alternative medicine
I have written about this subject before, and I probably will do so again. The reason for my insistence is simple: some homeopathy-fans’ attitude towards and advice about immunizations is, in my view, nothing short of a scandal. Here are excerpts from two articles published in the current issue of ‘HOMEOPATHY 4 EVERYONE’ which amply explain what I mean.
The first paper is by Alan Phillips, a leading U.S. vaccine rights attorney and self-declared fan of homeopathy. It goes through the usual arguments suggesting that immunizations are not effective, outright harmful and a vicious ploy to enrich the pharmaceutical industry at the cost of public health. Subsequently, the author gives advice as to how US citizens can avoid mandatory immunizations:
God bless homeopathy! A particularly wonderful example was in Cuba in the fall of 2008, when homeoprophylaxis was used in place of allopathic immunizations to respond to a leptospirosis outbreak. Two and a half million people were each given 2 doses of a remedy, and the results not only substantially exceeded prior experience with vaccines, it was about 1/15 the cost! And to the best of my knowledge, there are no serious adverse events with homeopathy as there are with virtually any widespread use of vaccines. The failure of our government health agencies to seize upon the Cuban and other homeoprophylaxis successes by aggressively pursuing further research in this area, and the incorporation of homeoprophylaxis into standard infectious disease control strategies, reveals a public health policy driven by something other than the best health interests of the members of our society.
With all of the problems in the allopathic world, and obvious safe and effective alternatives to immunizations that are being systematically ignored, it’s no wonder that a growing number of people are looking for ways to legally avoid immunization mandates. Ironically, vaccines are being required in greater and greater numbers for more and more people. The reason is simple: The federal government subsidizes vaccine research and development; state and federal governments mandate vaccines; state and federal governments purchase vaccines; and state and federal governments compensate those injured or killed by vaccines. So, for those who are able to throw ethics and morality out the window without a second thought, there’s a racket here offering profound profits, and a convenient vehicle for injecting who knows what into literally billions of people worldwide. The multi-billion dollar international vaccine industry is projected to grow at some 10-12% annually for the next several years…
So you’ve done your research, and you’ve decided that you’d like to postpone, or even forego some or all vaccines altogether. Can you do that? How do you do that? Well, it depends on your specific situation…
Fortunately, everywhere vaccines are mandated in the U.S., one or more exemptions are available…
Medical exemptions can be hard to get. They usually require the support of a medical doctor, and there are usually specific, narrow criteria that must be met to qualify… So, if you’re considering a medical exemption, make sure you find out first what qualifies for the exemption in your specific situation; and if you can get a doctor to support you for a qualifying reason, then pursuing a medical exemption may be an appropriate route to take.
Religious exemptions are probably the most commonly used exemption. What qualifies is a topic too lengthy for an article, but in brief, it doesn’t require membership in an organized religion, and it doesn’t matter what religion you belong to, if you do belong to one…
Philosophical exemptions, when available, are great in that they don’t require you to justify your beliefs or to state reasons. But states have been changing laws to make them harder to get… The long-held notion of a presumed net benefit from vaccines has been slowly undermined by medical science, though the medical authorities, increasingly controlled by the pharmaceutical industry, continue to actively suppress this reality to the best of their ability… However, in those religious exemption situations where you are required to state your beliefs, and where the authorities involved have authority to scrutinize your beliefs, it is highly advisable to seek out professional help from an experienced attorney…
The second article is by Fran Sheffield, a homeopath from NSW, who began her homeopathic studies after “seeing the benefits homeopathy brought to her vaccine-injured child”, and a founding member of ‘The Do No Harm Initiative Inc.’, a lobby group misinforming communities and governments about ‘homeopathic immunisation’:
Homeoprophylaxis has a remarkable record of safety – vaccines less so. From the homeopath’s point of view they are still associated with risks: the dose is too strong, they have toxic additives, and they’re given by inappropriate pathways.
Homeoprophylaxis has avoided these problems. It’s also versatile, inexpensive, quick to produce and easy to distribute.
Keeping these points in mind, I’ll return to Von Behring who went on to say:
“I am touching here upon a subject anathematized till very recently by medical penalty: but if I am to present these problems in historical illumination, dogmatic imprecations must not deter me”…
The same sentiments are true today – dogma and penalty must not be allowed to restrict information on homeoprophylaxis or deprive others of this safe, simple option. The time has come for all of us – governments and individuals – to take a closer look at homeoprophylaxis and how it relieves the burden of disease…
Future posts show what I did with the prophylactic information, why some were offended or upset, the inevitable backlash that followed, attempts at intimidation and suppression, what happens when a matter like this goes to court, what is lost when we don’t speak out about the truth, and what we should do for the future.
I think I will abstain from any comment; if I did, I would be in danger of being libellous. However, I do hope that my readers will post their opinions freely.
One of the questions I hear regularly is ‘HOW DO THE EFFECTS OF THIS ALTERNATIVE TREATMENT COMPARE TO THOSE OF CONVENTIONAL OPTIONS’? Take acupuncture in the management of osteoarthritis, for instance. There is some encouraging evidence suggesting it might help. The most recent systematic review that I know of concluded that “acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment.” However, in order to estimate its value in practice, we ought to know whether it is as good as or perhaps even better than standard treatments. In other words, what we really want to know is its relative effectiveness.
Data to evaluate the relative effectiveness of acupuncture or other alternative therapies are hard to come by. Ideally, one would require clinical trials which provide direct comparisons between the alternative and the conventional therapy. Sadly, such studies are scarce or even non-existent. Therefore we might have to rely on more indirect evidence. A new paper could be a step in the right direction.
The aim of this systematic review was to critically evaluate existing osteoarthritis (OA) management guidelines to better understand potential issues and barriers.
A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, two authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality; three generated summary recommendations based on the extracted guideline data.
Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol for first line treatment and oral or topical NSAIDs for second line therapy. Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin.
I think that this tells us fairly clearly that, compared to other options, acupuncture is not considered to be an overwhelmingly effective treatment for osteoarthritis by those who understand that condition best. Several other therapies seem to be preferable because the evidence is clearer and stronger and their effect sizes is larger. This, I think begs the question whether it is in the best interest of patients or indeed ethical to ignore this knowledge and recommend acupuncture as a treatment of osteoarthritis.
More generally speaking, we should always bear in mind that it is not enough proving a therapy to be effective; we usually also need to consider what else is on offer. And if you think that this is rather complex, you are, of course, correct – but wait until someone mentions issues such as safety and cost of all the relevant therapeutic options.
I am constantly on the look-out for good studies of alternative medicine, particularly those that yield positive findings. The trouble is that there aren’t many of those; studies tend to be either good or positive. Could this one be an exception?
The aim of this brand-new trial was to determine, if dietary supplements of glucosamine and/or chondroitin, result in reduced joint space narrowing (JSN) and pain in patients with knee osteoarthritis. It was designed as a double-blind randomised placebo-controlled clinical trial with 2-year follow-up. 605 participants, aged 45–75 years, reporting chronic knee pain and with evidence of medial tibio-femoral compartment narrowing (but retaining >2 mm medial joint space width) were randomised to once daily: glucosamine sulfate 1500 mg (n=152), chondroitin sulfate 800 mg (n=151), both of these dietary supplements (n=151) or placebo capsules (n=151). JSN (mm) over 2 years was measured from digitised knee radiographs. Maximum knee pain (0–10) was self-reported in a participant diary for 7 days every 2 months over 1 year.
The results indicate that, after adjusting for factors associated with structural disease progression (gender, body mass index (BMI), baseline structural disease severity and Heberden’s nodes), allocation to the dietary supplement combination (glucosamine–chondroitin) resulted in a statistically significant (p=0.046) reduction of 2-year JSN compared to placebo: mean difference 0.10 mm (95% CI 0.002 mm 0.20 mm); no significant structural effect for the single treatment allocations was detected. All 4 groups demonstrated reduced knee pain over the first year, but no significant between-group differences (p=0.93) were detected. 34 (6%) participants reported possibly-related adverse medical events over the 2-year follow-up period.
The authors drew the following conclusions: allocation to the glucosamine–chondroitin combination resulted in a statistically significant reduction in JSN at 2 years. While all allocation groups demonstrated reduced knee pain over the study period, none of the treatment allocation groups demonstrated significant symptomatic benefit above placebo.
This study has many strengths: it addresses a relevant research question, has a sufficiently large sample size, includes a long follow-up, and is well reported. So, it is a good study of an alternative therapy that is used by many patients. But did it really produce a positive result, i.e. findings which suggest that the tested treatments are effective? The answer seems ‘yes and no’. The combined, regular intake of both supplements caused less joint space narrowing which is a good objective sign of reduced disease activity. However, this was not paralleled by a reduction in pain that was better than that on placebo.
So, if you are a fan of glucosamine/chondroitin supplements, you will be pleased with this study, but if you are not in favour of such medications or do not have the spare cash to afford the considerable costs, you might say: I told you, they are pretty useless!
A recent survey included a random sample of 1179 Brits who were asked about their attitude towards and usage of homeopathy as well as other forms of alternative medicine (AM). The results indicate that a slim majority had never used AM at all. The most popular treatments within the group of AM-users were herbal medicines, homeopathy and acupuncture.
Perhaps because they are more up-to-date, these findings are considerably different from our own results obtained from the Health Survey for England 2005. We used data of all 7630 respondents and showed that lifetime and 12-month prevalence of AM-use were 44.0% and 26.3% respectively; 12.1% had consulted a practitioner in the preceding 12 months. Massage, aromatherapy and acupuncture were the most commonly used therapies. Twenty-nine percent of respondents taking prescription drugs had used AM in the last 12 months. Women, university educated respondents, those suffering from anxiety or depression, people with poorer mental health and lower levels of perceived social support, people consuming ≥ 5 portions of fruit and vegetables a day were significantly more likely to use AM.
In the new survey, a quarter of those not using homeopathy said this was because they had never heard of it; a third because they had never been advised to use it and/or that they’d never had an illness that required it; and 3% said it was because homeopathic remedies were too expensive. About a quarter of non-users said that they avoided homeopathy because they didn’t believe that it worked, or that conventional medicine worked better.
Of the homeopathy-users, 49% said they were “willing to try anything and didn’t think it could do any harm”. Only 16% claimed to use it because they believed it worked better than conventional medicine. This means that only around 3% of the population have used homeopathy because of a belief that it works where conventional medicine doesn’t. The rest either have not used it, or used it for other reasons.
The researchers arrived at the following conclusions and predictions: Our research suggests that nearly half of the public don’t believe and act as if AM and conventional medicine are at odds. Coupled with the significant global industry that has grown up around AM, it is easy to see why politicians have been unwilling to respond to the clear evidence that homeopathy and AM are ineffective. In the US, it’s a $34bn industry where half of people report using them.
The competition between proponents and opponents of AM in all likelihood is set to continue. But there’s some evidence that better science education can help people to distinguish between scientific and pseudo-scientific claims, and it appears that at least some of the openness to AM might stem from concerns about how medical research is regulated. And it is these that might hold the key to who ultimately comes out of the ring in better shape.
There are dozens of observational studies of homeopathy which seem to suggest – at least to homeopaths – that homeopathic treatments generate health benefits. As these investigations lack a control group, their results can be all to easily invalidated by pointing out that factors like ‘regression towards the mean‘ (RTM, a statistical artefact caused by the phenomenon that a variable that is extreme on its first measurement tends to be closer to the average on its second measurement) might be the cause of the observed change. Thus the debate whether such observational data are reliable or not has been raging for decades. Now, German (pro-homeopathy) investigators have published a paper which potentially could resolve this dispute.
With this re-analysis of an observational study, the investigators wanted to evaluate whether the observed changes in previous cohort studies are due to RTM and to estimate RTM adjusted effects. SF-36 quality-of-life (QoL) data from a cohort of 2827 chronically diseased adults treated with homeopathy were reanalysed using a method described in 1991 by Mee and Chua’s. RTM adjusted effects, standardized by the respective standard deviation at baseline, were 0.12 (95% CI: 0.06-0.19, P < 0.001) in the mental and 0.25 (0.22-0.28, P < 0.001) in the physical summary score of the SF-36. Small-to-moderate effects were confirmed for most individual diagnoses in physical, but not in mental component scores. Under the assumption that the true population mean equals the mean of all actually diseased patients, RTM adjusted effects were confirmed for both scores in most diagnoses.
The authors reached the following conclusion: “In our paper we showed that the effects on quality of life observed in patients receiving homeopathic care in a usual care setting are small or moderate at maximum, but cannot be explained by RTM alone. Due to the uncontrolled study design they may, however, completely be due to nonspecific effects. All our analyses made a restrictive and conservative assumption, so the true treatment effects might be larger than shown.”
Of course, the analysis heavily relies on the validity of Mee and Chua’s modified t-test. It requires the true mean in the target population to be known, a requirement that seldom can be fulfilled. The authors therefore took the SF-36 mean summary scores from the 1998 German health survey as proxies. I am not a statistician and therefore unable to tell how reliable this method might be (- if there is someone out there who can give us some guidance here, please post your comment).
In order to make sense of these data, we need to consider that, during the study period, about half of the patients admitted to have had additional visits to non-homeopathic doctors, and 27% also received conventional drugs. In addition, they would have benefitted from:
- the benign history of the conditions they were suffering from,
- a placebo-effect,
- the care and attention they received
- and all sorts of other non-specific effects.
So, considering these factors, what does this interesting re-analysis really tell us? My interpretation is as follows: the type of observational study that homeopaths are so fond of yields false-positive results. If we correct them – as the authors have done here for just one single factor, the RTM – the effect size gets significantly smaller. If we were able to correct them for some of the other factors mentioned above, the effect size would shrink more and more. And if we were able to correct them for all confounders, their results would almost certainly concur with those of rigorously controlled trials which demonstrate that homeopathic remedies are pure placebos.
I am quite sure that this interpretation is unpopular with homeopaths, but I am equally certain that it is correct.
Cancer patients are understandably desperate and leave no stone unturned to improve their prognosis. Thus they become easy prey of charlatans who claim that this or that alternative therapy will cure them or improve their outlook. One of the most popular alternative cancer therapies is mistletoe, a treatment dreamt up by Rudolf Steiner on the basis of the ‘like cures like’ principle: the mistletoe plant grows on a host tree like a cancer in the human body. One of many websites on this subject, for instance, states:
Mistletoe therapy
- integrates with conventional cancer treatments
- can be used for a wide range of cancers
- may be started at any stage of the illness….
potential benefits…include:
- Improved quality of life
- generally feeling better
- increased appetite and weight
- less tired/more energy
- reduced pain
- better sleep pattern
- felling more hopeful and motivated
- reduced adverse effects from chemo and radiotherapy
- reduced risk of cancer spread and recurrence
- increased life expectancy.
Mistletoe extracts have been shown in studies to:
- stimulate the immune system
- cause cancer cell death
- protect healthy cells against harmful effects of radiation and chemotherapy.
In fact, the debate about the efficacy of mistletoe either as a cancer cure, a supportive therapy, or a palliative measure is often less than rational and seems never-ending.
The latest contribution to this saga comes from US oncologists who published a phase I study of gemcitabine (GEM) and mistletoe in advanced solid cancers (ASC). The trial was aimed at evaluating: (1) safety, toxicity, and maximum tolerated dose (MTD), (2) absolute neutrophil count (ANC) recovery, (3) formation of mistletoe lectin antibodies (ML ab), (4) cytokine plasma concentrations, (5) clinical response, and (6) pharmacokinetics of GEM.
A total of 44 study participants were enrolled; 20 were treated in stage I (mistletoe dose escalation phase) and 24 in stage II (gemcitabine dose escalation phase). All patients had stage IV disease; the majority had received previous chemo-, hormonal, immunological, or radiation therapy, and 23% were chemotherapy-naïve.
Patients were treated with increasing doses of a mistletoe-extract (HELIXOR Apis (A), growing on fir trees) plus a fixed GEM dose in stage I, and with increasing doses of GEM plus a fixed dose of mistletoe in stage II. Response in stage IV ASC was assessed with descriptive statistics. Statistical analyses examined clinical response/survival and ANC recovery.
The results show that dose-limiting toxicities were neutropenia, thrombocytopenia, acute renal failure, and cellulitis, attributed to mistletoe. GEM 1380 mg/m2 and mistletoe 250 mg combined were the MTD. Of the 44 patients, 24 developed non-neutropenic fever and flu-like syndrome. GEM pharmacokinetics were unaffected by mistletoe. All patients developed ML3 IgG antibodies. ANC showed a trend to increase between baseline and cycle 2 in stage I dose escalation.
6% of patients showed a partial response, and 42% had stable disease. Of the 44 study participants, three died during the study, 10 participants requested to terminate the study, 23 participants progressed while on study, one terminated the study due to a dose limiting toxicity, 6 left due to complicating disease issues which may be tied to progression, and one voluntarily withdrew.
An attempt was made to follow study subjects once they terminated study treatment until death. At the last attempt to contact former participants, three were still alive and five others were lost to follow-up. The median time to death of any cause was approximately 200 days. Compliance with mistletoe injections was high.
The authors explain that a partial response rate of 6% is comparable to what would be expected from single agent gemcitabine in this population of patients with advanced, mostly heavily pretreated carcinomas. The median survival from study enrollment of about 200 days is within the range of what would be expected from single agent gemcitabine.
The authors concluded that GEM plus mistletoe is well tolerated. No botanical/drug interactions were observed. Clinical response is similar to GEM alone.
These results are hardly encouraging but they originate from just one (not particularly rigorous) study and might thus not be reliable. So, what does the totality of the reliable evidence tell us? Our 2003 systematic review of 10 RCTs found that none of the methodologically stronger trials exhibited efficacy in terms of quality of life, survival or other outcome measures. Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy.
Will this stop the highly lucrative trade in mistletoe extracts? will it prevent desperate cancer patients being misled about the value of mistletoe treatment? I fear not.
Continuing on the theme from my previous post, a website of a homeopath (and member of the UK ‘Society of Homeopaths’) caught my attention. In in it, Neil Spence makes a wide range of far-reaching statements. Because they seem rather typical of the claims made by homeopaths, I intent to scrutinize them in this post. For clarity, I put the (unaltered and unabbreviated) text from Neil Spence’s site in italics, while my own comments are in Roman print.
The holistic model of health says all disease comes from a disturbance in the vitality (life force) of the body. The energetic disturbance creates symptoms in the mind, the emotions and the physical body. Each patient has their own store of how this disturbance in vitality came about and each person has individual symptoms.
What is a ‘holistic model of health’, I wonder? Holism in health care means to treat patients as whole individuals which is a hallmark of any good health care; this means that all good medicine is holistic.
Holism and vitalism are two separate things entirely. Vitalism is the obsolete notion of a vital force or energy that determines our health. ‘Disturbances in vitality’ are not the cause of illness.
We will attempt, as far as possible, to treat the whole person and to change the conditions that created your susceptibility to cancer.
Much of the susceptibility to cancer is genetically determined and cannot be altered homeopathically.
Using Homeopathy to treat people with cancer
Homeopathic treatment can help someone with cancer. It can also be helpful for people who have a history of cancer in their family or have cared for a relative or friend with cancer. There are a number of methods of using homeopathic remedies to help people with cancer.
There is no good evidence that homeopathic remedies are effective for cancer patients or their carers.
Constitutional treatment: Treat the person who suffers the illness. A constitutional homeopathic remedy suits your nature as a person and its symptom picture reflects the unique expression of your symptoms. It can arouse the bodyʼs natural ability to heal itself and this can have profound benefits. It is appropriate if your vitality is strong.
There is no evidence that constitutional homeopathic treatments increase the body’s self-healing ability.
Stimulate the immune system to fight cancer: Remedies can be used to help the body fight the cancer, using specific homeopathic remedies called nosodes. A second treatment may be used to support the weakened organ. This method is most useful for people who are not using chemotherapy or radiotherapy.
There is no evidence that nosodes or other homeopathic remedies have any effect on the immune system ( – if they did, they would be contra-indicated for people suffering from auto-immune diseases).
Support the failing organs and the functions of the body that are not working: Remedies can be used to support weakened organs; to help with appetite; to help sleep and to treat sleep disturbances; to reduce the toxic symptoms; to help the body eliminate toxins. These treatments are helpful to people undergoing chemotherapy or radiotherapy.
For none of these claims is there good evidence; they are pure fantasy. The notion that homeopathy can help eliminate toxins is so wide-spread that it merits a further comment. It would be easy to measure such a detoxifying effect, but there is no evidence that it exists. Moreover, I would question whether, in the particular situation of a cancer patient on chemotherapy, a hastened elimination of the toxin (= chemotherapeutic agent) would be desirable; it would merely diminish the efficacy of the chemotherapy and reduce the chances of a cure.
Treat the pain: Homeopathic remedies can be very effective in aiding pain control. Remedies such as calendula can be effective in situations of intractable pain. If the cancer is at the terminal stage, remedies can be used to increase the quality of life. These remedies are palliative and can assist the patient keep mentally and emotionally alert so they can have quality time with loved ones.
Where is the evidence? Pain can obviously be a serious problem for cancer patients, and the notion that calendula in homeopathic dilutions reduces pain such that it significantly improves quality of life is laughable. Conventional medicine has powerful drugs to alleviate cancer pain but even they sometimes do not suffice to make patients pain-free.
Homeopathy in conjunction with other therapies
When a patient chooses to use chemotherapy or radiotherapy to treat their cancer the homeopath will prescribe remedies to support the body and ease the side-effects. Remedies can also be very useful after surgery to encourage the body to heal and allow greater mobility at an early stage.
Again no good evidence exists to support these claims – pure fantasy.
Other therapies can complement homeopathy but the homeopath will advise that you do not use every therapy just because they are available. It may be better to choose two or perhaps three main approaches to improving your health and ensure each one has positive effects that suit you very well.
Is he saying that cancer patients are best advised to listen to a homeopath rather than to their oncology-team? Is he encouraging them to not use all possible mainstream options available? If so, he is most irresponsible.
Each person will have different needs. It is always appropriate to change your diet. Nutritional and dietary advice is of the utmost importance to support the bodyʼs healing process. Cancer has many symptoms of disturbed metabolism and a poor diet has often contributed to the disturbance in the body that allowed the cancer to flourish. It is essential to remedy this situation. Nutritional advice puts you back in charge of your body; with good homeopathic treatments this provides the basis for improving your health.
Dietary advice can be useful and is therefore routinely provided by professionals who understand this subject much better than the average homeopath.
CONCLUSION
The thought that some cancer patients might be following such recommendations is most disturbing. Advice of this nature has doubtlessly the potential to significantly shorten the life and decrease the well-being of cancer patients. People who recommend treatments that clearly harm vulnerable patients are charlatans who should not be allowed to treat patients.
THERE WILL NEVER BE AN ALTERNATIVE CANCER CURE
This statement contradicts all those thousands of messages on the Internet that pretend otherwise. Far too many ‘entrepreneurs’ are trying to exploit desperate cancer patients by making claims about alternative cancer ‘cures’ ranging from shark oil to laetrile and from Essiac to mistletoe. The truth is that none of them are anything other than bogus.
Why? Let me explain.
If ever a curative cancer treatment emerged from the realm of alternative medicine that showed any promise at all, it would be very quickly researched by scientists and, if the results were positive, instantly adopted by mainstream oncology. The notion of an alternative cancer cure is therefore a contradiction in terms. It implies that oncologists are mean bastards who would, in the face of immense suffering, reject a promising cure simply because it did not originate from their own ranks.
BUT THAT DOES NOT NECESSARILY MEAN THAT ALTERNATIVE CANCER TREATMENTS ARE USELESS
So, let’s forget about alternative cancer ‘cures’ and let’s once and for all declare the people who sell or promote them as charlatans of the worst type. But some alternative therapies might nevertheless have a role in oncology – not as curative treatments but as supportive or palliative therapies.
The aim of supportive or palliative cancer care is not to cure the disease but to ease the suffering of cancer patients. According to my own research, promising evidence exists in this context, for instance, for massage, guided imagery, Co-enzyme Q10, acupuncture for nausea, and relaxation therapies. For other alternative therapies, the evidence is not supportive, e.g. reflexology, tai chi, homeopathy, spiritual healing, acupuncture for pain-relief, and aromatherapy.
So, in the realm of supportive and palliative care there is both encouraging as well as disappointing evidence. But what amazes me over and over again is the fact that the majority of cancer centres employing alternative therapies seem to bother very little about the evidence; they tend to use a weird mix of treatments regardless of whether they are backed by evidence or not. If patients like them, all is fine, they seem to think. I find this argument worrying.
Of course, every measure that increases the well-being of cancer patients must be welcome. But this should not mean that we disregard priorities or adopt any quackery that is on offer. In the interest of patients, we need to spend the available resources in the most effective ways. Those who argue that a bit of Reiki or reflexology, for example, is useful – if only via a non-specific (placebo) effects – seem to forget that we do not require quackery for patients to benefit from a placebo-response. An evidence-based treatment that is administered with kindness and compassion also generates specific non-specific effects. In addition, such treatments also generate specific effects. Therefore it would be a disservice to patients to merely rely on the non-specific effects of bogus treatments, even if the patients do experience some benefit from them.
ALTERNATIVE ‘PAMPERING’ AS A COMPENSATION FOR INADEQUACIES IN THE SYSTEM?
So, why are unproven or disproven treatments like Reiki or reflexology so popular for cancer palliation? This question has puzzled me for years, and I sometimes wonder whether some oncologists’ tolerance of quackery is not an attempt to compensate for any inadequacies within the routine service they deliver to their patients. Sub-standard care, unappetising food, insufficient pain-control, lack of time and compassion as well as other problems undoubtedly exist in some cancer units. It might be tempting to assume that such deficiencies can be compensated by a little pampering from a reflexologist or Reiki master. And it might be easier to hire a few alternative therapists for treating patients with agreeable yet ineffective interventions than to remedy the deficits that may exist in basic conventional care.
But this strategy would be wrong, unethical and counter-productive. Empathy, sympathy and compassion are core features of conventional care and must not be delegated to quacks.
Times of celebration are often also times of over-indulgence and subsequent suffering. Who would not know, for instance, how a hangover can spoil one’s pleasure at the start of a new year? But where is the research that addresses this problem? Scientists seem to be cynically devoid of sympathy for the hangover-victim – well, not all scientists.
During the course of my research-career, I must have conducted well over 60 clinical trials, but none was remotely as entertaining as the one my Exeter-team did several years ago to test whether an artichoke extract is effective in preventing the signs and symptoms of alcohol-induced hangover.
We recruited healthy adult volunteers from our own ranks to participate in a randomized double-blind crossover trial. Participants received either 3 capsules of commercially available standardized artichoke extract or indistinguishable, inert placebo capsules immediately before and after alcohol exposure. After a 1-week washout period the volunteers received the opposite treatment. Each participant predefined the type and amount of alcoholic beverage that would give him/her a hangover and ate the same meal before commencing alcohol consumption on the two study days. The primary outcome measure was the difference in hangover severity scores between the artichoke extract and placebo interventions. Secondary outcome measures were differences between the interventions in scores using a mood profile questionnaire and cognitive performance tests administered 1 hour before and 10 hours after alcohol exposure.
The mean number of alcohol units consumed per person during treatment with artichoke extract and placebo were 10.7 and 10.5 respectively, equivalent to 1.2 g of alcohol per kilogram body weight. The volume of non-alcoholic drink consumed and the duration of sleep after the binge were similar during the artichoke extract and placebo interventions. The hangovers we experienced the mornings after our alcohol exposure were monumental but unaffected by the treatments. None of the outcome measures differed significantly between interventions. Adverse events of the treatment were rare and were mild and transient. Our results therefore suggested that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover.
While it was great fun to obtain ethic’s approval and run this trial, the results of our two binges in the name of science were, of course, a disappointment. As diligent researchers we felt we had to do a little more for the poor victims of over-indulgence.
We thus decided to conduct a systematic review aimed at assessing the clinical evidence on the effectiveness of any medical intervention for preventing or treating alcohol hangover. We conducted systematic searches to identify all RCTs of any medical intervention for preventing or treating alcohol hangover. Fifteen potentially relevant trials were found. Seven publications failed to meet all inclusion criteria. Eight RCTs assessing 8 different interventions were reviewed. The agents tested were propranolol, tropisetron, tolfenamic acid, fructose or glucose as well as the dietary supplements Borago officinalis (borage), Cynara scolymus (artichoke), Opuntia ficus-indica (prickly pear), and a yeast based preparation. All studies were double blind. Significant intergroup differences for overall symptom scores and individual symptoms were reported only for tolfenamic acid, gamma linolenic acid from borage, and a yeast based preparation.
We concluded that the most effective way to avoid the symptoms of alcohol induced hangover is to practise abstinence or moderation.
WISE WORDS PERHAPS, BUT EASIER SAID THAN DONE, I’M SURE.
2013 has been an extremely busy year on this blog. We have had so many posts and comments that it is hard to decide which were the best, most important or most thought-provoking. The following selection is an entirely subjective and personal choice. I have copied the titles of the chosen posts and linked them to the original; in addition, I have selected a short conclusion from each post to provide an impression of its content so that, if interested, you can easily read the whole thing.
Prince Charles’ vision of a “post-modern medicine”
I don’t think anyone doubts that medicine needs improving. However, I do doubt that Charles’ vision of a “post-modern medicine” is the way to achieve improvement – in fact, I fear that it would lead us straight back to the dark ages.
Research in chiropractic seems in a dismal state
So, what does this tiny investigation suggest? … I think it supports the hypothesis that research into chiropractic is not very active, nor high quality, nor does it address the most urgent questions.
Three fallacies for the price of one!
The often-used and seemingly reasonable sentence “I don’t care how it works, as long as it is helpful” turns out to be a package of fallacies used to support the use of unproven treatments.
I think it is regrettable that the journal ‘Homeopathy’ has now lost the only editorial board member who had the ability to openly and repeatedly display a critical attitude about homeopathy – remember: without a critical attitude progress is unlikely!
Saving lives with alternative medicine research?
For 20 years, I have tried my best to dispel these dangerous myths and fallacies. In doing so, I had to fight many tough battles (sometimes even with the people who should have protected me, e.g. my peers at Exeter university), and I have the scars to prove it. If, however, I did save just one life by conducting my research into the risks of alternative medicine and by writing about it, the effort was well worth it.
“Strictly confidential”- for chiropractors only
The most remarkable aspect is that the BCA seems to attempt to silence its own members regarding the controversy about the value of their treatments. Instead they proscribe answers (should I say doctrines?) of highly debatable accuracy for them, almost as though chiropractors were unable to speak for themselves. To me, this smells of cult-like behaviour, and is by no means indicative of a mature profession – despite their affirmations to the contrary.
EBM and how it is abused in alternative medicine
To pretend that external evidence can be substituted by something else is erroneous and introduces double standards which are not acceptable – not because this would be against some bloodless principles of nit-picking academics, but because it would not be in the best interest of the patient. And, after all, the primary concern of EBM has to be the patient.
Time to re-write the guidelines on spinal manipulation for low back pain
The conclusion of such considerations is, I fear, obvious: the value of and need for these two professions [chiropractors and osteopaths] should be re-assessed.
Where is the line between poor and unethical research?
Unethical research of this nature should be prevented, and the existing mechanisms to achieve this aim must be strengthened.
Alternative medicine promotion dressed up as research
It is time that AM investigators focus on real research answering important questions which advance our knowledge, that AM-journal editors stop publishing meaningless nonsense, and that decision-makers understand the difference between promotion dressed up as science and real research.
Alternative medicine, is it a cult?
There are many other parallels between a cult and alternative medicine, I am sure. In my view, the most striking one must be the fact that any spark of cognitive dissonance in the cult-victim is being extinguished by highly effective and incessant flow of misinformation which often amounts to a form of brain-washing.
The “competent homeopath”, a contradiction in terms?
If a clinician practices evidence-based medicine, he/she cannot possibly practice homeopathy – the evidence shows that homeopathy is a placebo-therapy. So, here we have it: a competent homeopath has to be a contradiction in terms because either someone practices homeopathy or he/she practices evidence-based medicine. Doing both at the same time is simply not possible.
Why ‘patient choice’ does not apply to alternative medicine
To be meaningful, ethical and responsible, choice needs to be guided by sound evidence – if not, it degenerates into irresponsible arbitrariness, and health care deteriorates into some kind of Russian roulette. To claim, as some fans of alternative medicine do, that the principle of PATIENT CHOICE gives everyone the right to use unproven treatments at the expense of the taxpayer is pure nonsense. But some extreme proponents of quackery go even further; they claim that the discontinuation of payment for treatments that have been identified as ineffective amounts to a dangerous curtailment of patients’ rights. This, I think, is simply a cynical attempt to mislead the public for the selfish purpose of profit.
MORE GOOD THAN HARM? I herewith challenge my critics
I challenge my critics to answer this simple question: For how many alternative therapies is there a well-documented positive risk/benefit balance?
Some homeopaths, rather than admitting they are in the wrong, are prepared to dilute the truth until it might be hard for third parties to tell who is right and who is wrong. But however they may deny it, the truth is still the truth: I have been trained as a homeopath.
Nine lessons for the budding pseudo-scientist
This is how pseudo-scientists make sure that the body of pseudo-evidence for their pseudo-treatments is growing at a steady pace.
AFTER THE STORM… the lies? Or: Does alternative medicine have an alternative truth?
Not only has the truth about the libel case been turned upside down, but also the evidence on chiropractic as a treatment for infant colic seems mysteriously improved.
A tribute to Prince Charles, champion of anti-science, on his 65th birthday
I am sure that, in the future, we will hear much more about Charles’ indulgence in quackery; and, of course, we will hear more criticism of it.
This is the bizarre phenomenon that ‘Ernst’s law’ seems to capture quite well – and this is why I believe the ‘law’ is worth more than a laugh and a chuckle. In fact, ‘Ernst’s law’ might even describe the depressing reality of retrograde thinking in alternative medicine more accurately than most of us care to admit.
The ‘homeopathic epiphany’ and its role in creating true believers
In my experience, true believers will not change their mind; I have never seen this happening. However, progress might nevertheless be made, if we managed to instil a more (self-) questioning rationality and scientific attitudes into the minds of the next generations. In other words, we need better education in science and more training of critical thinking during their formative years.
Homeopaths’ often criminal fight against public health
Yes, I am afraid the fight of many homeopaths against public health is active, incessant and often criminal. Of course, they do not for one second believe that they are doing anything wrong; on the contrary, they are convinced of their good intentions. As Bert Brecht once wrote, THE OPPOSITE OF GOOD IS NOT EVIL, BUT GOOD INTENTIONS
