There seem to be plenty of myths and misunderstandings about homeopathy in India.
Homeopathy was first introduced to India by a German doctor from Siebenbuergen, Martin Honigberger (1795 – 1869). He first came to India in 1829 as a conventionally trained physician and treated amongst other personalities the Maharaja Ranjit Singh of Punjab. In 1834, he returned to Europe, met Hahnemann, and became a convert of homeopathy. Subsequently he returned to India, in 1839, and brought homeopathy to this country. Initially, homeopathy was practised mainly by lay practitioners. Mahendra Lal Sircar is said to have been the first Indian who became a homeopathic physician, and he is often called the ‘Hering of India’. The ‘Calcutta Homeopathic Medical College’ was established in 1881 and assumed a crucial role in popularising homeopathy.
Today, we are often being told that homeopathy is incredibly popular in India. For instance, the HINDUSTAN TIMES recently published the following article:
The government on Tuesday said homeopathy is ‘clinically effective’ and there has been a 50 % rise in the number of patients seeking homeopathic treatment in the country in the past five years.
“In India, at 23 Institutes/ Units under the Central Council for Research in Homeopathy (CCRH), there is 50 % more footfall of patients seeking homeopathic treatment during the last five years,” said AYUSH Minister of State (Independent Charge) Shripad Yesso Naik.
“Homeopathy is not a pseudoscience. The conclusion of most comprehensive systematic reviews of studies based on classical homeopathy has concluded that it has a positive and specific effect greater than placebo alone,” he said in a written reply in the upper house.
“Homeopathy is being promoted as it is not only safe and effective but also due to its high acceptance through high quality surveys of use of homeopathy,” said Naik, adding that there is evidence that homeopathy is beneficial.
“There is evidence based data (not anecdotal) with CCRH that warrants the promotion or acceptance of homeopathy in India,” said the Minister.
END OF QUOTE
In my view, this foremost begs one question: How does Shripad Yesso Naik get away with evidently false statements?
The minister describes himself as a ‘business person’ (not sure what this means, but it clearly does not describe a medical expert). Wikipedia has this interesting information on him: On March 25, 2016, Shripad Naik publicly stated he had access to research which proved that diseases such as cancer could be cured by yoga. He further stated that his Ministry was a year away from granting an endorsement to such techniques and research. The statement was challenged by medical researchers and doctors, who advocated caution in claiming a cure to cancer on the basis of unproven and unpublished research.
The AUYSH-ministry (AYUSH stands for ayurveda, yoga, siddha and homeopathy) seems to have the purpose of promoting homeopathy not on the basis of evidence but despite the evidence. For that purpose, it has set up a committee at the Central Council for Research in Homeopathy (CCRH) to “deal with issues related to false propaganda against homeopathy”. They claim to have written to Nobel laureate Venkatraman Ramakrishnan, who correctly stated that homeopathy and astrology were “bogus”… “No one in chemistry believes in homeopathy. It works because of placebo effect”. The director general of the CCRH countered that “The propaganda is coming from the West and it is picked up by newspapers here. They present homeopathy in a disproportionate and negative light, and it creates confusion… ” The CCRH has also been writing letters, rejoinders and counter-editorials to others to combat “false propaganda.”
I do not need to repeat here the evidence on homeopathy (we have dealt with it regularly on this blog); suffice to state that it fails to show that highly diluted homeopathic remedies differ from placebos. This, in turn, means that the accusation of ‘false propaganda’ must be directed not at the sceptics but at the AYUSH-ministry.
And what about the claim that homeopathy is currently so hugely popular in India? It seems that it is bogus too. A recent survey conducted by ‘Indian National Sample Survey Office’ revealed that 90% of the Indian population rely on conventional medicine. Merely 6% trust what the investigators chose to call ‘Indian systems of medicine’, e. g. ayurveda, yoga, siddha and homeopathy, often abbreviated as AYUSH.
The message that seems to emerge from all this is that, in India, homeopathy is being promoted on the basis of exaggerations and untruths – much like in many other countries, I hasten to add.
by Norbert Aust as ‘guest blogger’ and Edzard Ernst
Professor Frass has repeatedly stated that his published criticism of the Lancet meta-analysis has never been refuted, and therefore homeopathy is a valid therapy. The last time we heard him say this was during a TV discussion (March 2018) where he said that, if one succeeded in scientifically refuting the arguments set out in his paper, one would show the ineffectiveness of homeopathy.
In today’s post, we quote the paper Frass refers to, published as a ‘letter to the editor’ (published in the journal Homeopathy) by Frass et al (bold typing), and provide our rebuttal (in normal print) of it:
Even with careful selection, it remains problematic to compare studies of a pool of 165 for homeopathy vs 4200,000 for conventional medicine. This factor of 41000 already contains asymmetry.
We see no good reasons why the asymmetry poses a problem; it does not conceivably impact on the outcome, nor does it bias the results. In fact, such asymmetries are common is research.
Furthermore, it appears that there is discrimination when publications in English (94/110, 85% in the conventional medicine group vs 58/110, 53% in the homeopathy group) are rated higher quality (Table 2).
We cannot confirm that the table demonstrates such a discrimination, nor do we understand how this would disadvantage homeopathy.
Neither the Summary nor the Introduction clearly specify the aim of the study.
The authors stated that they “analysed trials of homoeopathy and conventional medicine and estimated treatment effects in trials least likely to be affected by bias”. It is hardly difficult to transform this into their aim: the authors aimed at analysing trials of homoeopathy and conventional medicine and estimating treatment effects in trials least likely to be affected by bias.
Furthermore, the design of the study differs substantially from the ﬁnal analysis and therefore the prolonged description of how the papers and databases were selected is misleading: instead of analysing all 110 studies retrieved by their deﬁned inclusion and exclusion criteria, the authors reduce the number of investigated studies to ‘larger trials of higher quality’. By using these sub-samples, the results seem to differ between conventional medicine and homeopathy.
This statement discloses a misconception of the approach used in the meta-analysis. The meta-analysis of all 110 trials found some advantages of homeopathy. When the authors performed a sensitivity analysis with high quality and larger studies, this advantage disappeared. The sensitivity analysis was to determine whether the overall treatment effect seen in the initial analysis was real or false-positive. In the case of homeopathy, it turned out to be false (and presumably for this reason, the authors hardly mention it in their paper), whereas for the trials of conventional medicines, it was real. This procedure is in keeping with the authors’ stated aims.
The meta-analysis does not compare studies of homeopathy vs studies of conventional medicine, but speciﬁc effects of these two methods in separate analyses. Therefore, a direct comparison must not be made from this study.
We fail to see the significance in terms of the research question stated by the authors. Even Frass et al use direct comparisons above.
However, there remains great uncertainty about the selection of the eight homeopathy and the six conventional medicine studies: the cut-off point seems to be arbitrarily chosen: if one looks at Figure 2, the data look very much the same for both groups. This holds true even if various levels of SE are considered. Therefore, the selection of larger trials of higher quality is a post-festum hypothesis but not a pre-set criterion.
This is not true, Shang et al clearly stated in their paper: “Trials with SE (standard error) in the lowest quartile were considered larger trials.” It is common, reasonable and in keeping with the authors’ aims to conduct sensitivity analyses using a subset of trials that seem more reliable than the average.
The question remains: was the restriction to larger trials of higher quality part of the original protocol or was this a data-driven decision? Since we cannot ﬁnd this proposed reduction in the abstract, we doubt that it was included a priori.
We are puzzled by this statement and fail to understand why Frass et al insist that this information should have been in the abstract.
However, even if one assumes that this was a predeﬁned selection, there are still some problems with the authors’ interpretation: for larger trials of higher reported methodological quality, the odds ratio was 0.88 (CI 95%: 0.65–1.19) based on eight trials of homeopathy: although this ﬁnding does not prove an effect of the study design on the 5% level, neither does it disprove the hypothesis that the results might have been achieved by homeopathy. For conventional medicine, the odds ratio was 0.58 (CI 95% 0.39–0.85), which indicates that the results may not be explained by mere chance with a 5% uncertainty.
As the outcome failed to reach the level of significance, the null-hypothesis (“there is no difference”) cannot be discarded, and this is sufficient evidence to show that there is no evidence for the effectiveness of homeopathy. The comment by Frass et al seems to be based on a misunderstanding how science operates.
Although the authors acknowledge that ‘to prove a negative is impossible’ the authors clearly favour the view that there is evidence that homoeopathy exhibits no effect beyond the placebo-effect. However, this conclusion was drawn after a substantial modiﬁcation of the original protocol which considerably weakens its validity from the methodological point of view. After acquiring the trials by their original inclusion- and exclusion criteria they introduced a further criterion, ‘larger trials of higher reported methodological quality’. Thus, eight trials (=46% of the larger trials) in the homoeopathy group were left and only six (32%) in conventional medicine group (an odds ratio of 0.75 in favour of homoeopathy).
As explained above, the authors’ reasoning was clear and rational; it did not follow the logic suggested by Frass et al. which confirms our suspicion already mentioned above that Frass et al misunderstood the concept of the Shang meta-analysis.
But the decisive point is that it is unlikely that these six trials are still matched to the eight samples of homoeopathy (although each of the 110 in the original was matched). Consequently, one cannot conclude that these trials are still comparable. Thus, any comparisons of results between them are unjustiﬁed.
Further evidence that Frass et al misunderstood the concept of the Shang meta-analysis.
The rationale for this major alteration of the study protocol was the assumption, that these larger, higher quality trials are not biased, but no evidence or databased justiﬁcation is given. Neither the actual data (odds ratio, matching parameters…) nor a funnel plot (to indicate that there is no bias) of the ﬁnal 14 trials are supplied although these parameters constitute the ground of their conclusion.
Further evidence that Frass et al misunderstood the concept of the Shang meta-analysis.
The other 206 trials (94% of the originally selected according to the protocol) were discarded because of possible publication biases as visualized by the funnel plots. However, the use of funnel plots is also questionable. Funnel plots are thought to detect publication bias, and heterogeneity to detect fundamental differences between studies.
Further evidence that Frass et al misunderstood the concept of the Shang meta-analysis.
New evidence suggests that both of these common beliefs are badly ﬂawed. Using 198 published meta-analyses, Tang and Liu demonstrate that the shape of a funnel plot is largely determined by the arbitrary choice of the method to construct the plot. When a different deﬁnition of precision and/or effect measure was used, the conclusion about the shape of the plot was altered in 37 (86%) of the 43 meta-analyses with an asymmetrical plot suggesting selection bias. In the absence of a consensus on how the plot should be constructed, asymmetrical funnel plots should be interpreted cautiously.
Further evidence that Frass et al misunderstood the concept of the Shang meta-analysis.
These ﬁndings also suggest that the discrepancies between large trials and corresponding meta-analyses and heterogeneity in metaanalyses may also be determined by how they are evaluated. Researchers tend to read asymmetric funnel plots as evidence of publication bias, even though metaanalyses without publication bias frequently have asymmetric plots and meta-analysis with publication bias frequently have symmetric plots, simply due to chance.
Perhaps we should mention that the senior author of the Lancet meta-analysis, Mathias Egger, is the clinical epidemiologist who invented the funnel plot and certainly knows how to use and interpret it.
Use of funnel plots is even more unreliable when there is heterogeneity. Apart from the questionable selection of the samples there is a further aspect of randomness which further weakens their conclusion: the odds ratio of the eight trials of homoeopathy was 0.88 (CI 0.65–1.19), which might be signiﬁcant around the 7–8% level. Actually, the reader might be interested to know at which exact level homeopathy would have become signiﬁcant. Thus, there is no support of their conclusion any more when you shift the level of signiﬁcance by mere, say 2–3%.
What number of grains is required to build a heap? Certainly there is such a limit. Five grains are not a heap, five billion are. But if you select any specific value, you will find it hard to explain if one grain less changes the characteristic of a heap to become a number of grains only. Same here. If p = 0.05 is the limit of significance, p = 0.05001 is not significant, let alone, when p is 2-3%higher than that.
In addition, with such controversial hypotheses the scientiﬁc community would tend to use a level of signiﬁcance of 1% in which case the odds ratio of the conventional studies would not be signiﬁcant either.
The level of 5% is commonly applied in medical research; it is the accepted standard. Frass et al also apply it in their studies; but here they want to change it. Why, to suit their preconceived ideas?
From a statistical point of view, the power of the test, considering the small sample sizes, should have been stated, especially in the case of a nonsigniﬁcant result.
This might have been informative but is rarely done in meta-analyses.
Above all, the choice of which trials are to be evaluated is crucial. By choosing a different sample of eight trials (eg the eight trials in ‘acute infections of the upper respiratory tract’, as mentioned in the Discussion section) a radically different conclusion would have had to be drawn (namely a substantial beneﬁcial effect of homeopathy—as the authors state).
Further evidence that Frass et al misunderstood the concept of the Shang meta-analysis.
The authors may not be aware that larger trials are usually not ‘classical’ homeopathic interventions, because the main principle of homeopathy, individualization are difﬁcult to apply in large trials. In this respect, the whole study lacks sound understanding of what homeopathy really is.
This is a red herring; firstly the authors did not aim to evaluate individualised homeopathy. Secondly, Frass et al know very well that clinical homeopathy is not individualised and regarded as entirely legitimate by homeopaths. And finally, the largest trial of individualised homeopathy included in Mathie’s review of individualized homeopathy had 251 participants.
So, why has so far no rebuttal of this ‘letter to the Editor’ been published? We suspect that the journal Homeopathy has little incentive to publish a critical response, and critics of homeopathy have even less motivation to submit one to this journal. Other journals have no reason at all to pursue a discussion started in ‘Homeopathy’. In other words, Frass et al were safe from any rebuttal – until today, that is.
A man is caught paying with fake money – gets arrested.
A man sells false insurance policies – gets arrested.
A man sells phoney investments – gets arrested.
A man traffics ‘diamonds’ made of glass – gets arrested.
A man flogs a car that does not work – gets arrested.
A silversmith fakes the hallmarks on jewellery – gets arrested.
A man sells TV sets that are faulty – gets arrested.
A man fakes labels of expensive wines – gets arrested.
A man is caught trafficking fake medicines – gets arrested.
A man is caught printing fake bank notes – gets arrested.
A man insists on changing monopoly money for real money – gets arrested.
A MAN PRESCRIBES ‘MEDICINES’ THAT CONTAIN NO ACTIVE INGREDIENTS – HE IS CALLED A HOMEOPATH.
A PHARMACY SPECIALISES IN MANUFACTURING SUCH ‘MEDICINES’ – THEY ARE GIVEN A ROYAL WARRANT.
On this blog, we are all fond of what homeopathy-guru DUllman tells us (see for instance here, here and here). It seems only fair, therefore, to show you an excerpt of his latest article, particularly as it is on the highly topical subject of the flu:
Scientific Evidence That Homeopathy Works for the Flu
There are several scientific studies published in peer-reviewed medical journals that have confirmed Oscillococcinum’s efficacy. One large study of 487 patients found that almost twice as many patients who were given Oscillococcinum recovered from the flu within 48 hours as those given a placebo (17 percent versus 10 percent).10 …
A different group of researchers conducted a randomized, double-blind study involving 372 patients (188 treated with Oscillococcinum and 187 with placebo) of both sexes, ranging in age from 12 to 60, who presented rectal temperature ≥ 100.4 F, muscle pains, headache, or at least one of the following symptoms: shivering, chest pain, spine pain, coughing, irritation of nasal mucosa or feeling of malaise.12
Patients received three tubes of Oscillococcinum or placebo each day (morning, noon and night) for three days. The results of this trial show a highly statistically significant difference between the two groups, for what concerns disappearance of symptoms after 48 hours (19.2 percent in the Oscillococcinum group versus 17.1 percent in the placebo group) and improvement in symptoms (43.7 percent vs 38.6 percent for placebo) ) (p = 0.0028).
Moreover, the frequency of use of concomitant medicines was slightly higher for the placebo group, as was also the use of multiple medicines. Only 13.8 percent of the Oscillococcinum group used two or three drugs (analgesics and antirheumatics), against 19.6 percent in the placebo group.
Another parameter considered was the percentage of patients able to return to work, which was higher in the Oscillococcinum group, both two days after the onset of the illness (16.3 percent against 9.3 percent) and after four days, with highly significant differences.
Homeopathic Treatment Reduced Length of Influenza Illness
The Cochrane Collaboration is an internationally respected group of researchers who evaluate scientific studies. In 2004, they reviewed seven studies using Oscillococcinum in the treatment or prevention of influenza.13 Four treatment trials (n = 1,194) and three prevention trials (n = 2,265) were evaluated.
Only two studies had sufficient information to complete data extraction fully, and both of these studies only evaluated the use of this medicine in the treatment of influenza or influenza-like conditions (the two studies mentioned above were the two studies that were evaluated).
Oscillococcinum treatment reduced length of influenza illness by 0.28 days (95 percent confidence interval 0.50 to 0.06). Oscillococcinum also increased the chance of a patient considering treatment effective (relative risk 1.08; 95 percent CI 1.17, 1). This review also concluded that the number of days needed to return to work were significantly reduced by 0.49 days (95 percent CI 0.89-0.08) compared to the control (average of 4.1 days).
The relative risk from treatment was 0.60 (0.37-0.98), meaning that the proportion of patients treated with Oscillococcinum who considered the treatment to be useless was 0.6, relative to 1.0 for the placebo (a significant difference of 40 percent). The authors of this research review considered these results “promising,” though not strong enough to warrant a general recommendation to use Oscillococcinum for “first-line” treatment of influenza or influenza-like syndromes.
As for the use of Oscillococcinum in the prevention of the flu, the researchers concluded that it was not effective. However, it should be highlighted that the company that makes Oscillococcinum does not market this medicine for “prevention” of the flu, only for the treatment of it (and for “influenza-like” syndrome).
In 2012, a new analysis of research on Oscillococcinum in the treatment of influenza was conducted by the Cochrane Collaboration, and their conclusion was more conservative than previous analyses by this organization.14
The 2012 analysis concluded, “Although the results from four other clinical trials (total of 1196 participants) suggested that Oscillococcinum relieved flu symptoms at 48 hours, this might be due to bias in the trial methods.” In other words, even though two of these studies were double-blind, randomized and placebo controlled, these studies did not achieve the higher caliber of standards of research, thereby enabling the possibility of bias in the results….
- 10 Ferley, JP, Zmirou, D, D’Admehar, D, et al., A Controlled Evaluation of a Homoeopathic Preparation in the Treatment of Influenza-like Syndrome, Britis [sic]
- 11 Anonymous. Quadruple-Blind (editorial). Lancet. April 22, 1989, 333, 8643: 914.
- 12 Papp, R. Schuback, G. Beck, E, et al, Oscillococcinum in Patients with Influenza-like Syndromes: A Placebo Controlled Double-blind Evaluation, British [sic]
- 13 Vickers A, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev. 2004;
- 14 Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness. Cochrane Database of Syste [The link given by Ullman does not work. The correct link is here.]
END OF QUOTE
It is perhaps not unusual for DUllman to fail noticing that Vickers review [ref 13] has long been withdrawn. It is, however, highly unusual for DUllman not to accuse the authors of the current Cochrane review of bias. After all, they concede that the effect might be an artefact due to bias! In fact, their published conclusions (in both the 2012 and 2015 reviews; the latter was not mentioned by DUllman at all) are quite different from DUllman’s interpretation:
There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum(®) in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum(®) could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling. There was no evidence of clinically important harms due to Oscillococcinum(®).
The reason why DUllman is so unusually restrained seems obvious: the authors of the review are some of the most vociferous promoters of homeopathy who he knows well and they are pals: Fisher, Frye, Robert Mathie.[For those who are interested, their COI statements (which might explain the rather off conclusion ‘Our findings do not rule out the possibility that Oscillococcinum(®) could have a clinically useful treatment effect…’) are here:
Robert T Mathie: Dr Mathie is Research Development Adviser, British Homeopathic Association. He was a member of the International Scientific Committee on Homeopathic Investigations, which ceased its committee activities in July 2013.
Joyce Frye: Dr. Frye received partial salary support from Standard Homeopathic Company, which terminated June 2013 and honoraria from the International Scientific Committee on Homeopathic Investigations, which was dissolved in July 2013.
Peter Fisher: I am Expert Adviser on Complementary and Alternative Medicine to the National Institute for Health and Clinical Excellence (NICE), which may take an interest in the evidence in this review. I am Editor in Chief of an international, peer-reviewed journal dedicated to homeopathy. All payments and reimbursements for lectures have been from universities or professional or learned societies. None of these lectures has been dedicated to the subject of this review. Some meetings have been supported by grants from commercial interests, including the manufacturer of the product that is the subject of the review.]
Moreover, DUllman does not mention how dismal the quality of the RCTs really is. Here is the quality rating by Mathie et al:
And here is the crucial quote from the review: The standard of trial reporting was poor or very poor.
But this might just be nit-picking. What is much more important in my view is this:
- Even at the most optimistic interpretation of the findings, these results are clinically meaningless. Their effect size is minute and therefore not relevant.
- If we consider the prior probability of less than one molecule of duck liver per universe (more on Oscillococcinum here) having any effect at all, the results (which DUllman calls ‘highly significant’) are not statistically significant at all.
My conclusions are simple:
- Oscillococcinum is a placebo (a fact that has been affirmed by several US judges).
- DUllman is great fun but not a great scientist (also confirmed by a US judge):…The Court found Mr. Ullman’s testimony to be not credible. Mr. Ullman’s bias in favor of homeopathy and against conventional medicine was readily apparent from his testimony. He admitted that he was not an impartial expert but rather is a passionate advocate of homeopathy…
Today, Price Charles celebrates his 69th birthday. Gun salutes will mark the occasion but he is said to celebrate in private. As in previous years, I take this occasion to update my tribute to him. Charles is one of the world’s most outspoken proponent of alternative medicine and attacker of science. He therefore has a prominent place on this blog.
His love affair with all things alternative started early in his life.
As a youngster, Charles went on a journey of ‘spiritual discovery’ into the wilderness of northern Kenya. His guru and guide at the time was Laurens van der Post (later discovered to be a fraud and compulsive fantasist and to have fathered a child with a 14-year old girl entrusted to him during a sea voyage). Van der Post wanted to awake Charles’ mind and attune it to the vitalistic ideas of Carl Jung’s ‘collective unconscious’, and it is this belief in vitalism that provides the crucial link to alternative medicine: virtually every form of alternative therapies is based on the assumption that some sort of vital force exists. Charles was so taken by van der Post that, after his death, he established an annual lecture in his honour (the lecture series was discontinued after Van der Post was discovered to be a fraud).
Throughout the 1980s, Charles lobbied for the statutory regulation of chiropractors and osteopaths in the UK. In 1993, this finally became reality.
Osteopathy has strong Royal links: Prince Charles is the President of the GOsC; Princess Diana was the President of the GCRO; and Princess Anne is the patron of the British School of Osteopathy (statement dated 2011).
In 1982, Prince Charles was elected as President of the British Medical Association (BMA) and promptly challenged the medical orthodoxy by advocating alternative medicine. In a speech at his inaugural dinner as President, the Prince lectured the medics: ‘Through the centuries healing has been practised by folk healers who are guided by traditional wisdom which sees illness as a disorder of the whole person, involving not only the patient’s body, but his mind, his self-image, his dependence on the physical and social environment, as well as his relation to the cosmos.’ The BMA-officials ordered a full report on alternative medicine which promptly condemned this area as implausible nonsense.
In 1993, Charles founded his lobby group which, after being re-named several times, ended up being called the ‘Foundation for Integrated Health’ (FIH). It was closed down in 2010 amidst allegations of money laundering and fraud. Its chief executive, George Gray, was later convicted and went to jail. The FIH had repeatedly been a little economical with the truth.
In 2000, Charles wrote an open letter to The Times stating that…It makes good sense to evaluate complementary and alternative therapies. For one thing, since an estimated £1.6 billion is spent each year on them, then we want value for our money. The very popularity of the non-conventional approaches suggests that people are either dissatisfied with their orthodox treatment, or they find genuine relief in such therapies. Whatever the case, if they are proved to work, they should be made more widely available on the NHS…But there remains the cry from the medical establishment of “where’s the proof?” — and clinical trials of the calibre that science demands cost money…The truth is that funding in the UK for research into complementary medicine is pitiful…So where can funding come from?…Figures from the department of complementary medicine at the University of Exeter show that less than 8p out of every £100 of NHS funds for medical research was spent on complementary medicine. In 1998-99 the Medical Research Council spent no money on it at all, and in 1999 only 0.05 per cent of the total research budget of UK medical charities went to this area…
In 2001, Charles worked on plans to help build a model hospital of integrated medicine. It was to train doctors to combine conventional medicine and alternative treatments, such as homeopathy, Ayurvedic medicine and acupuncture, and was to have have up to 100 beds. The prince’s intervention marked the culmination of years of campaigning by him for the NHS to assign a greater role to alternative medicine. Teresa Hale, founder of the Hale Clinic in London, said: “Twenty-five years ago people said we were quacks. Now several branches, including homeopathy, acupuncture and osteopathy, have gained official recognition.” The proposed hospital, which was due to open in London in 2003/4, was to be overseen by Mosaraf Ali, who runs the Integrated Medical Centre (IMC) in London. But the hospital never materialised. This might be due to Mosaraf Ali falling in disrepute: Raj Bathija, 69 and from India, went for a massage at the clinic of Dr Mosaraf Ali and his brother Imran in 2005 after suffering from two strokes. However, he claims that shortly after the treatment, his legs became pale and discoloured. Four days afterwards, Mr Bathija was admitted to hospital, where he had to have both legs amputated below the knee due to a shortage of blood. According to Mr Bathija, Dr Ali and his brother were negligent in that they failed to diagnose his condition and neglected to advise him to go to hospital. His daughter Shibani said: “My father was in a wheelchair but was making progress with his walking. He hoped he might become a bit more independent. With the amputations, that’s all gone.” Dr Ali was sued (if anyone knows the outcome of this case, please let me know).
In 2003, Prince Charles’ FIH launched a five-year plan which outlined how to improve access to alternative therapies.
In 2004, Charles publicly supported the Gerson diet as a treatment for cancer and Prof Baum, an eminent oncologists, was invited to respond in an open letter to the British Medical Journal: …Over the past 20 years I have treated thousands of patients with cancer and lost some dear friends and relatives to this dreaded disease…The power of my authority comes with knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth. I don’t begrudge you that authority but I do beg you to exercise your power with extreme caution when advising patients with life-threatening diseases to embrace unproven therapies.
In 2005, the ‘Smallwood-Report’ was published; it had been commissioned by Charles and paid for by Dame Shirley Porter to inform health ministers. It stated that up to 480 million pounds could be saved, if one in 10 family doctors offered homeopathy as an “alternative” to standard drugs for asthma. Savings of up to 3.5 billion pounds could be achieved by offering spinal manipulation rather than drugs to people with back pain. Because I had commented on this report, Prince Charles’ first private secretary asked my vice chancellor to investigate my alleged indiscretion; even though I was found to be not guilty of any wrong-doing, all local support at Exeter stopped which eventually led to my early retirement. ITV later used this incident in a film entitled THE MEDDLING PRINCE, I later published a full account of this sad story in my memoir.
In a 2006 speech, Prince Charles told the World Health Organisation in Geneva that alternative medicine should have a more prominent place in health care and urged every country to come up with a plan to integrate conventional and alternative medicine into the mainstream. But British science struck back. Anticipating Prince Charles’s sermon in Geneva, 13 of Britain’s most eminent physicians and scientists wrote an “Open Letter” which expressed concern over “ways in which unproven or disproved treatments are being encouraged for general use in Britain’s National Health Service.” The signatories argued that “it would be highly irresponsible to embrace any medicine as though it were a matter of principle.”
In 2008, The Times published my letter asking the FIH to withdraw two guides promoting alternative medicine, stating: “the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous.” A speaker for the FIH countered the criticism by stating: “We entirely reject the accusation that our online publication Complementary Healthcare: A Guide contains any misleading or inaccurate claims about the benefits of complementary therapies. On the contrary, it treats people as adults and takes a responsible approach by encouraging people to look at reliable sources of information… so that they can make informed decisions. The foundation does not promote complementary therapies.”
In 2009, the Prince held talks with the health Secretary to persuade him to introduce safeguards amid a crackdown by the EU that could prevent anyone who is not a registered health practitioner from selling remedies. This, it seems, was yet another example of Charles’ disregard of his constitutional role.
In the same year, Charles urged the government to protect alternative medicine because “we fear that we will see a black market in herbal products”, as Dr Michael Dixon, then medical director of Charles’ FIH, put it.
In 2009, the health secretary wrote to the prince suggesting a meeting on the possibility of a study on integrating complementary and conventional healthcare approaches in England. The prince had written to Burnham’s predecessor, Alan Johnson, to demand greater access to complementary therapies in the NHS alongside conventional medicine. The prince told him that “despite waves of invective over the years from parts of the medical and scientific establishment” he continued to lobby “because I cannot bear people suffering unnecessarily when a complementary approach could make a real difference”. He opposed “large and threatened cuts” in the funding of homeopathic hospitals and their possible closure. He complained that referrals to the Royal London homeopathic hospital were increasing “until what seems to amount to a recent ‘anti-homeopathic campaign’”. He warned against cuts despite “the fact that these homeopathic hospitals deal with many patients with real health problems who otherwise would require treatment elsewhere, often at greater expense”.
In 2009, it was announced that the ‘College of Integrated Medicine’ (the name was only later changed to ‘College of Medicine’, see below) was to have a second base in India. An Indian spokesman commented: “The second campus of the Royal College will be in Bangalore. We have already proposed the setting up of an All India Institute of Integrated Medicine to the Union health ministry. At a meeting in London last week with Prince Charles, we finalized the project which will kick off in July 2010”.
In 2010, Charles publicly stated that he was proud to be perceived as ‘an enemy of the enlightenment’.
In 2010, ‘Republic’ filed an official complaint about FIH alleging that its trustees allowed the foundation’s staff to pursue a public “vendetta” against a prominent critic of the prince’s support for complementary medicines. It also suggested that the imminent closure of Ernst’s department may be partly down to the charity’s official complaint about him after he publicly attacked its draft guide to complementary medicines as “outrageous and deeply flawed”.
In 2010, former fellows of Charles’ disgraced FIH launched a new organisation, The College of Medicine’ supporting the use of integrated treatments in the NHS. One director of the college is Michael Dixon, a GP in Cullompton, formerly medical director of the Foundation for Integrated Health. My own analysis of the activities of the new college leaves little doubt that it is promoting quackery.
In 2011, after the launch of Charles’ range of herbal tinctures, I had the audacity to publicly criticise Charles for selling the Duchy Herbals detox tincture which I named ‘Dodgy Originals Detox Tincture’.
In 2011, Charles forged a link between ‘The College of Medicine’ and an Indian holistic health centre (see also above). The collaboration was reported to include clinical training to European and Western doctors in ayurveda and homoeopathy and traditional forms of medicine to integrate them in their practice. The foundation stone for the extended campus of the Royal College known as the International Institution for Holistic and Integrated Medicine was laid by Dr Michael Dixon in collaboration with the Royal College of Medicine.
In 2012, Charles was nominated for ‘THE GOLDEN DUCK AWARD’ for his achievements in promoting quackery. However, Andrew Wakefield beat him to it; Charles certainly was a deserving runner-up.
In 2013, Charles called for society to embrace a broader and more complex concept of health. In his article he described a vision of health that includes the physical and social environment, education, agriculture and architecture.
In 2013, Charles’ Highgrove enterprise offered ‘baby-hampers’ for sale at £195 a piece and made a range of medicinal claims for the products it contained. As these claims were not supported by evidence, there is no way to classify them other than quackery.
By 2013, the ‘Association of Osteomyologists’ were seeking to become regulated by statute, with the help of Prince Charles as their patron. The chairman and founder of this organisation was knighted for services to alternative medicine. Osteomyologists encourage the use of techniques including cranio-sacral therapy and claim that “we all know that Colleges, Institutions, and Medical Practitioners, are brain washed from the very outset into believing that their discipline is the only way to go.”
In November 2013, Charles invited alternative medicine proponents from across the world, including Dean Ornish, Michael Dixon, chair of College of Medicine, UK and Issac Mathai of Soukya Foundation, Bangalore, to India for a ‘brain storm’ and a subsequent conference on alternative medicine. The prince wanted the experts to collaborate and explore the possibilities of integrating different systems of medicines and to better the healthcare delivery globally, one of the organisers said.
In June 2014, BBC NEWS published the following text about a BBC4 broadcast entitled ‘THE ROYAL ACTIVIST’ aired on the same day: Prince Charles has been a well-known supporter of complementary medicine. According to a… former Labour cabinet minister, Peter Hain, it was a topic they shared an interest in. He had been constantly frustrated at his inability to persuade any health ministers anywhere that that was a good idea, and so he, as he once described it to me, found me unique from this point of view, in being somebody that actually agreed with him on this, and might want to deliver it. Mr Hain added: “When I was Secretary of State for Northern Ireland in 2005-7, he was delighted when I told him that since I was running the place I could more or less do what I wanted to do.*** I was able to introduce a trial for complementary medicine on the NHS, and it had spectacularly good results, that people’s well-being and health was vastly improved. And when he learnt about this he was really enthusiastic and tried to persuade the Welsh government to do the same thing and the government in Whitehall to do the same thing for England, but not successfully,” added Mr Hain. On this blog, I have pointed out that the research in question was fatally flawed and that Charles, once again, overstepped the boundaries of his constitutional role.
In 2015, two books were published which are relevant in this context. My memoir A SCIENTIST IN WONDERLAND recounts most of my dealings with Charles and his sycophants, including how an intervention from his first private secretary eventually led to the closure of my department. The book by Catherine Meyer CHARLES, THE HEART OF A KING is far less critical about our heir to the throne; it nevertheless severely criticises his stance on alternative medicine.
In October 2015, the Guardian obtained the infamous “black spider memos” which revealed that Charles had repeatedly lobbied politicians in favour of alternative medicine (see also above).
In 2016, speaking at a global leaders summit on antimicrobial resistance, Prince Charles warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”
In 2017, the ‘College of Medicine’ mentioned above was discretely re-named ‘College of Medicine and Integrated Health’
In the same year, Charles declared that he will open a centre for alternative medicine in the recently purchased Dumfries House in Scotland.
As I am writing this update, Prince Charles is facing a backlash over a letter he wrote in 1986 in which he urged the US to “take on the Jewish lobby” and blamed “the influx of foreign Jews” for the unrest in the Middle East. The chairman of the Campaign Against Antisemitism has called the letter “disturbing” and the comments as “unmistakably anti-Semitic”. But that is, of course, another story.
Prince Charles’ dedication to quackery is remarkable. As every year, on his birthday he deserves credit for the hard work he has put into it. The late Christopher Hitchens repeatedly wrote about this passion, and his comments are, in my view, unsurpassable:
We have known for a long time that Prince Charles’ empty sails are so rigged as to be swelled by any passing waft or breeze of crankiness and cant. He fell for the fake anthropologist Laurens van der Post. He was bowled over by the charms of homeopathic medicine. He has been believably reported as saying that plants do better if you talk to them in a soothing and encouraging way… The heir to the throne seems to possess the ability to surround himself—perhaps by some mysterious ultramagnetic force?—with every moon-faced spoon-bender, shrub-flatterer, and water-diviner within range.
HAPPY BIRTHDAY YOUR ROYAL HIGHNESS
On their website, the ASA yesterday published a statement about chiropractic. It outlines which claims UK chiropractors are allowed to make and which are likely to get them into conflict with the ASA. Here are a few excerpts (my comments are added in bold):
Chiropractic is a healthcare profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, with special emphasis on the spine. It emphasises manual therapy including spinal manipulation and other joint and soft-tissue manipulation, and includes exercises, and health and lifestyle counselling…
Why not say as it is: more than 90% of patients consulting a chiropractor will receive spinal manipulations. Therefore the best way to define chiropractic is by its hallmark intervention. Using vague language like ‘manual therapy… exercises, and health and lifestyle counselling’ creates big problems and opens the door to all sorts of therapeutic claims (see below).
In 2017 the ASA carried out an evidence review on the use of multi-modal approaches used in Chiropractic in treating sciatica, whiplash and sports injuries as well as the treatment of babies, children and pregnant women as specific patient groups. The subsequent ASA Guidance explains in more detail the types of claims (including phraseology) that are likely to be acceptable for chiropractors to make in their advertising and those which are not. We recommend chiropractors consider this CAP advice and the ASA Guidance together when making treatment claims in advertising.
Based on all evidence submitted and reviewed to date, the ASA and CAP accept that chiropractors may claim to treat the following conditions:
- Ankle sprain (short term management)
- Elbow pain and tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
- Headache arising from the neck (cervicogenic)
- Inability to relax
- Joint pains
- Joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
- General, acute & chronic backache, back pain (not arising from injury or accident)
- Generalised aches and pains
- Mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)
- Migraine prevention
- Minor sports injuries and tensions
- Muscle spasms
- Plantar fasciitis (short term management)
- Rotator cuff injuries, disease or disorders
- Shoulder complaints (dysfunction, disorders and pain)
- Soft tissue disorders of the shoulder
I am puzzled by this list; for most indications, there is no good evidence at all – unless, of course, we consider chiropractic to consist of ‘manual therapy… exercises, and health and lifestyle counselling’ (see above). But, in this case, the list is still very odd because it would then need to include practically all conditions that can affect humans. Or does anyone know of many diseases that cannot benefit from ‘health and lifestyle counselling’?
…As regulated health professionals, chiropractors may refer to treating specific population groups such as pregnant women, children and babies. However, at present there is a limited or negative evidence base for the effectiveness of chiropractic (here the ASA use the term ‘chiropractic’ not as defined above but as a type of therapy which I think is correct but most chiros object to) in treating conditions specific to those groups, such as colic or morning sickness.
Consequently, references to treatment for symptoms and conditions that are likely to be understood to be specific to babies, children or pregnant women are unlikely to be acceptable unless the marketer holds a robust body of evidence…
And why should this be? Is ‘health and lifestyle counselling’ not effective for these conditions? Clearly it is! So this restriction is illogical.
I think, the ASA got themselves into a major muddle here. The only way to sort it out is to define chiropractic by its main therapy, spinal manipulation, and judge it by the proven risks and benefits of this intervention. (A surgeon will also often give ‘health and lifestyle counselling’, but this does not mean that surgery is indicated for migraine, common cold, asthma etc.)
And if we follow this approach, we instantly see that the ASA list of allowed claims makes no sense whatsoever!
‘Chiropractic is safe’ is a statement by Dr Arleen Scholten (see below) and thousands of other chiropractors like her. This sentence seems to be a nice marketing slogan – but sadly it is far removed from reality:
- chiropractic causes mild to moderate adverse effects in about 50% of all patients;
- in addition, it caused many much more serious complications, including deaths.
How many such serious events have occurred is anyone’s guess. The reason for this uncertainty is that there is no monitoring system that would give us this information. About 500 serious complications have been published in the medical literature. But these published cases are just the tip of a much bigger iceberg. We have shown that under-reporting is close to 100%.
This means that the vast majority of these cases remain completely undocumented. Some appear in the popular press, like the one recently published in the DAILY MAIL:
A chiropractor has been arrested on suspicion of manslaughter after a retired bank manager died following treatment for backache.
John Lawler, 80, was undergoing routine treatment at a private clinic when he lost consciousness and appeared to have become paralysed from the shoulders down. He was taken straight to hospital but died the next day as a result of a ‘traumatic spinal cord injury.’
His wife of 55 years, Joan Lawler, 81, was in the chiropractor’s clinic with her husband and witnessed the incident. Police are investigating to establish whether or not criminal negligence was a factor in his death.
Dr Arleen Scholten, 40, the chiropractor who treated Mr Lawler, was arrested by police on suspicion of manslaughter and released pending further inquiries.
Mr Lawler, a former Barclays Bank manager, was an active and healthy grandfather who lived in York. It is understood he was taken ill on his third visit in a week to Chiropractic 1st – a clinic within walking distance of the family home. He was seen by Dr Scholten, a chiropractor and director of the company, on Friday, August 11 and was undergoing treatment on his back when the unexpected and fatal problem occurred.
Mr Lawler was taken to York District Hospital by ambulance before being transferred to Leeds General Infirmary when the seriousness of his condition became clear.
END OF QUOTE
DOCTOR Scholten tells us on her website that we get to help people who suffer from a variety of health issues. Naturally, chiropractic helps traditional neck and back problems, but chiropractic has also produced wonderful results with a variety of organic and systemic problems. Chiropractic is safe.*** Chiropractic is natural. And Chiropractic works!
Doctor Scholten also informs us that our children were all adjusted the day they were born, 2 were homebirths and I continue to check their spines regularly. There is a saying in Chiropractic ‘If the twig is bent so grows the tree’.
Say no more!
(*** my emphasis)
Researchers from Texas have recently shown that the administration of hdc Lactobacillus reuteri in the gut resulted in luminal hdc gene expression and histamine production in the intestines of Hdc mice.
Would you conclude from this result that human colon cancer can be reversed or prevented by consuming probiotics?
You would need to be a moron to do so, in my view.
Colon cancer could be reversed just with probiotics that change the gut’s bacteria—and the disease can be prevented in the first place by eating whole grains, such as brown rice and whole-wheat bread, every day, two new research studies have found. In a breakthrough study that could herald in a new drugs-free approach to treating colon cancer, researchers have discovered that sufferers lack certain enzymes known as metabolites, simple ‘building-block’ compounds, in their gut, and this can cause inflammation and cancer…
I am not! By now, I know what to expect from my favourite source of misinformation, WDDTY.
The authors of a recent paper stated that cerebellar and spinal cord injuries related to cervical chiropractic manipulation were first reported in 1947. By 1974, there were 12 reported cases. Non-invasive imaging has since greatly improved the diagnosis of cervical artery dissection and of stroke, and cervical artery dissection is now recognized as pathogenic of strokes occurring in association with chiropractic manipulation.
The purpose of their study was to determine the frequency of patients seen at a single institution who were diagnosed with a cervical vessel dissection related to chiropractic neck manipulation.
The authors identified cases through a retrospective chart review of patients seen between April 2008 and March 2012 who had a diagnosis of cervical artery dissection following a recent chiropractic manipulation. Relevant imaging studies were reviewed by a board-certified neuro-radiologist to confirm the findings of a cervical artery dissection and stroke. The authors also conducted telephone interviews with each patient to ascertain the presence of residual symptoms in the affected patients.
Of the 141 patients with cervical artery dissection, 12 had documented chiropractic neck manipulation prior to the onset of the symptoms that led to medical presentation. The 12 patients had a total of 16 cervical artery dissections. All 12 patients developed symptoms of acute stroke. All strokes were confirmed with magnetic resonance imaging or computerized tomography. Follow-up information could be obtained from 9 patients, 8 of whom had residual symptoms and one of whom died as a result of their injury. The tables below give the full details. [Click to enlarge.]
The authors concluded that in this case series, 12 patients with newly diagnosed cervical artery dissection(s) had recent chiropractic neck manipulation. Patients who are considering chiropractic cervical manipulation should be informed of the potential risk and be advised to seek immediate medical attention should they develop symptoms.
How many times have we on this blog issued similar warnings?
And how many times have chiropractors countered with denial?
This time will be no different, I am sure.
But sadly, repeating a lie many times does not turn it in to a truth.
I am sending you Richard Eaton’s excellent update on developments around complementary medicine. As you will know, the College is supportive of an integrated approach that offers each patient the best of both worlds – conventional and complementary. In both worlds it is important that treatment and advice offered is safe, appropriate and evidence based…
Thank you for your continued support of the College of Medicine.
With best wishes,
Dr Michael Dixon
College of Medicine
I received this via email today, and of course I was interested. The ‘excellent update’ turned out to be truly amazing. For reasons that will become clear when you read on, I will abstain from any criticism – but I urge you to read it in full and perhaps let me know what you think by posting a comment:
START OF QUOTE
The Charity Commission’s Consultation: The use and promotion of complementary and alternative medicine – Making decisions about charitable status, (13.03.17):
The deadline for responses to the Charity Commission’s Consultation about the charitable status of CAM expired on 19th May (see the May edition of this blog). Many responses were filed, including by The Complementary & Natural Healthcare Council (CNHC) and by The College of Medicine.
Confusingly, the Commission’s Consultation Document expressly provided (in the section What the Commission is not consulting on at page 5) that:
‘…This consultation is not about…whether or not CAM therapies in general, or any particular CAM therapies, are effective…’
Yet logic dictates that the effectiveness of CAM and, therefore, the reliability of the evidence for it, will clearly feature significantly in the Commission’s deliberations as it assesses the extent to which CAM is of benefit to the public for charitable purposes.
The submission by The College of Medicine included the following:
‘…the continuing appetite of the public for access to CAM both in the private sector and through NHS organisations, should offer the Commission at least some reassurance that CAM has overall, a beneficial impact for those who use it…’
and further that:
‘…Whilst an RCT can be regarded as the highest level evidence, this type of study is not always the most suitable for assessing the benefits (efficacy/effectiveness) of CAM. Other research designs such as observational studies, surveys and qualitative methods can provide high quality information. In addition, RCTs invariably require very large budgets to underpin their delivery and CAM has not on the whole been the recipient of sufficient grant funding to enable large RCTs to be performed…’
The outcome of this important Charity Commission Consultation is awaited. It will be of huge significance to charitable organisations using or promoting CAM and to CAM practitioners and patients.
The Exclusivity of the Randomised Controlled Trial – the debate:
There is a continuing debate about the exclusivity of the Randomised Controlled Trial (RCT). Research articles about the RCT may be found here [Getting off the “Gold Standard”: Randomised Controlled Trials and Education Research: PMCID-PMC3179209] and here [Fool’s gold, lost treasures, and the randomised controlled trial-PMID: 23587187].
Further observations on the efficacy of the RCT may be found in the (free) April 2017 Newsletter published online by the Alliance for Natural Health International.
The Human effect and its desirability:
Also relevant to the debate about the evidence-base for CAM is the desirability of the Human effect. The Smallwood Report (The Role of Complementary and Alternative Medicine in the NHS: 2005), at page 23, makes the following observation:
‘…While some critics have derided the use of CAM treatments, claiming the success of some therapies to be purely based on a placebo effect, CAM proponents see what Dr Michael Dixon calls the “human effect” as desirable in itself…’
(Dixon & Sweeny, 2000 and see the BMJ book review here)
National Institute for Health & Care Excellence: CAM Updates
Practitioners of complementary and alternative medicine (CAM) may recall my November 2016 blog which referred to confirmation by the National Institute for Health and Care Excellence (NICE) that it had decided to retain its guideline on improving supportive care for adults with cancer, thereby ensuring that, for the time being at least, selected CAM therapies will continue to be available within the NHS in England & Wales. This guideline has been given the new title of End of life care for adults in the last year of life: service delivery and is currently “in development” with a publication date of January 2018 when it is hoped that CAM therapies will continue to be retained.
In the meantime, Further NICE guidelines have been published covering the planning and management of end of life and palliative care for infants, children and young people (aged 0 – 17 years) with life-limiting conditions. These aim to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives. Recommendations include (paragraph 1.3.25) consideration of non-pharmacological interventions for pain management including music and physical contact such as touch, holding or massage. These Guidelines will next be reviewed in December 2018.
As mentioned in my blogs posted in September 2016 and February 2017, NICE Guidelines regarding the assessment and management of low back pain and sciatica in people aged 16 or over (published in November 2016) have stopped recommending acupuncture. The removal of acupuncture from the guidelines conflicts with research published (in January 2017) by MacPherson H, Vickers A (and others) in The National Institute for Health Research Journals Library: Programme Grants for Applied Research, Volume 5, issue 3 (“Acupuncture for chronic pain and depression in primary care: a programme of research”), which concludes as follows:
‘…We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence…’
These Guidelines will next be reviewed in November 2018 when, again it is hoped, acupuncture will be reinstated and that Alexander Technique together with other beneficial CAM therapies will be included.
Professional Standards Authority: Accredited Registers Programme
Practitioners will already be aware of the Accredited Registers Programme which is overseen by the Professional Standards Authority for Health and Social Care (PSAHSC). This programme aims to provide assurance to the public, care commissioners and patients who are seeking health practitioners (including complementary therapists) who are not regulated by statute. The President of the Federation of Holistic Therapists (FHT), Jennifer Wayte, has suggested that:
‘…By signposting the Accredited Registers programme in relevant Guidelines, NICE would help to ensure better safety and standards of care…’ (International Therapist Journal, Issue 117 at page 17: Summer 2016).
Commissioning cost-saving CAM: The future for Integrated Medicine
In March 2016, The Kings Fund published its report Bringing together physical and mental health: A new frontier for integrated health about which a discussion can be viewed here and a blog by the FHT may be read here. In the News & Analysis section of its Health and Wellbeing Board Bulletin (06.06.17), The Kings Fund also highlighted the article published in The Lancet on 23.05.17 titled Forecasted trends in disability and life expectancy in England & Wales up to 2025: a modelling study which concludes:
‘…The rising burden of age-related disability accompanying population ageing poses a substantial societal challenge and emphasises the urgent need for policy development that includes effective prevention interventions…’
In the light of this and having regard to research such as that relating to the worsening mental well-being of year 10 school children, practitioners and their patients could lobby relevant Government departments, NICE and the PSAHSC regarding the potential of CAM as a cost-saving contributor to preventative and integrated medicine. In his Economic Outlook published in The Sunday Times on 23.04.17 (Business Section, page 4), Economist David Smith predicted frightening health spending as doubling from (roughly) 7% of gross domestic product to over 12.5% over the next 40-50 years and that social care costs will also double to 2% of GDP. Health spending policy makers and Clinical Commissioning Groups would do well to keep these (long-term) numbers in mind when assessing the potential of CAM and integrated medicine.
Further information about integrated and complementary medicine may be found in the Elsevier publications Advances in Integrative Medicine and the European Journal of Integrative Medicine and by accessing British Medical Journal (BMJ) articles such as Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour (as amended), which concludes:
‘…The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence…’
For further research and debate about the cost-effective integration of CAM into the NHS, please refer to the February 2017 issue of this blog.
Adopting a business approach to practising CAM
Turning to a very different topic, my message to Practitioners and especially to those who are in the process of starting or establishing their CAM practice, is that adopting a business approach to practice management is crucial. By doing so and without compromising their professionalism, practitioners can help to defend their freedom to practice.
The past year has been challenging for practitioners. It looks like next few years will be even more so as those working in the health and social care sectors continue to assess the implications of ‘Brexit’ and how these may affect their freedom to practise and their patient’s right to receive a CAM treatment of their choice.
As ever, much of the popular press continues to present an unbalanced and misrepresentative view of CAM. For instance, I have yet to see popular print or broadcast journalism properly cover The World Health organisation Traditional Medicine Strategy 2014 to 2023: Strategy Document which states (at page 19; note: italics added by me):
‘…As the uptake of T&CM (Traditional and Complementary medicine) increases, there is a need for its closer integration into health systems…’
(refer to my November 2016 blog for more information).
Contrast this with the column in the Times Newspaper (by a Times leader writer and columnist) on Tuesday 13th December last year, captioned:
‘…Prince Charles’s homeopathy fad is joke medicine…’
I suggest there has never been greater need for practitioners to ‘fight their corner’, including by effectively organising the management of their practice and promoting the health benefits of their treatments.
To this end, I suggest that practitioners need to accept that running a CAM practice is, in essence, the same as trading in any (small) business. The knowledge, experience, professionalism and ethical standards of a qualified, insured and properly regulated CAM practitioner are acknowledged and to be congratulated. Nevertheless, now more than ever, practitioners need to embrace business processes.
The following are some straightforward business processes that could assist your business and thereby enhance the health and care of your patients.
Business planning will help you to prepare for most eventualities, including when, like most businesses, your practice encounters financial losses or failures. Don’t delay taking good business advice and realise that it is sometimes what you don’t want to hear that constitutes the most valuable advice.
Remember, “people buy from people” so you need to build good rapport with your patients. Listen to what they have to say about you and how you provide your practice specialism(s). If appropriate, adapt the structure and delivery of your business to their needs and requirements. Give them the opportunity to provide feedback [maybe use: surveymonkey]
While established practitioners may have the well-deserved and hard-earned luxury of relying on ‘word of mouth’ recommendations to find them new clients, this will rarely be an option for a new practitioner. So, whether you are practising alone or in association with other practitioners, for instance at a Health Centre, do not wait for patients to find you. You need to go out and find them. Recruit them by actively promoting yourself and your expertise.
Join local and national business support organisations such as the Federation of Small Businesses and the Chamber of Commerce. Always attend their meetings, networking events and, if appropriate, Trade Shows. As the contacts you make get to know and to trust you, they are likely to seek your professional help for themselves and their family and possibly for their colleagues and employees, too. Encourage this by offering to give a presentation [maybe use: presentme] about your practice to local businesses, to community groups and to the employees and students of local colleges and universities. Introduce them to your practice.
Sign-up to (often free) supportive online business newsletters and memberships like enterprisenation.
Using, among other things, the feedback from your patients (see above), prepare a patient database and create a Marketing Plan and a Business Plan, including a cash-flow forecast. You will have a much better chance of achieving your business goals if you first write them down.
Ask yourself: when and why did my patients seek my services and how can I keep in touch with them? Distribute print or e-newsletters [maybe use constantcontact]. Write articles about your practice and its treatments for professional journals and general healthcare-focused magazines. Produce a well-designed, good quality brochure and publicity material, both in print [see, for instance, moo.com] and also online.
Make use of social media platforms. Although new practitioners are likely to be familiar with how this is done, it’s possible this may not be the case with established practitioners. Record a video about you and your business and post it on YouTube. Link this to your Twitter and Facebook accounts. Your “followers” might then “comment”, “like” or “re-tweet” to their “followers”, thereby promoting your professional status and practice. Create, or, if you already have one, keep updated a (free) LinkedIn business account profile.
A website that is well designed and informative is a vital marketing tool. It is a worldwide ‘shop window’ as it informs your patients (existing and prospective) about you, where you are located, what you do and when you do it. If, when starting your business, you cannot afford a professionally built site, then build you own (maybe try wordpress].
Keep your cyber security under constant review and seek advice and support from websites like cyberware and getsafeonline. Your business will be processing your patients personal and health information/patient records, so ensure that you comply with data protection legislation including the new General Data Protection Regulation.
There are other business processes that could assist your practice, especially if you decided to diversify into the manufacture and sale of CAM-based products (e.g. first-aid kits, aromatherapy oils/preparations, books/course material, meditation audio-packs, therapy tools and devices) or to associate your business with other health professionals (e.g. at a veterinary practice, NHS Practice or Hospital, as appropriate for your specialism).
I hope that you have found this focus on the business aspects of practising CAM useful and thought provoking. My further thoughts can be found as either a paperback or as an e-book (the latter including hyperlinks to business and CAM websites) and at the amazon.co.uk bookstore. Information about business guides for complementary medicine may be found online.
I anticipate that, in the coming years, the freedom to practise CAM (whether or not independently of the conventional medicine sector or as a contribution to the provision of integrated healthcare and medicine) will depend upon the adoption of a business-focused approach by practitioners.
Established practitioners might be prepared to mentor new members to help them to adopt this approach.
Veterinary CAM Practitioners: Review of guidance by the RCVS
The Royal College of Veterinary Surgeons has announced a review of its position statement and guidance regarding the prescribing of CAM by its members (see my November 2016 blog). A campaign by is underway by www.vets4informedchoice.org to:
‘…raise the awareness of the Evidence Base (or lack of) for many current Veterinary Practices, enabling animal owners and guardians to make considered responsible choices without pressure from the Veterinary Industry…concerns over frequent and unnecessary Vaccination, Corporatisation of Veterinary Clinics, Pressure Selling of products and services, etc, are widespread and growing…’
A facility is available on the campaign website to sign-up to join the campaign and to get regular updates.
Therapy Expo 2017 and RCCM Membership
Therapy Expo returns to Birmingham’s NEC on 22nd – 23rd November. Conference information and booking details can be found here. Have you thought of becoming a member of the Research Council for Complementary Medicine? CAMRN membership ‘is free and provides members with access to the CAMRN research network, which provides regular email messages about conferences, events, projects, funding, new research and dissemination of members queries and requests’.
Department of Health Policy Research Programme Project – The effectiveness and cost effectiveness of complementary and alternative medicine (CAM) for multimorbid patients with mental health and musculoskeletal problems in primary care in the UK: a scoping study (The University of Bristol):
On 13th July this year, I received a circulated email from the Senior Research Associate at The School of Social and Community Medicine (University of Bristol) advising as follows:
‘…We are pleased to be able to let you know that our project ‘SCIM’ – “The effectiveness and cost effectiveness of complementary and alternative medicine (CAM) for multimorbid patients with mental health and musculoskeletal problems in primary care in the UK: a scoping study” has now finally been approved by the funders and the final report is available on their website. I have also attached our Executive Summary. I hope you find it interesting and please do get in touch with any feedback…We may well be in touch again over the summer as we progress with this piece of work and look for collaborators and input from the wider CAM, primary care and research communities…’
(The Executive Summary may be found here).
This is great news. Many congratulations to Professor Deborah Sharp and to her colleagues. There will, of course, be more about this project in my next blog (November 2017). In the meantime, CAM practitioners and others will no doubt welcome the opportunity to provide feedback and to respond to a request for further input to this project.
Professor George Lewith
Finally and most importantly, I add my belated (following its inexcusable omission from my blog in May) expressions of sadness and shock to those of countless others at the untimely and sudden death of Professor George Lewith for whom numerous obituaries have been recorded, including by the College of Medicine, the University of Southampton and The Research Council for Complementary Medicine. All practitioners, patients, students and researchers of CAM and orthodox medicine owe him so much. Along with those of many, my thoughts are with his family.
1st August 2017
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Who is Richard Eaton?, I asked myself after reading this. The answer is here:
Richard Eaton LL.B (Hons) whose professional background is as a barrister (Bar Council – Academic Division) – now retired – and as a lecturer in law, believes that the future for practitioners of complementary and alternative medicine in private practice lies within well-managed Health Centres. He formerly owned and managed, together with his wife Marion Eaton LLB (Hons) Reiki Master Teacher, the Professional Centre for Holistic Health in Hastings, East Sussex. He now provides consultancy services through his company, Touchworks Ltd, including in relation to the practice management of CAM.
SAY NO MORE!!!