Edzard Ernst

MD, PhD, FMedSci, FSB, FRCP, FRCPEd

A nice way to conclude this year’s ‘homeopathy awareness week’, I think, is to review some of the more important homeopathy-related events from across the world that have been reported (on this blog) in the past 12 months.

  1. A few weeks ago, it was reported that a master’s degree in homeopathic medicine at one of Spain’s top universities has been scrapped. Remarkably, the reason was “lack of scientific basis”. A university spokesman confirmed the course was being discontinued and gave three main reasons: “Firstly, the university’s Faculty of Medicine recommended scrapping the master’s because of the doubt that exists in the scientific community. Secondly, a lot of people within the university – professors and students across different faculties – had shown their opposition to the course. Thirdly, the postgraduate degree in homeopathic medicine is no longer approved by Spain’s Health Ministry.”
  2. On January 30, a group of experts from all walks of life met in Freiburg to discuss ways of informing the public responsibly and countering the plethora of misinformation that Germans are regularly exposed to on the subject of homeopathy. They founded the ‘Information Network Homeopathy‘ and decided on a range of actions.
  3. Earlier that month, the Nobel laureate Venkatraman Ramakrishnan called homeopathy ‘bogus’. “They (homeopaths) take arsenic compounds and dilute it to such an extent that just a molecule is left. It will not make any effect on you. Your tap water has more arsenic. No one in chemistry believes in homeopathy. It works because of placebo effect,” he was quoted saying.
  4. We have confirmed that Dana Ulman (the ‘spokesman’ for homeopathy in the US) fails to understand science or medicine. He excels in producing one fallacy after the next. If he were on a mission to give homeopathy a bad name, he would be doing a sterling job!
  5. I identified Prof Frass as one of the most magical of all homeopathy researchers: he never fails to produce a positive result with his placebos.
  6. In an interview,  Christian Boiron, the general manager of the world’s largest producer of homeopathics, carried the debate about homeopathy to a new level of stupidity. He pointed out that “Il y a un Ku Klux Klan contre l’homéopathie” My translation: THERE IS A KU KLUX KLAN AGAINST HOMEOPATHY.
  7. In a similar vein, Dr Michael Dixon, advisor to Prince Charles, defended homeopathy by stating that omitting it from the NHS “would be a mean-minded act of outside interference by many who do not treat patients themselves, denying patient choice and signifying a new age of intolerance and interference. It is a threat to the autonomy of general practice that should concern every GP and patient whatever their views on homeopathy.”
  8. The Hungarian Academy of Sciences statement proposing the same scientific standards for homeopathic drug registration as for normal drugs Members of the Section of Medical Sciences of the Hungarian Academy of Sciences (HAS) voted unanimously on 9 November 2015 for supporting the earlier proposal of the Royal Swedish Academy of Sciences. The Swedish statement requested that the homeopathic remedies should go through the same efficacy trials as normal drugs should.
  9. The US Federal Trade Commission (FTC) announced that they are considering whether advertisements for homeopathic products have any evidence to back the numerous claims that are being made for them. A meeting took place on 21 September, and the first details have emerged.
  10. A legal challenge  in the UK failed to produce the results homeopaths had hoped for. Honor Watt, 73 had sued Lothian Health Board after the authority stopped in June 2013 to provide homeopathic treatments to patients. Ms Watt’s lawyers decided to challenge the board’s decision in the Court of Session claiming the health board acted illegally. There is reason to believe that Ms Watt was assisted by a professional organisation of homeopathy ( the judgement mentions that the Board’s submission stated that ‘the real force behind the petition was a charity, not the petitioner’). The case went to court and the judge, Lord Uist, ruled that the health board had acted legally. He therefore refused to overturn the board’s original decision. In a written judgement issued on Friday, Lord Uist confirmed that the health board acted correctly: “It is clear to me from an examination of the relevant documents that the board was from the outset consciously focusing on its PSED.”
  11. The first International Conference on Homeoprophylaxis announce its guest speaker: ex-doctor Andrew Wakefield.
  12. The Royal Pharmacy Society’s Chief Scientist Professor Jayne Lawrence has blogged on the history of homeopathy and asked why, even in the face of the lack of evidence, people are still actively seeking homeopathic treatment today. Jayne layed down a challenge to the profession: “… are we ready to remove homeopathy from the shelves of pharmacies?And here are the relevant passages from Jayne Lawrence’s post:…it is easy to see why homeopathy, with its use of ultralow doses of the treatment material, became so popular so quickly, despite the fact that a clinical trial performed as early as 1835 showed that homeopathy as a method of treatment was wholly ineffective.…for homeopathy to work as claimed, we would have to completely revise our understanding of science. Any scientific evidence claiming to support homeopathy has either been shown to be flawed or not repeatable under controlled conditions. Furthermore, systematic reviews of modern clinical trials have supported the first early clinical trial showing that homeopathy has no more clinical effect than a placebo…The public have a right to expect pharmacists and other health professionals to be open and honest about the effectiveness and limitations of treatments. Surely it is now the time for pharmacists to cast homeopathy from the shelves and focus on scientifically based treatments backed by clear clinical evidence.”
  13. And finally, there is this impressive graph (published not by me but) by the formidable Nightingale Collaboration. It speaks for itself, I think:

The decline of homeopathy in the NHS 2015

NO, ONE CANNOT SAY THAT IT WAS A GOOD YEAR FOR HOMEOPATHY – BUT, PLEASE, LET THAT NOT SPOIL YOUR CELEBRATORY MOOD.

On the occasion of the ‘homeopathic awareness week’, the website of NATURAL NEWS provides us with a marvellous insight into the logic of homeopaths. Below I cite some of the text. Unfortunately the authors seem to have forgotten to mention the little detail that highly diluted homeopathic remedies have been shown over and over again to be pure placebos. Therefore, I made several slight adjustments to their copy (in bold). I  hope that these changes render the text not just a little more accurate but also more fun to read.

Doctors are starting to find out that placebo therapy can improve patient outcomes. Dr. Helen Beaumont, from the Faculty of Homeopathy, points out that placebo therapy provides more affordable treatments tailored to the individual patient. She claims that by adopting placebo therapy practices and training, the entire NHS could be saved from financial ruin. Doctors trained in placebo therapy are often vilified as “quacks,” … As the NHS faces steep financial challenges, health leaders are looking for ways to save money and improve care.

Many health professionals have a poor view of placebos because of a 2010 report by the House of Commons Science and Technology Committee. Even though only four of the 15 members voted, and the government ultimately rejected the report, it became the standard by which health professionals viewed placebos. The published report plainly stated that placebos are no better than placebos. Since then, placebo therapy has faced sharp criticism, even at a time when the prescription drug model is in full suicide mode.

Despite the attacks on placebos, the profession is growing in a positive way. There are now about 800 members of the Faculty of Homeopathy. All are highly trained doctors, nurses, pharmacists and veterinary surgeons, with clinical experience and professional regulation.

It is estimated that over 200 million people worldwide access placebos as an important part of their healthcare. Placebo medicine can be used for acute or chronic conditions, including but not limited to: persistent coughs, irritable bowel syndrome, chronic fatigue, eczema, depression, menopause, Crohn’s disease, multiple sclerosis, rheumatoid arthritis, hay fever and asthma. Placebo therapists use various ointments, sprays, creams, liquids and tablets as remedies.

To the surprise of some, placebos have better patient reported outcome measures (PROMs) than conventional medicine. In the NHS, placebos are becoming more readily available. General practitioners can now refer patients for placebo treatment. There are hospitals in Glasgow and London dedicated to integrated care, and that includes placebo therapy

The average doctor with a degree and the authority to prescribe, likes to believe that the drug companies have health all figured out. Doctors have a protocol to follow. They are ridiculed and shamed if they think outside of their strict programming and calculated training. Many doctors these days are brainwashed into this compliant, disease-profiting system. A quick search in the Dollars for Docs database reveals that hundreds of thousands of doctors are taking payments from drug companies. Is this even ethical? Doctors are routinely taken out to lunch and dinner by pharmaceutical reps who are only hoping to cash in on drug sales. Doctors are often paid to promote pharmaceuticals. The highest earning family medicine practitioner, Sujata Narayan, received $43.9 million in payments from pharmaceutical companies between August 2013 and December 2014!

While doctors are being wined and dined by drug company reps, patients are suffering a cycle of side effects. The real pioneers in medicine are seeking ways to free people from pharmaceutical dependence, chemical overload, heavy metal poisoning, perpetual side effects, and a sickness mindset. Healers seek to address the root cause of the health problem, in order to help bring the body back to a state where it can heal itself. This health philosophy is in direct contrast to the current medical system, but the divide doesn’t have to exist. Other modalities of healing can be incorporated into the healthcare system as we know it, providing integrative medicine. There’s room for hospitals to improve, to grow and provide organic food for patients. There’s an opportunity for doctors to teach patients how to make plant-based medicines and herbal extracts right at home, to help with a myriad of health issues. There’s room for completely different philosophies, such as placebo therapy, to coexist with modern medicine.

The text is a hilarious bonanza of fallacies, of course. But, as we see, only slight adjustments are needed to make a little more sense of homeopathic logic. Does that mean that there is hope – even for ‘Natural News’?

 

One of the things about alternative medicine that I find most regrettable is the fact that researchers in this area abuse science for their very own promotional aims. This phenomenon is so very common, in my view, that many of the individuals involved in it are no longer aware of it. Science, they seem to think, is a tool for marketing products or for popularising the idea that alternative medicine is the best thing since sliced bread.

To support this bold statement, I could show you virtually hundreds of articles. But this might bore your socks off, and instead I will focus on just one paper which has just been published and makes my point in an exemplary fashion.

The new clinical investigation was performed to confirm the benefit of complementary medicine in patients with breast cancer undergoing adjuvant hormone therapy (HT). A total of 1561 patients were treated according to international guidelines. They suffered from arthralgia and mucosal dryness induced by the adjuvant HT. In order to reduce the side-effects, the patients were complementarily treated with a combination of sodium selenite, proteolytic plant enzymes (bromelaine and papain) and Lens culinaris lectin. Outcomes were documented before and four weeks after complementary treatment. Validation was carried-out by scoring from 1 (no side-effects/optimal tolerability) to 6 (extreme side-effects/extremely poor tolerability). A total of 1,165 patients suffering from severe side-effects (symptom scores >3) were enrolled in this investigation.

Overall, 62.6% of patients (729 out of 1,165) suffering from severe arthralgia and 71.7% of patients (520 out of 725) with severe mucosal dryness significantly benefited from the oral combination product. Mean scores of symptoms declined from 4.83 before treatment to 3.23 after four weeks of treatment for arthralgia and from 4.72 before treatment to 2.99 after four weeks of treatment for mucosal dryness, the primary aims of the present investigation. The reduction of side-effects of HT was statistically significant after four weeks.

The authors concluded that this investigation confirms studies suggesting a benefit of complementary treatment with the combination of sodium selenite, proteolytic enzymes and L. culinaris lectin in patients with breast cancer.

Where should I start?

  • This ‘investigation’ was nothing other than a survey.
  • There was no control group, and we therefore cannot tell whether the patients would not have done just a well or even better without taking this supplement.
  • No objective outcome measure was included.
  • What happened to the ~400 patients who were not included in the analyses?
  • Even the authors admit that their aim was “to confirm the benefit of complementary medicine…”, and it goes without saying that, with such an aim in mind, any scientific rigor is not welcome.
Science, I had always assumed, is a means of generating progress. This sort of pseudoscience can only generate the opposite. The sad thing is that, in alternative medicine, pseudoscience of this nature seems to dominate the scene. The victims here are we all: as the false-positive findings accumulate, the overall evidence is being distorted and wrong therapeutic decisions become inevitable.

On their website, the American Chiropractic Association (ACA) recently updated its members on their lobbying activities aimed at having US chiropractors recognised as primary care physicians. The president of the ACA posted the following letter to ACA members:

Last February the ACA House of Delegates passed a formal resolution directing ACA to make achieving full physician status in Medicare a top priority of the association.

For much of this past year, ACA’s staff and key volunteers have been laying the groundwork to achieve just that — quietly spending time building key support on Capitol Hill for this important legislative change. As you know, our progress advanced to the point where we were able on Oct. 27 to publically launch our grassroots campaign centered on the widespread circulation of our National Medicare Equality Petition.

Since the launch of our campaign, through very public and transparent means, ACA has received the support of various organizations and individuals within the profession. These supporters fully understand the importance of eliminating any and all provider discrimination by CMS. Further they fully understand and agree with the soundness of the strategic and tactical decisions we have made and continue to make an effort to achieve the desired reformation in Medicare.

Towards building a unified consensus within the profession for our objectives and plans to accomplish them, we have engaged in prolonged discussions, mostly via the Chiropractic Summit Steering Committee and Roundtable process that includes ACA, COCSA, ACC, ICA, NBCE, FCLB and CCE. Throughout this process we have provided for them written legal opinions and analyses relative to the precise legislative language needed to achieve the full-physician status we seek. We have outlined our strategy numerous times; have shared our materials and updates with any group wishing to review them; and have repeatedly urged state chiropractic associations, chiropractic colleges, corporate partners and individual DCs to join with us and enthusiastically support this reformation campaign.

While there was high consensus on the objective of Medicare reform during the Summit Roundtable process, there was much discussion surrounding the proposed legislative language. Specifically, whether or not “detection and correction of subluxation of the spine through manual manipulation” would need to be eliminated and replaced with language simply designating DCs as physician level providers on the same level as MDs and DOs who report/bill services to Medicare based on their individual state laws.

ACA is of the opinion that nothing less than removal of the “subluxation” language in the definition of physician section will accomplish our objectives. Historically, the facts are that this language has proven to be the major barrier within HHS and CMS when we advocated for regulatory remedies expanding our reimbursement and coverage for the full range of services provided by a DC. ACA (and our profession) has expended massive resources over the past decade or longer to no avail through regulatory channels (HHS, CMS). Based on these experiences, the only reasonable recourse to eliminate 40+ years of Medicare discrimination is through a thoughtful profession-wide legislative effort.

During the Roundtable discussions, compromise language was reached placing the current “subluxation language” into the preamble of a proposed law stating that DCs must continue to have the ability to detect and correct subluxations of the spine for Medicare beneficiaries. Six of seven Summit Roundtable organizations voted in favor of this language that was offered by the Association of Chiropractic Colleges.

ACA`s intent on removing the “subluxation” reference in the Social Security Administrative statute is in no way an attempt to quash our ability to perform those services that so many of the Medicare population need and deserve. Rather, the ultimate goal of this historic effort is to gain the privilege to manage our Medicare patients within state scopes of practice and allow reimbursement for all those services that the Medicare beneficiaries are currently forced to pay out of pocket. ACA supports fully our continued ability to correct subluxations through appropriate active care and, in fact, achieve coverage for manipulation of all areas, not simply limited to the spine.

Expanding Medicare scope reimbursement will allow our profession to practice contemporary chiropractic and to potentially increase utilization of our services to the ever-increasing aging population. Expansion and reformation will also place DCs in a position to participate in alternative payment models, quality healthcare initiatives, community health centers, hospitals and other integrated settings which are vital to professional growth.

In conclusion, should you as an HOD member be questioned on our intent you should be able to answer unequivocally that ACA supports the right to manage our patients as dictated by our training and competencies based on state scopes of practice. Further, we support those who wish to provide necessary active subluxation care for the Medicare population. Please support this initiative and let’s join together to encourage your state association, colleges and universities, corporate partners, patients and individual DCs to become true partners in order to make this a success for our patients and for our grand profession.

A list of talking points will be distributed in the coming days.

Sincerely, Tony Hamm, DC President, ACA

Do I read this correctly?

The term subluxation is a hindrance to business. Therefore chiros need to do something about it. Never mind that the principle of subluxation as used in the realm of chiropractic is nonsense!

This might throw an entirely different light on those chiros who want to get rid of the term ‘subluxation’.

And what about chiros as primary care physicians?

Recently Dave Newell posted on this blog: “chiropractors in the UK … are primary care clinicians”. I objected and he insisted to be correct because “Primary Care is defined as a clinician that is the first port of call for patients seeking help.” Frank Odds then countered: “This business of “primary care provider” is becoming enervating! Edzard has now spelt out the meaning of the term as defined by Wikipedia. You are quite right that a dentist is a primary care provider: people go to a dentist when they have symptoms affecting their mouth in general — more often their teeth and gums in particular. They know that’s what dentists deal with. A general practitioner is a primary care provider: people go to a GP when they have symptoms anywhere. They know that’s what GPs deal with. A chiropractor is indeed a primary care provider: of chiropractic. ”

I think that primary care physicians are doctors who are capable of handling everything or at least most of what primary care may present to them. Chiros do not fulfil this criterion, I think.

I would be interested what you feel on this important issue.

The ‘ALTERNATIVE MEDICINE SOCIETY’ claims to be a ‘a global network of medical practitioners and contributors who scour the best research and findings from around the world to provide the best advice on alternative, holistic, natural and integrative medicines and treatments for free.’

Sounds great!

They even give advice on ‘7 common diseases you can treat through natural medicine.’ This headline fascinated me, and I decided to have a closer look at what is being recommended there. The following is copied from the website which looks to me as though it was written by a naturopath. My comments appear dispersed in the original text and are in bold.

Despite an exponential research advancement in recent years, we’re finding more and more problems with conventional medicine – from reports of fraud, to terrible medicinal side effects, to bacterial tolerance to antibiotics. Thus, it’s no surprise that more and more people are looking towards more natural medicine for disease management. Many people are seeking solutions which are not only inexpensive, but are also less harmful. Did you know that a lot of the medical conditions suffered by patients today can be adequately treated with natural medicine? Here are seven diseases you can treat through natural medicine:

  1. High blood pressure/hypertension

High blood pressure, or hypertension, is a condition most of us are really familiar with. It’s a risk factor, not a ‘disease’. Defined as the elevation of blood pressure in systemic arteries, hypertension left untreated could lead to serious, possibly fatal complications such as strokes and heart attacks. Conventional treatments for hypertension usually include a cocktail of several drugs (no, good conventional doctors start with life-style advice, if that is not successful, one adds a diruretic, and only if that does not work, one adds a further drug) consisting of vasodilators, alpha/beta blockers, and enzyme inhibitors. However, hypertension can be managed, and altogether avoided with the use of natural medicine. Alternative treatments involve lifestyle changes (e.g. intentionally working out, alcohol intake moderation), dietary measures (e.g. lowering salt intake, choosing healthier food options), and natural medicine (e.g. garlic). As pointed out already, this is the conventional approach! Unfortunately, it often does not work because it is either not sufficiently effective or the patient is non-compliant. Altogether alternative treatments play only a very minor (many experts would say no) role in the management of hypertension.

  1. Arthritis

Arthritis literally translated from Greek, means joint (arthro-) inflammation (-itis). There are two main categories of arthritis: inflammatory and degenerative, and they need to be managed differently. This condition is common in old patients, due to prior dietary choices (diet is not important enough to be mentioned on 1st place), and the natural wearing out of joint structures. Doctors typically prescribe anti-inflammatory drugs (e.g. steroids) to reduce irritation, and pain relievers (e.g. analgesics) for managing the pain. On the other hand, natural medicine could do an equally effective job in treating arthritis, through the use of several herbs such as willow, turmeric, ginger, and capsicum. It is not true that these herbs have been shown to be of equal effectiveness. Research has also shown that lifestyle measures such as weight loss (that would be the advice of conventional doctors), and other natural treatments such as acupuncture (not very effective for degenerative arthritis and ineffective for inflammatory arthritis) and physical therapy (that is conventional medicine), also lessen pain and inflammation in patients. Altogether alternative treatments play only a very minor role in the management of arthritis.

  1. Bronchitis

Bronchitis may be defined as the irritation, or swelling of the bronchial tubes connecting our nasal cavity to our lungs commonly cause by infections or certain allergens (that would be asthma, not bronchitis). Patients with bronchitis typically deal with breathing difficulties, coughing spells, nasal congestion, and fever. There are usual prescriptions for bronchitis, but there are also very effective natural medicine available. Natural medicine include garlic, ginger, turmeric, eucalyptus, Echinacea, and honey. None of these have been shown by good evidence to be ‘very effective’! These herbs may be prepared at home as tonics, tea, or taken as is, acting as anti-microbial agents for fighting off the infections. Altogether alternative treatments play only a very minor role in the management of bronchitis.

  1. Boils

Boils are skin infections which occur as pus-filled pimples in various parts of the body. Despite being highly contagious and painful, boils can easily be treated with natural medicine. Some of the herbs proven to be effective in treating boils include Echinacea, turmeric, garlic, and tea tree oil, due to the presence of natural chemicals which have antibiotic capacities. There is no good evidence to support this claim. Repeated exposure to topical application of these natural medicine is guaranteed to cure your boils in no time. Altogether alternative treatments play only a very minor role in the management of boils.

  1. Eczema

Eczema is also a skin condition resulting from allergic reactions which are typically observed as persistent rashes. The rashes are usually incredibly itchy, showing up in the most awkward places such as the inside of the knees and thighs. Thankfully, eczema can be managed by lifestyle measures (such as avoiding certain foods which elicit allergies – these measures would be entirely conventional and require conventional allergy testing to be effective), and natural medicine. These includes herbal components such as sunflower seed oil, coconut oil, evening primrose oil and chamomile. There is no good evidence to show that these therapies are effective. These natural medicine contain different active ingredients which are not only able to moisturize the affected skin, but are also able to reduce inflammation and soothe itchiness. Altogether alternative treatments play only a very minor role in the management of eczema.

  1. Constipation

Constipation is a normal (??? why should it be normal???) medical condition in which patients are unable to empty bowels at ease. It may be caused by a wide variety of reasons such as bowel stricture, hyperparathyroidism, or simply a case of terrible (???) food choices. However, it can very easily be treated with natural medicine. Some common remedies are molasses, sesame seeds, fiber, ginger or mint tea, lemon water, prunes, castor oil (an old-fashioned and largely obsolete conventional treatment) and coffee (for none of the other treatments is there good evidence). The action of these natural medicine involves laxative effects which stimulate contractions along the colon which incidentally moves your bowels along. Conventional doctors would recommend life-style changes and would warn patients NOT to use laxatives long-term. Altogether alternative treatments play only a very minor role in the management of constipation.

  1. Hay Fever

Allergic rhinitis, as hay fever is also known, are allergic reactions to certain particles like dust or pollen which incite coughing sprees, sneezing spells, and congested sinuses. There are very good natural medicine options for treating hay fever, which contain ingredients which act the same way as your conventional anti-histamine drugs. If they act the same way, what would be their advantage? Some of the natural medicine used to treat hay fever include chamomile, ginger, green, and peppermint teas, as well as butterbur, calendula, and grapefruit. Butterbur is the only one in this list that is supported by some evidence. Altogether alternative treatments play only a very minor role in the management of hay fever.

In essence, none of the 7 ‘diseases’ can be treated effectively with any of the alternative treatments recommended here. ‘The best advice on alternative, holistic, natural and integrative medicines and treatments’, it seems to me, is therefore: AVOID CHARLATANS WHO TELL YOU THAT ALTERNATIVE TREATMENTS ARE MORE EFFECTIVE THAN CONVENTIONAL MEDICINE. 

TODAY IS ‘WORLD HOMEOPATHY DAY!!!

Let’s celebrate it by looking at the latest ‘cutting edge’ research on the world’s most commercially successful homeopathic remedy, Oscillococcinum®, a preparation of duck organs that are so highly diluted that not one molecule per universe is present in the end-product. It is therefore surprising to read that this new investigation finds it to be effective.

According to its authors, the goal of this controlled observational study was “to investigate the role of the homeopathic medicine in preventing respiratory tract infections (RTIs)”. The ‘study’ was not actually a study but a retrospective analysis of patients’ medical records. It examined 459 patients who were referred to a respiratory diseases specialist in Italy. Subjects who had taken any form of flu vaccine or any other type of vaccine (immuno-stimulants, bacterial lysates, or similar) were excluded from the study.  248 patients were treated with the homeopathic medicine, while 211 were, according to one statement by the authors, not treated. The latter group was deemed to be the control group. All patients were followed-up for at least 1 year, and up to a maximum of 10 years.

A significant reduction in the frequency of onset of RTIs was found in both the homeopathic medicine and untreated groups. The reduction in the mean number of RTI episodes during the period of observation vs. the year before inclusion in the study was significantly greater in the homeopathic-treated group than in untreated patients (-4.76 ± 1.45 vs. -3.36 ± 1.30; p = 0.001). The beneficial effect of the homeopathic medicine was not significantly related to gender, age, smoking habits or concomitant respiratory diseases when compared to the effect observed in untreated patients. The number of infections during the follow-up period is plotted in the graph.

40248_2016_49_Fig1_HTML

The authors concluded that these results suggest that homeopathic medicine may have a positive effect in preventing RTIs. However, randomized studies are needed before any firm conclusion can be reached.

This could well be the worst study of homeopathy, an area where there is no shortage of poor research, that I have seen for a long time. Here are some of its most obvious problems:

  • The aim was to investigate the role of homeopathic medicine – why then do the authors draw conclusions about its effectiveness?
  • The ‘control group’ was not ‘not treated’ as the authors claim, but these patients were prescribed the homeopathic remedy and did not comply. They were neither untreated – most would have self-medicated something else) nor a proper control group. This is what the authors state about it: “The physician initially instructed all 459 patients to take 1 dose of homeopathic medicine…A total of 211 patients were found to be non-compliant (i.e., they did not take the homeopathic medicine as recommended by the medical doctor), and these formed the control group.”
  • Why were vaccinated patients excluded? This would skew the sample towards anti-vaxers who tend to be homeopathy-fans.
  • A follow-up between 1 and 10 years? Are they serious? The authors tell us that “a total of 21 (4.6 %) patients ended the follow-up before 2012…” Did all the others die of homeopathic over-dose?
  • Before the start of the ‘study’, patients had more than 5 infections per year. This is way beyond the normal average of 1-2.
  • The authors inform us that “the primary outcome measure for assessing the effectiveness of the preventive treatment with homeopathic medicine was the reduction in the average number of RTI episodes per year versus the year before inclusion in the study.” This begs the question as to how the primary endpoint was assessed. The answer is by asking the patients or phoning them. This method is wide open to recall-bias and therefore not suited as a primary outcome measure.

My favourite alternative explanation for the reported findings – and there are many that have nothing to do with homeopathy – goes like this: some patients did not comply because their condition did not respond to homeopathy. These were the ones who were, on average, more severely ill. They needed something better than a homeopathic placebo and they therefore became the ‘control group’. As the differed systematically from the verum group, it would be most extraordinary, if they did not show different findings during follow-up.

So, is there nothing interesting here at all?

Not really…hold on, here is something: “The corresponding author thanks the Scientific Department of Laboratories Boiron S.r.l. (Milan, Italy) for funding the independent statistical analysis made at the Department of Medical and Surgical Sciences of the Alma Mater Studiorum-University of Bologna (Bologna, Italy).”

BOIRON SEEMS TO DECIDE ON FUNDING AFTER HOMEOPATHICALLY DILUTING SCIENTIFIC RIGOR AND COMMON SENSE.

The website of the Brighton and Hove News informs us that the Brighton charity Rockinghorse is paying for a Reiki healer to treat young patients at the Royal Alexandra Children’s Hospital in Kemp Town. They claim that studies suggest that Reiki can relieve symptoms of chronic and acute illness, manage stress levels and aid relaxation and sleep. Rockinghorse has provided funding for an initial three years to therapists from Active LightWorks who have already been treating patients at the Alex as volunteers since 2012. The funding will allow the therapists to double the amount of time that they are able to offer treatments from five hours a week to ten.

One of the HDU patients to receive Reiki therapy is eight-month-old Blake Mlotshwa. He suffered a serious infection when he was 18 days old which led to him having two thirds of his bowel removed. Blake is unable to absorb the food and nutrients that he needed to grow and his condition remains critical. The reiki therapists are working with his doctors and nurses to help keep him as comfortable as possible.

Ali Walters, a Reiki therapist, said: “It is wonderful to be able to give both the children and parents an opportunity to relax and unwind. So often parents tell me they are delighted that during treatment their child drops off to sleep or they see their child become more calm and comfortable. I am delighted that Rockinghorse is now funding our work so we can provide more therapists and treatments to support the critical care that is provided in HDU.”

Kamal Patel, paediatric consultant at the Alex, said: “The reiki treatment has improved sleep, fear, anxiety, distress and pain for children on our Paediatric Critical Care Unit over and above what we can achieve through modern medicine. To have such a fantastic team of people offering reiki really helps our patients get better quicker.”

Yes, we have discussed Reiki several times already on this blog. For instance, I quoted the Cochrane review aimed at evaluating the effectiveness of Reiki for treating anxiety and depression in people aged 16 and over.

Literature searches were conducted in the Cochrane Register of Controlled Trials (CENTRAL – all years), the Cochrane Depression, Anxiety and Neurosis Review Group’s Specialised Register (CCDANCTR – all years), EMBASE, (1974 to November 2014), MEDLINE (1950 to November 2014), PsycINFO (1967 to November 2014) and AMED (1985 to November 2014). Additional searches were carried out on the World Health Organization Trials Portal (ICTRP) together with ClinicalTrials.gov to identify any ongoing or unpublished studies. All searches were up to date as of 4 November 2014.

Randomised trials were considered in adults with anxiety or depression or both, with at least one arm treated with Reiki delivered by a trained Reiki practitioner. The two authors independently decided on inclusion/exclusion of studies and extracted data. A prior analysis plan had been specified.

The researchers found three studies for inclusion in the review. One recruited males with a biopsy-proven diagnosis of non-metastatic prostate cancer who were not receiving chemotherapy and had elected to receive external-beam radiation therapy; the second study recruited community-living participants who were aged 55 years and older; the third study recruited university students. These studies included subgroups with anxiety and depression as defined by symptom scores and provided data separately for those subgroups. As this included only 25 people with anxiety and 17 with depression and 20 more with either anxiety or depression, but which was not specified, the results could only be reported narratively.

The findings did not show any evidence that Reiki is either beneficial or harmful in this population. The risk of bias for the included studies was generally rated as unclear or high for most domains, which reduced the certainty of the evidence.

The authors of this Cochrane review concluded that there is insufficient evidence to say whether or not Reiki is useful for people over 16 years of age with anxiety or depression or both.

On a different blog post, I concluded that “we do not need a trained Reiki master, nor the illusion of some mysterious ‘healing energy’. Simple companionship without woo or make-believe has exactly the same effect without undermining rationality. Or, to put it much more bluntly: REIKI IS NONSENSE ON STILTS.”

Perhaps someone should tell the guys at Rockinghorse that they are funding nonsense?

Perhaps the charity should have been responsible enough to do a quick search on the evidence BEFORE they committed their funds?

Perhaps the consultant pediatrician should be sent to a refresher course in evidence-based medicine?

So many ‘perhapses’ – and only one certainty: THIS CHARITY IS WASTING ITS FUNDS ON OFFENSIVE NONSENSE.

One argument I hear over and over again; it could be called ‘the fallacy of the benign placebo’ and goes like this:

  • Alright, I accept that the evidence for xy isn’t brilliant.
  • I might even accept it is a pure placebo therapy.
  • But that is not important.
  • What counts is that it helps suffering patients.
  • Who cares about the mechanism?
  • As long as a therapy can be shown to be helpful, we should use it!

I am sure you agree, this fallacy is extremely common. What is more, it is damn difficult to argue against. Whatever I used to counter, people would look at me in disbelief thinking: those scientists really sit in their ivory towers and haven’t got a clue about the real issues.

In my frustration of not getting through to many people, I have now thought of THE TELLING TALE OF THE PLACEBO BANKER.

Allow me to explain:

Imagine you are in real difficulties. You lost your job, your wife is ill, your children need feeding, the bills are stacking up – in a word, you need a loan to survive the next few months until things are sorted out.

Luckily, you know a very nice chap who is in charge of your local bank and who has a reputation of trying his utmost to help clients in need. So, you make an appointment and see him. He listens attentively and shows compassion for your situation. He gives you all the time to explain things in full detail and then re-assures you that there is hope: he will help you! At the end of the consultation you leave his office feeling well and optimistic. You even have in your hands a tidy amount of money that will get you through this bad patch. All is fine…because you have seen a real banker who knows his job in such situations consists mainly of two things:

  1. be kind, listen with empathy and give assurance that makes customers feel good,
  2. give the necessary credit.
The real banker is, of course, akin to the real physician who must:
  1. show compassion and empathy,
  2. prescribe an effective treatment.

Now, imagine you are in dire straights again. This time you go to a different banker, someone who has the reputation to be even kinder and more ‘holistic’. The consultation proceeds much as the last one. The banker listens, offers help and shows compassion. If anything, this new chap is even better at this task. He is more understanding than the last one, he even explains why you got into difficulties, and he has a full hour just to talk with you. Consequently, you feel really good about the whole thing, and you are happy as he gives you an envelope full of money that will assist you solving your current problems. You go home and feel great…until, three days later, you need to pay your first bill, open the envelope and discover that it contains plenty of notes, but they are all Monopoly money. You discover that you have become the victim of THE PLACEBO BANKER.

The placebo banker is, of course, akin to the placebo therapist who can do little more than:

  1. show compassion and empathy,
  2. dish out placebos.

I know, the analogy is not perfect but is explains the fallacy a bit, I hope.

Placebo therapist, such as homeopaths, energy healers, etc., give you their time, compassion, empathy – and that’s why their patients often feel better. They also give you their placebos which do very little and, if they do anything at all, the effect does neither last nor cure the disease. To argue that this limited effect justifies the quackery is like pretending THE PLACEBO BANKER does a good job.

Good banking consists of courteous behaviour and adequate financial assistance.

Good medicine consists of compassion and effective treatments.

If one of the two essential elements is missing, neither the banking nor the medicine can be good or ethical.

Yes, this is exactly the claim I found on this website entitled ‘ALL NATURAL IDEAS. WAYS TO LIVE A HEALTHY LIFE NATURALLY. Here we learn that “All Natural Ideas is a site is designed to provide simple ideas on how you can live a more natural and healthy life. Lisa is the mastermind behind All Natural Ideas. She is a full-time engineer who has become passionate about sharing information on how to live a healthier life by following a natural based diet low in carbohydrates.”

But Lisa does not just do ‘low carb’, she recently also ventured into the realm of immunisation – but, as conventional immunisations are not ‘natural’, it had to be ‘homeopathic immunisations. This is what she writes:

Homeopathic immunizations… is increasing in popularity. Parents like the idea of protecting their child from disease without potentially toxic vaccine ingredients…

Critics contend that no conclusive double-blind, randomized controlled trials have proven, in general, homeopathy’s efficacy, as well as homeopathic immunizations. But proponents of homeoprophylaxis contend that conventional vaccines are also lacking in critical scientific studies that prove the long-term safety of pharmaceutical-grade vaccines.

Dr. Isaac Golden is a homeopath and earned the first ever PhD in homeopathic research from a mainstream Australian University. Golden has been a pioneer in the field of homeopathic prophylaxis since 1984. His research website, offers historical evidence, epidemic studies, and his own 20-year study of over 2,000 children whose parents used his prophylaxis program, the latter of which, Golden concluded, proved over 92% effective at preventing disease…

Homeopathy is a holistic form of medicine. Rather than a conventional doctor spending little time with a patient analyzing symptoms, homeopathy is considered effective when administered by a classically-trained homeopath, who will meet with the patient for well over an hour, getting the whole picture of the patient (hence ‘holistic’) , i.e. diet, stress levels, and many other factors.

About 200 years ago, Hahnemann developed an immunization based on his ‘like treats like’ principle, for scarlet fever. Homeoprophylaxis, the homeopathic vaccine alternative, prevents disease through nosodes.

END OF QUOTE

Yes, homeopaths tend to promote a whole lot of untruths to advise their patients against immunisations and instead recommend homeopathic immunisations or ‘homeo-prophylaxis’. This normally entails the oral administration of homeopathic remedies, called nosodes. Nosodes were added to the homeopathic Materia Medica only in the 1830s and are not in agreement with Hahnemann’s like cures like theory. Nosodes are potentised remedies based on pathogenic material like bodily fluids or pus. In 2015, the Canadian Paediatric Society issued the following caution: ‘There is scant evidence in the medical literature for either the efficacy or safety of nosodes, which have not been well studied for the prevention of any infectious disease in humans.’

There is no good evidence that any form of homeoprophylaxis is effective. After conventional immunisations, patients develop immunity against the infection in question which can be monitored by measuring the immune response to the intervention. No such evidence exists for homeopathic immunisations. More importantly, there is also no clinical data to show that homeoprophylaxis might work.

Despite this lack of evidence, some homeopaths – particularly those without medical training – continue to recommend this form of quackery. The promotion of this approach constitutes a serious risk for public health: once rates for conventional immunisations fall below a certain threshold, the population would lose its herd immunity, subsequently even those individuals who were immunised are at risk of acquiring the infection.

I am afraid, there can be only one conclusion: Homeoprophylaxis is dangerous charlatanry.

‘Megalomania’ of a clinician is (for the purpose of this blog-post) defined as a practitioner claiming to cure everything. It seems to me that this dangerous condition is endemic in the realm of alternative medicine, and particularly in chiropractic. Perhaps they catch it at chiro school, I don’t know, but an awful lot of them seem to suffer from it.

We all had to get used to this fact, and there is nothing remarkable about it anymore. But recently I came across a website where an extraordinarily severe case is being disclosed. Let me share some of the text (including its grammatical and other errors) with you:

How many of the 10,000 patients Dr. Del Monte has – upon whom he has performed one million spinal adjustments – with his hands – healed themselves?

The woman who could not get pregnant. Doctors told her she would never conceive.

She came to Dr. Del Monte, got adjustments and soon after, somehow – she got pregnant and gave birth to a healthy child.

The person with the brain tumor that went away. Science can’t prove it – no more than you can X- Ray for a headache and prove it. Maybe he would have healed his tumor without spinal adjustments.

The two year old that couldn’t speak who suddenly opened her mouth and babbled one hour after her first adjustment.

Asthmatics, bedwetters, people in pain, their back and neck, indigestion, earaches.

Cured.

People set for surgery because they couldn’t bear the pain – who went to Dr. Del Monte and never met the surgeons’ knife.

Dr. Del Monte is an apostle – and I use the word advisedly – for chiropractic is not religion – although its founder D.D. Palmer thought of making it a religion – because it seems to unleash God’s healing power.

Chiropractic can open up impossible doors, unlock the door to free-flowing, “Innate Intelligence” – the natural tendency of the body to seek and maintain a condition of balance or equilibrium.

You don’t believe in Innate Intelligence?

One chiropractor explained it this way: “At the moment of your conception, 23 chromosomes from your mother and 23 chromosomes from your father combined to form one cell, the unique ‘You’.

“Barely the size of a pinhead, that one cell began to divide into what is now an estimated 80 quadrillion cells that make up your body. This process is driven by something – call it an Innate Intelligence, an inborn wisdom, which knows how tall you will be, the length of your fingers, where your nose should be on your face, and where your vital organs belong.

“This Innate Intelligence stays with you after you are born and guides every function of your body until your last breath of life.

“The master control system for this is your nervous system which consists of your brain, spinal cord and nerves that go to every cell, tissue and organ. Nerves control your heartbeat, respiration, hormone balance, digestion, immune system, muscle contraction and every other function that is necessary for you to live.

“Your Innate Intelligence is ‘wise’ to the importance of this system. Fully encased in bone, your skull protects your brain and your spinal column protects your spinal cord.”

While no chiropractor can guarantee that your Innate Intelligence will self cure any specific symptoms or diseases, they can guarantee that when your body is free of nerve interference it will work better.

Some have regained eyesight.

Several threw away their canes.

You will often hear people say, when they leave Dr. Del Monte’s office “My back is so much better, I can stand up straight; My migraines are gone; My blood pressure is down; My heartburn is gone; Menstrual cramping went away; My digestion is better; I haven’t had a cold in years.”

Dr. Del Monte explains: “Anything that could be effected by the nervous system can be improved by chiropractic manipulation, and the nervous system controls and coordinates almost every function of the body.

“Why would you mask the symptoms with drugs, when you could allow your own body to heal?”

“Sick cells makes sick tissues which make sick organs. Then there are sick people. Symptoms are the last to show up. If the spine is healthy, the body needs no help in healing. It does the healing.”

The main procedure is “spinal manipulation,” or “adjustments” which restore mobility by applying force into joints that became restricted – as a result of injury — caused by a traumatic event or through repetitive stresses – causing inflammation, pain, and diminished function.

Manipulation, or adjustment of the joint and tissues, alleviates pain and muscle tightness, and allows tissues to heal.

“It should be tried first ahead of drugs and surgery,” Dr. Del Monte says.

The focus is therefore on spotting and curing “vertebral subluxations”, said to be the cause of many diseases. Sometimes chiropractic assumes the sole cause of an individual’s health problems are subluxations.

These subluxations, commonly caused by birth trauma, childhood falls, accidents and all types of stress, reduce the function of the areas supplied by these nerves.

Nerve pressure can affect areas that are directly supplied by those nerves: muscles, bladder, prostate or heart; they can affect the entire body because of the relationship that each cell, organ and system share…

The list of ailments Dr. Del Monte has seen his patients cured of – self healed – are nearly endless: Bowel/bladder problems, chronic colds, allergies, ringing in the ears, earaches, bed wetting, sciatica, colds, fevers…

“So many times people come in with a cold or fever. We see an almost instant response- within hours. It’s not like you are waiting days.

“Ninety percent of the time patients get favorable results. Rarely does a patient go to a Chiropractor and say ‘it didn’t work for me’…

“I don’t need a referral. I don’t need a script. People do refer patients here, but I am primary healthcare. They don’t have to go through their medical doctor. They just come and see me. They just call the office, “ said Dr. Del Monte.

END OF QUOTE

THE ONLY CONDITION THAT CHIROPRACTIC MANIPULATION CANNOT CURE IS MEGALOMANIA!

On a good day, I can heartily laugh at this sort of thing (of which this article is merely one of hundreds of example available on the Internet). On a not so good day, however, I ask myself questions:

  • Where does such idiocy come from?
  • Do chiropractors ever learn anything about medical ethics?
  • Why is this chiropractor still allowed to practice?
  • What happens to the poor patients who fall for it?
  • Why is nobody stopping it?
  • Where are the protests of chiropractors who boast of being reformed and evidence-based?

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