Systematic reviews are aimed at summarising and critically evaluating the evidence on a specific research question. They are the highest level of evidence and are more reliable than anything else we have. Therefore, they represent a most useful tool for both clinicians and researchers.
But there are, of course, exceptions. Take, for instance, this recent systematic review by researchers from the
- Texas Chiropractic College, Pasadena, the Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport,
- Department of Planning, Policy and Design, University of California, Irvine,
- VA Puget Sound Health Care System, Tacoma,
- New York Chiropractic College, Seneca Falls,
- Logan University College of Chiropractic, Chesterfield,
- University of Western States, Portland.
After almost a life-time of exposure to seriously compact BS about alternative medicine, you would expect me to be used to it. And it’s true, I usually don’t bat an eyelash when someone writes nonsense about this or that therapy. But every once in a while, I come across an exception, some statement that is outstanding in its ‘naiveness’ (see below) or ground-breaking in its stupidity. When I found this article, for instance, I almost fell off my chair. So, please hold on tight, if you want to read on:
START OF QUOTE
Dr Edward Bach was a qualified allopathic physician. Later he got his degree in homoeopathy. He discovered 38 Bach flower remedies. Bach remedies are prescribed on basis of mental state of the patient it does not mean that this treatment is confined to the mental cases only. It simply means that the patient is cured physically and mentally by the remedy which is prescribed on the basis of mental symptoms only. ADHD is the disorder which shows the spectrum of signs & symptoms in both mental and physical plane hence Bach flower remedies are helpful in treating this condition.
This is the remedy prepared by boiling the young twigs with shoots. This remedy has a lack of sufficient interest in present circumstances. Chestnut Bud relates to a state of a flighty mind, inattention, and a soul not yet grounded in maturity. Learning experiences of either a factual or moral kind are not integrated into the consciousness to the person’s full benefit. Chestnut bud child is restless and impulsive. The child lacks the power of concentration because of mental hurriedness or precipitation of thoughts. Chestnut child exhibits childish and foolish behaviour which we can relate to the remedies like Bufo, Baryta carb etc. These children are reckless, careless, they lack the power of reasoning. Chestnut bud has general weakness of memory, failure to retain learned material, this being either of factual or moral content. Chestnut bud also has naiveness, immaturity of mind/emotions, developmental delay. Children’s are hyperactive and impulsive they may show impulsive movements; lack of serenity and focused gaze. Chestnut bud is also helpful in kids who have symptoms like disobedience, commit anti-social acts, sins, crimes, again and again, factitious disorders and malingering.
Chestnut Bud has general weakness of memory, failure to retain learned material, this being either of factual or moral content. Chestnut Bud also has naiveness, the immaturity of mind/emotions, developmental delay. Children’s are hyperactive and impulsive they may show impulsive movements; lack of serenity and focused gaze. Chestnut bud is also helpful in kids who have symptoms like disobedience, commit anti-social acts, sins, crimes, again and again, factitious disorders and malingering.
Chestnut Bud helps to improve concentration power and moral growth in ADHD patients which are suffering from other behavioural disorders. It improves the power of reasoning. Many other Bach flower remedies depending upon the mental state of the child can be prescribed.
END OF QUOTE
This is a true treasure trove of fallacious reasoning!
My favourite is the opening argument: “Bach remedies are prescribed on basis of mental state of the patient… [which] means that the patient is cured physically and mentally by the remedy…”
My runner-up is this statement: “ADHD is the disorder which shows the spectrum of signs & symptoms in both mental and physical plane hence Bach flower remedies are helpful in treating this condition.”
What sharp logic!
What tightly argued thought!
I think this is brilliant and totally convincing (provided you suffer from terminal stupidity).
I was surprised to receive this email yesterday: “Hello Edzard Ernst, You may remember I got in touch last week regarding losing a loved one to the ravages of drugs or alcohol. I just wanted to remind you that Narconon is here to help. For over fifty years Narconon drug and alcohol rehabilitation centres have been successfully reversing the tide of addiction for men and woman from all walks of life. The Narconon programme has saved them from the misery of addiction, and the potential of an early grave. We not only address the cause of the addiction, we resolve them…”
The email was signed by a man from ‘Narconon International’. First I thought someone has been counting the empty bottles in my bin, then I read it again and noticed the word ‘NARCONON’ and remembered that I once wrote about it. A quick search located my article from THE GUARDIAN 2012:
Imagine a therapy that “enables an individual to rid himself of the harmful effects of drugs, toxins and other chemicals that lodge in the body and create a biochemical barrier to spiritual well-being“. If you were told that the treatment was entirely natural and had already “enabled hundreds of thousands to free themselves from the harmful effects of drugs and toxins and so achieve spiritual gains”, wouldn’t you be tempted to try it?
Who doesn’t want a body free of nasty chemicals? And who wouldn’t be delighted at the chance to counter a growing threat to an “advancement in mental … wellbeing”?
These claims are being made for the “Purification Rundown” (“Purif” for short) and the closely related Narconon detox programmes, which mainly consist of regular exercise, sauna and nutrition, with industrial doses of vitamins and minerals added for good measure. Some of the claims are quite specific: the Purif programme is supposed to increase your IQ, reduce the level of cancer-causing agents in your body, and even enable you to lose weight easily and quickly. The Narconon programme is more specifically targeted at drug and alcohol dependency and is claimed to have an impressive success rate of 75%.
Both programmes were developed by L Ron Hubbard (1911-1986) and are currently marketed by the Church of Scientology. The CoS is not generally known to be an organisation that promotes healthcare programmes. Hubbard, the pulp-fiction writer who founded the CoS, portrayed himself somewhat over-optimistically as a pioneer, innovator and nuclear physicist.
He taught his followers that, at their core, humans contain a “thetan”. After creating the universe, thetans accidentally became trapped in physical bodies and, through scientology, we can restore the immortal, omnipotent, god-like powers of the “thetan” within us. Weird stuff that is the preserve of Hollywood eccentrics, you might think, but perhaps the CoS’s detox-ventures are an attempt to conquer new territory?
A typical course of treatment lasts several weeks and consists of many hours of exercise and sauna every day. This regimen is supplemented with megadoses of vitamins and minerals, which can cause problems. Niacin, one vitamin that is given in high doses as part of the regimen, can be particularly dangerous. The US National Institutes of Health warns that at high doses it can cause “liver problems, gout, ulcers of the digestive tract, loss of vision, high blood sugar, irregular heartbeat, and other serious problems.” It should not be taken by people who already have liver damage.
Seven fatalities of people undergoing the Narconon programme are currently being investigated in Oklahoma, although the CoS says these deaths are not connected with the treatment regimen itself.
Whatever the truth regarding these deaths, a review of the evidence about the treatment regimen’s effectiveness – carried out by the Norwegian Knowledge Centre for the Health Services in 2008 – found no good evidence that the Narconon programme works:
There is currently no reliable evidence for the effectiveness of Narconon as a primary or secondary drug prevention program. This is partly due to the insufficient research evidence about Narconon and partly due to the non-experimental nature of the few studies that exist.
The claim that such detox treatments eliminate toxins from the body is, of course, easily testable. All we would need to do is define what toxin we are talking about and measure the change in levels of that toxin compared with a control group of volunteers who did not receive the detox.
But such studies are not available. Why? Do the marketing men believe in their own claims? Maybe they feel that profits and evidence are like fire and water? Or possibly the thetans have an aversion to science?
If you think that the Purif, Narconon or any other form of alternative detox eliminates toxins, you might be mistaken. Most clients have lost some money, many have lost their ability to think straight, some may even have lost their lives. But there is no reliable evidence that they have actually lost any toxins.
END OF MY 2012 ARTICLE
In 2012, I found no evidence to suggest that NARCONON works. Now, I looked again and found this article reporting a non-randomised, controlled study:
“In 2004, Narconon International developed a multi-module, universal prevention curriculum for high school ages based on drug abuse etiology, program quality management data, prevention theory and best practices. We review the curriculum and its rationale and test its ability to change drug use behavior, perceptions of risk/benefits, and general knowledge. After informed parental consent, approximately 1000 Oklahoma and Hawai’i high school students completed a modified Center for Substance Abuse Prevention (CSAP) Participant Outcome Measures for Discretionary Programs survey at three testing points: baseline, one month later, and six month follow-up. Schools assigned to experimental conditions scheduled the Narconon curriculum between the baseline and one-month follow-up test; schools in control conditions received drug education after the six-month follow-up. Student responses were analyzed controlling for baseline differences using analysis of covariance. At six month follow-up, youths who received the Narconon drug education curriculum showed reduced drug use compared with controls across all drug categories tested. The strongest effects were seen in all tobacco products and cigarette frequency followed by marijuana. There were also significant reductions measured for alcohol and amphetamines. The program also produced changes in knowledge, attitudes and perception of risk. The eight-module Narconon curriculum has thorough grounding in substance abuse etiology and prevention theory. Incorporating several historically successful prevention strategies this curriculum reduced drug use among youths.”
The question arises: would I send anyone to the NARCONON programme?
My answer is NO!
Not because the trial is lousy (which it is) and not because the programme is too expensive (which it is); I would not send anyone to any institution that has even the slightest links to Scientology.
The claim that Cannabis can cure cancer is all over the Internet. Such promotion is regularly enhanced by announcements of VIPs that they intend to try Cannabis when affected by cancer.
As her back pain turned out to be caused by metastases from her earlier breast cancer, Olivia Newton-John now intends to complete a course of photon radiation therapy along with alternative therapies for improving her quality of life. “I decided on my direction of therapies after consultation with my doctors and natural therapists and the medical team at my Olivia Newton-John Cancer Wellness and Research Centre in Melbourne”, she said. Newton-John had been diagnosed with breast cancer in 1992. At that time, she initially tried acupuncture and homeopathy and only later underwent chemotherapy. Olivia Newton-John’s daughter, Chloe Lattanzi, has stated that her mother would now use cannabis oil to aid in her fight against cancer. Lattanzi owns a marijuana farm and said that her mother would use natural healing remedies plus modern medicine in addition to cannabis oil to help her battle the deadly disease for the second time.
So, how realistic is the assumption that Cannabis does anything for cancer patients? Cannabis produces a resin containing pharmacologically active compounds called cannabinoids. Some cannabinoids are known for their psychoactive properties. Cannabis has therefore been used for medicinal and recreational purposed since ancient times. Today, the recreational use of Cannabis is illegal in many states, including the UK.
The main active cannabinoids are delta-9-THC and cannabidiol (CBD); the latter compound may relieve pain, lower inflammation, and decrease anxiety without causing the “high” of delta-9-THC. Cannabis and cannabinoids have been studied in the laboratory and the clinic for relief of pain, nausea and vomiting, anxiety, and loss of appetite. There also is some evidence that they can alleviate the side-effects of cancer therapies. Two cannabinoids have even been approved by the regulators in some countries for the prevention and treatment of chemotherapy-related nausea and vomiting. Some test tube results have suggested that Cannabis can kill cancer cells. However, there are no clinical trials yet, and therefore not enough evidence exists to recommend that patients use Cannabis as a treatment for cancer.
The possibility that Cannabis might be useful for cancer patients currently attracts much original research. The most recent review states that “favorable outcomes are demonstrated for chemotherapy-induced nausea and vomiting and cancer-related pain, with evidence of advantageous neurological interactions. Benefit in the treatment of anorexia, insomnia and anxiety is also suggested. Short- and long-term side effects appear to be manageable and to subside after discontinuation of the drug. Finally, cannabinoids have shown anti-neoplastic effects in preclinical studies in a wide range of cancer cells and some animal models. Further research is needed before cannabis can become a part of evidence-based oncology practice.”
Similarly, the conclusions by our ‘CAMcancer’ initiative were cautious: ” The antiemetic efficacy of the cannabinoid dronabinol (THC), when compared to standard antiemetics that were in use before the development of 5-HT3 antagonists for chemotherapy-induced nausea and vomiting, has been established in a meta-analysis. The question of whether cannabis-based medicines have a place in the era of modern antiemetic medication, e.g. for patients with refractory nausea and vomiting despite antiemetic prophylaxis according to current standards, remains uncertain but warrants further research. Limited evidence is available to support the use of cannabis-based medicines in the therapy of radiotherapy-related nausea and multifactorial nausea in advanced cancer patients. The use of cannabis-based medicines for appetite loss and other symptoms associated with cancer cachexia is still unclear at present, since trial results have not only varied widely but also been criticised for the methodology employed (including diversity in stages of cachexia in the patients included and possibly too a low dose of THC/medical cannabis). For cancer pain, several randomised controlled trials of cannabis-based medicines in cancer patients with various pain syndromes have indicated an analgesic effect comparable to weak opioids. The role of cannabinoid medicines as add-on medication for pain that is insufficiently relieved by strong opioids is currently being investigated in several clinical studies and has shown some promising results so far.”
So, the evidence suggests that Cannabis might be helpful in the supportive and palliative treatment of cancer by reducing some of the symptoms from which cancer patients may suffer. But there is no good evidence to show that it can change the natural history of any type of cancer. Even with the symptomatic use of Cannabis, we need to consider at least two caveats.
Firstly, we have no good evidence to suggest that Cannabis is significantly more effective than conventional therapies. A Cochrane review, for instance concluded that ” Cannabinoids can lead to an increase in appetite in patients with HIV wasting syndrome but the therapy with megestrol acetate is superior to treatment with cannabinoids. The included studies were not of sufficient duration to answer questions concerning the long-term efficacy, tolerability and safety of therapy with cannabis or cannabinoids. Due to the sparse amount of data it is not possible to recommend a favoured use of cannabis or cannabinoids at this point.”
Secondly, the Cannabis trials tend to be of low quality. Another Cochrane review concluded that “Cannabis-based medications may be useful for treating refractory chemotherapy-induced nausea and vomiting. However, methodological limitations of the trials limit our conclusions and further research reflecting current chemotherapy regimens and newer anti-emetic drugs is likely to modify these conclusions.”
Back to Olivia Newton-John; her case is, I think, telling. It seems that, by initially using alternative therapies instead of conventional treatments for her breast cancer in 1992, she worsened her prognosis. Now that the cancer has returned, she has learnt her lesson and opts for the best conventional oncology can offer her. Yet, her liking for alternative medicine has not disappeared completely. This confirms what I have observed all too frequently: for many of its fans, alternative medicine is a belief system that is largely untouchable by evidence.
Dr Gabriella Day is a GP in England who describes herself and her beliefs as follows: “I began training in homeopathy as it is clear that for many conditions conventional treatment options are not effective and can have unwanted side effects. It seemed to me that there must be another way to help people suffering from symptoms such as these… I believe in whole person medicine. No illness exists in isolation. The human body is immensely sophisticated and complicated and we do not understand it fully. Therefore the illness cannot be separated from the person suffering the disease. This may be as simple as stress impairing the immune system to far more complex interactions. Homeopathic treatment seeks to match the underlying disturbance in the system and stimulate the body to correct itself.”
I do not know Dr Day, but she caught my attention recently when she published an article in THE HIPPOCRATIC POST (I had never heard of this publication before!). It is, I think, sufficiently noteworthy to show you some excerpts (the references [in square brackets] were added by me, and they refer to my comments below):
START OF QUOTES
…Homeopathy can be helpful for pretty much any condition , whether as the main treatment , as a complement to a conventional treatment  to speed up the healing process , or to lessen the side-effects of a pharmacological medication . It can be helpful in the treatment of emotional problems , physical problems  and for multi-morbidity patients . I find it an invaluable tool in my GP’s toolbox and regularly see the benefits of homeopathy in the patients I treat …
There are many conditions for which I have found homeopathy to be effective … There are, however, a multitude of symptomatic treatments available to suppress symptoms, both on prescription and over-the-counter. Most symptoms experienced by patients in this context result from the body’s attempt to eliminate the infection. Our immune systems have spent thousands of years refining this response; therefore it seems counter-intuitive to suppress it .
For these types of acute conditions homeopathy can work with the body to support it . For instance, homeopathic Arsenicum album (arsenic) is a classic remedy for diarrhoea and vomiting that can be taken alongside essential oral rehydration . And in influenza I’ve found Eupatorium perfoliatum (ague or feverwort) to be very helpful if the patient is suffering with bony pain .
…Unless it is clinically imperative for a pharmacological intervention, I will always consider homeopathy first  and have successfully prescribed the homeopathic remedy Nux vomica (strychnine) for women suffering from morning sickness . Problems associated with breastfeeding such as mastitis have also responded well to the classic remedies Belladonna (deadly nightshade) and Phytolacca (pokeweed), while I have found Urtica urens (dog nettle) effective in switching off the milk supply to prevent engorgement when the mother stops breastfeeding .
…“heart sink” patients are clearly suffering from pain and discomfort, which is blighting their lives. This is understandably frustrating for them, for they know full well something is awry but there is no medical evidence for this… Homeopathy affords me another approach in trying to help these patients [1,3]. It doesn’t work for them all, but I’m frequently surprised at how many it does help .
The beauty of homeopathy is that it combines mental and emotional symptoms with physical symptoms . When the right remedy is found it appears to stimulate the body to recognise how it is being dysfunctional and corrects this, with no suppression, just a correction of the underlying disturbance . Thus homeopathy not only eliminates unwanted symptoms , it dramatically improves a patient’s overall well-being .
…homeopathy… enables me to reduce the number of painkillers and other drugs I’m prescribing [1,3]. This is particularly true for older multi-morbidity, polypharmacy patients  who are often taking huge amounts of medication.
Contrary to what most homeopaths will tell you, I believe homeopathic treatment does have side-effects – positive side-effects!  It fosters an enhanced doctor patient relationship . The process of eliciting the relevant information to select a remedy enables me to better understand the patient’s condition and helps me to get to know them better . And the patient, seeing that the doctor is interested in the idiosyncrasies and detail of their disease, finds themselves heard and understood . In short, since training in homeopathy I enjoy my job as a GP and my relationship with patients so much more .
Dr Gabriella Day BSc, MBBS, MRCP, DCH, MRCGP, MFHom
END OF QUOTES
- statement without good evidence,
- Hahnemann was vehemently against combining homeopathy with other treatments and called clinicians who disregarded this ‘traitors’,
- statement of belief,
- wrong assumption,
- questionable ethics.
I have recently attempted to slip into the brain of lay-homeopaths and shown how illogical, misguided and wrong the arguments of such enthusiasts really are. Surely, the logic of a doctor homeopath must be better, I then thought. Once you have studied medicine, you have learnt an awful lot of things about the body, disease, therapy, etc., etc., I felt.
Judging from the above article, I might have been wrong.
Alternative medicine differs from conventional medicine in numerous ways. One important difference is that patients often opt to try this or that product without consulting any healthcare professional at all. In such cases, the pharmacist might be the ONLY professional who can advise the patient who is about to purchase such a product.
This is why the role of the pharmacist in alternative medicine is crucial, arguably more so than in conventional medicine. And this is why I am banging on about pharmacists who far too often behave like shop-keepers and not like ethical healthcare professionals. A new review addresses these issues and provides relevant information.
Pharmacists from the University of Macau in Macau, China conducted a literature review to extract publications from 2000 to 2015 that related pharmacist to alternative medicine products. 41 publications which reported findings from exploratory studies or discussed pharmacists’ responsibilities towards such products were selected for inclusion.
Seven major responsibilities emerged:
- to acknowledge the use of alternative medicine products;
- to be knowledgeable about such products;
- to ensure safe use of such products;
- to document the use of such products;
- to report ADRs related to such products;
- to educate about such products;
- to collaborate with other health care professionals in respect to such products.
One point that is not directly covered here is the duty of pharmacists to comply with their own ethical codes. As I have pointed out ad nauseam, this would mean in many instances to not sell alternative medicine products at all, because there is no good evidence to show that they are generating more good than harm and thus are potentially harmful as well as wasteful.
Some pharmacists have realised that there is a problem. Some pharmacists are trying to initiate discussions about these issues within their profession. Some pharmacists are urging to change things. Some pharmacists are well-aware that healthcare ethics are being violated on a daily basis.
All this has been going on now for well over a decade.
And has there been any noticeable change?
Not as far as I can see!
Perhaps it is time to realise that not merely the sale of bogus medicines by pharmacists is unethical, but so is dragging one’s feet in initiating improvements.
“Highly diluted homeopathic remedies cannot possibly work beyond a placebo effect because there is nothing in them”. This is the argument, we often hear. It is, I think correct. But homeopaths have always disagreed. Hahnemann claimed that the healing power of his remedies was due to a ‘vital force’, and for a long time his followers repeated this mantra. Nowadays, it sounds too obsolete to be taken seriously, and homeopaths came up with new theories as to how their remedies work. The current favourite is the ‘nano-theory’.
This article explains it quite well: “… some of the most exciting findings have been in the world of tiny nano-particles. Nano-particles are described as particles between 1 and 100 nanometers in size. For an idea of scale, a nanometer is 1 billionth of a meter. A single atom is one-tenth of a nanometer, and subatomic particles are still smaller than that. Quantum mechanics (the study of these very small particles) has shown that these tiny particles can and do have impact our macro world, and can be useful in everything from medical PET scans to quantum computing. But the breakthrough that I’m most excited about is the latest study around nano-particles which has shown that at the very highest prescription strength dilutions of a homeopathic substance (50M) there are still nano-particles of the original substance that exist. Further, not only did researchers discover that these particles exist, but they showed that they had demonstrable effects when tests were run on homeopathic dilutions versus a control substance…”
So, the claim is that, during the process of potentisation of a homeopathic remedy, nano-particles of the original stock are formed. Therefore, even ultra-molecular dilutions are not devoid of material but do contain tiny bits of what is says on the bottle. This is the reason why homeopaths now claim WE WERE RIGHT ALL ALONG; HOMEOPATHY WORKS!!!
I Have several problems with this assumption:
- The nano-particles have been shown by just 1 or 2 research groups. I would like to see independent confirmations of their findings because I am not convinced that this is not simply an artefact without real meaning.
- Even if we accept the ‘nano-theory’ for a moment, there are numerous other issues.
- What about the many homeopathic remedies that use stock which is not material by nature, for instance, X-ray, luna, etc.? Do we need to assume that there are also nano-particles of non-materials?
- And for remedies that are based on a material stock (like arnica or nux vomica, or Berlin Wall, for instance), how do the nano-particles generate heath effects? How do a few nano-particles of arnica make cuts and bruises heal faster? How do nano-particles of nux vomica stop a patient from vomiting? How do nano-particles of the Berlin Wall do anything at all?
If the ‘nano-theory’ were true (which I doubt very much), it totally fails to provide an explanation as to how homeopathy works. This explanation would still need to be identified for each of the thousands of different remedies in separate investigations.
If nano-particles are truly generated during the potentisation process, it proves almost nothing. All it would show is that shaken water differs from unshaken water. The water in my kitchen sink also differs from pure water; this, however, does not mean that it has healing properties.
My conclusion: there is no plausible mode of action of highly diluted homeopathic remedies.
David Needleman, a pharmacist at Wilkinson Chemist in Barnet, UK, has published a brilliant article explaining that complementary medicine such as homeopathy, nutrition and aromatherapy could make smaller pharmacies “more viable and competitive”, as they look to “survive” the funding cuts across England. In doing so, he made it clear that retail pharmacists are shop-keepers, not healthcare professionals, as previously assumed.
“We need to explore other ways of maintaining profitability. One of these is to enter profitable niche markets”. Mr Needleman – who is also joint principal of The School of Complementary Medicine (TSOCM) – helped set up a homeopathic dispensary in a North London pharmacy while studying for his qualification in 1987. “Within a year, the various homeopathic remedies, various other nutritional supplements and herbal medicines we stocked accounted for nearly 40% of the pharmacy’s turnover, with a considerably higher margin. This 40% turnover was the difference between bankruptcy and survival [of this pharmacy],” he added.
Mr Needleman and his colleague at TSOCM have designed a two-year “comprehensive complementary medicines” course for pharmacists and technicians, which will launch at the London School of Pharmacy in September. “It is going to cover nutrition, homeopathy, herbal medicine, flower remedies, aromatherapy and Chinese medicines and will lead to a [certificate] for pharmacists to become registered with a professional body,” Mr Needleman said. He said “it is early days” but “everyone I have spoken to has shown an interest” in the training. Mr Needleman is now looking to expand the offer to pharmacists across the country, “possibly Manchester next”.
Mr Needleman said he reacted with “sadness” to the news that some clinical commissioning groups (CCG) plan to scrap homeopathy funding. “Homeopathy has been under a lot of threat and a lot of pressure for some considerable time. It is going to disenfranchise thousands of people who can’t afford to pay. When you think that between six and 10 million people a year use complementary medicines…it is rather a large chunk of business that pharmacies are missing out on. There are only about six dedicated homeopathic pharmacies in the country, but there are a number of pharmacies that will dispense remedies and give advice. Anything that can take us away from NHS dispensing has got to be useful for the survival of community pharmacy,” he added. A full copy of Mr Needleman’s letter can be found here.
I want to personally thank Mr Needleman for this statement. It avoids all the BS pharmacists tend to unpack when asked about homeopathy or other bogus treatments they sell. I agree entirely with Needleman, no need to beat about the bush! Pharmacists who sell homeopathic remedies do so mostly to make money, they are essentially shop-keepers. I find it easier to deal with the truth – even though it may be slightly embarrassing for the profession of pharmacists – than with the excuses pharmacists usually provide when asked why they sell disproven nonsense to the unsuspecting public. I guess, I prefer a slight embarrassment to a painfully big one.
The downside of the behaviour of the shop-keepers in the pharmacist profession is, of course, that they violate their own code of ethics. But who cares about ethics? Who cares about responsibly advising patients on the best therapy for their conditions? Who cares about evidence? The aim of the game is not about niceties, it is about saving the pharmacists’ income!!!
In its ‘quick guide’ to homeopathy, the Royal Pharmaceutical Society (RPS) said it “does not endorse homeopathy as a form of treatment because there is no scientific basis for homeopathy nor any evidence to support the clinical efficacy of homeopathic products beyond a placebo effect”.
The ‘Daily Mail’ is not a paper famed for its objective reporting. In politics, this can influence elections; in medicine, it can endanger public health.
A recent article is a case in point, I think.
START OF QUOTE
Traditional Chinese medicines could help prevent heart disease and the progression of pre-diabetes, according to research. Some herbal treatments proved as effective in lowering blood pressure as Western drugs and improved heart health by lowering cholesterol, scientists found. Certain alternative medicines could lower blood sugar and insulin levels, too.
Chinese medicines could be used alongside conventional treatments, say researchers from Shandong University Qilu Hospital in China. Or they can be beneficial as an alternative for patients intolerant of Western drugs, they said in their review of medical studies over a ten-year period. Senior review author from the university’s department of traditional Chinese medicine said: ‘The pharmacological effects and the underlying mechanisms of some active ingredients of traditional Chinese medications have been elucidated. Thus, some medications might be used as a complementary and alternative approach for primary and secondary prevention of cardiovascular disease.”
It’s potentially good news for people living with diabetes, which is now a global epidemic and has proved a tricky condition to manage for many people. High blood pressure is very common too, affecting more than one in four adults in the UK, although many won’t show symptoms and realise it. If untreated, it increases your risk of serious problems including heart disease, the number one killer globally.
The Chinese have used herbs for treating diseases for thousands of years and have become increasingly popular in Europe and North America, mainly as complement to Western medicine. But the researchers also warn that much of the research conducted have limitations and so their long-term effects are not proven.
Herbs for high blood pressure
The blood pressure-lowering effect of herb zhongfujiangya was found to be similar to that of oral anti-hypertension medication benazeprilm, which goes by the brand name Lotensin. Similarly, patients treated for eight weeks with herbal tiankuijiangya had a lower reading than those given a placebo. Herbal Jiangya tablets were found to ‘significantly lower’ systolic blood pressure, that is the amount of pressure in your arteries during contraction of your heart muscle compared to a fake treatment. The herb Jiangyabao also had a significant effect compared to a placebo, but just at night. But overall, compared to the drug Nimodipine, a calcium channel blocker, it worked just as well. Qiqilian capsules also proved more effective compared to a placebo.
Herbs for diabetes
The team report some Chinese medicines medications – such as xiaoke, tangminling, jinlida, and jianyutangkang – have a ‘potent’ effect on lowering blood sugar levels and b-cell function, which controls the release of insulin. Some remedies – such as tangzhiping and tianqi – might prevent the progression of pre-diabetes to diabetes, they note.
Herbs for cholesterol
The researchers looked at research on dyslipidemia, the term for unbalanced or unhealthy cholesterol levels. They found that jiangzhitongluo, salviamiltiorrhiza and pueraria lobata, and zhibitai capsule all have a ‘potent lipid-lowing effect’.
Herbs for heart disease
Some traditional Chinese medicines such as qiliqiangxin, nuanxin, shencaotongmai, and yangxinkang, might be effective in improving function in patients with chronic heart failure, they wrote.
Limitations with trials
But Western scientists often reject Chinese medicine for specific reasons, warned Dr Zhao’s team. Chinese medicines are frowned upon because they do not go through the same exhaustive approval process as trials conducted domestically, they pointed out. Plus, one treatment can be made of many different ingredients with various chemical compounds, making it hard to pinpoint how their benefits work. ‘One should bear in mind that traditional Chinese medicine medications are usually prescribed as complex formulae, which are often further manipulated by the practitioner on a personalized basis,’ said Dr Zhao.
END OF QUOTE
Apart from the fact that this article is badly written, it is also misleading to the point of being outright dangerous. Regular readers of my blog will be aware that Chinese research is everything but reliable; there are practically no Chinese TCM-trials that report negative results. Furthermore, the safety of Chinese herbal preparations is as good as unknown and they are often contaminated with toxic substances as well as adulterated with synthetic drugs. Most of these preparations are also unavailable outside China. Moreover, Chinese herbal treatments are usually individualised (mixtures are tailor-made for each individual patient), and there is no good evidence that this approach is effective. Crucially, the trial evidence is often of such poor quality that it would be a dangerous mistake to trust these findings.
None of these important caveats, it seems, are important enough to get a mention in the Daily Mail.
Don’t let the truth get in the way of a sensational story!
Let’s just for a moment imagine what would happen if people took the Mail article seriously (is there anyone out there who does take the Mail seriously?). In a best case scenario, they would take Chinese herbs in addition to their prescribed medication. This might case plenty of unwanted side-effects and herb-drug interactions. In addition, people would lose a lot of their hard-earned cash. In a worst case scenario, they would abandon their prescribed medication for dubious Chinese herbal mixtures. This could cause thousands of premature deaths.
With just a little research, I managed to find the original article on which the Mail’s report was based. Here is its abstract:
Traditional Chinese medicine (TCM) has more than 2,000 years of history and has gained widespread clinical applications. However, the explicit role of TCM in preventing and treating cardiovascular disease remains unclear due to a lack of sound scientific evidence. Currently available randomized controlled trials on TCM are flawed, with small sample sizes and diverse outcomes, making it difficult to draw definite conclusions about the actual benefits and harms of TCM. Here, we systematically assessed the efficacy and safety of TCM for cardiovascular disease, as well as the pharmacological effects of active TCM ingredients on the cardiovascular system and potential mechanisms. Results indicate that TCM might be used as a complementary and alternative approach to the primary and secondary prevention of cardiovascular disease. However, further rigorously designed randomized controlled trials are warranted to assess the effect of TCM on long-term hard endpoints in patients with cardiovascular disease.
In my view, the authors of this review are grossly over-optimistic in their conclusions (but nowhere near as bad as the Mail journalist). If the trials are of poor quality, as the review-authors admit, no firm conclusions should be permissible about the usefulness of the therapies in question.
As the Mail article is obviously based on a press release (several other papers worldwide reported about the review as well), it seems interesting to note what the editor of the Journal of the American College of Cardiology (the journal that published the review) recently had to say about the responsibility of journalists and researchers:
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…I would like to suggest that journalists and researchers must share equally in shouldering the burden of responsibility to improve appropriate communication about basic and clinical research.
First, there is an obligation on the part of the researchers not to inflate the importance of their findings. This has been widely recognized as damaging, especially if bias is introduced in the paper…
Second, researchers should take some responsibility for the creation of the press release about their research, which is written by the media or press relations department at their hospital or society. Press releases are often how members of the media get introduced to a particular study, and these releases can often introduce errors or exaggerations. In fact, British researchers evaluated 462 press releases on biomedical and health-related science issued by 20 leading U.K. universities in 2011, alongside their associated peer-reviewed research papers and the news stories that followed (n = 668). They found that 40% of the press releases contained exaggerated advice, 33% contained exaggerated causal claims, and 36% contained exaggerated inference to humans from animal research. When press releases contained such exaggeration, 58%, 81%, and 86% of news stories, respectively, contained further exaggeration, compared with rates of 17%, 18%, and 10% in the news when the press releases were not exaggerated. Researchers should not be excused from being part of the press release process, as the author(s) should at least review the release before it gets disseminated to the media. I would even encourage researchers to engage in the process at the writing stage and to not allow their hospital’s or society’s public relations department to extrapolate their study’s results. Ultimately, the authors and the journals in which the studies are published will be held accountable for the information that trickles into the headlines, not the public relations departments, so we must make sure that the information is accurate and representative of the study’s actual findings.
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Sound advice indeed.
Now we only need to ALL follow it!!!
Quackademia is an apt term for the teaching or promotion of quackery in universities. Sadly, this is a serious problem, and we have therefore discussed it already several times (see here, here and here). If you have read my memoir, you know that I had my fair share of quackademia ‘hands-on’, so to speak. This article from Australia has more on the subject:
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Friends of Science in Medicine have complained that alternative practitioners who speak at events were then using the names and logos of universities on their promotional material. Edith Cowan University recently cancelled a workshop promoting pranic crystal healing — which claims to use crystals to energise and heal the body — after complaints from FSM that it had no scientific basis. The university also cancelled Brisbane-based nutrition author Christine Cronau, who was due to promote her low-carbohydrate, high-fat diet on June 25. In response to a website petition calling on the university to cancel Cronau’s seminar, ECU said it rejected the booking because “it does not align with our evidence-based approach to dietetics teaching and research”.
The talk has been moved to Murdoch University, which, despite being lobbied to cancel the booking, said in a statement this week that it would go ahead. Murdoch said it promoted critical thinking and learning through discussion, debate and exposure to alternatives points of view. “One way to achieve this is to welcome other voices on campus in the form of guest speakers or visiting lecturers,” the statement said. “The university takes a common sense approach to the debate of controversial issues and we encourage respectful and insightful debate of thought- provoking topics.”
FSM president John Dwyer said universities should review the content of external health seminars before they hired out their venues. “We don’t have an issue with free speech, but some of the material is just not scientific,” Professor Dwyer said. “Often universities don’t know about the nature of the pseudo-scientific events they are hosting.”
Cronau said she was disappointed ECU had cancelled her talk but her faith in common sense had been restored by Murdoch University. “My approach has actually become a lot less controversial, so I don’t know why it has generated such comments,” she said.
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I find this story interesting. It reveals several things:
- Quacks love to infiltrate universities; this gives them a veneer of respectability, they think.
- This discloses their schizophrenic attitude to the ‘scientific establishment’ in an exemplary fashion: they often are fiercely against science but, at the same time, they are only too happy to jump at opportunities of decorating themselves with scientific feathers.
- Universities are run like businesses these days. They tend to take the money where they can get it. Issues like scientific credibility rarely figure high on the agenda.
- When challenged, universities claim they are favouring free speech, open-mindedness and respectful debate.
- This usually is but a lame excuse.
I remember protesting while at Exeter against a weekend course of pure quackery which the organisers were advertising under the logo of my university. My protest fell on deaf ears, and my peers pretended to favour free speech, open-mindedness and respectful debate. After I had retired, the University of Exeter even allowed quacks to infiltrate and made this surprising announcement: Our complementary therapists will be offering 15-20 minute taster sessions in our complementary therapies yurt. The therapy taster sessions on offer will include: shaitsu bodywork, reflexology, indian head Massage, seated back massage and much more. To take advantage of these free taster sessions just pop along to the yurt on the day of the festival.
But the Australian events also offer a glimmer of hope in this usually bleak situation. Sometimes our protests do have an effect! I therefore urge everyone to not give up. Quackademia is a pest, and for the sake of future generations, we must not allow it to infest our universities.