Edzard Ernst

MD, PhD, FMedSci, FSB, FRCP, FRCPEd

“THERE IS A SUCKER BORN EVERY MINUTE” – this quote is commonly attributed to P.T.Barnum. If he really coined the sentence, he certainly did not think of the little cups sucking in the skin of patients undergoing cupping therapy. Yet, the recent media coverage of cupping made me think of this quote. The suckers here are not the therapeutic devices employed for cupping but the athletes, the journalists and the general public.

In my experience, athletes are often very worried about their body. This is perhaps understandable but, at the same time, it makes them the ideal victims of all types of charlatans. I am therefore not really surprised to see that some Olympic athletes fell for cupping. They want to use every means allowed by the doping rules to enhance their performance. Cupping therapists claim all sorts of strange and unwarranted things, and some athletes seem to be gullible enough to believe them. Belief can perhaps not move mountains, but it might give you the edge in an Olympic competition.

The ‘beauty’ of cupping when applied to an athlete’s body is that its traces are so publicly visible. During Olympic games, this means that the entire world knows within hours about the cupping-habit of an athlete. What could be more exciting for journalists than these odd cupping marks decorating the muscular bodies of some Olympic athletes? If they are not worth a good story, what is?

There is hardly a newspaper on the planet that did not jump on this band-waggon full of snake oil – there is a sucker born every minute! Nothing wrong with reporting what is happening at the Olympic games, of course. But what has sometimes been reported in the press about cupping beggars belief. Rarely have I read so much nonsense about an alternative therapy in such a short time.

Do you need an example? The DAILY MAIL is as good – or rather bad? – as most; this is what the DM published yesterday on the subject: Chinese media have been cheering cupping’s appearance at the Olympics as proof of the value of traditional culture, with both the official Xinhua news agency and Communist Party mouthpiece People’s Daily touting the soft-power benefits. “Chinese traditions and products proliferate Olympic village”, read one headline on the People’s Daily website. Ding Hui, manager of the Lily Spring Health & Spa in Beijing, said she has seen a 30 percent jump in clients asking for cupping treatment since the Olympics started. “Even though Chinese people have known about it for a long time, they see a great athlete does it and see it really works,” Ding said. “For athletes, they build up harmful lactic acid in the body and cupping can help relieve it.”

You might think that, when reporting about a weird therapy, journalists have little options but to interview weird ‘experts’ relating cupping to even weirder ‘energies’, ‘life forces’, ‘meridians’, yin and yang, TCM, etc. But you would be wrong. They do of course have other options; they would only have needed to log on Medline to find hundreds of references related to the subject. If they had done that, they would even have found an abstract of mine that might have answered many of their question and would have clarified many of the questions about the scientific evidence for or against cupping. Here it is:

The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.

With just one further click on their keyboard, they would have been able to read the full text of my article which cautioned in no uncertain terms: The number of trials and the total sample size are too small to distinguish between any nonspecific or specific effects, which preclude any firm conclusions. Moreover, the methodological quality was often poor.

Sadly, few journalists seemed to have bothered to do this tiny bit of research. Why? Surely, journalists are trained to investigate their subject before putting pen to paper! Yes, most of them are, but a headline like THE EVIDENCE FOR CUPPING IS FLIMSY does not sell newspapers. The public wants something much more interesting – there is a sucker born every minute!

And what should be wrong with that? People deserve a bit of an entertaining story about their Olympic idols! Perhaps, but there is a downside, of course. The media-hype of the last week will create a demand. The general public will now want the very therapy that helped athletes win gold medals (never mind that it didn’t). Thanks to the media, cupping is now destined to become the alternative therapy of the future.

And what is wrong with that? Quite a lot, I think!

For one, quacks will jump on this fast-moving band-waggon filled with snake oil and try to divert as much cash as they can from their victims’ into their own bank accounts. Perhaps that would not be the worst effect. The worst would be, if some people believe what some quacks will undoubtedly tell them, that cupping is effective (“they see a great athlete does it and see it really works”) for all sorts of conditions, including serious diseases (“Cupping has also been used by some as an alternative treatment for cancer.”) – THERE IS A SUCKER BORN EVERY MINUTE (and some might even die sucking)!

No, I don’t want to put you off your breakfast… but you probably have seen so many pictures of attractive athletes with cupping marks and read articles about the virtues of this ancient therapy, that I feel I have to put this into perspective:

Cupping burnsI am sure you agree that this is slightly less attractive. But, undeniably, these are also cupping marks. So, if you read somewhere that this treatment is entirely harmless, take it with a pinch of salt.

Cupping has existed for centuries in most cultures, and there are several variations of the theme. We differentiate between wet and dry cupping. The above picture is of wet cupping gone wrong. What the US Olympic athletes currently seem to be so fond of is dry cupping.

The principles of both forms are similar. In dry cupping, a vacuum cup is placed over the skin which provides enough suction to create a circular bruise. Eventually the vacuum diminishes, and the cup falls off; what is left is the mark. In wet cupping, the procedure is much the same, except that the skin is injured before the cup is placed. The suction then pulls out a small amount of blood. Obviously the superficial injury can get infected, and that is what we see on the above picture.

In the homeopathic hospital where I worked ~40 years ago, we did a lot of both types of cupping. We used it mostly for musculoskeletal pain. Our patients responded well.

But why? How does cupping work?

The answer is probably more complex than you expect. It clearly has a significant placebo effect. Athletes are obviously very focussed on their body, and they are therefore the ideal placebo-responders. Evidently, my patients 40 years ago also responded to all types of placebos, even to the homeopathic placebos which they received ‘en masse’.

But there might be other mechanisms as well. A TCM practitioner will probably tell you that cupping unblocks the energy flow in our body. This might sound very attractive to athletes or consumers, and therefore could even enhance the placebo response, but it is nevertheless nonsense.

The most plausible mode of action is ‘counter-irritation’: if you have a pain somewhere, a second pain elsewhere in your body can erase the original pain. You might have a headache, for instance, and if you accidentally hit your thumb with a hammer, the headache is gone, at least for a while. Cupping too would cause mild to moderate pain, and this is a distraction from the muscular pain the athletes aim to alleviate.

When I employed cupping 40 years ago, there was no scientific evidence testing its effects. Since a few years, however, clinical trials have started appearing. Many are from China, and I should mention that TCM studies from China almost never report a negative result. According to the Chinese, TCM (including cupping) works for everything. More recently,also some trials from other parts of the world have emerged. They have in common with the Chinese studies that they tend to report positive findings and that they are of very poor quality. (One such trial has been discussed previously on this blog.) In essence, this means that we should not rely on their conclusions.

A further problem with clinical trails of cupping is that it is difficult, if not impossible, to control for the significant placebo effects that this treatment undoubtedly generates. There is no placebo that could mimic all the features of real cupping in clinical trials; and there is no easy way to blind either the patient or the therapist.

So, we are left with an ancient treatment backed by a host of recent but flimsy studies and a growing craze for cupping fuelled by the Olympic games. What can one conclude in such a situation?

Personally, I would, whenever possible, recommend treatments that work beyond a placebo effect, because the placebo response tends to be unreliable and is usually of short duration – and I am not at all sure that cupping belongs into this category. I would also avoid wet cupping, because it can cause substantial harm. Finally, I would try to keep healthcare costs down; cupping itself is cheap but the therapist’s time might be expensive.

In a nutshell: would I recommend cupping? No, not any more than using a hammer for counter irritation! Will the Olympic athletes care a hoot about my recommendations? No, probably not!

 

When a leading paper like the FRANKFURTER ALLGEMEINE ZEITUNG (FAZ) publishes in its science pages (!!!) a long article on homeopathy, this is bound to raise some eyebrows, particularly when the article in question was written by the chair of the German Association of Homeopaths (Deutscher Zentralverein homöopathischer Ärzte) and turns out to be a completely one-sided and misleading white-wash of homeopathy. The article (entitled DIE ZEIT DES GEGENEINANDERS IST VORBEI which roughly translates into THE DAYS OF FIGHTING ARE OVER)  is in German, of course, so I will translate the conclusions for you here:

The critics [of homeopathy] … view the current insights of conventional pharmacology as some type of dogma. For them it is unthinkable that a high potency can cause a self-regulatory and thus healing effect on a sick person. Homeopathic doctors are in their eyes “liars”. Based on this single argument, the critics affirm further that therefore no positive studies can exist which prove the efficacy of homeopathy beyond placebo. After all, high potencies “contain nothing”. The big success of homeopathy is a sore point for them, because efficacious high potencies contradict their seemingly rational-materialistic world view. Research into homeopathy should be stopped, the critics say. This tune is played unisono today by critics who formerly claimed that homeopaths block the research into their therapy. The fact is: homeopathic doctors are today in favour of research, even with their own funds, whenever possible. Critics meanwhile demand a ban.

In the final analysis, homeopathic doctors do not want a fight but a co-operation of the methods. Homeopathy creates new therapeutic options for the management of acute to serious chronic diseases. In this, homeopathy is self-evidently not a panacea: the physician decides with every patient individually, whether homeopathy is to be employed as an alternative, as an adjunct, or not at all. Conventional diagnostic techniques are always part of the therapy.

END OF QUOTE

[For those readers who read German, here is the German original:

Die Kritiker … betrachten die heutigen Erkenntnisse der konventionellen Pharmakologie als eine Art Dogma. Für sie ist es undenkbar, dass eine Hochpotenz einen selbstregulativen und damit heilenden Effekt bei einem kranken Menschen auslösen kann. Homöopathische Ärzte sind in ihren Augen “Lügner”. Von diesem einen Argument ausgehend, wird dann weiter behauptet, dass es deshalb gar keine positiven Studien geben könne, die eine Wirksamkeit der Homöopathie über einen Placebo-Effekt hinaus belegen. Schließlich sei in Hochpotenzen “nichts drin”. Der große Erfolg der Homöopathie ist ihnen ein Dorn im Auge, weil wirksame Hochpotenzen ihrem vermeintlich rational-materialistischen Weltbild widersprechen. Die Erforschung der Homöopathie solle gestoppt werden, heißt es. Unisono wird diese Melodie von Kritikern heute gespielt, von ebenjenen Kritikern, die früher behaupteten, die homöopathischen Ärzte sperrten sich gegen die Erforschung ihrer Heilmethode. Fakt ist: Heute setzen sich homöopathische Ärzte für die Forschung ein, auch mit eigenen Mitteln, soweit es ihnen möglich ist. Kritiker fordern mittlerweile das Verbot.

Letztlich geht es homöopathischen Ärzten allerdings nicht um ein Gegeneinander, sondern um ein Miteinander der Methoden. Durch die Homöopathie entstehen neue Therapieoptionen bei der Behandlung von akuten bis hin zu schweren chronischen Erkrankungen. Dabei ist die ärztliche Homöopathie selbstverständlich kein Allheilmittel: Bei jedem erkrankten Patienten entscheidet der Arzt individuell, ob er die Homöopathie alternativ oder ergänzend zur konventionellen Medizin einsetzt – oder eben gar nicht. Die konventionelle Diagnostik ist stets Teil der Behandlung.]

While translating this short text, I had to smile; here are some of the reasons why:

  • ‘conventional pharmacology’ is a funny term; do homeopaths think that there also is an unconventional pharmacology?
  • ‘dogma’… who is dogmatic, conventional medicine which changes almost every month, or homeopathy which has remained essentially unchanged since 200 years?
  • ‘liars’ – yes, that’s a correct term for people who use untruths for promoting their business!
  • ‘Based on this single argument’… oh, I know quite a few more!
  • ‘doctors are today in favour of research’ – I have recently blogged about the research activity of homeopaths.
  • ‘co-operation of the methods’ – I have also blogged repeatedly about the dangerous nonsense of ‘integrative medicine’ and called it ‘one of the most colossal deceptions of healthcare today’. Hahnemann would have ex-communicated the author for this suggestion, he called homeopaths who combined the two methods ‘traitors’!!!
  • ‘new therapeutic options’… neither new nor therapeutic, I would counter; to be accepted as ‘therapeutic’, one would need a solid proof of efficacy.
  • ’employed as an alternative’ – would this be ethical?
  • ‘Conventional diagnostic techniques are always part of the therapy’… really? I was taught that diagnosis and treatment are two separate things.

There were many comments  by readers of the FAZ. Their vast majority expressed bewilderment at the idea that the chair of the German Association of Homeopaths has been given such a platform to dangerously mislead the public. I have to say that I fully agree with this view: the promotion of bogus treatments can only be a disservice to public health.

According to an article in DER SPIEGEL, 4 patients of an alternative medicine centre died, while several other websites reported that the figure amounted to ‘just’ three. The centre in question is the Klaus Ross clinic in the German town of Bruggen-Bracht on the border with the Netherlands.

In addition to these fatalities, several further patients are being treated in hospital and German prosecutors in the town of Moenchengladbach have urged other patients showing any symptoms to “urgently seek medical advice.” Dutch police, who are supporting the inquiry, appealed for information from other patients, as newspapers reported the clinic had been using an experimental transfusion.

Concern was first raised when a 43-year-old Dutch woman with breast cancer complained of headaches and became confused after being treated at the clinic on July 25. She later lost the ability to speak, and died on July 30. The “cause of her death remains unclear,” the German prosecutors said in a statement earlier this week. Many Dutch people are known to have visited the clinic and while “it is not yet known exactly what happened, there is a health risk to patients who have undergone treatment at this clinic”, according to a statement by Dutch police.

Klaus Ross was cited saying that “one of our patients unexpectedly has passed away… We regret this seriously and are in shock as we heard the news. Our thoughts and deep condolences are with her family, friends and loved ones… we regret the suspicion set in the media that alternative medicine, and our clinic especially, could be held responsible…. Alternative medicine is always an extra tool to battle diseases.” Allegedly, Ross always advised patients to be monitored by their own doctors.

The centre in question specialised in ‘biological’ cancer therapies and beauty treatments; it has now been closed and Ross has reportedly been charged with manslaughter. The interventions on offer include a wide range of unproven therapies, including detox, oxygen therapy, various supplements, immunotherapy and hyperthermia. According to some reports, the therapy implicated in the fatalities was 3- bromopyruvate (3BP). 3BP is an experimental cancer treatment which is currently attracting much, mostly pre-clinical research. One review article summarized the evidence such:

Although the “Warburg effect”, i.e., elevated glucose metabolism to lactic acid (glycolysis) even in the presence of oxygen, has been recognized as the most common biochemical phenotype of cancer for over 80 years, its biochemical and genetic basis remained unknown for over 50 years. Work focused on elucidating the underlying mechanism(s) of the “Warburg effect” commenced in the author’s laboratory in 1969. By 1985 among the novel findings made two related most directly to the basis of the “Warburg effect”, the first that the mitochondrial content of tumors exhibiting this phenotype is markedly decreased relative to the tissue of origin, and the second that such mitochondria have markedly elevated amounts of the enzyme hexokinase-2 (HK2) bound to their outer membrane. HK2 is the first of a number of enzymes in cancer cells involved in metabolizing the sugar glucose to lactic acid. At its mitochondrial location HK2 binds at/near the protein VDAC (voltage dependent anion channel), escapes inhibition by its product glucose-6-phosphate, and gains access to mitochondrial produced ATP. As shown by others, it also helps immortalize cancer cells, i.e., prevents cell death. Based on these studies, the author’s laboratory commenced experiments to elucidate the gene basis for the overexpression of HK2 in cancer. These studies led to both the discovery of a unique HK2 promoter region markedly activated by both hypoxic conditions and moderately activated by several metabolites (e.g., glucose), Also discovered was the promoter’s regulation by epigenetic events (i.e., methylation, demethylation). Finally, the author’s laboratory turned to the most important objective. Could they selectively and completely destroy cancerous tumors in animals? This led to the discovery in an experiment conceived, designed, and conducted by Young Ko that the small molecule 3-bromopyruvate (3BP), the subject of this mini-review series, is an incredibly powerful and swift acting anticancer agent. Significantly, in subsequent experiments with rodents (19 animals with advanced cancer) Ko led a project in which 3BP was shown in a short treatment period to eradicate all (100%). Ko’s and co-author’s findings once published attracted global attention leading world-wide to many other studies and publications related to 3BP and its potent anti-cancer effect. This Issue of the Journal of Bioenergetics and Biomembranes (JOBB 44-1) captures only a sampling of research conducted to date on 3BP as an anticancer agent, and includes also a Case Report on the first human patient known to the author to be treated with specially formulated 3BP. Suffice it to say in this bottom line, “3BP, a small molecule, results in a remarkable therapeutic effect when it comes to treating cancers exhibiting a “Warburg effect”. This includes most cancer types.

While 3BP seems to show some promise, clinical trials have not yet been published and another review correctly cautioned that clinical trials using 3BP are needed to further support its anticancer efficacy against multiple cancer types… 

The person in charge of the centre, Klaus Ross, has no medical qualifications but claims to have studied naturopathy and was a ‘Heilpraktiker’. As such, he is probably not licenced to administer 3BP to cancer patients.

A standard series of out-patient cancer treatments at Mr Ross’ clinic was reported to cost around 10 000 Euros.

The aim of a new meta-analysis was to estimate the clinical effectiveness and safety of acupuncture for amnestic mild cognitive impairment (AMCI), the transitional stage between the normal memory loss of aging and dementia. Randomised controlled trials (RCTs) of acupuncture versus medical treatment for AMCI were identified using six electronic databases.

Five RCTs involving a total of 568 subjects were included. The methodological quality of the RCTs was generally poor. Participants receiving acupuncture had better outcomes than those receiving nimodipine with greater clinical efficacy rates (odds ratio (OR) 1.78, 95% CI 1.19 to 2.65; p<0.01), mini-mental state examination (MMSE) scores (mean difference (MD) 0.99, 95% CI 0.71 to 1.28; p<0.01), and picture recognition score (MD 2.12, 95% CI 1.48 to 2.75; p<0.01). Acupuncture used in conjunction with nimodipine significantly improved MMSE scores (MD 1.09, 95% CI 0.29 to 1.89; p<0.01) compared to nimodipine alone. Three trials reported adverse events.

The authors concluded that acupuncture appears effective for AMCI when used as an alternative or adjunctive treatment; however, caution must be exercised given the low methodological quality of included trials. Further, more rigorously designed studies are needed.

Meta-analyses like this one are, in my view, perfect examples for the ‘rubbish in, rubbish out’ principle of systematic reviews. This may seem like an unfair statement, so let me justify it by explaining the shortfalls of this specific paper.

The authors try to tell us that their aim was “to estimate the clinical effectiveness and safety of acupuncture…” While it might be possible to estimate the effectiveness of a therapy by pooling the data of a few RCTs, it is never possible to estimate its safety on such a basis. To conduct an assessment of therapeutic safety, one would need sample sizes that go two or three dimensions beyond those of RCTs. Thus safety assessments are best done by evaluating the evidence from all the available evidence, including case-reports, epidemiological investigations and observational studies.

The authors tell us that “two studies did not report whether any adverse events or side effects had occurred in the experimental or control groups.” This is a common and serious flaw of many acupuncture trials, and another important reason why RCTs cannot be used for evaluating the risks of acupuncture. Too many such studies simply don’t mention adverse effects at all. If they are then submitted to systematic reviews, they must generate a false positive picture about the safety of acupuncture. The absence of adverse effects reporting is a serious breach of research ethics. In the realm of acupuncture, it is so common, that many reviewers do not even bother to discuss this violation of medical ethics as a major issue.

The authors conclude that acupuncture is more effective than nimodipine. This sounds impressive – unless you happen to know that nimodipine is not supported by good evidence either. A Cochrane review provided no convincing evidence that nimodipine is a useful treatment for the symptoms of dementia, either unclassified or according to the major subtypes – Alzheimer’s disease, vascular, or mixed Alzheimer’s and vascular dementia.

The authors also conclude that acupuncture used in conjunction with nimodipine is better than nimodipine alone. This too might sound impressive – unless you realise that all the RCTs in question failed to control for the effects of placebo and the added attention given to the patients. This means that the findings reported here are consistent with acupuncture itself being totally devoid of therapeutic effects.

The authors are quite open about the paucity of RCTs and their mostly dismal methodological quality. Yet they arrive at fairly definitive conclusions regarding the therapeutic value of acupuncture. This is, in my view, a serious mistake: on the basis of a few poorly designed and poorly reported RCTs, one should never arrive at even tentatively positive conclusion. Any decent journal would not have published such misleading phraseology, and it is noteworthy that the paper in question appeared in a journal that has a long history of being hopelessly biased in favour of acupuncture.

Any of the above-mentioned flaws could already be fatal, but I have kept the most serious one for last. All the 5 RCTs that were included in the analyses were conducted in China by Chinese researchers and published in Chinese journals. It has been shown repeatedly that such studies hardly ever report anything other than positive results; no matter what conditions is being investigated, acupuncture turns out to be effective in the hands of Chinese trialists. This means that the result of such a study is clear even before the first patient has been recruited. Little wonder then that virtually all reviews of such trials – and there are dozens of then – arrive at conclusions similar to those formulated in the paper before us.

As I already said: rubbish in, rubbish out!

We have discussed the subject of urine therapy before. And, as I did then, I again apologise for the vulgar title of my post – but it describes urine therapy just perfectly. My new post is based on what I recently found on a website that is entirely devoted to this strange form of treatment:

Around 4 am, workers at the Keeshav Shrusti Go Shaala at Bhayander, in India, head to the tabelas (cow sheds) to collect the first urine of their 230 cows. They collect 200 litres of gomutra (cow urine), which is then sent to a production unit where it is filtered, bottled and then shipped across the country to be sold at high prices.

The popularity of alternative medicine and a back-to-nature rush has meant that those seeking gomutra as the cure for all ailments — it is touted as a cure for cancer, diabetes, high blood pressure, psoriasis among others — has spurred a rise of gomutra products in the Indian market.

A year ago the Indian ‘Council for Scientific and Industrial Research’ even initiated projects to study the anti-cancer and anti-infection properties of various cow products including cow urine and dung. Last September, Maa Gou Products (MGP) approached BigBasket to distribute its range of cow-urine based products, ranging from floor cleaner, tooth powder, balm and face pack.

ARK1

Today there are several sites that have been set up specifically to sell cow products. For instance, the one-year-old vendor portal www.gaukranti.org. The site, which retails a range of products, gets 40 per cent of its revenue from cow urine.

ARK2
But, not all cow urine bottles are the same or tout the same solutions. Some are used as cleansers; Mumbaikars will recall the Kandivli ccorporator who suggested that KEM Hospital be cleansed daily with cow urine. Some others are meant specifically for weight loss.

ARK3

GoArk, for instance, is a weight loss product made by boiling cow urine in an iron pot to which a vapour condensing device is attached. The main difference lies in the source of the cows. Goseva GoArk is prepared from the GIR cow’s urine and GouGanga is from mixed Indian breeds. Bos Indicus, the breed indigenous to the subcontinent, is to be preferred. One expert explains: “foreign breeds such as the Jersey cow have been subjected to genetic modification.” He says that once the gomutra is collected it is filtered around eight times through a piece of cotton cloth. The distillation process, he says, helps ensure that there is no ammonia so that the shelf life is increased. Typically, it’s good to be used up to two years after bottling. The demand for gomutra — whether as a medicine, a face pack or a floor cleanser — is now rising beyond India. There even have been inquiries from the UK, US, Australia and even Arabic countries.

So, watch this space!

 

This is a post that I wanted to write for a while (I had done something similar on acupuncture moths ago); but I had to wait, and wait, and wait…until finally there were the awaited 100 Medline listed articles on homeopathy with a publication date of 2016. It took until the beginning of August to reach the 100 mark. To put this into perspective with other areas of alternative medicine, let me give you the figures for 3 other therapies:

  • there are currently  1 413 articles from 2016 on herbal medicine;
  • 875 on acupuncture;
  • and 256 on chiropractic.

And to give you a flavour of the research activity in some areas of conventional medicine:

  • there are currently almost 100 000 articles from 2016 on surgery;
  • 1 410 on statins;
  • and 33 033 on psychotherapy.

This suggests quite strongly, I think, that the research activity in homeopathy is relatively low (to put it mildly).

So, what do the first 100 Medline articles on homeopathy cover? Here are some of the findings of my mini-survey:

  • there were 4 RCTs;
  • 3 systematic reviews;
  • 8 papers on observational-type data (case series, observational studies etc.);
  • 9 animal studies;
  • 14 other pre-clinical or basic research studies;
  • 1 pilot study;
  • 14 investigations of the quality of homeopathic preparations;
  • 15 surveys;
  • 2 investigations into the adverse effects of homeopathic treatments;
  • 49 other papers (e. g. comments, opinion pieces, letters, perspective articles, editorials).

I should mention that, because I assessed 100 papers, the above numbers can be read both as absolute as well as percentage figures.

How should we interpret my findings?

As with my previous evaluation, I must caution not to draw generalizable conclusions from them. What follows should therefore be taken with a pinch of salt (or two):

  1. The research activity into homeopathy is currently very subdued.
  2. Arguably the main research question of efficacy does not seem to concern researchers of homeopathy all that much.
  3. There is an almost irritating abundance of papers that are data-free and thrive on opinion (my category of ‘other papers’).
  4. Given all this, I find it hard to imagine that this area of investigation is going to generate much relevant new knowledge or clinical progress.

An analysis of the 2012 National Health Interview Survey Data examined the associations between self-reported use of various forms of complementary and alternative medicine (CAM) therapies (dietary supplements, mind-body practices) and the number of days missed from job or business in the past 12 months due to illness or injury. Multivariable Poisson regression was used to determine the association between CAM use and absence from work among individuals with one or more chronic disease (n = 10,196).

Over half (54 %) of the study population reported having one chronic disease, while 19 % had three or more conditions. The three most common chronic diseases were high cholesterol (48 %), arthritis (35 %) and hypertension (31 %). More participants used dietary supplements (72 %) while fewer individuals reported using mind-body practices (17 %) in the past twelve months. Over half of individuals reported missing any number of days from job or business due to illness or injury (53 %). Of those who had missed any days from work, 42 % missed one or two days, 36 % missed three to five days, and 23 % missed six days or more.

In multivariable Poisson regression adjusting for demographic variables (race, age, gender, income, education) and potential confounders (BMI, general health, and use of CAM to improve energy), the rate of missing days from job or business in the past 12 months among those who used mind-body therapy was significantly greater than those who did not use these practices (IRR = 1.55, 95 % CI: 1.09, 2.21) (Table 4). Similar association was observed for dietary supplements use (IRR = 1.13, 95 % CI: 0.85, 1.51) (Table 4), although the result was not significant.

The authors concluded: Although nearly all individuals who practiced mind-body therapies reported being in good to excellent health, these individuals had a higher rate of absenteeism compared to non-users. Previous studies have shown that many individuals with chronic illness use CAM with the intent of alleviating the symptoms associated with chronic illness but this body of evidence is limited. Further studies are needed to examine the potential effects of these self-managed CAM therapies on the symptoms associated with chronic disease. Additionally, future studies should explore how managing these symptoms through the integration CAM therapies chronic disease management and employee programs could have a positive effect on absence from work, school, and other responsibilities.

How can these finding be interpreted?

The authors offer two possible explanations: Self-administered CAM practices may be more accessible to individuals with chronic disease regardless of socioeconomic status and other demographic factors. Alternatively, CAM use without the advisement of a practitioner may be harmful due to lack of knowledge on proper technique or dosage.

I am sure there are other ways to make sense of these data. How about this interpretation, for instance: CAM-use and absenteeism have in common that they are the things that the ‘worried well’ tend to do. Thus the two phenomena correlate because they are a characteristic of a certain type of consumer.

Yes, I am just guessing, because the data certainly does not give us anything like a conclusive explanation.

Nonetheless, one thing seems to be fairly clear: CAM-use in this population is not a thing that motivates consumers to go to work.

If you feel that, on this blog and elsewhere, some sceptics sometimes use harsh language, you haven’t recently read what ‘the other side’ of the debate regularly publish. A good example is ‘NATURAL NEWS’; slander and insult seem to be the daily fare of this publication. A good example is this recent article; it is so disgustingly vile that I cannot resist showing you a few passages.

START OF QUOTE

Meet the ultimate pharma whore and vaccine-toxin apologist, Dr. Paul ‘Profit’ Offit

Possibly one of the most dangerous doctors on planet Earth is Paul Offit, a man capable of creating, promoting and profiting from the most toxic “medicine” known to mankind – experimental vaccines. Not only is injecting neurotoxins into children extremely dangerous, but the whole vaccine industry is loosely regulated, and the CDC requires no proof of safety or efficacy for immunizations.

Plus, the vaccine industry has their own rigged court system so that families cannot sue the manufacturers. Anyone who lets their children be injected with mercury, formaldehyde, aluminum and MSG (contaminants found in nearly every vaccine and flu shot), is putting a ton of faith in something they should not have any faith in. The inoculation industry as a whole has been making fraudulent medical claims for more than 60 years. Vaccines and prescription medications are fast-tracked through the FDA and CDC without any tests for safety or efficacy.

That’s why about one sixth of all Americans (about 50 million) have sought out holistic care of some sort, at least once already. People are fed up with pediatricians who know nothing about nutrition or quality, non-invasive, non-chemical care. They’re also realizing that prescription meds come with side effects that are worse than the conditions being treated. That’s where scare tactic “professionals” and criminal propagandists come into play, like Dr. Paul Offit.

Never trust someone who can ‘vote themselves rich’ – like Dr. Paul ‘Offit-for-Profit’

One of the biggest scams of the century is the “RotaTeq” rotavirus vaccine. Invented by, patented by, promoted by, and worth millions in profit to Offit, the extremely toxic (oral) vaccine contains live rotavirus strains (G1, G2, G3, G4 and P1), plus highly toxic polysorbate 80 and fetal bovine serum. Scared yet? There’s more. This insane inoculation contains parts of porcine circovirus, a virus that infects pigs! This is all per the Merck website’s list of ingredients, in case you’d like to check for yourself. Want to infect your infant with all of this and help “Profit-Offit” get richer, so he can infect more infants?

Bill Gates promotes Offit in their combined attempt to mass-vaccinate the whole world and decrease the population by several billion, by injecting cancer-causing carcinogens and toxins that cause infertility. That’s the plan.

Offit works at the Children’s hospital of Philadelphia (appropriately nicknamed CHOP), and he is a founding advisory board member of the Autism Science Foundation. All this in spite of the fact that autism has been directly linked to the MMR vaccine, which contains, not coincidentally, many of the same ingredients as the RotaTeq vaccine.

The Rotavirus vaccine has never been proven to work, yet Offit made tens of millions of dollars when he sold the patent. Offit has direct financial ties to Merck, and formerly served on the CDC’s Advisory Committee on Immunization Practices, a position which has come into question as an extreme conflict of interest. That job entailed Offit creating the market for the rotavirus vaccine, which means he basically voted himself rich in the process.

Paul “Profit” Offit is quoted as saying he could get “10,000 vaccines at once” and be fine, knowing even a dozen would probably kill him or maim him for life…

END OF QUOTE

Such extreme diatribe does, of course, not deserve a comment. However, I want to stress that Paul Offit is one of the leading paediatrician and immunization expert in the US; his reputation is undisputed (except, of course, in circles of deranged loons) and he recently published a book on alternative medicine, entitled ‘DO YOU BELIEVE IN MAGIC’, that I highly recommend.

Guest post by Frank Van der Kooy

Something happened in 2008. Something, or a number of things, triggered an exponential rise in the number of rhinos being killed in South Africa. Poaching numbers remained quite low and was stable for a decade with only 13 being killed in 2007. But then suddenly it jumped to 83 in 2008 and it reached a total of 1 175 in 2015. To explain this will be difficult and it will be due to a number of factors or events coinciding in 2008. One possible contributing factor, which I will discuss here, is the growing acceptance of TCM in western countries! For example: Phynova recently advertised a new product as being the first traditional Chinese medicine (TCM) being registered in the UK. By directing customers to a separate site for more information regarding their product they ‘accidently’ linked to a site which ‘advertised’ rhino horn (this link has since been removed). Another example is a University in Australia who published a thesis in 2008, in which they described the current use of Rhino horn as a highly effective medicine, just like you would describe any other real medicine. Surely this will have an impact!

But first a bit of background, so please bear with me. There are two ‘opposing’ aspects regarding TCM that most members of the public do not seem to understand well. Not their fault, because the TCM lobby groups are spending a huge amount of effort to keep the lines between these two aspects as blurred as possible. The first aspect is the underlying pseudoscientific TCM principles; the yin and yang and the vitalistic “energy” flow through “meridians” and much more. Science has relegated this to the pseudosciences, just like bloodletting, which was seen as a cure-all hundreds of years ago. Unfortunately, the pseudoscientific TCM principles are still with us and based on these principles almost every single TCM modality works! From acupuncture to herbs to animal matter (including rhino horn) – everything is efficacious, safe and cost effective. Evidence for this is that close to a 100% of clinical trials done on TCM in China give positive results. Strange isn’t it! People in China should thus no die of any disease – they have ‘effective’ medicine for everything! This is the world of TCM in a nutshell.

The second aspect of TCM is the application of the modern scientific method to test which of the thousands of TCM modalities are really active, which ones are useless and which ones are dangerous. Decades of investigation have come up empty-handed with one or two exceptions. One notable exception is Artemisia annua which contain a single compound that is highly effective for the treatment of malaria, and once identified and intensely studied, it was taken up into conventional medicine – not the herb, but the compound. If you investigate all the plants in the world you are bound to find some compounds that can be used as medicine – it has nothing to do with TCM principles and it can most definitely not be used as evidence that the TCM principles are correct or that it based on science.

These two aspects are therefore quite different.

In the TCM world just about everything works, but it is not backed up by science. It is huge market ($170 billion) and it creates employment for many – something that make politicians smile. In the modern scientific world, almost nothing in TCM works, but it is based on science. It is however not profitable at all – you have to investigate thousands of plants in order to find one useful compound.

Many TCM practitioners and researchers are avidly trying to combine the positives of these two worlds. They focus mainly on the money and employment aspect of the TCM world and try and combine this with the modern scientific approach. They tend to focus on the one example where modern science discovered a useful compound (artemisinin) in the medicinal plant Artemisia annua, which was also coincidently used as an herb in TCM – as evidence that TCM works! Here are some examples:

“To stigmatise all traditional medicine would be unfair. After all, a Chinese medicine practitioner last year won a Nobel prize.” No, a Chinese scientist using the modern scientific method identified artemisinin after testing hundreds or even thousands of different plants.

This year, Chinese medicine practitioners will be registered in Australia. ….. Chinese herbal medicine is administered routinely in hospitals for many chronic diseases. …… This has led to recognising herbs such as Artemisia as a proven anti-malarial ……” No, the compound artemisinin is a proven anti-malarial!

There has been enormous progress in the last 20 years or so. I am sure you are familiar with the use of one of the Chinese herbs in managing resistant malaria.” No, very little progress and no, the compound artemisinin!

So this is a game that is being played with the simple intention to blur the lines between these two aspects regarding TCM – but the real reason might simply be “A new research-led Chinese medicine clinic in Sydney, better patient outcomes and the potential for Australia to tap into the $170 billion global traditional Chinese medicine market”

Prof Alan Bensoussan the director of the National Institute of Complementary Medicine (NICM) and registered in Australia as a TCM and acupuncture practitioner is a champion in blurring this line. Alan has been instrumental in lobbying the Australian regulatory agency that a long tradition of use is all you need to be able to register new products. He was also influential in establishing the Chinese medicine practitioner registry in Australia, in 2012, and thereby legitimising TCM in Australia. He has been actively chipping away at the resistance that the Australian public have against these pseudoscientific healthcare systems such as TCM – one can argue that he has done so quite successfully because they are expanding their operations into the Westmead precinct of Sydney with a new TCM clinic/hospital.

Enough background; so what does all of this have to do with Rhino horn? (and for that matter other endangered species). We have to remember that in the TCM world just about everything works and that includes rhino horn! Searching Western Sydney University’s theses portal for Xijiao (Chinese for Rhino horn) I found a thesis published in 2008 from the NICM and co-supervised by Alan; “Development of an evidence-based Chinese herbal medicine for the management of vascular dementia”

On page 45-46: “Recently, with fast developing science and technologies being applied in the pharmaceutical manufacturing area, more and more herbs or herbal mixtures have been extracted or made into medicinal injections. These have not only largely facilitated improved application to patients, but also increased the therapeutic effectiveness and accordingly reduced the therapeutic courses …… lists the most common Chinese herbal medicine injections used for the treatment of VaD. “

“Xing Nao Jing Injection (for clearing heat toxin and opening brain, removing phlegm) contains ….. Rhinoceros unicornis (Xijiao), …… Moschus berezovskii (Shexiang), …..”

“…. Xing Nao Jing injection has been widely applied in China for stroke and vascular dementia. …. After 1-month treatment intervention, they found the scores in the treatment group increased remarkably, as compared with the control group …… “

They list two endangered species; the Rhino and the Chinese forest musk deer (Moschus berezovskii). But what is truly worrying is that they don’t even mention the endangered status or at least recommend that the non-endangered substitutes, which do exist in the TCM world, should be used instead – or maybe use fingernails as a substitute? It is not discussed at all. Clearly they are stating that using these endangered animals are way more effective than western medicine (the control group) for the treatment of vascular dementia! This is deplorable to say the least. Statements like this fuels the decimation of this species. But this shows that they truly believe and support the underlying pseudoscientific principles of TCM – they have to, their ability to tap into the TCM market depends on it!

As a scientist you are entitled to discuss historic healthcare treatments such as bloodletting. But make sure to also state that this practice has been shown to be ineffective, and quite dangerous, and that modern science has since come up with many other effective treatments. If it is stated that bloodletting is currently being used and it is effective – then you will simply be promoting bloodletting! The same goes for Rhino horn and this is exactly what they have done here. But then again they live in a world where all TCM modalities are active!

How to solve this problem of growing acceptance of TCM in western countries? A simple step could be that people like Alan publicly denounce the underlying pseudoscientific TCM principles and make the ‘difficult’ switch to real science! Admittedly, he will have to part with lots of money from the CM industry and his Chinese partners, and maybe not built his new TCM hospital! But for some reason I strongly doubt that this will happen. The NICM have successfully applied a very thin, but beautiful, veneer of political correctness and modernity over the surface of complementary medicine. Anyone who cares to look underneath this veneer will find a rotten ancient pseudoscientific TCM world – in this case the promotion and the use of endangered animals.

After reading chapter two of this thesis one cannot believe that this is from an Australian University and paid for by the Australian taxpayer! The main question though: Can I directly link this thesis with the increase in rhino poaching? This will be very difficult if not impossible to do. But that is not the problem. Promoting the pseudoscientific principles of TCM in Australia expands the export market for TCM, and hence will lead to an increased need for raw materials, including the banned Rhino horn. That Rhino horn has been a banned substance since the 1980’s clearly does not seem to have any impact looking at the poaching statistics. In an unrelated paper published in 2010 the ingredients in the Xingnaojing injection is listed as “…. consisting of Chinese herbs such as Moschus, Borneol, Radix Curcumae, Fructus Gardeniae, ….” No full list is given in the paper – dare I say because it contains Rhino horn as well? The drug Ice is also banned, but if you are going to promote it at a ‘trusted’ university, then you shouldn’t be surprised that Ice production increases and more of it flows into Australia – even if it is illegal. The same goes for Rhino horn!

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