Edzard Ernst – why he changed his mind! This is the title of a blog which I just found. It is such fun to read that I must show it to you in full [I added a few numbered footnotes in square brackets]:
BBC Radio 4 gave Professor Edzard Ernst a 15 minute slot to explain “Why I Changed My Mind’ on Wednesday 4th May 2016. It was repeated on 12th May 2016. He was interviewed by Dominic Lawson . The programme demonstrates the lengths to which the BBC is prepared to go in order under undermine Alternative Medicine, and Homeopathy, in particular .
Lawson set the tone. Ernst, he stated, is hated by alternative health practitioners, the Prince of Wales tried to get him sacked, and he eventually lost his academic post because of the criticism he attracted for his work. Ernst was left to agree with this dreadfully unfair and unreasonable treatment . So Ernst was then led to explain his ‘change of mind’ about homeopathy. As a friend and colleague of mine said,
“Ernst (says) that as a German, he was raised on Homeopathy, and later treated his patients with homeopathy. And it worked! But when he approached it ‘scientifically’, he concluded that it’s merely placebo.”
So let’s be clear. Ernst’s experience of homeopathy has been that it does work , but that the science he has looked at does not demonstrate that it works. (Even this is wrong , but leave that for now!) So people do get better as the result of homeopathic treatment, but ‘science’, or at least Ernst’s science , does not understand why it should . Ernst also said that he was convinced, at the time, that he was ‘helping patients’.
Lawson then asked his most difficult question (sic). If he knew that homeopathy worked, why did it work? Ernst’s response was that it was charlatanism and quackery, and was “quite puzzling’ really . So as homeopathy worked, but science said it should not work , he went on to study this in his post at Exeter University.
Lawson, in the great tradition of BBC impartiality , (sic), continued to lead him on. “When did you decide that homeopathy was useless, delusional?”
Ernst said that when he ‘did the science’ it became clear that homeopathy is placebo.
Now, lets look at this word, placebo. The Oxford English Dictionary defines ‘the placebo effects’ as”
“A beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment”
So by using the term ‘placebo’ Ernst is once again saying the homeopathy has a ‘beneficial effect’ on patients who are ill . Lawson did ask Ernst whether there was anything wrong using placebo if this brought positive benefits to patients. Ernst said that people got better anyway! (Is it really is a simple as this?) 
Lawson, now thoroughly convinced of Ernst’s arguments, asked his whether he thought homeopaths were lying. With some apparent grace, Ernst said that lying was a strong term, by the were ‘deluded’, and ‘treated homeopathy as a religion’.
Lawson came back, asking why there were lots of qualified doctors who believe in homeopathy, and whether they should they be struck off, or stopped from practising? No, said Ernst, they were just not thinking critically, and needed to be educated out of their delusions.
Presumably, for both Lawson and Ernst, using a medical therapy that worked and brought benefit to patients , but which science could not explain, should be restricted, if not banned altogether.
Lawson’s final question clearly demonstrated his impartiality. “Can we justify homeopathy, or any other kind of quackery? (My emphasis). “No”, said Ernst, predictably!
The BBC regularly broadcasts these kind of anti-homeopathy, anti-alternative-medicine programmes, with never an attempt to redress the balance . They will never broadcast a programme that provides an alternative medical view. The BBC appears to be firmly in the camp of the conventional medical establishment , and committed to providing time to anti-homeopaths without any ‘right of reply’.
Why, for example, was there no question about the quality of the ‘science’ Ernst is associated with? Certainly, his science has come under serious scrutiny. For instance, I blogged about “The contribution of Professor Edzard Ernst to disinformation about Homeopathy” in September 1915 [!!!]. This followed an assessment made by Professor Robert Kahn about the quality of Ernst’s science. This was his conclusion .
“I have never seen a science writer so blatantly biased as Edzard Ernst: his work should not be considered of any worth at all, and discarded.”
Kahn’s paper shows, in his view, how ‘science’ has been taken over by ideology, (or as I suggested the financial interests of Big Corporations like Big Pharma). He revealed that in order to demonstrate homeopathy is ineffective over 95% of scientific research into homeopathy has to be discarded or removed! 
There was, of course, no mention of this in the BBC programme! 
So if Ernst’s change of mind was ‘scientific’, it was based on bad science , the kind of science much discussed in this blog, bought science, cheque book science, the kind of science based on university faculties funded by the pharmaceutical industry . Ernst’s funding dried up when his academic position had become untenable , and he lost the support of his financial backers . As my friends and colleague said, in response to the programme:
“Ernst’s religion is Science, not the well being of the patients. I wonder how many listeners will
be influenced by him as he does come across as an experienced and rational man?”
I agree with her assessment. Anyone can come over as an ‘experience and rational man’ when given an uncritical platform, such as this BBC programme proved to be. Certainly, Peter Fisher, the Queen’s homeopath, was one of his main critics. Why, Lawson asked Ernst, did homeopathy have ‘such a grip’ on the Royal Family? Ernst did not know, but he did know that “when they get really ill they do not go to a homeopathy, otherwise they would not get so old!”
At this point I began to wonder on what knowledge Ernst used to know how the Royal Family were being treated, and scientific basis his belief that their longevity was nothing to do with homeopathy? The question was never asked, so we will, I fear, never know!   you can listen to the programme here a serious allegation for which no evidence is provided, and I suppose none exists  this is the truth  not true, my experience was that patients got better for which there are good, scientifically sound explanations that do not involve homeopathy  no, it’s not  the best available evidence today which has little to do with ‘my’ science; might this be a little attempt at an ad hominem?  no, science does understand the phenomena involved well: placebo, regression towards the mean, natural history of the disease etc.  a wilful misinterpretation of my words  no, this is not what I said, homeopathic remedies are ineffective and the observed effects are due to other phenomena  not Kahn but Hahn; and his criticism is laughable, see here  the programme is a series of interviews with people who have changed their mind on an important subject; such questions do not belong there  any proof for that other than Hahn?  false and libellous allegation  no, when HRH had filed his complaint; this is all described in detail in my memoir  poor logic: if I had been funded by the ‘enemies of homeopathy’, my funding should have increased  anyone who follows the news bulletins about the Royals will know where they go when seriously ill.
It has been reported in most newspapers that Prince Charles has proposed a solution to the problem of antibiotic over-use in animals and humans. He told an international gathering of scientists and government officials in London that he treats his own cows and sheep with homeopathy. Many people reacted with dismay. I, however, plead for more understanding of this thoroughly good-willed man.
In fact, I intend to go one step further.
We have often heard that he is a considerate and caring man. We ought to give him the benefit of the doubt. I have tried therefore to empathise with his situation, put myself into his shoes and repeat the considerations that made him say what he said. My empathy went so far that I tried to re-live and formulate his thoughts in the first person singular (or should I have used the ‘Royal We’?). The result is the following little monologue where I categorised the considerations under 7 headings.
I wonder why they invited me to give a speech. True, I am a farmer at heart and I know all about husbandry, but I have no real expertise in the field of antibiotics.
Perhaps it is an occasion to tell them a bit about homeopathy. Yes, that subject would surely fascinate the audience!
THE INTELLECTUAL ENVIRONMENT
They tell me that the conference will be packed with very bright people. That sort of thing always makes me a bit self-conscious. Perhaps I should decline the invitation after all? Sometimes, I have the impression that people make fun at me.
No, I must not think like that – after all, I have had a very expensive education too, and I know my stuff.
Homeopathy is such a wonderful subject. I must try to win them over and make them appreciate its beauty. These experts should realize that homeopathy is the future.
I have heard rumours that some blinkered scientists doubt that homeopathy works. But my advisors tell me that it is best to ignore this sort of thing. And my advisors know their stuff even better than I.
This conference is going to have a very high impact. The press will be there. It will be reported across the world. And government’s chief medical officer, Dame Sally Davies (why can we not have more holistic doctors in position like these; I must remember to discuss this with Michael Dixon asap); she once called homeopathy ‘rubbish’ – enough to throw her in the Tower!
Mustn’t think like that! On the contrary, I will make sure they all get the message. I will bowl them over! The press will surely be on my side. This will be a victory for homeopathy.
Mother might be upset; she does not like me to stick my neck out like that…goes on about constitutional role and such trivia…she thinks we should not put our nose into things that are none of our business. And the Royal PR team will not like it either. They do what they can to distract from the image of ‘THE MEDDLING PRINCE’ might think that my speech is a hindrance to their efforts. I better don’t tell anyone in advance about this, they might try to stop me.
But now I feel quite unstoppable.
This is what I will tell them about homeopathy: “It was one of the reasons I converted my farming operation to an organic – or agro-ecological – system over 30 years ago and why we have been successfully using homeopathic – yes, homeopathic – treatments for my cattle and sheep as part of a programme to reduce the use of antibiotics.” I think this will convince everyone. Who needs science when there is powerful rhetoric like this?
What if it does not go well? They will not dare to contradict me, I am the future King, for heaven’s sake! Even if they disagree, they will not show it. They just don’t have the guts. And anyway, I will not take questions, I never do enter into any debate on homeopathy. It is simply too tedious to argue with people who do not understand the issues involved.
It is decided – I’ll do it. I’ll do it for homeopathy and for the good of mankind. If they then chose to misunderstand me, that’s their problem, and my people will issue a statement for the press saying “Homeopathy is used on a case-by-case basis at Home Farm, in combination with more conventional medicine, to minimise dependence on antibiotics.”
*In case you are a lawyer hired by HRH to check out this post: it is pure satire through and through, there is not a factual sentence here; if you want to sue me, please find another reason.
In a previous post, I asked this important question: how can research into alternative medicine ever save a single life?
The answer I suggested was as follows:
Since about 20 years, I am regularly pointing out that the most important research questions in my field relate to the risks of alternative medicine. I have continually published articles about these issues in the medical literature and, more recently, I have also made a conscious effort to step out of the ivory towers of academia and started writing for a much wider lay-audience (hence also this blog). Important landmarks on this journey include:
Alternative medicine is cleverly, heavily and incessantly promoted as being natural and hence harmless. Several of my previous posts and the ensuing discussions on this blog strongly suggest that some chiropractors deny that their neck manipulations can cause a stroke. Similarly, some homeopaths are convinced that they can do no harm; some acupuncturists insist that their needles are entirely safe; some herbalists think that their medicines are risk-free, etc. All of them tend to agree that the risks are non-existent or so small that they are dwarfed by those of conventional medicine, thus ignoring that the potential risks of any treatment must be seen in relation to their proven benefit.
For 20 years, I have tried my best to dispel these dangerous myths and fallacies. In doing so, I had to fight many tough battles (sometimes even with the people who should have protected me, e.g. my peers at Exeter university), and I have the scars to prove it. If, however, I did save just one life by conducting my research into the risks of alternative medicine and by writing about it, the effort was well worth it.
END OF QUOTE FROM MY PREVIOUS POST
Just now, I received an email from someone who clearly and vehemently disagrees with any of the above. As this blog is a forum where all sorts of opinions can and should be voiced, I thought I share this communication with you. Here it is:
Having been out of chiropractic practice for a while, I was thrilled to hear that you have been forced into early retirement on today’s Radio 4 programme. You have caused so many good people anguish and pain and your tunnel-visioned arrogance is staggering and detrimental to humanity. You REALLY think modern science has all the answers? Wow.
The question I ask myself is who is correct, the (ex-)chiropractor or I?
- Have I caused anguish and pain to many?
- Do I suffer from tunnel-vision?
- Am I arrogant?
- Is my work detrimental to humanity?
- Do I believe that modern science has all the answers?
Here is what I think about these specific questions:
- I have probably caused anguish (but no pain, as far as I am aware). This sadly is unavoidable if one seeks the truth in an area as alternative medicine.
- I am not the best person to judge this.
- Possibly; again I cannot judge.
- I truly don’t see this at all.
- No, not for one second.
In case you wonder what programme the author of the above email had been listening to, you can find it here.
Is there a bottom line? I am not sure. Perhaps this: whenever strong believes clash with scientific facts, some people are going to be unhappy. If we want to make progress, this seems to be almost unavoidable; all we can try to do is to minimize the anguish by being humble and by showing human decency.
I am pleased to report that my ‘ALTERNATIVE MEDICINE HALL OF FAME’ is growing steadily. So far, this elite club includes:
Time, I think, to elect another member. I was fascinated to read what the COLLEGE OF MEDICINE (I have published about this organisation before, for instance, here) writes about a former co-worker of mine, Simon Mills (those who have read my memoir will know more about him and about my struggle to disassociate me and my work from him and his activities):
Simon Mills is a member of the College of Medicine Council. He is a Cambridge graduate in medical sciences who has since 1977 been a herbal practitioner and natural therapist in Exeter. In that time he has led the main organizations for herbal medicine in the UK (the British Herbal Medicine Association, the College of Practitioners of Phytotherapy, and National Institute of Medical Herbalists) and served on Government and House of Lords committees. Since 1997 he has been Secretary of ESCOP, the lead herbal scientific network in Europe, that produces defining monographs on herbal medicines for the European Medicines Agency. He has also written award-winning seminal herbal medicine textbooks, notably with Kerry Bone the two editions of Principles and Practice of Phytotherapy and the Essential Book of Herbal Safety. He has long been involved in academic work having co-founded the world’s first University centre for complementary health in Exeter (1987), the first integrated health course at a UK medical school at the Peninsula Medical School in Exeter (2000) and the first masters degree programme in herbal medicine in the USA (2001). He has published in many peer-reviewed scientific journals including full clinical trials with herbal medicines, and has supervised 10 successful doctorate theses. Simon is currently building a new role for healthcare practitioners as ‘health guides. With health workbooks, training programmes, community projects and websites.
It was new to me that he has ‘published in many peer-reviewed scientific journals’, so I did a Medline search and found a total of 14 articles. Most of these were comments, letters etc. I decided to identify the first 10 papers that drew some sort of conclusions about the value of alternative therapies. This is what I found (as usual, I have copied the conclusions in bold):
Pengelly A, Snow J, Mills SY, Scholey A, Wesnes K, Butler LR.
J Med Food. 2012 Jan;15(1):10-7. doi: 10.1089/jmf.2011.0005. Epub 2011 Aug 30.
The positive effect of the dose nearest normal culinary consumption points to the value of further work on effects of low doses over the longer term.
Dent HE, Dewhurst NG, Mills SY, Willoughby M.
Complement Ther Med. 2003 Jun;11(2):72-7.
Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.
Mills SY, Jacoby RK, Chacksfield M, Willoughby M.
Br J Rheumatol. 1996 Sep;35(9):874-8.
It is concluded that Reumalex has a mild analgesic effect in chronic arthritis at a level appropriate to self-medication.
Yes, there were just three such papers; perhaps the College of Medicine’s description is just a trifle misleading? As all of these arrived at positive conclusions, I think Mr Mills nevertheless deserves a place in my ALTERNATIVE MEDICINE’S HALL OF FAME.
In 2010, we published an investigation of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.
We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain.
At the time, we concluded that the majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.
Have things changed since?
I fear not! I regularly come across websites of chiropractors where they happily make bogus claims. On this website, for instance, chiropractor Karen Smith claims that muscles in the upper neck affect the ear canals. “We don’t actually treat the ear infection, or the symptoms. What we do is, we assist the body’s natural healing ability,” says Smith. “So if there’s something going on with the joints and the muscles soft tissue, the nerves coming out that supply those muscles, those muscles can’t relax, so then they’re almost tight and in spasm, so that can’t allow the drainage to happen properly.”
When fluid builds up in the ears, it’s a breeding ground for bacteria and infection. Smith says specific, gentle adjustments, can help the body drain those fluids through the nose. “What we do is we get some motion in the upper neck, with my hands, or I might use an instrument as well,” says Smith. “There’s a few other techniques that we can do. We can do some sinus drainage. We can drain some of the fluid in the ear.”
A simple ear pull technique can also help. “So what we do is, we just take the ear of the child and we do a little pull and that can actually drain the fluid as well,” says Smith. Smith says a child’s overall health and immune system impacts how quickly they see results from the treatment. In some cases, relief can be instant. “What we notice right after an adjustment is a lot of times you’ll actually see the fluid drain through the nose,” says Smith… Smith says she also treats adults who have had chronic ear issues as a child or who are experiencing pain in the ear.
When I or others expose such nonsense, the apologists say that these are just a few ‘rotten apples’, and that the chiropractic profession is fast progressing. Yet, I very much doubt this claim. For any fast progression, one would want to see the profession taking decisive and effective action against the ‘rotten apples’. This is clearly not happening, at least not to an extend that would stop such dangerous quackery.
What practical lesson can be learnt from such insights?
The only responsible advice I can think of is this: IF YOU OR YOUR CHILD IS ILL, AVOID CONSULTING A CHIROPRACTOR.
Shiatsu is a popular alternative therapy with a remarkable void of research. According to one of the rare reviews on the subject, Shiatsu is a form of Japanese massage, working on the meridian system of the body; the energetic pathways along which the acupuncture points are placed. The theory for shiatsu is based in the system of traditional Chinese medicine, understood in China for over 2000 years. Shiatsu can be valuable for reintegrating the body, mind and spirit, helping with the general energy level of the body as well as specific symptoms… Feelings of deep relaxation, support and increased vitality are common following a shiatsu treatment. The method, strength and frequency of treatment can be varied to suit individual need…
If this seems an optimistic evaluation to you, have a look on the Internet where bogus claims for Shiatsu abound. But such uncritical nonsense is, of course, neither informative nor responsible. In a previous post, I have been a little more critical about the value of Shiatsu and concluded that is an unproven therapy. I reached this conclusion mainly because, for our Oxford Handbook of Complementary Medicine (2008), we systematically researched the evidence and found very little of it. In fact, we concluded that NO CONVINCING DATA AVAILABLE TO SUGGEST THAT SHIATSU IS EFFECTIVE FOR ANY CONDITION.
Since then, a systematic review has been published. The Shiatsu studies found comprised just one single RCT, three controlled non-randomised, one within-subjects study, one observational study and 3 uncontrolled studies investigating mental and physical health issues. The authors, who usually are very much in favour of alternative therapies, concluded that more research is needed, particularly for Shiatsu, where evidence is poor.
This seems to indicate that our verdict of 2008 is still not far off the mark.
And what about the risks?
On this aspect of Shiatsu, it is even harder to find reliable information. One website, for instance, warns that certain individuals should take caution and consult a physician before receiving shiatsu. For example, there’s some concern that shiatsu may have harmful effects in pregnant women, patients who have recently undergone chemotherapy or radiation, and people with such conditions as osteoporosis, heart disease, and blood clotting disorders. Additionally, shiatsu should not be performed directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures. Shiatsu should also be avoided immediately after surgery, and by people with infectious skin disease, rash, or open wounds.
But what about adverse reactions and complications?
Another website, tells us that, when performed properly, shiatsu is not associated with any significant side effects. Some people may experience mild discomfort, which usually disappears during the course of the treatment session.
So, is Shiatsu without side-effects?
The answer, I am afraid, is NO – but has to dig deep to find even a tentative answer to this question.
A prospective, 6 months cohort, pragmatic study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK) has been published by UK authors in 2009 . Data were collected via postal questionnaires, including on client-perceived negative responses. Shiatsu was delivered by the practitioner in routine practice. 633 clients provided full follow-up data, a response rate of 67%. A prevalence rate of 12-22 per 100 of client-perceived ‘negative responses’ was found across the three countries. Transitional effects accounted for 82% of all the client-described ‘negative’ responses. Nine clients (1.4% of the total), relating to 10 sets of written comments, reported a negative response that was classified as ‘a potentially adverse event or effect’ that might represent a risk to client safety.
In addition there are much more serious complications such as strokes. These might be extreme rarities – but who knows? Nobody! Why? Because, as with most alternative therapies, there is no reporting or monitoring system for such events. Therefore the true prevalence is anyone’s guess.
The bottom line, I am afraid, is all too familiar: There is no good evidence for effectiveness and some evidence of risk – which can only mean one thing: the proven benefits do not outweigh the potential harm.
I just came across this website entitled 11 HARD QUESTIONS ABOUT CHIROPRACTIC PHYSICIANS. The title fascinated me; I am always in favour of addressing hard questions. I therefore read the 11 questions with interest; and I quite liked them. However, the answers provided by the author, a chiropractor of course, struck me as being more than a little uncritical towards chiropractic (feel free to click on the above link and see for yourself). Therefore, I decided to try my own answers (except for No 5). And then – being in the swing of it – I added a few more supplementary questions as well.
In other words, the first 11 questions are the ones posed by the chiro but the 4 additional ones are mine, and so are all the answers. Here we go:
Question No 1: What can a chiropractic physician do for me that another doctor can’t?
Question No 2: Does chiropractic therapy really work?
No. The best evidence available today fails to show that chiropractic spinal manipulations work for any condition. If one is generous, one might make an exception for back pain, but even for this symptom, the evidence is flimsy.
Question No 3: What other types of health problems can chiropractic treatment help?
Question No 4: What does a chiropractic physician do to find my problem?
He/she often uses non-validated diagnostic techniques that are prone to give fantasy-results. You might also get extensive X-rays – mostly because the chiropractor wants to pay for the expensive equipment.
Question No 5: What therapies do chiropractic physicians use?
Chiropractic physicians may use manual and physical therapies including manipulation of the spine and joints of the arms and legs. Supportive therapies may also include massage, myofascial release, and therapeutic modalities such as ultrasound, electric stimulation and diathermy. Rehabilitative measures are often used such as specific corrective exercises to stabilize your problem. (This is the only answer I roughly agreed with, and I therefore left it unchanged.)
Question No 6: What is the standard length of treatment?
This depends mainly on the patient’s ability to pay. As a rule of thumb, as many treatments as possible will be given. Many chiros even advocate ‘maintenance treatment’ which means you receive regular spinal manipulations even when there is nothing wrong with you. The little porky they give you as an explanation is that this prevents future illnesses.
Question No 7: Is chiropractic care covered by insurance?
Because of very active lobbying by chiro interest groups, it may well be.
Question No 8: If I need a referral, how do I ask my doctor to refer me to a chiropractic physician?
Chiros are presently trying very hard to be accepted as ‘primary care physicians’; this means you can consult them directly without the need of a referral.
Question No 9: If I go see a chiropractor do I need to keep on going?
Only if you believe the nonsense about maintenance treatment they often tell you (see above) for which there is not a jot of convincing evidence.
Question No 10: What training do chiropractors have?
Not enough to realise that their spinal adjustments fail to generate more good than harm.
Question No 11: How should I select a good chiropractic physician?
If you are ill, it’s best to see are real doctor and avoid chiros.
AND NOW MY SUPPLEMENTARY QUESTIONS
No 1 Are chiros really physicians?
The definition of a physician is : ‘A person trained and licensed to practice medicine; a medical doctor’. Therefore, the answer is no.
No 2 What are the risks of spinal manipulations or adjustments, the main treatments used by chiros?
~50% of all patients have mild to moderate adverse effects that last 2-3 days.
In addition, several hundred cases of severe complications have been noted, including strokes and deaths.
No 3 How are such adverse outcomes monitored?
There is no effective monitoring system at all.
No 4 Is such an omission responsible or ethical?
Reiki is one of the most popular types of ‘energy healing’. Reiki healers believe to be able to channel ‘healing energy’ into patients’ body thus enabling them to get healthy. If Reiki were not such a popular treatment, one could brush such claims aside and think “let the lunatic fringe believe what they want”. But as Reiki so effectively undermines consumers’ sense of reality and rationality, I feel I should continue informing the public about this subject – despite the fact that I have already reported about it several times before, for instance here, here, here, here, here and here.
A new RCT, published in a respected journal looks interesting enough for a further blog-post on the subject. The main aim of the study was to investigate the effectiveness of two psychotherapeutic approaches, cognitive behavioural therapy (CBT) and a complementary medicine method Reiki, in reducing depression scores in adolescents. The researchers from Canada, Malaysia and Australia recruited 188 adolescent depressed adolescents. They were randomly assigned to CBT, Reiki or wait-list. Depression scores were assessed before and after 12 weeks of treatments/wait list. CBT showed a significantly greater decrease in Child Depression Inventory (CDI) scores across treatment than both Reiki (p<.001) and the wait-list control (p<.001). Reiki also showed greater decreases in CDI scores across treatment relative to the wait-list control condition (p=.031). Male participants showed a smaller treatment effects for Reiki than did female participants. The authors concluded that both CBT and Reiki were effective in reducing the symptoms of depression over the treatment period, with effect for CBT greater than Reiki.
I find it most disappointing that these days even respected journals publish such RCTs without the necessary critical input. This study may appear to be rigorous but, in fact, it is hardly worth the paper it was printed on.
The results show that Reiki produced worse results than CBT. That I can well believe!
However, the findings also suggest that Reiki was nevertheless “effective in reducing the symptoms of depression”, as the authors put it in their conclusions. This statement is misleading!
It is based on the comparison of Reiki with doing nothing. As Reiki involves lots of attention, it can be assumed to generate a sizable placebo effect. As a proportion of the patients in the wait list group are probably disappointed for not getting such attention, they can be assumed to experience the adverse effects of their disappointment. The two phenomena combined can easily explain the result without any “effectiveness” of Reiki per se.
If such considerations are not fully discussed and made amply clear even in the conclusions of the abstract, it seems reasonable to accuse the journal of being less than responsible and the authors of being outright misleading.
As with so many papers in this area, one has to ask: WHERE DOES SLOPPY RESEARCH END AND WHERE DOES SCIENTIFIC MISCONDUCT BEGIN?
A recent comment to a blog-post about alternative treatments for cancer inspired me to ponder a bit. I think it is noteworthy because it exemplifies so many of the comments I hear in the realm of alternative medicine on an almost daily basis. Here is the comment in question:
“Yes…it appears that the medical establishment have known for years that chemotherapy a lot of the time kills patients faster than if they were untreated…what’s more, it worsens a person’s quality of life in which many die directly of the severe effects on the endocrine, immune system and more…cancers often return in more aggressive forms metastasising with an increased risk of apoptosis. In other words it makes things worse whereas there are many natural remedies which not only do no harm but accumulating evidence points to their capacity to fight cancer…some of it is bullshit whilst some holds some truth!! So turning away from toxic treatments that kill towards natural approaches that are showing more hope with the backing of trials kinda reverses the whole argument of this article.”
The comment first annoyed me a bit, of course, but later it made me think and consider the differences between conspiracy theories, assumptions, opinions, evidence and scientific facts. Let’s tackle each of these in turn.
A conspiracy theory is an explanatory or speculative theory suggesting that two or more persons, or an organization, have conspired to cause or cover up, through secret planning and deliberate action, an event or situation typically regarded as illegal or harmful.
Part of the above comment bears some of the hallmarks of a conspiracy theory: “…the medical establishment have known for years that chemotherapy a lot of the time kills patients faster than if they were untreated…” The assumption here is that the conventional healthcare practitioners are evil enough to knowingly do harm to their patients. Such conspiracy theories abound in the realm of alternative medicine; they include the notions that
- BIG PHARMA is out to kill us all in order to maximize their profits,
- the ‘establishment’ is suppressing any information about the benefits of alternative treatments,
- vaccinations are known to be harmful but nevertheless being forced on to our children,
- drug regulators are in the pocket of the pharmaceutical industry,
- doctors accept bribes for prescribing dangerous drugs
- etc. etc.
In a previous blog-post, I have discussed the fact that the current popularity of alternative medicine is at least partly driven by the conviction that there is a sinister plot by ‘the establishment’ that prevents people from benefitting from the wonders of alternative treatments. It is therefore hardly surprising that conspiracy theories like the above are voiced regularly on this blog and elsewhere.
An assumption is something taken for granted or accepted as true without proof.
The above comment continues stating that “…[chemotherapy] makes things worse whereas there are many natural remedies which not only do no harm but accumulating evidence points to their capacity to fight cancer…” There is not proof for these assertions, yet the author takes them for granted. If one were to look for the known facts, one would find the assumptions to be erroneous: chemotherapy has saved countless lives and there simply are no natural remedies that will cure any form of cancer. In the realm of alternative medicine, this seems to worry few, and assumptions of this or similar nature are being made every day. Sadly the plethora of assumptions or bogus claims eventually endanger public health.
The above comment continues with the opinion that “…turning away from toxic treatments that kill towards natural approaches that are showing more hope with the backing of trials kinda reverses the whole argument of this article.” In general, alternative medicine is based on opinions of this sort. On this blog, we have plenty of examples for that in the comments section. This is perhaps understandable; evidence is usually in short supply, and therefore it often is swiftly replaced with often emotionally loaded opinions. It is even fair to say that much of alternative medicine is, in truth, opinion-based healthcare.
One remarkable feature of the above comment is that it is bar of any evidence. In a previous post, I have tried to explain the nature of evidence regarding the efficacy of medical interventions:
The multifactorial nature of any clinical response requires controlling for all the factors that might determine the outcome other than the treatment per se. Ideally, we would need to create a situation or an experiment where two groups of patients are exposed to the full range of factors (e. g. placebo effects, natural history of the condition, regression towards the mean), and the only difference is that one group does receive the treatment, while the other one does not. And this is precisely the model of a controlled clinical trial.
Such studies are designed to minimise all possible sources of bias and confounding. By definition, they have a control group which means that we can, at the end of the treatment period, compare the effects of the treatment in question with those of another intervention, a placebo or no treatment at all.
Many different variations of the controlled trial exist so that the exact design can be adapted to the requirements of the particular treatment and the specific research question at hand. The over-riding principle is, however, always the same: we want to make sure that we can reliably determine whether or not the treatment was the cause of the clinical outcome.
Causality is the key in all of this; and here lies the crucial difference between clinical experience and scientific evidence. What clinician witness in their routine practice can have a myriad of causes; what scientists observe in a well-designed efficacy trial is, in all likelihood, caused by the treatment. The latter is evidence, while the former is not.
Don’t get me wrong; clinical trials are not perfect. They can have many flaws and have rightly been criticised for a myriad of inherent limitations. But it is important to realise that, despite all their short-comings, they are far superior than any other method for determining the efficacy of medical interventions.
There are lots of reasons why a trial can generate an incorrect, i.e. a false positive or a false negative result. We therefore should avoid relying on the findings of a single study. Independent replications are usually required before we can be reasonably sure.
Unfortunately, the findings of these replications do not always confirm the results of the previous study. Whenever we are faced with conflicting results, it is tempting to cherry-pick those studies which seem to confirm our prior belief – tempting but very wrong. In order to arrive at the most reliable conclusion about the efficacy of any treatment, we need to consider the totality of the reliable evidence. This goal is best achieved by conducting a systematic review.
In a systematic review, we assess the quality and quantity of the available evidence, try to synthesise the findings and arrive at an overall verdict about the efficacy of the treatment in question. Technically speaking, this process minimises selection and random biases. Systematic reviews and meta-analyses [these are systematic reviews that pool the data of individual studies] therefore constitute, according to a consensus of most experts, the best available evidence for or against the efficacy of any treatment.
Some facts related to the subject of alternative medicine have already been mentioned:
- chemotherapy prolongs survival of many cancer patients;
- no alternative therapy has achieved anything remotely similar.
The comment above that motivated me to write this somewhat long-winded post is devoid of facts. This is just one more feature that makes it so typical of the comments by proponents of alternative medicine we see with such embarrassing regularity.
My last post was about a researcher who manages to produce nothing but positive findings with the least promising alternative therapy, homeopathy. Some might think that this is an isolated case or an anomaly – but they would be wrong. I have previously published about researchers who have done very similar things with homeopathy or other unlikely therapies. Examples include:
But there are many more, and I will carry on highlighting their remarkable work. For example, the research of a German group headed by Prof Gustav Dobos, one of the most prolific investigator in alternative medicine at present.
For my evaluation, I conducted a Medline search of the last 10 of Dobos’ published articles and excluded those not assessing the effectiveness of alternative therapies such as surveys, comments, etc. Here they are with their respective conclusions and publication dates:
RCTs with different yoga styles do not differ in their odds of reaching positive conclusions. Given that most RCTs were positive, the choice of an individual yoga style can be based on personal preferences and availability.
Despite methodological drawbacks, yoga can be preliminarily considered a safe and effective intervention to reduce body mass index in overweight or obese individuals.
REVIEW OF INTEGRATIVE MEDICINE IN GYNAECOLOGICAL ONCOLOGY (2016)
…there is published, positive level I evidence for a number of CAM treatment forms.
Mindfulness- and acceptance-based interventions can be recommended as an additional treatment for patients with psychosis.
Cabbage leaf wraps are more effective for knee osteoarthritis than usual care, but not compared with diclofenac gel. Therefore, they might be recommended for patients with osteoarthritis of the knee.
This review found strong evidence for A. paniculata and ivy/primrose/thyme-based preparations and moderate evidence for P. sidoides being significantly superior to placebo in alleviating the frequency and severity of patients’ cough symptoms. Additional research, including other herbal treatments, is needed in this area.
Dietary approaches should mainly be tried to reduce macronutrients and enrich functional food components such as vitamins, flavonoids, and unsaturated fatty acids. People with Metabolic Syndrome will benefit most by combining weight loss and anti-inflammatory nutrients.
In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs.
CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.
Study data have shown that therapy- and disease-related side effects can be reduced using the methods of integrative medicine. Reported benefits include improving patients’ wellbeing and quality of life, reducing stress, and improving patients’ mood, sleeping patterns and capacity to cope with disease.
Dobos seems to be an ‘all-rounder’ whose research tackles a wide range of alternative treatments. That is perhaps unremarkable – but what I do find remarkable is the impression that, whatever he researches, the results turn out to be pretty positive. This might imply one of two things, in my view:
- all alternative therapies are effective,
- the ‘Trustworthiness Index’ of Prof Dobos is unusual.
I let my readers chose which possibility they deem to be more likely.