Edzard Ernst

MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

I have often cautioned about what I call the ‘survey mania’ in alternative medicine. Yet, once in a while, an informative survey gets published. Take this recent survey, for instance:

It was based on a design-based logistic regression analysis of the European Social Survey (ESS), Round 7. The researchers distinguished 4 modalities: manual therapies, alternative medicinal systems, traditional Asian medical systems and mind-body therapies.

In total, 25.9% of the general population had used at least one of these therapies during the last 12 months which was around one-third of the proportion of those who had visited a general practitioner (76.3%). Typically, only one treatment had been used, and it was used more often as complementary rather than alternative treatment. The usage varied greatly by country (see Table 1 below). Compared to those in good health, the use of CAM was two to fourfold greater among those with health problems. The health profiles of users of different CAM modalities varied. For example, back or neck pain was associated with all types of CAM, whereas depression was associated only with the use of mind-body therapies. Individuals with difficult to diagnose health conditions were more inclined to utilize CAM, and CAM use was more common among women and those with a higher education. Lower income was associated with the use of mind-body therapies, whereas the other three CAM modalities were associated with higher income.

The authors concluded that help-seeking differed according to the health problem, something that should be acknowledged by clinical professionals to ensure safe care. The findings also point towards possible socioeconomic inequalities in health service use.

As I said, this is one of the rare surveys that is worth studying in some detail. This is mainly because it is rigorous and its results are clearly presented. Much of what it reports has been known before (for instance, we showed that the use of CAM in the UK was 26% which ties in perfectly with the 21% figure considering that here only 4 CAMs were included), but it is undoubtedly valuable to see it confirmed based on sound methodology.

Apart of what the abstract tells us, there are some hidden gems from this paper:

  • 8% of CAM users had used CAM exclusively (alternative use), without any visits to biomedical professionals in the last 12 months. This may look like a low figure, but I would argue that it is worryingly high considering that alternative usage of CAM has the potential to hasten patients’ deaths.
  • The most frequently used CAM treatment was massage therapy, used by 11.9% of the population, followed by homeopathy (5.7%), osteopathy (5.2%), herbal treatments (4.6%), acupuncture (3.6%), chiropractic (2.3%), reflexology (1.7%) and spiritual healing (1.3%). Other modalities (Chinese medicine, acupressure and hypnotherapy) were used by around by 1% or less. The figure for homeopathy is MUCH smaller that the ones homeopaths want us to believe.
  • About 9% of healthy survey-participants had used at least one of the CAM modalities during the last 12 months. One can assume that this usage was mostly for disease-prevention. But there is no good evidence for CAM to be effective for this purpose.
  • The highest ORs for the use of Traditional Asian Medical Systems were found in Denmark, Switzerland and Israel, followed by Austria, Norway and Sweden. The highest OR for the use of Alternative Medical Systems was found in Lithuania, while manual therapies were most commonly used in Finland, Austria, Switzerland, Germany and Denmark. Moreover, Denmark, Ireland, Slovenia and Lithuania had the highest ORs for using mind-body therapies. France, Spain and Germany presented a common pattern, with relatively similar use of the different modalities. Poland and Hungary had low ORs for use of the different CAM modalities.

But by far the nicest gem, however, comes from my favourite source of misinformation on matters of health, WDDTY. They review the new survey and state this: The patients are turning to alternatives for a range of chronic conditions because they consider the conventional therapy to be inadequate, the researchers say. Needless to point out that this is not a theme that was addressed by the new survey, and therefore its authors also do not draw this conclusion.

The British press recently reported that a retired bank manager (John Lawler, aged 80) died after visiting a chiropractor in York. This tragic case was published in multiple articles, most recently in THE SUN. Personally, I find this regrettable – not the fact that the press warns consumers of chiropractic, but the tone and content of the articles.

Let me explain this by citing the one in THE SUN of today. Here is the critical bit that concerns me:

Ezvard Ernst, Emeritus Professor of Complementary Medicine at Exeter University, published a study showing at least 26 people had died as a result. He said: “The evidence is not in favour of chiropractic treatments. Nobody knows how many have suffered severe complications or died.” Edvard Ernst, Professor of Complementary Medicine, says many have suffered complications or died from chiropractors treatments… A study from Exeter University shows at least 26 people have died as a result of treatment.

And what is wrong with this?

The answer is lots:

  • My first name is consistently misspelled (a triviality, I agree).
  • I am once named as Emeritus Professor and once as Professor of Complementary Medicine. The latter is wrong (another triviality, perhaps, but some of my more demented critics have regularly accused me of carrying wrong titles)
  • The mention of 26 deaths after chiropractic treatments is problematic and arguably misleading (see below).
  • Our ‘study’ was not a study but a systematic review (another triviality?).

Now you probably think I am being pedantic, but I feel that the article is regrettable not so much by what it says but by what it fails to say. To understand this better, I will below copy my emails to the journalist who asked for help in researching this article.

  • My email of 17/10 answering all 7 of the journalist’s specific questions:
  • 1. Why are you sceptical of chiropractic?
  • I have researched the subject for more than 2 decades, and I know that the evidence is not in favour of chiropractic
  • 2. How many people do you believe have died in Britain as a result of being treated by a chiropractor? If it’s not possible to say, can you estimate?
  • nobody knows how many patients have suffered severe complications or deaths. there is no system to monitor such events that is comparable to the post-marketing surveillance of conventional medicine. we did some research and found that the under-reporting of cases of severe complications was close to 100% in the UK.
  • 3. What is so dangerous about chiropractic? Is there a particular physical treatment than endangers life?
  • manipulations that involve rotation and over-extension of the upper spine can lead to a vertebral artery breaking up. this causes a stroke which sometimes is fatal.
  • 4. Is the industry well regulated?
  • UK chiropractors are regulated by the General Chiropractic Council. it is debatable whether they are fit for purpose (see here:http://edzardernst.com/2015/02/the-uk-general-chiropractic-council-fit-for-purpose/)
  • 5. Should we be suspicious of claims that chiropractic can cure things like IBS and autism?
  • such claims are not based on good evidence and therefore misleading and unethical. sadly, however, they are prevalent.
  • 6. Who trains chiropractors?
  • there are numerous colleges that specialise in that activity.
  • 7. Is it true Prince Charles is to blame for the rise in popularity/prominence of chiropractic?
  • I am not sure. certainly he has been promoting all sorts of unproven treatments for decades.
  • My email of 18/10 answering 3 further specific questions
  • 1. Would you actively discourage anyone from being treated by a chiropractor?
    yes, anyone I feel responsible for
    2. Are older people particularly at risk or could one wrong move affect anyone?
    older people are at higher risk of bone fractures and might also have more brittle arteries prone to dissection
    3. If someone has, say, a bad back or stiff neck what treatment would you recommend instead of chiropractic?
    I realise every case is different, but you are sceptical of all complementary treatments (as I understand it) so what would you suggest instead?
    I would normally consider therapeutic exercises and recommend seeing a good physio.
  • 3. My email of 23/10 replying to his request for specific UK cases
  • the only thing I can offer is this 2001 paper
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297923/
  • where we discovered 35 cases seen by UK neurologists within the preceding year. the truly amazing finding here was that NONE of them had been reported anywhere before. this means under-reporting was exactly 100%.

END OF QUOTES
I think that makes it quite obvious that much relevant information never made it into the final article. I also know that several other experts provided even more information than I did which never appeared.

The most important issues, I think, are firstly the lack of a monitoring system for adverse events, secondly the level of under-reporting and thirdly the 50% rate of mild to moderate adverse-effects. Without making these issues amply clear, lay readers cannot possibly make any sense of the 26 deaths. More importantly, chiropractors will now be able to respond by claiming: 26 deaths compare very favourably with the millions of fatalities caused by conventional medicine. In the end, the message that will remain in the heads of many consumers is this: CONVENTIONAL MEDICINE IS MUCH MORE DANGEROUS THAN CHIROPRACTIC!!! (The 1st comment making this erroneous point has already been published: Don’t be stupid Andy. You wanna discuss how many deaths occur due to medication side effects and drug interactions? There is a reason chiros have the lowest malpractice rates.)

Don’t get me wrong, I am not accusing the author of the SUN-article. For all I know, he has filed a very thoughtful and complete piece. It might have been shortened by the editor who may also have been the one adding the picture of the US starlet with her silicone boobs. But I am accusing THE SUN of missing a chance to publish something that might have had the chance of being a meaningful contribution to public health.

Perhaps you still think this is all quite trivial. Yet, after having experienced this sort of thing dozens, if not hundreds of times, I disagree.

You may think that all TCM treatments come from China – most people do, but they are wrong. It is the Bavarians who have invented much 0f TCM long before the Chinese ever thought of it.

Remember Oetzi? Well, he was (almost) Bavarian. He had acupuncture points tattooed all over his body, and he lived more than 5000 years ago. And now the Chinese have the chutzpa to claim having invented acupuncture 3 000 ago. No, they have nicked it from the Bavarians! It’s obvious!

But it gets better.

Remember slapping therapy? You think that is TCM-inspired? No, it is an old Bavarian tradition! We call it the Watschentanz. If you don’t believe me, look at the videos below.

You must admit this is convincing evidence, if there ever was one.

What does this Bavarian slapping therapy cure?

It is a holistic form of energy healing to cure foremost thirst. You have to drink 1 litre of beer (a herbal infusion of hops and a few other ingredients – also Bavarian, of course) before you start and 2 when it’s over (perfect detox as well!). Moreover it is a better workout than Tai Chi, and it re-balances your vital energies more effectively than any acupuncture needle.

Trust me – I am a (Bavarian) doctor!

For some time now, I got the impression that the research literature of alternative medicine is yielding more and more animal experiments. But impressions can of course be misleading, so I did a small statistical analysis. I went on to Medline, searched for all papers on ‘complementary/alternative medicine’, and counted the number of animal studies as well as clinical studies (including observational studies but excluding surveys) amongst the first 100 hits.

The results confirmed the above-named impression. There were:

  • 30 animal studies,
  • 12 clinical trials,
  • the rest was made up of other pre-clinical studies (mostly in-vitro studies), comments and other types of publications.

I find this dominance of animal studies surprising, particularly as I got the impression that many were odd, meaningless and not followed by adequate further research. But again, this is just an impression. Let’s see some data. Here are the first 3 papers listed:

Paper number 1

BACKGROUND:

Essential hypertension is mainly caused by endothelial dysfunction which results from nitric oxide (NO) deficiency. The present study was design to evaluate the protective effect of Bidens pilosa ethylene acetate extract (Bp) on L-NAME induced hypertension and oxidative stress in rats.

METHODS:

Male Wistar rats were used to induce hypertension by the administration of L-NAME (a non-pecific nitric oxide inhibitor) (50 mg/kg/day). The others groups were receiving concomitantly L-NAME plus Bp extract (75 and 150 mg/kg/day) or losartan (25 mg/kg/day). All the treatments were given orally for 4 weeks. At the end of the treatment, the hemodynamic parameters were recorded using the direct cannulation method. The effects of the extract on lipid profile, kidney and liver functions as well as oxidative stress markers were evaluated by colorimetric method. Results were expressed as the mean ± SEM. The difference between the groups was compared using one-way analysis of variance (ANOVA) followed by the Duncan’s post hoc test.

RESULTS:

Animals receiving L-NAME presented high blood pressure, normal heart rate and lipid profile as well as NO depletion, liver and kidney injuries and oxidative stress. The concomitant treatment with L-NAME and Bp or losartan succeeded to prevent the raised of blood pressure and all the other injuries without affecting the heart rate.

CONCLUSION:

These results confirm the antihypertensive effects of Bidens pilosa and highlight its protective properties in L-NAME model of hypertension in rat, probably due to the presence of Quercetin 3,3 ‘-dimethyl ether 7-0-β-D-glucopyranoside.

Paper number 2

BACKGROUND:

Oxidative stress has a pivotal role in the pathogenesis and development of diabetic peripheral neuropathy (DPN), the most common and debilitating complications of diabetes mellitus. There is accumulating evidence that Juglans regia L. (GRL) leaf extract, a rich source of phenolic components, has hypoglycemic and antioxidative properties. This study aimed to determine the protective effects of Juglans regia L. leaf extract against streptozotocin-induced diabetic neuropathy in rat.

METHODS:

The DPN rat model was generated by intraperitoneal injection of a single 55 mg/kg dose of streptozotocin (STZ). A subset of the STZ-induced diabetic rats intragastically administered with GRL leaf extract (200 mg/kg/day) before or after the onset of neuropathy, whereas other diabetic rats received only isotonic saline as the same volume of GRL leaf extract. To evaluate the effects of GRL leaf extract on the diabetic neuropathy various parameters, including histopathology and immunohistochemistry of apoptotic and inflammatory factors were assessed along with nociceptive and biochemical assessments.

RESULTS:

Degeneration of the sciatic nerves which was detected in the STZ-diabetic rats attenuated after GRL leaf extract administration. Greater caspase-3, COX-2, and iNOS expression could be detected in the STZ-diabetic rats, which were significantly attenuated after GRL leaf extract administration. Also, attenuation of lipid peroxidation and nociceptive response along with improved antioxidant status in the sciatic nerve of diabetic rats were detected after GRL leaf extract administration. In other word, GRL leaf extract ameliorated the behavioral and structural indices of diabetic neuropathy even after the onset of neuropathy, in addition to blood sugar reduction.

CONCLUSION:

Our results suggest that GRL leaf extract exert preventive and curative effects against STZ-induced diabetic neuropathy in rats which might be due to its antioxidant, anti-inflammatory, and antiapoptotic properties.

Paper number 3

BACKGROUND:

Many people still experience pain and inflammation regardless of the available drugs for treatments. In addition, the available drugs have many side effects, which necessitated a quest for new drugs from several sources in which medicinal plants are the major one. This study evaluated the analgesic and anti- inflammatory activity of the solvent fractions of Moringa stenopetala in rodent models of pain and inflammation.

METHODS:

Successive soxhlet and maceration were used as methods of extractions using solvents of increasing polarity; chloroform, methanol and water. Swiss albino mice models were used in radiant tail flick latency, acetic acid induced writhing and carrageenan induced paw edema to assess the analgesic and anti-inflammatory activities. The test groups received different doses (100 mg/kg, 200 mg/kg and 400 mg/kg) of the three fractions (chloroform, methanol and aqueous). The positive control groups received morphine (20 mg/kg) or aspirin (100 mg/kg or 150 mg/kg) based on the respective models. The negative control groups received the 10 ml/kg of vehicles (distilled water or 2% Tween 80).

RESULTS:

In all models, the chloroform fraction had protections only at a dose of 400 mg/kg. However, the methanol and aqueous fraction at all doses have shown significant central and peripheral analgesic activities with a comparable result to the standards. The aqueous and methanol fractions significantly reduced carrageenan induced inflammation in a dose dependent manner, in which the highest reduction of inflammation was observed in aqueous fraction at 400 mg/kg.

CONCLUSION:

This study provided evidence on the traditionally claimed uses of the plant in pain and inflammatory diseases, and Moringa stenopetala could be potential source for development of new analgesic and anti-inflammatory drugs.

END OF QUOTE

I may be wrong, but I have my doubts that these papers are useful (and there are many that are far worse than these 3. Take for instance this one that I blogged about previously). Animal studies could clearly be helpful, but they have to fulfil certain conditions.

Medline is currently littered with dubious animal experiments which never seem to be followed up with further research. Without subsequent research verifying whether the effects observed in animals might have any meaning for treating humans, such studies are, I think, in danger of being a waste of animals, money and time. It is my impression – one that would be difficult to back up by hard data – that most of these dubious animal studies are never followed by further research. If true, this would render them meaningless and arguably unethical.

Yet I am not an expert in pre-clinical research and would be most interested to hear your opinion on this matter.

The nonsense that some naturopaths try to tell the public never ceases to amaze me. This article is a good example: a “naturopathic doctor” told a newspaper that “We do have a reputation associated with cancer, but we don’t treat cancer. We use highly intelligent computer software to find out what is wrong with the body at a scientific level, and we simply correct that, and the people who do that, they cure their own cancer.” As far as he is concerned, “The only hope for cancer is alternative medicine… When you look at the medical texts, the scientific literature, what is used, the chemotherapy and the radiation, they cannot cure cancer,” he said.

Through artificial intelligence, he said that he simply teaches people how to heal. Clients are hooked up to a computer that reads their body and gives a printout of what needs to be done to correct the abnormalities. “It looks at the abnormalities in the energetic pathways, abnormalities in nutritional status, and abnormalities in the toxic load of the body and how much it can carry. Once these things are identified and you actually put the patient on a path, they go out and heal themselves. I have nothing to do with it,” he said.

Before you discard this neuropath as an unimportant nutter, consider that this article is a mere example. There are thousands more.

This website, for instance, gives the impression of being much more official and trustworthy by adopting the name of CANCER TREATMENT CENTERS OF AMERICA. But the claims are just as irresponsible:

… natural therapies our naturopathic medicine team may recommend include:

  • Herbal and botanical preparations, such as herbal extracts and teas
  • Dietary supplements, such as vitamins, minerals and amino acids
  • Homeopathic remedies, such as extremely low doses of plant extracts and minerals
  • Physical therapy and exercise therapy, including massage and other gentle techniques used on deep muscles and joints for therapeutic purposes
  • Hydrotherapy, which prescribes water-based approaches like hot and cold wraps, and other therapies
  • Lifestyle counseling, such as exercise, sleep strategies, stress reduction techniques, as well as foods and nutritional supplements
  • Acupuncture, to help with side effects like nausea and vomiting, dry mouth, hot flashes and insomnia
  • Chiropractic care, which may include hands-on adjustment, massage, stretching, electronic muscle stimulation, traction, heat, ice and other techniques.

END OF QUOTE

And, would you believe it, there even is a NATUROPATHIC CANCER SOCIETY. They proudly claim that: Naturopathic medicine works best to eliminate:

     Bladder cancer

     Breast cancer

     Cervical & Uterine cancers

     Colorectal cancer

     Gastric & Esophag. cancers

     Leukemias & Lymphomas

     Liver & Biliary cancers

     Lung cancer

     Ovarian cancer

     Pancreatic cancer

     Prostate cancer

     Skin cancers

     Thyroid cancer

     General & other cancers

END OF QUOTE

Vis a vis this plethora of irresponsible and dangerous promotion of quackery by naturopathic charlatans, I feel angry, sad and powerless. I know that my efforts to prevent cancer patients going to an early grave because of such despicable actions are bound to be of very limited success. But that does not mean that I will stop trying to tell the truth:

THERE IS NOT A JOT OF EVIDENCE THAT NATUROPATHY CAN CURE CANCER. SO, PLEASE DO NOT GO DOWN THIS ROUTE!

PS: …and no, I am not paid by BIG PHARMA or anyone else to say so.

 

 

If you had chronic kidney disease (CKD), would you be attracted by an article entitled ‘How to Reduce Creatinine Level in Homeopathy’? (Elevated levels are normally caused by CKD which makes it an important diagnostic test to diagnose the condition) I am sure many patients would! A few days ago, an article with exactly this title caught my eye; it comes from this website. I find it remarkable and cannot resist showing you a short excerpt from it:

START OF QUOTE

…These [homeopathic] medicines work in two ways. First of all, they control the condition so that no more damage is done to the kidneys. Secondly, they start elimination the root causes of renal failure. Unlike allopathic medicines, there are no side effects associated with the use of Homeopathic medicines. If treatment is done in a right, patients starts feeling better within few weeks. After few months, most of the patients are recovered and their kidney starts functioning properly and normally. And then your creatinine level will come down…

Toxin-Removing Treatment for patients with high creatinine level

Here we recommend you another treatment. It is Toxin-Removing Treatment, which is a combination of various Chinese medicine. Compared with homeopathy, Chinese medicine has a particularly longer history. It can expel waste products and extra fluid out of body to make internal environment good for kidney self-healing and other medication application. It can also dilate blood vessels and remove stasis to improve blood circulation and increase blood flow into damaged kidneys so that enough essential elements can be transported into damaged kidneys to speed up kidney recovery. Besides, it can strengthen your immunity to fight against kidney disease. After about one week’s treatment, you will see floccules in urine, which are wastes being passed out. After about half month’s treatment, your high creatinine, high BUN and high uric acid level will go down. After about one month’s treatment, your kidney function will start to increase. With the improvement of renal function, creatinine can be excreted out naturally.

END OF QUOTE

After reading this article some CKD patients might decide to try homeopathy or Chinese Herbal Medicine (CHM) for their condition. This, however, would be very ill-advised.

Why?

Because there is not a jot of evidence to suggest that homeopathy works for CKD. If any homeopath reading this has a different opinion, please show us the evidence.

There is also, as far as I can see, little good evidence to suggest that CHM is effective for CKD. On the contrary, there is quite a bit of evidence to show that CHM can cause kidney damage.

So?

The above article is misleading to the extreme! Or, to put it bluntly, it’s full of lies.

But why is this remarkable? On the Internet, we find thousands of similarly idiotic texts promoting bogus treatments for every disease known to mankind – and nobody seems to bat an eyelash about it. Nobody seems to think that the public needs to be better protected from the habitual liars who write such vile stuff. Many influential people and institutions not merely tolerate such abuse but seem to support it.

Precisely … and this is why I find this article, together with the thousands of similar ones, remarkable.

 

 

Herbal and homeopathic lobby groups have petitioned to stop NHS England from removing herbal and homeopathic medicines: NHS England is consulting on recommendations to remove herbal and homeopathic medicines from GP prescribing. The medicines cost very little and have no suitable alternatives for many patients. Therefore we call on NHS England to continue to allow doctors to prescribe homeopathy and herbal medicine. The petition received around 16 500 signatures.

Now the UK government has responded. I take the liberty of posting the full response below:

Information from NHS England (NHSE) shows that in 2015, the cost for all prescriptions dispensed in primary care, not including any dispensing costs or fees, was £9.27 billion, a 4.7% increase on the previous year. Due to the increasing cost, NHSE is leading a review of medicines which can be considered as being of low clinical value and develop new guidance for Clinical Commissioning Groups (CCGs).

On 21 July, NHSE launched a three month consultation on the draft guidance on low value prescription items which is based on the latest clinical evidence, including that from the National Institute of Health and Care Excellence (NICE). Careful consideration has been given to ensure that particular groups of people are not disproportionately affected, and that principles of best practice on clinical prescribing are adhered to.

The commissioning guidance, upon which NHSE is consulting, will be addressed to CCGs to support them to fulfil their duties around the appropriate use of prescribing resources. This will need to be taken into account by CCGs in adopting or amending their own local guidance to their clinicians in primary care.

The aim of this consultation is to provide individuals with information about the proposed national guidance and to seek people’s views about the proposals. NHSE welcomes the views of the public, patients, clinicians, commissioners and providers through this consultation process to help inform the final guidance. The consultation ends on 21 October. Links to the consultation can be found here:
https://www.england.nhs.uk/2017/07/medicine-consultation/ and
https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/

It is the responsibility of local NHS organisations to make decisions on the commissioning and funding of any healthcare treatments for NHS patients, such as homeopathy, taking account of issues to do with safety, clinical and cost-effectiveness and the availability of suitably qualified and regulated practitioners.

Complementary and alternative medicine (CAMs) treatments can, in principle, feature in a range of services offered by local NHS organisations. A treating clinician would take into account an individual’s circumstances and medical history in deciding what would be the most appropriate treatment for their condition. CCGs will have specific policies on the commissioning and funding of CAMs, and may have also developed local policies on priorities with regards to the funding of treatments. A GP would have to work within such policies in providing any treatments on the NHS.

The Department of Health supports an approach to evidence-based prescribing which does not support the commissioning of services which are not clinically and cost effective. We are not aware of any evidence that demonstrates the therapeutic effectiveness of homeopathic products. The National Institute for Health and Care Excellence (NICE) does not currently recommend that homeopathy should be used in the treatment of any health condition, whilst primary care prescribing data shows that there has been a significant decline in the prescribing of homeopathic products over the last 10 years. Furthermore, a good number of NHS organisations are reviewing their funding of homeopathic treatments and some have already stopped funding such treatment altogether.

Department of Health

END OF QUOTE

This hardly needs a comment. Perhaps just this:

I find phraseology such as “We are not aware of any evidence that demonstrates the therapeutic effectiveness of homeopathic products” regrettable. It enables homeopaths and their supporters to counter that the government or anyone else who use this argument are ill-informed. There are, of course, quite a few positive trials of homeopathy. To deny it is a mistake, in my view, and one that would be easily avoidable.

I would have formulated this sentence differently: “We are not aware that the totality of the reliable evidence demonstrates the therapeutic effectiveness of homeopathic products”.

That is a correct and relevant statement.

Gastro-oesophageal reflux disease (GORD) is a common, benign condition. It can be treated by changing eating habits or drugs. Many alternative therapies are also on offer, for instance, acupuncture. But does it work? Let’s find out.

The objective of this meta-analysis was to explore the effectiveness of acupuncture for the treatment of gastro-oesophageal reflux disease (GORD). Four English and four Chinese databases were searched through June 2016. Randomised controlled trials investigating the effectiveness of manual acupuncture or electroacupuncture (MA/EA) for GORD versus or as an adjunct to Western medicine (WM) were selected.

A total of 12 trials involving 1235 patients were included. The results demonstrated that patients receiving MA/EA combined with WM had a superior global symptom improvement compared with those receiving WM alone  with no significant heterogeneity. Recurrence rates of those receiving MA/EA alone were lower than those receiving WM  with low heterogeneity, while global symptom improvement (six studies) and symptom scores (three studies) were similar. Descriptive analyses suggested that acupuncture also improves quality of life in patients with GORD.

The authors concluded that this meta-analysis suggests that acupuncture is an effective and safe treatment for GORD. However, due to the small sample size and poor methodological quality of the included trials, further studies are required to validate our conclusions.

I am glad the authors used the verb ‘suggest’ in their conclusions. In fact, even this cautious terminology is too strong, in my view. Here are 9 reasons why:

  1. The hypothesis that acupuncture is effective for GORD lacks plausibility.
  2. All the studies were of poor or very poor methodological quality.
  3. All but one were from China, and we know that all acupuncture trials from this country are positive, thus casting serious doubt on their validity.
  4. Six trials had the infamous ‘A+B versus B’ design which never generates a negative result.
  5. There was evidence of publication bias, i. e. negative trials had disappeared and were thus not included in the meta-analysis.
  6. None of the trials made an attempt to control for placebo effects by using a sham-control procedure.
  7. None used patient-blinding.
  8. The safety of a therapy cannot be assessed on the basis of 12 trials
  9. Seven studies failed to report adverse effects, thus violating research ethics.

Considering these facts, I think that a different conclusion would have been more appropriate:  this meta-analysis provides no good evidence for the assumption that acupuncture is an effective and safe treatment for GORD.

This is the question asked by the American Chiropractic Association. And this is their answer [the numbers in square brackets were inserted by me and refer to my comments below]:

Chiropractic is widely recognized [1] as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints [2]. Although chiropractic has an excellent safety record [3], no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small [4]. Many patients feel immediate relief following chiropractic treatment [5], but some may experience mild soreness, stiffness or aching, just as they do after some forms of exercise [6]. Current research shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours [7]…

Some reports have associated high-velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection [8]. However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease [9]. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon [10]. Patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or family physician—but that care is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare—about one to three cases in 100,000 patients who get treated with a course of care [11]. This is similar to the incidence of this type of stroke among the general population [12]…

When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition [13]. In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favorably with even the most conservative care options. For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) and prescription painkillers—are significantly greater than those of chiropractic manipulation [14]…

Doctors of chiropractic are well trained professionals who provide patients with safe, effective care for a variety of common conditions. Their extensive education has prepared them to identify patients who have special risk factors [15] and to get those patients the most appropriate care, even if that requires referral to a medical specialist [16].

END OF QUOTE

  1. Appeal to tradition = fallacy
  2. and every other condition that brings in cash.
  3. Not true.
  4. Probably not true.
  5. The plural of anecdote is anecdotes, not evidence.
  6. Not true, the adverse effects of spinal manipulation are different and more severe.
  7. Not true, they last 1-3 days.
  8. Not just ‘some reports’ but a few hundred.
  9. Which does not mean that spinal manipulation cannot provoke such events.
  10. True, but this does not mean that spinal manipulation cannot provoke such events.
  11. There are other estimates that gives much higher figures; without a proper monitoring system, nobody can provide an accurate incidence figure.
  12. Not true, see above.
  13. ‘Available’ is meaningless – ‘effective’ is what we need here.
  14. The difference between different treatments is not merely their safety but also their effectiveness; in the end it is the risk/benefit balance that determines their value.
  15. Not true, there are no good predictors to identify at-risk populations.
  16. Chiropractors are notoriously bad at referring to other healthcare professionals; they have a huge conflict of interest in keeping up their cash-flow.

So, is chiropractic a safe treatment?

My advice here is not to ask chiropractors but independent experts.

 

‘Chiropractic is safe’ is a statement by Dr Arleen Scholten (see below) and thousands of other chiropractors like her. This sentence seems to be a nice marketing slogan – but sadly it is far removed from reality:

How many such serious events have occurred is anyone’s guess. The reason for this uncertainty is that there is no monitoring system that would give us this information. About 500 serious complications have been published in the medical literature. But these published cases are just the tip of a much bigger iceberg. We have shown that under-reporting is close to 100%.

This means that the vast majority of these cases remain completely undocumented. Some appear in the popular press, like the one recently published in the DAILY MAIL:

A chiropractor has been arrested on suspicion of manslaughter after a retired bank manager died following treatment for backache.

John Lawler, 80, was undergoing routine treatment at a private clinic when he lost consciousness and appeared to have become paralysed from the shoulders down. He was taken straight to hospital but died the next day as a result of a ‘traumatic spinal cord injury.’

His wife of 55 years, Joan Lawler, 81, was in the chiropractor’s clinic with her husband and witnessed the incident. Police are investigating to establish whether or not criminal negligence was a factor in his death.

Dr Arleen Scholten, 40, the chiropractor who treated Mr Lawler, was arrested by police on suspicion of manslaughter and released pending further inquiries.

Mr Lawler, a former Barclays Bank manager, was an active and healthy grandfather who lived in York. It is understood he was taken ill on his third visit in a week to Chiropractic 1st – a clinic within walking distance of the family home. He was seen by Dr Scholten, a chiropractor and director of the company, on Friday, August 11 and was undergoing treatment on his back when the unexpected and fatal problem occurred.

Mr Lawler was taken to York District Hospital by ambulance before being transferred to Leeds General Infirmary when the seriousness of his condition became clear.

END OF QUOTE

DOCTOR Scholten tells us on her website that we get to help people who suffer from a variety of health issues. Naturally, chiropractic helps traditional neck and back problems, but chiropractic has also produced wonderful results with a variety of organic and systemic problems. Chiropractic is safe.*** Chiropractic is natural. And Chiropractic works!

Doctor Scholten also informs us that our children were all adjusted the day they were born, 2 were homebirths and I continue to check their spines regularly. There is a saying in Chiropractic ‘If the twig is bent so grows the tree’.

Say no more!

(*** my emphasis)

 

 

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