the necessary courage or convincing arguments, but for a variety of other reasons, both personal and pragmatic. Firstly, I do not enjoy disagreements nearly as much as some people seem to think. If conflict becomes unavoidable, I can certainly put up a good fight, but that does not mean I enjoy the process. Secondly, I was honestly tired of having disputes. The battles I had fought in Vienna had left me drained and somewhat bruised. Over the years, I did develop a thicker skin but it certainly was not something I was born with. Thirdly, conflicts take far too much time, energy and concentration away from one’s real work: the more time I was compelled to spend locked in combat, the less time I would have to focus on the science I was so eager to generate. Fourthly, if the worst came to the worst, and if I was going to have to defend my views at every turn, I needed to be entirely sure of my ground. Solid research was the only way to ensure that; and I felt the need to do the research first and have the arguments later.

The Science Media Centre (SMC) in London is a unit that aims to facilitate the interactions between scientists, journalists and the media. During the last 10 years or so, they have invited me several times to present my research to journalists, and Fiona Fox who heads the SMC became a trusted friend and ally. Her letter reproduced below (with her permission, of course) is deeply touching for me; if it were the only reaction to my new book that I ever received, it would have been worth the effort writing the memoire.

Dear Edzard,

I have just finished your book and wanted to write to say how much I loved it.  It was fascinating in every way and a compelling read.

However I also found the full story of the end of the unit profoundly depressing. I was a fan of the unit’s work from the SMC’s rather narrow perspective of science in the media.  Given the percentage of the population who use some form of alternative medicine I was very, very keen to ensure that the SMC helped to bring the best scientific evidence to bear on the media debates.  However as you highlight in the book finding academics who are doing top quality clinical research in this field is not easy – all roads led us to your unit. Since the unit has closed the amount we have been able to do proactively on this issue has declined dramatically which I fear is a loss to the wider public and to the public understanding of medical science.

However until reading your book I had not understood the whole story about the closure of the unit and now feel that the scientific community should have fought much harder to save it.  If it had just run out of steam and funds that would be fine – but your claim that it was closed down in part because of the influence of people who do not want to see critical research carried out in this field really is bad news for us all.  All of us who care about the importance of bringing the best evidence to bear on contested areas of science should reflect on why we lost one of the best units in this field.

I also wanted to say how important it is that you spoke to a trusted science editor about your concerns about the Smallwood report.  It feels to me like people were looking very narrowly at rules governing the media release of a report without considering the wider ethics of what you did. Had you remained quiet about your concern at the time the mass media would almost certainly have been full of headlines championing the need for alternative medicine on the NHS and may well have reported inaccurate facts from this ostensibly authoritative report. Worse still it looks likely the authors may even have used your involvement as a badge of credibility to enhance the media coverage. Your commitment to accurate reporting of alternative medicine has been second only to your research record and  challenging myths and inaccuracies does indeed often involve taking courage and embracing the media interest when it most matters.

I will certainly be buying the book for my friends inside and outside science. While it is ostensibly about one man’s research career, it is for me about something much more profound..it’s about courage it takes to stand up for the very best science in areas that are contested in wider society. There is not enough of that courage in science but there is a huge amount of it in the pages of this book.  I hope you can remember that the work of the unit will live on for many, many years to come, better informing the debate and proving the evidence base for those who want to follow in your footsteps.

Cheers

Fiona

This is not a hoax! Homeopaths have jumped on the Ebola-bandwagon and are recommending we treat this infection with homeopathy.

You don’t believe it? Read for yourself; the following text is taken from a pro-homeopathy website:

Your best bet is to find a homeopath to treat yourself or your patient. With Ebola this might not be so feasible, and if you find there is no other assistance available, continue as described below.

Add a pill or two of the homeopathic remedy found to have the most similar symptoms to a plastic cup filled with water (tap or mineral water). Starting with Crotalus Horridus 30C is probably the best idea. Stir the cup with a plastic spoon until the pills dissolve. With the spoon, place some drops of the remedy on the patient’s tongue.

How often the remedy is taken depends on the severity of symptoms. If they are very severe, give the remedy every half hour until improvement is observed, then repeat it every hour. This can be reduced to once or twice a day, depending on improvement.

If no improvement is observed after 24 hours, go to the next homeopathic remedy on the list above.

What to Do In Case Homeopathic Remedies are Unavailable
 …With any epidemic, such as Ebola, bird and swine flu, if you have no other recourse for treatment—no medical assistance available— there is a procedure for making a remedy at home that will keep you alive, although you may have a rough time of it. Vitamins, especially C, will be helpful.

You may think the following procedure—developed by the English homeopath Peter Chappell—is a crazy thing to do. But, if you or a loved one is sick with Ebola with the prospect of having one week to live, and no other help is available, you might consider it. Besides, Einstein said that if an idea didn’t seem crazy, it wasn’t worth anything.

This procedure is based on a form of therapy related to homeopathy called isopathy (curing a disease with the virulent agent of the same disease), which has proven successful for many ailments….

How to Make Your Own Ebola Remedy

What you need:
1. A face mask and gloves
2. Two bottles (50 ml up to 500 ml glass or plastic bottles) with caps
3. Clean water (mineral or tap water)
4. An Ebola sample: some spit or other disease product, such as blood, from a person infected with Ebola, or who is suspected sick with it. Any small quantity will do, even a pinhead.
5. An alcoholic liquid, such as whisky, brandy, rum, etc.
6. Half an hour of your time.

Procedure:
1. Fill the bottle with water, leaving about 20% space at the top.
2. Place the Ebola sample in the water in the bottle.
3. Close the top of the bottle with the cap.
4. Hold the bottle and strike it hard against a solid surface, such as a large book, 40 times.
5. Pour out the contents of the bottle.
6. Refill the bottle with water (the fluid remaining on the inside surface of the bottle will serve as the next Ebola sample).
7. Repeat steps 3 to 6 a total of 30 times.

Storage:
1. Pour the bottle solution into another bottle—your stock bottle.
2. Add 10% by volume of the alcoholic liquid (whisky, brandy, etc.) as a preservative.
3. Store in a place away from sunlight and electronic equipment.

Using this stock bottle, you can supply the Ebola remedy to as many people you want. With one drop from the stock bottle as an Ebola sample you can produce another stock bottle to give to someone else. Instead of the original Ebola sample you used above to make the original stock bottle, you use a drop from the first stock bottle. This process can be carried out ad infinitum, supplying a whole city, etc., if needed.

Taking Your Home-Made Ebola Remedy

For prevention:
1. Place a teaspoonful of your Ebola remedy from the stock bottle into a cup filled with water.
2. Stir the water five times with a disposable spoon or stick.
3. Take a sip from the cup.
4. During the epidemic, take a sip once or twice a day, stirring five times before taking the sip.
5. Refill the cup as needed after striking the stock bottle against a hard surface five times.

If you are sick with Ebola:
1. Place a teaspoonful of the Ebola remedy from your stock bottle into a cup filled with water.
2. Stir the water five times with a disposable spoon or stick.
3. Take a sip every 15 minutes, stirring five times each time until you notice improvement, then stop.
4. On improving, you can ease off and take the remedy every hour or so, again stirring five times before taking the remedy each time.
5. Refill the cup as needed after striking the stock bottle against a hard surface five times.

Another website had similar advice:

The following remedies would be considered by a homeopath for any of the viral hemorrhagic fevers that match this symptom picture.

As a preventative if an outbreak happens nearby, Crotalus horridus 30C, one dose daily, until the threat is out of the area is the method many homeopaths familiar with this disease suggest.

If a person is infected, the remedies most commonly used would be the following. One dose every hour, but as the severity of the symptoms decrease, frequency is reduced. If no improvement is seen after 6 doses, a new remedy ought to be considered.

Crotalus horridus 30C – Is to be considered for when there is difficulty swallowing due to spasms and constriction of the throat, dark purplish blood, edema with purplish, mottled skin.

Bothrops 30C – Is the remedy to think of when nervous trembling, difficulty articulating speech, sluggishness, swollen puffy face, black vomiting are present

Lachesis mutus 30C ,– when there’s delirium with trembling and confusion, hemorrhaging in any area, consider this remedy. Often, the person cannot bear tight or constricting clothing or bandages and feels better from heat and worse on the left side.

Mercurius corrosivus 30C, – For copious bleeding, better when lying on the back with the knees bent up, delirium, headache with burning cheeks, photophobia, black swollen lip, metallic, bitter or salt taste in mouth.

Secale cornutum 30c,– For thin, slow, painless oozing dark hemorrhage with offensive odor, cold skin and tingling in the limbs. The individual wants to be uncovered and feels WORSE from motion.

Echinacea 30C – For when there’s sepsis or blood poisoning, fetid smelling discharges and enlarged lymph nodes.

Homeopathy is an ideal medical stratagem for survivalists, homesteaders and anyone wanting to be self-reliant in any situation.

I felt quite sick after reading these texts – sick and frightened. If some homeopaths really believe this nonsense, we should, I think, all be frightened of them.

A remarkable article about homeopathy and immunisation entitled THE IMMUNISATION DILEMMA came to my attention recently. Its abstract promised: “evidence quantifying the effectiveness of vaccination and HP (homeoprophylaxis) will be examined. New international research describing and analysing HP interventions will be reported. An evidence-based conclusion will be reached.”

Sounds interesting? Let’s see what the article really offers. Here is the relevant text:

…evidence does exist to support claims regarding the effectiveness of homeopathic immunisation is undeniable.

I was first invited to visit Cuba in December 2008 to present at an international conference hosted by the Finlay Institute, which is a W. H. O.-accredited vaccine manufacturer. The Cubans described their use of HP to control an outbreak of leptospirosis (Weilʼs syndrome – a potentially fatal, water-born bacterial disease) in 2007 among the residents of the three eastern provinces which were most severely damaged by a severe hurricane – over 2.2 million people [7]. 2008 was an even worse year involving three hurricanes, and the countryʼs food production was only just recovering at the time of the conference. The HP program had been repeated in 2008, but data was not available at the conference regarding that intervention.

I revisited Cuba in 2010 and 2012, each time to work with the leader of the HP interventions, Dr. Bracho, to analyse the data available. Dr. Bracho is not a homeopath; he is a published and internationally recognised expert in the manufacture of vaccine adjuvants. He worked in Australia at Flinders University during 2004 with a team trying to develop an antimalarial vaccine.

In 2012 we accessed the raw leptospirosis surveillance data, comprising weekly reports from 15 provinces over 9 years (2000 to 2008) reporting 21 variables. This yielded a matrix with 147 420 possible entries. This included data concerning possible confounders, such as vaccination and chemoprophylaxis, which allowed a careful examination of possible distorting effects. With the permission of the Cubans, I brought this data back to Australia and it is being examined by mathematicians at an Australian university to see what other information can be extracted. Clearly, there is objective data supporting claims regarding the effectiveness of HP.

The 2008 result was remarkable, and could only be explained by the effectiveness of the HP intervention. Whilst the three hurricanes caused immense damage throughout the country it was again worse in the east, yet the three homeopathically immunised provinces experienced a negligible increase in cases whilst the rest of the country showed significant increases until the dry season in January 2009 [8].

This is but one example – there are many more. It is cited to show that there is significant data available, and that orthodox scientists and doctors have driven the HP interventions, in the Cuban case. Many people internationally now know this, so once again claims by orthodox authorities that there is no evidence merely serves to show that either the authorities are making uninformed/unscientific statements, or that they are aware but are intentionally withholding information. Either way, confidence is destroyed and leads to groups of people questioning what they are told…

Final Conclusions

The attacks against homeopathy in general and HP in particular will almost certainly continue. If we can achieve a significant level of agreement then we would be able to answer challenges to HP with a single, cohesive, evidence-based, and generally united response. This would be a significant improvement to the existing situation.

 

Reference 7 is the following article: Bracho G, Varela E, Fernández R et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy 2010; 99: 156-166. The crucial bit if this paper are as follows:

A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions.

After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall.

The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted.

The paper thus describes little more than an observational study. It shows that one region was less affected than another. I think it is quite clear that this could have many reasons which are unrelated to the homeopathic immunisation. Even the authors are cautious and speak in their conclusions not of a causal effect but of an “association”.

The 2012 data cited in the text remains unpublished; until it is available for public scrutiny, it is impossible to confirm that it is sound and meaningful.

Reference 8 refers to this article: Golden I, Bracho G. Adaptability of homœoprophylaxis in endemic, epidemic and stable background conditions. Homœopathic Links 2009; 22: 211-213. I have no access to this paper (if someone does, please fill us in) but, judging from both its title and the way it is described in the text, it does not seem to show reliable data about the efficacy of homeopathic immunisation.

So, is it true that “evidence does exist to support claims regarding the effectiveness of homeopathic immunisation”?

I do not think so!

Immunisation is by no means a trivial matter; wrong decisions in this area have the potential to cost the lives of millions. Therefore proofs of efficacy need to be published in peer-reviewed journals of high standing. These findings need then be criticised, replicated and re-criticised and re-replicated. Only when there is a wide consensus about the efficacy/safety or lack of efficacy/safety of a new form of immunisation, can it be generally accepted and implemented into clinical practice.

The current consensus about homeopathic immunisation is that it is nothing less than dangerous phantasy. Those who promote this quackery should be publicly exposed as charlatans of the worst kind.

Homeopathy is a deeply puzzling subject for many observers. Perhaps it gets a little easier to understand, if we consider the three main perspectives on homeopathy. For the purpose of this post, I take the liberty of exaggerating, almost caricaturizing, these perspectives in order to contrast them as clearly as possible.

THE SCEPTICS’ PERSPECTIVE

Sceptics take a brief look at the two main assumptions which underpin homeopathy (like cures like and potentiation/dilution/water memory) and henceforward are convinced that homeopathic remedies are pure placebos. Homeopathy flies in the face of science; if homeopathy is right, several laws of nature must be wrong, they love to point out. As this is most unlikely, they reject homeopathy outright, usually even without looking in any detail at what homeopaths consider to be evidence in support of their trade. If sceptics are forced to consider a positive study of homeopathy, they know before they have seen it that its results are wrong – due to an error caused by chance, faulty study design or fabrication. The sceptics’ conclusion on homeopathy: it is a placebo-therapy, no doubt about it; and further investment into research is a waste of scarce resources which must be stopped.

THE BELIEVERS’ PERSPECTIVE

The believers in homeopathy know from experience that homeopathy works. They therefore feel that they have no choice but to reject almost every word the sceptics might tell them. They cling on to the gospel of Hahnemann and elaborate on the modern but vague theories that might support the theoretical assumptions of homeopathy. They point to positive clinical trials and outcome studies, to 200 years of experience, and to the endorsement of homeopathy by VIPs. When confronted with the weaknesses of their arguments, they find even weaker ones, such as ‘much of conventional medicine is also not based on good evidence, and the mechanism of action of many mainstream drugs is also not fully understood’. Alternatively, they employ the phoniest argument of them all: ‘even if it works via a placebo effect, it still helps patients and therefore is a useful therapy’. When even this fails, they tend to resort to ad hominem attacks against their opponents. The believers’ conclusion on homeopathy: it is unquestionably a valuable type of therapy regardless of what anyone else might say; research is merely needed to confirm their belief.

THE PERSPECTIVE OF THE ADVOCATES OF EVIDENCE-BASED MEDICINE (EBM)

The perspective of EBM-advocates is pragmatic; they simply say: “show me the evidence!” If the majority of the most reliable clinical trials of homeopathic remedies (or anything else) suggests an effect beyond placebo, they conclude that they are effective. If that is not the case, they doubt the effectiveness. If the evidence is highly contradictory or incomplete, they are likely to advocate more rigorous research. Advocates of EBM are usually not all that concerned by the lack of plausibility of the interventions they evaluate. If it works, it works, they think – and if a plausible mechanism is currently not available, it might be found in due course. The advocates of EBM have no preconceived ideas about homeopathy. Their conclusion on homeopathy goes exactly where the available best evidence leads them.

COMMENT

The arguments and counter-arguments originating from the various perspectives would surely continue for another 200 years – unless, of course, two of the three perspectives merge and arrive at the same or very similar conclusions. And this is precisely what has now happened. As I have pointed out in a recent post, the most thorough and independent evaluation of homeopathy according to rigorous EBM-standards has concluded that “the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.”

In other words, two of the three principal perspectives have now drawn conclusions which are virtually identical: there is a consensus between the EBM-advocates and the sceptics. This isolates the believers and renders their position no longer tenable. If we furthermore consider that the believers are heavily burdened with obvious conflicts of interest, while the other two groups are by definition much more independent and objective, it appears more and more as though homeopathy is fast degenerating into a cult characterised by the unquestioning commitment and unconditional submission of its members who are too heavily brain-washed to realize that their fervour has isolated them from the rational sections of society. And a cult is hardly what we need in heath care, I should think.

It seems to me therefore that these intriguing developments might finally end the error that homeopathy represented for nearly 200 years.

Progress at last?

THERE WILL NEVER BE AN ALTERNATIVE CANCER CURE

This statement contradicts all those thousands of messages on the Internet that pretend otherwise. Far too many ‘entrepreneurs’ are trying to exploit desperate cancer patients by making claims about alternative cancer ‘cures’ ranging from shark oil to laetrile and from Essiac to mistletoe. The truth is that none of them are anything other than bogus.

Why? Let me explain.

If ever a curative cancer treatment emerged from the realm of alternative medicine that showed any promise at all, it would be very quickly researched by scientists and, if the results were positive, instantly adopted by mainstream oncology. The notion of an alternative cancer cure is therefore a contradiction in terms. It implies that oncologists are mean bastards who would, in the face of immense suffering, reject a promising cure simply because it did not originate from their own ranks.

BUT THAT DOES NOT NECESSARILY MEAN THAT ALTERNATIVE CANCER TREATMENTS ARE USELESS

So, let’s forget about alternative cancer ‘cures’ and let’s once and for all declare the people who sell or promote them as charlatans of the worst type. But some alternative therapies might nevertheless have a role in oncology – not as curative treatments but as supportive or palliative therapies.

The aim of supportive or palliative cancer care is not to cure the disease but to ease the suffering of cancer patients. According to my own research, promising evidence exists in this context, for instance, for massage, guided imagery, Co-enzyme Q10, acupuncture for nausea, and relaxation therapies. For other alternative therapies, the evidence is not supportive, e.g. reflexology, tai chi, homeopathy, spiritual healing, acupuncture for pain-relief, and aromatherapy.

So, in the realm of supportive and palliative care there is both encouraging as well as disappointing evidence. But what amazes me over and over again is the fact that the majority of cancer centres employing alternative therapies seem to bother very little about the evidence; they tend to use a weird mix of treatments regardless of whether they are backed by evidence or not. If patients like them, all is fine, they seem to think. I find this argument worrying.

Of course, every measure that increases the well-being of cancer patients must be welcome. But this should not mean that we disregard priorities or adopt any quackery that is on offer. In the interest of patients, we need to spend the available resources in the most effective ways. Those who argue that a bit of Reiki or reflexology, for example, is useful – if only via a non-specific (placebo) effects – seem to forget that we do not require quackery for patients to benefit from a placebo-response. An evidence-based treatment that is administered with kindness and compassion also generates specific non-specific effects. In addition, such treatments also generate specific effects. Therefore it would be a disservice to patients to merely rely on the non-specific effects of bogus treatments, even if the patients do experience some benefit from them.

ALTERNATIVE ‘PAMPERING’ AS A COMPENSATION FOR INADEQUACIES IN THE SYSTEM?

So, why are unproven or disproven treatments like Reiki or reflexology so popular for cancer palliation? This question has puzzled me for years, and I sometimes wonder whether some oncologists’ tolerance of quackery is not an attempt to compensate for any inadequacies within the routine service they deliver to their patients. Sub-standard care, unappetising food, insufficient pain-control, lack of time and compassion as well as other problems undoubtedly exist in some cancer units. It might be tempting to assume that such deficiencies can be compensated by a little pampering from a reflexologist or Reiki master. And it might be easier to hire a few alternative therapists for treating patients with agreeable yet ineffective interventions than to remedy the deficits that may exist in basic conventional care.

But this strategy would be wrong, unethical and counter-productive. Empathy, sympathy and compassion are core features of conventional care and must not be delegated to quacks.

Here is a quick reminder of some important things you should take care of before the year is out. Shops are still open; so hurry, there is no time to lose on the alternative path to holistic health.

1) Buy some Rescue Remedies

No matter whether your mother-in-law visits this Christmas or not, the ‘festive’ season can be extremely stressful. Think how often in the past a member of your family was next to a breakdown! Think of how often you felt like hitting the bottle and forgetting about the rest of the unthankful bunch. This year, you should be prepared; for just a little outlay, you can purchase these wonderful Bach Flower Remedies specifically designed to rid everyone of stress and disharmony.

2) Get yourself Prince Charles’ Detox Tincture

Some say that Christmas is the time of love, peace and quiet, but surely you were not born last Wednesday and know better: it is the time of over-indulgence. At the end of the holiday season your body will be as polluted as the toxic sewage of a Bayer Leverkusen. What you need now is detox!!! Luckily, the heir to the thrown has thought of us; his detox-tincture is just the ticket – best get two bottles, think of the looming New Year celebrations!

3) Homeopathic ‘Nux Vomica’

Alcohol hangovers are almost unavoidable during this time of the year. Based on the ‘like cures like’ principle, the homeopathic best-seller ‘Nux Vomica’ is every homeopath’s standard recommendation for this sort of thing – and we all know how valuable the advice of homeopaths invariably is.

4) Donation to ‘HOMEOPATHS WITHOUT BORDERS’

Christmas should also be the time for charity, and this fine organisation deservers your support! They do all sorts of splendid things; for instance, they make sure that AIDS-patients in Africa have enough trained homeopaths to cure then from the nasty infection once and for all without any side-effects whatsoever.

5) Support your local chiropractor

Chiropractors have had a really rough time of late: they lost a much publicised libel-case and their good reputation along with it. Now they are suffering badly from vicious in-fighting. Worst of all, the world is slowly realising that there is ‘NOT A JOT OF EVIDENCE’ for most of their therapeutic claims. You should therefore pop into your local chiro’s office and book the entire family for life-long ‘maintenance treatment’. It does not really work, but they so need your money.

6) Buy a few ear-candles

Who wants conventional candles on the Christmas tree? Ear-candles are so much more original! They are supposed to do all sorts of amazing things for your health plus they do look very becoming when worn during the festivities and make a nice alternative to those silly hats that you used to put on. An additional benefit is that your local health food shop selling the ear-candles desperately needs your trade – times have been hard, you know!

7) Protect yourself against the common cold

Echinacea is the product to buy for this purpose. Scientists still debate whether it works or not, but it would be a mistake to listen to these nit-picking pedants. Take Echinacea and take it generously, the herbal industry counts on you.

8) Give up smoking

Your acupuncturist is the person you need for meeting your perennial New Year’s target of stopping to smoke. Book now!!! By January, they will all be fully booked with people who are desperate to give up the filthy habit; they earn their living by pretending that regularly sticking a few needles in your skin makes smoking cessation a piece of cake.

9) Lose a few pounds

Look at you! The feasting has not even started properly, and you are already several pounds over your ideal weight. Luckily, the alternative medicine industry has dozens of slimming aids on offer. Do they work? You should not ask such impertinent questions – there are no guarantees in life, you know! But at the very minimum, you will lose quite a few £s.

Here are 3 more short pieces of alternative medicine satire. if you like them, please consider to send me your own short articles.

AT FAP No 7 (sent in by ‘Ex-Acupuncturist’)

Heroin junkies are now putting another type of needle in their body to get high…  Acupuncture needles!  Acupuncturists have long theorized that an endorphin release is part of the clinical effect of acupuncture.  Endorphins are the body’s own painkillers.  They are in a group of chemicals called endogenous opioids.  While sceptics have pointed out that endorphin release is also a key part of the placebo effect, it seems that ancient Chinese wisdom wins this round of the battle.

“The key is to twirl the needle in the correct direction for each individual,” one experienced user reported.  “In general, men get clockwise, women counter-clockwise, but it reverses depending on the phase of the moon and whether the kidney pulse on the wrist is floating or deep.  It may sound strange, but once you hit the right point and twirl the right way, you’re talking to the rabbit on the moon for hours.”

Apparently, heroin-like effects aren’t the only drugs acupuncture can mimic.  Homeless researcher William S. Burrows reports point combinations which replicate cannabis, magic mushrooms, and even methamphetamines.  “We confirmed this with a double-blind test down in the park.  I drew the point combinations and labelled them with codes, then taught a few volunteers how to do the needling without telling them what combinations mimic each drug.  Then I hit the bar while they rolled dice and randomly did these combinations on hundreds of homeless addicts, who then were observed and interviewed by different volunteers who didn’t know what group they had been randomized to.  The differences between the meth points and the horse points were pretty obvious by behaviour, but we also gathered more objective data such as blood pressure, pupil size, and pre- and post- treatment urinalysis results.  Most of our volunteers are users of real drugs, but when you get the acupuncture right it the metabolites show up in urine.”

Science journal editor Dr. Edward Ernest was impressed.  “This acupuncture research carried out by homeless drug addicts, literally under a bridge, is better and more convincing than all previous acupuncture research combined.  What’s more impressive is that it’s being replicated as we speak in addicted populations around the world, all through grassroots efforts.”
When asked why his research was so well structured and recorded compared to previous acupuncture research, Burrows said, “I’m not sure, but it may have something to do with how important getting high is to addicts.  Regular acupuncturists are just telling people they can treat normal pain and diseases, and many of those go away on their own.  We are dealing with serious drug habits here, it’s not something to mess around with.  Regular people can be fooled with post hoc reasoning, regression to the mean, and a good bedside manner.  Junkies in withdrawal have a higher standard of evidence.”

While getting high with acupuncture is safer and less expensive than using black market drugs, public health officials are already warning users that familiar communicable disease dangers exist if needles are shared.  “We are discussing setting up a free acupuncture needle exchange to reduce the risk of hepatitis and HIV transmission.”

AT FAP No 8 (by Edzard Ernst)

THE END OF EBM and the arrival of VBM

Inspired by a recent popular vote in Scotland on the need of having homeopathy free on the NHS, top-ranking health politicians from across the UK have met to discuss the implications of this intriguing and ground-breaking development. The politicians were taken by the idea of replacing evidence with a popular vote. They felt that they were much more familiar with the various ways to influence voters than with the often fiendishly complex issues of scientific evidence. “Everything becomes understandable and transparent with one single stroke”, one senior official commented, “what could be more logical than finally democratising health care? It was time anyway to break the dictatorship of science; as politicians, we cannot tolerate to be told by scientists what is right and wrong.”

The panel drew up plans to have all major health care decisions decided by popular vote. Pilot projects that followed this courageous move have already generated most encouraging results: diabetics voted to have free chocolate, claudicants opted for cheaper cigarettes, addicts wanted to legalise hard drugs and the entire population of Totness was in favour of replacing conventional by alternative medicine.

On the basis of these findings, the secretary for health issued a press release pointing out that innovations of this nature might look counter-intuitive to notoriously short-sighted medics but from a more realistic perspective, they do make a lot of sense: patients deserve to be given a choice; if many to the most desperately ill diabetics die early as a consequence, it might even be humane to let them end their suffering quickly and with dignity – and from a societal point of view, early fatalities mean significant cost-savings which will certainly free funds to improve the health of the rest of the nation. “I am sure that this innovation will win us votes”, one Tory health politician was quoted saying. A white paper was drawn up which suggests the nationwide implementation of these progressive concepts, and well-informed circles at Westminster indicate that David Cameron views the new ‘Vote-Based Medicine’ (VBM) as a possible solution to steer the NHS out of its current crisis.

AT FAP No 9 (by Edzard Ernst)

A bitter row has broken out in the US-based ‘Palmer Institute of Straight Chiropractic’ (PISC) over the interpretation of the results generated by the largest long-term study of chiropractic that has ever been initiated. The study in question, which had been funded by the NIH and several chiropractic bodies across the world, started recruiting in the 1970. Its was aimed at testing the effects of chiropractic maintenance treatment. Based on D D Palmer’s , the father of chiropractic, axiom that all diseases are caused by ‘subluxations of the spine’, chiropractic maintenance care is a method of regularly adjusting subluxations of healthy people before they can do any significant damage to health and well-being. Top officials of PICS had therefore concluded that regular adjustments would prevent illness and prolong life. The project was thus to administer maintenance care to 1000 volunteers for their entire life time and compare the mortality and morbidity of this cohort with the data from the US population at large.

So far, the findings of this study had been kept under tight wraps; the protocol foresaw that the first analysis should only be at the 40-year follow-up. Last months, however, the first preliminary analysis emerged at a closed meeting of the PISC in Devonport, US. A leaked note shows that, despite the large sample size and the sizable number of morbidity and mortality outcomes in the study cohort, the comparison with the general population did not demonstrate any significant differences; if anything, the incidence of neurological problems, e.g. stroke, in the experimental group seems unusually high.

As soon as the results were known to the PISC-officials, dramatically different interpretations of these findings emerged, our reporter was told:

  • One group of chiropractors claimed the results were obviously rigged; some were sure that BIG PHARMA had bribed the researchers/statisticians to produce false negative findings. “It stands to reason”, one chiropractor from this camp was quoted saying, “just imagine what would happen, if the effectiveness of chiropractic maintenance care would become general knowledge; nobody would need the pharma-industry any more. It is therefore clear that they did everything in their power to supress the truth”
  •  The other group of chiropractors claimed that the maintenance treatment implemented in the study was not intensive enough to be effective. On average, every study participant had 1.6 sessions of spinal manipulation per week (the costs of these treatments were estimated at US$ 60 million across the study period). But these chiropractors argued that “subluxations occur much more frequently and need to be treated more regularly; we advocate daily sessions to be on the safe side – besides, this would be ever so good for the profession as a whole.”

So far none of the chiropractors who have commented on the results of this study considered that their original hypothesis was false, i.e. that subluxations might not be the cause of all human disease. When our reporter put this possibility to the president of PISC, the answer was prompt and abrupt: ” You must be kidding! That would mean that D D Plamer was wrong. This is not a realistic possibility at all. Chiropractors are foremost manipulators; we will now manipulate the data until they confirm Palmer’s theory.”

CAM-Cancer is short for a project entitled “Concerted Action for Complementary and Alternative Medicine Assessment in the Cancer Field”. Originally funded by the European Commission, it is now hosted by the National Information Center for Complementary and Alternative Medicine (NIFAB) at the University of Tromsø, Norway.

Our executive Committee is very international and, in my view, fairly balanced; it consists of the following experts:

  • Prof Vinjar Fønnebø, The Norwegian National Research Center in CAM
  • Prof Thomas Cerny, Kantonsspital St Gallen, Switzerland
  • Prof Edzard Ernst, University of Exeter, UK
  • Dr Markus Horneber, Department of Oncology/Hematology, Klinikum Nuernberg, Germany
  • Dr Christine Paludan-Müller, Danish Cancer Society

Our work consists mainly of conducting and updating systematic reviews of treatments often used by cancer patients and providing them for free via the Internet. To date, we have concluded more than 60 such projects and they are all available for anyone to study. I have previously reported about our results in the area of herbal medicine. Today, I will briefly mention those on mind-body interventions.

The Internet is awash with information on the effectiveness of such treatments which is not always accurate, and even top-journals publish reviews which paint a rather optimistic picture: Mind-body therapies categorized as CAM could potentially serve as a positive platform from which providers could discuss CAM and even link survivor subgroups to services that may, at least, partly address unmet psychosocial needs. This would be especially relevant for survivor subgroups that have a cultural bias toward CAM. The mind-body therapies reviewed in this article have some supportive evidence and a rationale for use in cancer survivors. Although data on efficacy and mechanisms of action of mind-body therapies are incomplete and inconclusive, the potential benefits of using these therapies in survivor care plans warrant consideration.

By contrast, our reviews seem far less positive. Here are the key sentences describing the evidence of the four mind-body therapies that we at ‘CAM cancer’ have so far tackled.

  • Based on one clinical trial and two pilot studies, it is not possible to draw conclusions about the effectiveness of autogenic therapy for people with cancer
  • There is presently a lack of good quality, single-intervention trials, so it is not possible to draw clear conclusions about the efficacy of biofeedback for people with cancer
  • Existing evidence suggests that hypnotherapy may reduce cancer therapy related pain, anticipatory nausea and vomiting, and anxiety
  • There is insufficient evidence for the effectiveness of PMR for cancer patients suffering from pain, anxiety, depression, sleep disorders and chemotherapy-induced nausea

The question is, what precisely does that mean? I think this evidence is compatible with several interpretations:

  1. Mind-body therapies are generally over-rated but not really that helpful.
  2. They are effective, but the research is in its infancy and currently fails to document their value adequately.
  3. Some mind-body therapies are effective, while others are not.

At present, it is impossible to tell which interpretation is correct. What is clear, however, is the fact that ‘CAM-Cancer’ is a source that tries its utmost to inform people accurately while doing everything possible to minimise bias.

The NHS tells us that our “choices include more than just which GP or hospital to use. You also have choices about your treatment decisions…”  In most other countries, similarly confusing statements about PATIENT CHOICE are being made almost on a daily basis, often by politicians who have more ambition to win votes than to understand the complex issues at hand. Consequently, patients and consumers might be forgiven to assume that PATIENT CHOICE means we are all invited to indulge in the therapy we happen to fancy, while society foots the bill. Certainly, proponents of alternative medicine are fond of the notion that the principle of PATIENT CHOICE provides a ‘carte blanche’ for everyone who wants it to have homeopathy, Reiki, Bach Flower Remedies, crystal healing, or other bogus treatments – paid for, of course, by the taxpayer.

Reality is, however, very different. Anyone who has actually tried to choose his/her hospital will know that this is far from easy. And deciding what treatment one might employ for this or that condition is even less straight forward. Choice, it turns out, is a big word, but often it is just that: a word.

Yet politicians love their new mantra of PATIENT CHOICE; it is politically correct as it might give the taxpayer the impression that he/she is firmly installed in the driving seat. Consequently PATIENT CHOICE has become a slogan that is used to score points in public debates but that, in fact, is frequently next to meaningless. More often than not, the illusion of being in control has to serve as a poor substitute for actually being in control.

To imply that patients should be able to choose their treatment has always struck me as a little naïve, particularly in the way this is often understood in the realm of alternative medicine. Imagine you have a serious condition, say cancer: after you have come over the shock of this diagnosis, you begin to read on the Internet and consider your options. Should you have surgery or faith healing, chemotherapy or homeopathy, radiotherapy or a little detox?

Clearly PATIENT CHOICE, as paid for by society, cannot be about choosing between a realistic option and an unrealistic one. It must be confined to treatments which have all been shown to be effective. Using scarce public funds for ineffective treatments is nothing short of unethical. If, for a certain condition, there happen to be 10 different, equally effective and safe options, we may indeed have a choice. Alas, this is not often the case. Often, there is just one effective treatment, and in such instances the only realistic choice is between accepting or rejecting it.

And, anyway, how would we know that 10 different treatments are equally effective and safe? After going on the Internet and reading a bit about them, we might convince ourselves that we know but, in fact, very few patients have sufficient knowledge for making complex decisions of this nature. We usually need an expert to help us. In other words, we require our doctor to guide us through this jungle of proven benefits and potential risks.

Once we accept this to be true, we have arrived at a reasonable concept of what PATIENT CHOICE really means in relation to deciding between two or more treatments: the principle of shared decision making. And this  is a  fundamentally different concept from the naïve view of those alternative medicine enthusiasts who promote the idea that PATIENT CHOICE opens the door to opting for any unproven or disproven pseudo-therapy.

To be meaningful, ethical and responsible, choice needs to be guided by sound evidence - if not, it degenerates into irresponsible arbitrariness, and health care deteriorates into some kind of Russian roulette. To claim, as some fans of alternative medicine do, that the principle of PATIENT CHOICE gives everyone the right to use unproven treatments at the expense of the taxpayer is pure nonsense. But some extreme proponents of quackery go even further; they claim that the discontinuation of payment for treatments that have been identified as ineffective amounts to a dangerous curtailment of patients’ rights. This, I think, is simply a cynical attempt to mislead the public for the selfish purpose of profit.

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