Updated Edition!
It has been reported that the PLASTIC SURGERY INSTITUTE OF ·UTAH, INC.; MICHAEL KIRK MOORE JR.; KARI DEE BURGOYNE; KRISTIN JACKSON ANDERSEN; AND SANDRA FLORES, stand accused of running a scheme out of the Plastic Surgery Institute of Utah, Inc. to defraud the United States and the Centers for Disease Control and Prevention.
Dr. Michael Kirk Moore, Jr. and his co-defendants at the Plastic Surgery Institute of Utah have allegedly given falsified vaccine cards to people in exchange for their donating $50 to an unnamed organization, one which exists to “liberate the medical profession from government and industry conflicts of interest.” As part of the scheme, Moore and his co-defendants are accused of giving children saline injections so that they would believe they were really being vaccinated.
The co-defendants are Kari Dee Burgoyne, an office manager at the Plastic Surgery Institute of Utah; Sandra Flores, the office’s receptionist; and, strangest of all, a woman named Kristin Jackson Andersen, who according to the indictment is Moore’s neighbor. Andersen has posted copious and increasingly conspiratorial anti-vaccine content on Facebook and Instagram; Dr. Moore himself was a signatory on a letter expressing support for a group of COVID-skeptical doctors whose certification was under review by their respective medical boards. The letter expresses support for ivermectin, a bogus treatment for COVID.
According to the indictment, the Plastic Surgery Center of Utah was certified as a real vaccine provider and signed a standard agreement with the CDC, which among other things requires doctor’s offices not to “sell or seek reimbursement” for vaccines.
Prosecutors allege that, when people seeking falsified vaccine cards contacted the office, Burgoyne, the office manager, referred them to Andersen, Dr. Moore’s neighbor. Andersen, according to the indictment, would ask for the name of someone who’d referred them—it had to be someone who’d previously received a fraudulent vaccine card, per the indictment—then direct people to make a $50 donation to a charitable organization, referred to in the indictment only as “Organization 1.” Each vaccine card seeker was required to put an orange emoji in the memo line of their donation.
After making a donation to the unnamed charitable organization, prosecutors allege, Andersen would send a link to vaccine card seekers to enable them to make an appointment at the Plastic Surgery Institute. With adult patients, Moore would allegedly use a real COVID vaccine dose in a syringe, but squirt it down the drain. Flores, the office’s receptionist, gave an undercover agent a note, reading “with 18 & younger, we do a saline shot,” meaning that kids were injected with saline instead of a vaccine. Prosecutors allege the team thus disposed of at least 1,937 doses of COVID vaccines.
All four people are charged with conspiracy to defraud the United States; conspiracy to convert, sell, convey, and dispose of government property; and conversion, sale, conveyance, and disposal of government property and aiding and abetting.
Throughout the scheme, the group reported the names of all the vaccine seekers to the Utah Statewide Immunization Information System, indicating that the practice had administered 1,937 doses of COVID-19 vaccines, which included 391 pediatric doses. The value of all the doses totaled roughly $28,000. With the money from the $50 vaccination cards totaling nearly $97,000, the scheme was valued at nearly $125,000, federal prosecutors calculated.
“By allegedly falsifying vaccine cards and administering saline shots to children instead of COVID-19 vaccines, not only did this provider endanger the health and well-being of a vulnerable population, but also undermined public trust and the integrity of federal health care programs,” Curt Muller, special agent in charge with the Department of Health and Human Services for the Office of the Inspector General, said in a statement.
_________________________________
I am already baffled by anti-vax attitudes when they originate from practitioners of so-called alternative medicine (SCAM). When they come from real physicians and are followed by real actions, I am just speechless. As I stated many times before: studying medicine does unfortunately not protect you from recklessness, greed, or stupidity.
Two years ago, I published a blog about the research activity in SCAM. To demonstrate the volume of SCAM research I looked into Medline to find the number of papers published in 2020 for the SCAMs listed below. Now I repeated the exercise for the year 2022. The respective 1st numbers below are those of 2020, and the second ones refer to 2022 (in bold):
- acupuncture 2 752 – 3,565
- anthroposophic medicine 29 – 28
- aromatherapy 173 – 205
- Ayurvedic medicine 183 – 249
- chiropractic 426 – 498
- dietary supplement 5 739 – 8,915
- essential oil 2 439 – 3,340
- herbal medicine 5 081 – 16,207
- homeopathy 154 – 212
- iridology 0 – 0
- Kampo medicine 132 – 176
- massage 824 – 996
- meditation 780 – 1,016
- mind-body therapies 968 – 1,616
- music therapy 539 – 716
- naturopathy 68 – 92
- osteopathic manipulation 71 – 85
- Pilates 97 – 152
- qigong 97 – 121
- reiki 133 – 158
- tai chi 397 – 470
- Traditional Chinese Medicine 15 277 – 22,586
- yoga 698 – 837
These data suggest the following:
- As before, the research activity in SCAM seems relatively low.
- Most numbers are pretty stable with a slight overall increase.
- The meager numbers for anthroposophic medicine, homeopathy, iridology, Kampo, and naturopathy are remarkable.
- In absolute terms, only acupuncture, dietary supplements, essential oil, herbal medicine, and TCM are impressive; by and large, these are areas where commercial interest and sponsors exist.
- The ‘big winners’ in terms of increase over time are acupuncture, supplements, essential oil, herbal medicine, and TCM; I suspect that much of this is due to the fast-growing (and repeatedly mentioned) influence that China is gaining in SCAM.
Cervical spondylosis (CS) is a general term for wear and tear affecting the spinal disks in the neck. As these disks age, they shrink and signs of osteoarthritis can develop, including bony projections along the edges of bones (bone spurs). CS is very common and worsens with age. About 85% of people over 60 are affected by cervical spondylosis. For most of them, it causes no symptoms. When symptoms do occur, non-surgical treatments often are effective. I think there are not many so-called alternative treatments that are not being promoted as effective for CS – often with the support of some lousy clinical trials. Homeopathy does not seem to be an exception.
This trial attempted evaluating the efficacy of individualized homeopathic medicines (IHMs) against placebos in the treatment of CS.
A 3-month, double-blind, randomized, placebo-controlled trial was conducted at the Organon of Medicine outpatient department of the National Institute of Homoeopathy, India. Patients were randomized to receive either IHMs (n = 70) or identical-looking placebos (n = 70) in the mutual context of concomitant conservative and standard physiotherapeutic care. Primary outcome measures were 0-10 Numeric Rating Scales (NRSs) for pain, stiffness, numbness, tingling, weakness, and vertigo, and the secondary outcome was the Neck Disability Index (NDI), measured at baseline and every month until 3 months. The intention-to-treat sample was analyzed to detect group differences and effect sizes.
Overall, improvements were clinically significant and higher in the IHM group than in the placebo group, but group differences were statistically nonsignificant with small effect sizes (all p > 0.05, two-way repeated measure analysis of variance). After 2 months of time points, improvements observed in the IHM group were significantly higher than placebo on a few occasions (e.g., pain NRS: p < 0.001; stiffness NRS: p = 0.024; weakness NRS: p = 0.003). Sulfur (n = 21; 15%) was the most frequently prescribed medication. No harm, unintended effects, or any serious adverse events were reported from either group.
The authors concluded that an encouraging but nonsignificant direction of effect was elicited favoring IHMs against placebos in the treatment of CS.
I agree that it is encouraging that Indian homeopaths have recently dared to publish also negative findings! However, I do not agree that the findings are encouraging in the sense that they indicate anything other than that homeopathy is a placebo therapy.
Unfortunately, I cannot access the full article without paying for it. Thus I am unable to provide detailed criticism of this study – sorry.
Cervical radiculopathy is a common condition that is usually due to compression or injury to a nerve root by a herniated disc or other degenerative changes of the upper spine. The C5 to T1 levels are the most commonly affected. In such cases local and radiating pains, often with neurological deficits, are the most prominent symptoms. Treatment of this condition is often difficult.
The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR).
MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO were searched from inception to June 15, 2022, to identify studies that were randomized clinical trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach.
Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. The results show very-low certainty evidence supporting the use of
- acupuncture,
- prednisolone,
- cervical manipulation,
- low-level laser therapy
for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term.
There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty.
The authors concluded that there is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.
The fact that we cannot offer a truly effective therapy for CR has long been known – except, of course, to chiropractors, acupuncturists, osteopaths, and other SCAM providers who offer their services as though they are a sure solution. Sometimes, their treatments seem to work; but this could be just because the symptoms of CR can improve spontaneously, unrelated to any intervention.
The question thus arises what should these often badly suffering patients do if spontaneous remission does not occur? As an answer, let me quote from another recent systematic review of the subject: The 6 included studies that had low risk of bias, providing high-quality evidence for the surgical efficacy of Cervical Spondylotic Radiculopathy. The evidence indicates that surgical treatment is better than conservative treatment … and superior to conservative treatment in less than one year.
‘Bio’ – from biology
‘kin’ – from kinetics
‘ergy’ – not from energy as in physics but vital force as in chi and TCM
Together, these three terms give BIOKINERGY
Biokinergy is hardly well-known in most countries. Yet, in France, it’s all the rage. It is a manual therapy that allegedly restores the mobility of the patient’s body and increases the elasticity of its tissues while supporting the circulatory and nervous systems as well as our biological and psycho-emotional balance. It is said to incorporate concepts from osteopathy, fascia techniques, and Traditional Chinese Medicine.
Am I the only one who finds this more than a bit vague and full of platitudes?
So, what is biokinergy really?
Apparently, it is based on 4 main principles:
- Biomechanics
Biokinergy takes into account the release of blockages and the rebalancing of the mobility of the different structures and tissue layers (bones, viscera, muscles, subcutaneous tissues, skin), through innovative neuro-informational processes
2. Fasciatherapy
Richly innervated, the fascias envelop, partition, and connect all our structures without discontinuity from head to toe and, as Dr. Guimberteau’s work has shown, from the skin to the depths of the bone. Their tensions are at the origin of pain, visceral dysfunctions, and disturbances of vascular and nervous exchanges which alter the functional balance of the organism. The fascia techniques developed at CERB aim, through specific treatment of the different strata of fascia, to cure all these disturbances
3. Energetics
The energetic action aims to regulate the metabolic and biochemical activity and the exchange of information that is constantly taking place between the different tissues of the body by circulatory, nervous, and electromagnetic means and by means of the meridians of Traditional Chinese Medicine.
4.Psychosomatic
As a place of affects, representations, emotions, and a tool for relationships, the body expresses our emotional damage through its tissue tensions and dysfunctions. By using the body as a mediation, Biokinergie develops a psycho-corporal approach with a therapeutic, prophylactic, and preventive aim. By going back to the origin of the stress, inscribed in the tissues, it allows patients to free themselves from their conscious and unconscious blockages in order to find a physical, emotional, and mental balance.
Biokinergy was developed by Michel LIDOREAU, a physiotherapist and osteopath, who studied shiatsu and Chinese massage. At the beginning of the 1980s, he claims to have discovered specific tissue tensions in our body, associated with both joint blockages and energetic imbalances. This led to the invention of biokinergy.
Personally, I am still puzzled and unclear about what all this is supposed to mean. Perhaps we get a bit further if we ask what the therapy is used for.
The aim of biokinergy, I learn from this seemingly competent source, is not to treat only the symptoms but to takle their causes. The body is a whole, and its imbalances can be expressed symptomatologically very far from their origin. It is important to understand that pathology is not a coincidence, but results from the accumulation of a multitude of imbalances that must be treated together if we want to be effective quickly and in the long term.
The body has an amazing memory capacity. It keeps track of all our traumas (falls, repetitive gestures, false movements, emotional shocks, fatigue, stress) in the form of tensions, blockages, and energetic [biological, metabolic] imbalances. Initially, the body compensates and adapts, but gradually these disorders add up. They then end up hampering the functioning of the joints, disturbing the activity of the organs and compressing the blood vessels and nerves. The conduction of blood and nerve impulses is no longer done correctly, which favors the installation of biological disorders, the inflammation of tissues, and the appearance of pain (tendonitis, arthritis, gastritis, colitis, etc.). This can gradually lead to tissue degeneration.
The aim of a Biokinergy treatment is therefore to restore the body’s optimal functioning by restoring the function of all systems (locomotor, visceral, vascular, nervous, hormonal, etc.); this is done by releasing areas of tension and blockages, to restore flexibility to the tissues and free up, among others, the vascular and nervous axes.
Blast! I am getting more and more lost here. This just does not make much sense. Perhaps it is best to ask what actually happens during a therapy session. Again, the seemingly competent source offers some information:
A Biokinergy session lasts about 1 hour. After a precise interrogation, it consists in “reading” the body to find the tissue windings in order to reharmonize them. Bearing in mind that the human organism forms a whole, the biokinergist applies, from coil to coil, the corrections adapted to the disorders encountered. The techniques are gentle.
Well, this isn’t all that clear either.
Let’s take another approach: is there any evidence that biokinergy works? My Medline search gives a very clear answer: “Your search for biokinergy retrieved no results.”
So, now we know!
Biokinergy serves only one proven purpose: it improves the bank balance of the therapist.
I have been informed by the publisher, that my book has been published yesterday. This is about two months earlier than it was announced on Amazon. It is in German – yes, I have started writing in German again. But not to worry, I translated the preface for you:
Anyone who falls ill in Germany and therefore needs professional assistance has the choice, either to consult a doctor or a non-medical practitioner (Heilpraktiker).
– The doctor has studied and is licensed to practice medicine; the Heilpraktiker is state-recognized and has passed an official medical examination.
– The doctor is usually in a hurry, while the Heilpraktiker takes his time and empathizes with his patient.
– The doctor usually prescribes a drug burdened with side effects, while the Heilpraktiker prefers the gentle methods of alternative medicine.
So who should the sick person turn to? Heilpraktiker or doctor? Many people are confused by the existence of these parallel medical worlds. Quite a few finally decide in favor of the supposedly natural, empathetic, time-tested medicine of the Heilpraktiker. The state recognition gives them the necessary confidence to be in good hands there. The far-reaching freedoms the Heilpraktiker has by law, as well as the coverage of costs by many health insurances, are conducive to further strengthening this trust. “We Heilpraktiker are recognized and respected in politics and society,” writes Elvira Bierbach self-confidently, the publisher of a standard textbook for Heilpraktiker.
The first consultation of our model patient with the Heilpraktiker of his choice is promising. The Heilpraktiker responds to the patient with understanding, usually takes a whole hour for the initial consultation, gives explanations that seem plausible, is determined to get to the root of the problem, promises to stimulate the patient’s self-healing powers naturally, and invokes a colossal body of experience. It almost seems as if our patient’s decision to consult a Heilpraktiker was correct.
However, I have quite significant reservations about this. Heilpraktiker are perhaps recognized in politics and society, but from a medical, scientific, or ethical perspective, they are highly problematic. In this book, I will show in detail and with facts why.
The claim of government recognition undoubtedly gives the appearance that Heilpraktiker are adequately trained and medically competent. In reality, there is no regulated training, and the competence is not high. The official medical examination, which all Heilpraktiker must pass is nothing more than a test to ensure that there is no danger to the general public. The ideas of many Heilpraktiker regarding the function of the human body are often in stark contradiction with the known facts. The majority of Heilpraktiker-typical diagnostics is pure nonsense. The conditions that they diagnose are often based on little more than naive wishful thinking. The treatments that Heilpraktiker use are either disproven or not proven to be effective.
There is no question in my mind that Heilpraktiker are a danger to anyone who is seriously ill. And even if Heilpraktiker do not cause obvious harm, they almost never offer what is optimally possible. In my opinion, patients have the right to receive the most effective treatment for their condition. Consumers should not be misled about health-related issues. Only those who are well-informed will make the right decisions about their health.
My book provides this information in plain language and without mincing words. It is intended to save you from a dangerous misconception of the Heilpraktiker profession. Medical parallel worlds with the radically divergent quality standard – doctor/Heilpraktiker – are not in the interest of the patient and are simply unacceptable for an enlightened society.
When I was still at Exeter, I used to do an average of about 4 peer reviews per week of articles that had been submitted to all sorts of journals for publication. Now I reject most of these invitations and do perhaps just one per month.
Why?
Conducting a peer review is by no means an easy task. You have to realize that the authors have usually put a lot of hard work into their paper and a lot may depend on it in terms of their future. They thus have the right to receive a fair and responsible review. To do the job properly, it took me (even with plenty of experience in reading scientific papers) between 1 and 3 hours per article. Crucially, low-quality articles typically submitted to low-quality journals are more work than papers that adhere to a certain standard.
I do not think that the journal editors who send the submissions out for review appreciate how much work they ask from the reviewers. They normally pay nothing (even if they charge exorbitant handling fees from the authors) and offer you no benefit at all. In addition, many have systems that are more than tedious asking you to register, create a pin number, etc., etc. Then you have to follow certain rules and formats that differ from journal to journal. In a word, they add an administrative burden to the task of reading, understanding, checking a paper, and composing your judgment on it.
All this can be cumbersome but it’s not the reason why I do less and less peer reviews. The true reason is that research papers on so-called alternative medicine (SCAM) are now mostly published in one of the many 3rd class SCAM journals that have recently sprung up. There are so many of them that they, of course, struggle to get enough articles to fill their pages. In turn, this means that they are far too keen to publish anything regardless of its quality or validity. As a consequence, the quality of these articles and their authors are often dismal.
Here is an example of a (rather shocking but not unusual) email I received only today; it might show you what I mean:
Dear Professor!
…
I want to publish some papers in “Areas related to your research field”. Can you help me? I can provide a thank you fee!
For example, I will give you a $2000 thank you fee for helping me write articles. For example, if you add my name to your article, I will give you a $1000 thank you fee. Or I can help you pay for APC.
I know this email is presumptuous, but my friends and I need to publish dozens of papers every year. If you can help me, we can cooperate for a long time. I’m not kidding, I’m very sincere!
If you are offended, please forgive me!
Look forward to your reply!
Warmly Wishes, …
When I do a review for a low-quality SCAM journal and find major defects in an article, my experience has been that the editor then decides to publish it nonetheless. When this happens, I feel frustrated and ask myself: WHY DID THEY ASK FOR MY OPINION IF THEY DO NOT ABIDE BY IT?
Thus I decided that these journals are just as well off without my contributions. So, if you are an editor of a SCAM journal, do me a favor and do not molest me with your invitations to conduct a peer review and
COUNT ME OUT!
Menopausal symptoms are a domaine of so-called alternative medicine (SCAM), not least because many women are worried about hormone treatments and therefore want ‘something natural’. TCM practitioners are only too keen to offer their services. But do their treatments really work?
This study aimed to analyze the effectiveness of acupuncture combined with Chinese herbal medicine (CHM) on mood disorder symptoms for menopausal women.
A total of 95 qualified Chinese participants were randomly assigned to one of three groups:
- 31 in the acupuncture combined with CHM group (combined group),
- 32 in the acupuncture combined with CHM placebo group (acupuncture group),
- 32 in the CHM combined with sham acupuncture group (CHM group).
The patients were treated for 8 weeks and followed up for 4 weeks. The data were collected using the Greene Climacteric Scale (GCS), self-rating depression scale (SDS), self-rating anxiety scale (SAS), and safety index.
The three groups each showed significant decreases in the GCS, SDS, and SAS after treatment (p < 0.05). Furthermore, the effect on the GCS total score and the anxiety domain lasted until the follow-up period in the combined group (p < 0.05). Within the three groups, there was no difference in GCS and SAS between the three groups after treatment (p > 0.05). However, the combined group showed significant improvement in the SDS, compared with both the acupuncture group and the CHM group at 8 weeks and 12 weeks (p < 0.05). No obvious abnormal cases were found in any of the safety indexes.
The authors concluded that the results suggest that either acupuncture, or CHM or combined therapy offer safe improvement of mood disorder symptoms for menopausal women. However, the combination therapy was associated with more stable effects in the follow-up period and a superior effect on improving depression symptoms.
Previous reviews have drawn conclusions that are far less positive, e.g.:
- the observed clinical benefit associated with acupuncture may be due, in part, or in whole to nonspecific effects.
- the evidence gathered was not sufficient to affirm the effectiveness of traditional acupuncture compared with sham acupuncture.
- For natural menopause, one large study has shown acupuncture to be superior to self-care alone in reducing the number of hot flushes and improving the quality of life; five small studies have been unable to demonstrate that the effect of acupuncture is limited to any particular points, as traditional theory would suggest; and one study showed acupuncture was superior to blunt needle for flash frequency but not intensity.
- Sham-controlled RCTs fail to show specific effects of acupuncture for control of menopausal hot flushes.
It seems therefore wise to take the conclusions of the new study with a pinch of salt. The intergroup difference observed in this trial may well be due to residual biases, multiple testing, or coincidence. And the reported intragroup differences are in complete accord with the fact that the employed therapies are mere placebos.
This, of course, begs the question of whether SCAM has anything else to offer for women suffering from menopausal symptoms. To answer it, I can refer you to one of our systematic reviews:
Some evidence exists in favour of phytosterols and phytostanols for diminishing LDL and total cholesterol in postmenopausal women. Similarly, regular fiber intake is effective in reducing serum total cholesterol in hypercholesterolemic postmenopausal women. Clinical evidence also exists on the effectiveness of vitamin K, a combination of calcium and vitamin D or a combination of walking with other weight-bearing exercise in reducing bone mineral density loss and the incidence of fractures in postmenopausal women. Black cohosh appears to be effective therapy for relieving menopausal symptoms, primarily hot flashes, in early menopause. Phytoestrogen extracts, including isoflavones and lignans, appear to have only minimal effect on hot flashes but have other positive health effects, e.g. on plasma lipid levels and bone loss. For other commonly used CAMs, e.g. probiotics, prebiotics, acupuncture, homeopathy and DHEA-S, randomized, placebo-controlled trials are scarce and the evidence is unconvincing. More and better RCTs testing the effectiveness of these treatments are needed.
Hemiparesis is a severe impairment following a stroke that affects the majority of stroke patients. Rehabilitation is usually at least partly successful. But might results be improved with homeopathy?
This trial tested the efficacy of individualized homeopathic medicines (IHMs) in comparison with identical-looking placebos in the treatment of post-stroke hemiparesis (PSH) in the mutual context of standard physiotherapy (SP).
A 3-months, open-label, randomized, placebo-controlled trial (n = 60) was conducted at the Organon of Medicine outpatient departments of the ‘National Institute of Homoeopathy’, West Bengal, India. Patients were randomized to receive IHMs plus SP (n = 30) or identical-looking placebos plus SP (n = 30). The primary outcome measure was Medical Research Council (MRC) muscle strength grading scale; secondary outcomes were Stroke Impact Scale (SIS) version 2.0, Modified Ashworth Scale (MAS), and stroke recovery 0-100 visual analog scale (VAS) scores; all measured at baseline and 3 months after the intervention. Group differences and effect sizes (Cohen’s d) were calculated on the intention-to-treat sample.
Although overall improvements were higher in the IHMs group than in the placebo group with small to medium effect sizes, the group differences were statistically non-significant (all P>0.05, unpaired t-tests). Improvement in SIS physical problems was significantly higher with IHM than with placebo (mean difference 2.0, 95% confidence interval 0.3 to 3.8, P = 0.025, unpaired t-test). Causticum, Lachesis mutus, and Nux vomica were the most frequently prescribed medicines. No harms, unintended effects, homeopathic aggravations, or any serious adverse events were reported from either group.
The authors concluded that there was a small, but non-significant direction of effect favoring homeopathy against placebos in treatment of post-stroke hemiparesis.
Considering the fact that homeopathy has become the holy cow of India which led to the phenomenon that almost no negative homeopathy trials are being reported by Indian researchers, this article is a happy surprise. Its authors clearly report that IHM had no effect on the primary outcome measure.
Bravo!
But who had the bizarre idea that it might?
I have heard many outlandish claims by homeopaths but the one about PSH was a new one to me.
Equally puzzling is, in my view, the design of this study: it was an “open-label, randomized, placebo-controlled trial”. The reason for having a placebo group is to blind the patients, i.e. not let them know whether they receive the verum or the placebo. In an open-label trial, however, the patient is given exactly that information. I totally fail to understand the logic of this. Can someone enlighten me, please?
I had come across them so often that I had almost stopped noticing them: the ‘little extras‘ that make ineffective so-called alternative medicines (SCAMs) seem effective. Then, recently, during an interview about detox diets, the interviewer responded to my explanation of the ineffectiveness of these treatments by saying: “but these diets include stopping the consumption of alcohol, cigarettes, and other harmful stuff; therefore they must be good.” This seemingly convincing argument reminded me of a phenomenon – I call it here the ‘little extra‘ – that applies to so many (if not most) SCAMs.
Let me schematically summarise it as follows:
- A practitioner applies an ineffective SCAM to a patient.
- Because it is ineffective, it has little effect other than a small placebo response.
- The ineffective SCAM comes with a ‘little extra‘ which is unrelated to the SCAM.
- The ‘little extra‘ is effective.
- The end result is that the ineffective SCAM appears to be effective.
The above example makes it quite clear: the detox diet is utter nonsense but, as it goes hand in hand with effective lifestyle changes, it appears to be effective. A classic case. But SCAM offers no end of similar examples:
- Acupuncture is useless but it involves touch, time, attention, and empathy all of which are effective in making a patient feel better.
- Chiropractic is useless but it involves touch, time, attention, and empathy all of which are effective in making a patient feel better.
- Homeopathy is useless but it involves a long, empathic consultation and attention which are effective in making a patient feel better.
- Osteopathy is useless but it involves touch, time, attention, and empathy all of which are effective in making a patient feel better.
- Reflexology is useless but it involves touch, time, attention, and empathy all of which are effective in making a patient feel better.
Do I need to continue?
Probably not!
The ‘little extras‘ are often forgotten or subsumed under the heading ‘placebo’. Yet, they are not part of the placebo effect. Strictly speaking, they are concomitant treatments comparable to a pain patient using SCAM and also taking a few paracetamols. In the end, she forgets about the painkillers and thinks that her SCAM worked wonders.
Even ardent SCAM proponents have long realized this phenomenon. Here, for example, is a paper entitled ‘Acupuncture as a complex intervention: a holistic model’ by ex-colleagues of mine at Exeter looking at it but coming up with a very different perspective:
Objectives: Our understanding of acupuncture and Chinese medicine is limited by a lack of inquiry into the dynamics of the process. We used a longitudinal research design to investigate how the experience, and the effects, of a course of acupuncture evolved over time.
Design and outcome measures: This was a longitudinal qualitative study, using a constant comparative method, informed by grounded theory. Each person was interviewed three times over 6 months. Semistructured interviews explored people’s experiences of illness and treatment. Across-case and within-case analysis resulted in themes and individual vignettes.
Subjects and settings: Eight (8) professional acupuncturists in seven different settings informed their patients about the study. We interviewed a consecutive sample of 23 people with chronic illness, who were having acupuncture for the first time.
Results: People described their experience of acupuncture in terms of the acupuncturist’s diagnostic and needling skills; the therapeutic relationship; and a new understanding of the body and self as a whole being. All three of these components were imbued with holistic ideology. Treatment effects were perceived as changes in symptoms, changes in energy, and changes in personal and social identity. The vignettes showed the complexity and the individuality of the experience of acupuncture treatment. The process and outcome components were distinct but not divisible, because they were linked by complex connections. The paper depicts these results as a diagrammatic model that illustrates the components and their interconnections and the cyclical reinforcement, both positive and negative, that can occur over time.
Conclusions: The holistic model of acupuncture treatment, in which “the whole being greater than the sum of the parts,” has implications for service provision and for research trial design. Research trials that evaluate the needling technique, isolated from other aspects of process, will interfere with treatment outcomes. The model requires testing in different service and research settings.
I think the perspective of viewing SCAMs as complex interventions is needlessly confusing and deeply unhelpful. The truth is that there is no treatment that is not complex. Take a surgical treatment, for instance, it involves dozens of ‘little extras‘ that are known to be effective. Should we, therefore, try to use this fact for justifying useless surgical interventions? Or take a simple prescription of medication from a doctor. It involves time, empathy, attention, explanations, etc. all of which will affect the patient’s symptoms. Should we thus use this to justify a useless drug? Certainly not!
And for the same reason, it is nonsense to use the ‘little extras‘ that come with all the numerous ineffective SCAMs as a smokescreen that makes them look effective.
