Edzard Ernst

MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

My friend and colleague Willem Betz has died on 8 June 2019. He was a physician and professor emeritus at the Belgian university Vrije Universiteit Brussel. Willem was a leading sceptic and a founding member of the Belgian sceptic organization SKEPP.

After having worked 20 years as a general practitioner, he made a career change and became a teacher of general practice and a researcher. As a clinician, he received training in several alternative therapies and practiced them of a short while. Soon, he started questioning the validity of these methods and thus became a dedicated sceptic. He served SKEPP as vice-president and as president and became a fellow of the Committee for Scientific Inquiry.

His last paper was published less than a year ago. Here is its abstract:

Conventional treatment of multiple sclerosis (MS) is often disappointing. As a result, some of these patients seek salvation in traditional and complementary medicine (T&CM). The aim of this study is to describe how many patients with MS use T&CM and what their motives and expectations are in doing so. Methods. Ninety-nine patients with diagnosed MS, attending the service of ambulatory revalidation of the National Clinic for Multiple Sclerosis in Melsbroek (Belgium) were included in February 2004 in this retrospective study. All patients had MS resulting in motoric or psychosocial symptoms. The disability was not quantified for this study. Participants were interviewed by means of a structured questionnaire on their current treatment of MS including T&CM. Results. In total 44% of the participants had experiences with T&CM. The most frequently used T&CM were homeopathy and acupuncture. Participants using conventional treatment were more satisfied with the support (p=0.006) and the treatment outcome (0.018) than T&CM users. The use of T&CM was not related to gender, education, living conditions, causal treatment such as disease modifying-therapy (DMT), grade of disability or subtype of the disease. Conclusion. Patients diagnosed with MS seek hope in T&CM such as homeopathy or acupuncture. The results of this study suggest that MS patients need more professional support in their personal search for alternative therapies. Key point. 50% of patients diagnosed with multiple sclerosis search relief in traditional and complementary medicine such as homeopathy or acupuncture. These patients often feel compelled to try every opportunity to heal, often stimulated or urged on by friends or relatives. Multiple sclerosis patients are more satisfied with their conventional treatment than with the traditional and complementary medicine.

Through his personality, enthusiasm, analytical mind, humour and dedication, Willem has inspired an entire generation of sceptics. We will miss you Willem.

In 1995, the Church of Scientology attempted to suppress the Fishman Affidavit which contained Church-copyrighted versions of Operating Thetan levels I-VII. This promptly resulted in hundreds of copies being circulated around the world.

In 2003, Barbra Streisand’s lawyers sent a cease and desist letter to the California Coastal Records Project about the inclusion of a photo of her Malibu beach house on their website. When the website operators rejected the demand, Streisand sued. Subsequently, the Los Angeles Superior Court dismissed the case and the worlds attention focussed on her villa (see below).

 

Today, there are numerous further cases where someone has tried to censor another party and the attempt spectacularly backfired thus resulting in the opposite effect. Ever since the events surrounding the Streisand affair, the phenomenon has been called the ‘Streisand Effect‘. But recently, German sceptics have proposed to re-name it in

THE ‘HEVERT EFFECT’.

The reason is that a firm producing homeopathic remedies in Germany, Hevert, sent a desist letter to German critics of homeopathy demanding they stop stating that homeopathy is not effective beyond placebo (I did mention the story in a previous post).

I do get the impression that Hevert are not very lucky with their PR. On their website, they claim that homeopathy activates the body’s own self-healing powers. I fear this is much more wishful thinking than fact; at least I know of no sound evidence that would prove this statement to be correct. They also claim that homeopathy is a naturopathic treatment method that was developed at the beginning of the 19th century by German physician and pharmacist Samuel Hahnemann (1755-1843). This does not seem correct either; homeopathy does not fall under the umbrella of naturopathic medicine, not least because it includes plenty of remedies as unnatural as the Berlin Wall. The Hevert website furthermore states that Hahnemann discovered that, with many substances, the healing powers are only released by potentization. He also discovered that toxic substances became valuable medicines when potentized. I fear that this is wrong too; in fact, Hahnemann discovered nothing of the sort – he merely postulated stuff that evidently turned out to be untrue.

Anyway, one of the recipients of the above mentioned desist letters, Natalie Grams, decided not to comply and rather risk the penalty of Euro 5 100. This news then resulted in a storm of angry protests. Germans do not like to be told what to say, and freedom of speech is valued highly these days. Numerous newspapers, magazines, radio broadcasts, blogs and tweets thus sided firmly with Dr Grams.

This week, even a prominent and rather excellent German TV satirical programme aired a long film mercilessly mocking Hevert and homeopathy (no, nothing to do with me!). It is is, in my view, the best critique of homeopathy ever broadcast on German TV. Even if you do not understand the language , it is worth watching, if only for the musical finale:

One theme that occurs repeatedly in the film is the concept of ‘the three pillars of homeopathy’:

  1. dilute;
  2. shake;
  3. waffle BS (the German original is even less polite [‘Scheisse labern’]).

The ‘three pillars’ have become an instant hit on twitter, with bloggers and elsewhere. They look destined to become the future hallmark of homeopathy. Hevert will now be asking themselves whether the thing with the desist letters was such a brilliant idea.

I suspect it wasn’t – perhaps only trumped by the idea to sell homeopathic remedies?

 

 

 

A few days ago, I received this email:

Dear Dr. Edzard Ernst,

I am xxyy*, Editorial assistant from xxxzzz* Publishing Group Ltd. contacting you with the reference from our editorial department. Basing on your outstanding contribution to the scientific community, we would like to write a book for you.

Researchers like you are adding so much value to the scientific community, yet you are not getting enough exposure. No matter how many papers you publish in famous journals, you will be still unknown to common people. To solve this problem, we came up with this unique solution.

With our book writing service, we will write your research contributions in common man’s language. We will also include all your published papers into this book in a way that a common man can understand it. And then, we will publish your book with our publishing group. Before, publication, we will send the draft to you for scientific accuracy, once you approve our draft, we then proceed for publication. You will get all the rights of your book, and all the sales generated from your book will be credited to you.

Your book will then be listed on famous websites like Amazon, eBay, Goodreads, and many other popular book websites. As a result, you will get good credit and people will recognize your hard work and your scientific contributions.

Last but not least, after the publication of your book, it will be published in Google News, Yahoo, and other major news channels. What more can you ask for?

All we need is your book writing contract, and you will get all the rights for your book.

Will be waiting to hear from you.

Best Regards,

xxyy

__________________________________________________

Amazed and curious, I replied:

Thanks xxyy,

that sounds interesting; please let me know what costs are involved.

Regards

E Ernst

____________________________________________________

The answer came a few days later. Here is the passage that addressed my question:

Usually, Researchers want their articles converted into common man’s language and make them into a book. But if you have a special requirement, then please let us know, so that our writers can write according to your needs. And once the drafting has finished, we will send it for your review for scientific accuracy. This includes book cover & page design, ISBN (International Standard Book Number) for your book, proofreading service and publication fee. And Our service fee for this is $1895. And it will take around 1 month to complete your project. Last but not least, once your book is published, we will write a news article about you and your book and will publish it in major newspapers to get proper publicity.

Image result for ghost writer, comic

_______________________________________________________

I have to admit, I am still amazed! The price seems not high (though, judging from the quality of their English, the price/value balance might still be doubtful). Whenever I write a book, it takes me the best part of a year. Once I calculate a realistic $-figure for this effort, it would surely be more than one dimension higher.

So, am I going to have my next book ghost-written by this or any other service?

No, thanks!

(*Yes, I deleted the names)

The question whether chiropractic spinal manipulations are an effective treatment of infantile colic has been raging ever since the BCA sued Simon Singh over it (and lost). On this blog, I have discussed the evidence several times (see here, here, here and here). Now a new paper has emerged with the title ‘MEDICAL MANAGEMENT OF INFANTILE COLIC AND OTHER CONDITIONS WITH SPINAL MANIPULATION: A NARRATIVE REVIEW OF THE EUROPEAN MEDICAL LITERATURE’. As it was published on a journal not listed in Medline (J Contemporary Chiropr 2019;2:60-75), I will quote more extensively from it than I do normally. Here is the abstract in its original form:

Objective: Strong evidence is found for European medical management of ‘infantile colic’ by spinal manipulation. This paper identifies and describes this body of evidence. We apply the social research method of document analysis to the European medical literature and report the medical practices regarding the management of infantile colic by manual means including manipulation.
Data Sources: Primary data sources were Medline, accessed via PubMed, and the Index to Chiropractic Literature (ICL). Secondary material was sourced from the private collections of the authors. Acceptability criterion included a report of the medical management of infantile colic.
Data Synthesis: A range of languages were accepted and either translated or interpreted by clinicians known to the authors. Each retrieved paper was then hand-searched to identify additional citations which were also collected. A total of 69 papers met the acceptance criteria. The statements accepted for appraisal were those of methods descriptive of the clinical assessment and management of patients classified by the practitioner as a child with infantile colic.
Results: The medical management of infantile colic by spinal manipulation is well reported in the European medical literature. Triangulation also identified reports of medical management of a range of pediatric nonneuromusculoskeletal conditions. European medical papers report a number of positive outcomes for infantile colic with care broadly considered to be manipulative care. These outcomes parallel those known to be widely reported in the chiropractic literature.
Conclusion: We report strong evidence from the European medical literature related to the management by manipulation of infants with infantile colic and other conditions.

In the article proper, the authors conclusions are more detailed and very much longer:

It is difficult to reconcile the positive evidence for manipulative management of infantile colic recorded in
the European medical literature and the known safety of chiropractic management with the need for the 2019 Safer Care Victoria inquiry into Chiropractic manipulation of infants. We consider there is no reasonable evidential basis for this inquiry.
The evidence is that “Infantile colic is an easily identified childhood entity that has no clear treatment guidelines. The management of infantile colic varies among physicians, and families are often frustrated by the medical community’s inability to prescribe a cure for colic.” (163)
Infantile colic remains a medical enigma with no evidence of safety for medical management, in fact the determination of terminology for reporting such adverse events is relatively new. (164) On the other hand the remarkable safety of chiropractic management is known and the finding that European medical literature strongly indicates manipulative management of infantile colic as a safe and effective practice, places conventional chiropractic as a safe evidence-based choice to meet parental demand.
Alcantara et al (165) show support for this position by stating “chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.”
In the absence of consistently effective management options, accepting the evidence of the European medical literature shows the benefit of manipulative care for infantile colicky patients and the wider collateral beneficial effect on parents. (166,167)
We consider it important to report the uncertainty of medical management of infantile colic and to recognize manual therapy as a legitimate management option as actively utilized by mostly European medical doctors. Multiple case reports document the efficacy of manual therapy of infants. There is a distinct absence of original evidence contradicting the efficacy of spinal manipulative management of infantile colic and an absence of evidential contraindications for its implementation.
This paper reports considerable material in the European medical literature on the manipulative management of infants, particularly infantile colic. Although supportive in safety (150,158) and efficacy (145), the chiropractic literature on these topics was not the primary focus at this time. However in relation to safety, Funabashi and colleagues noted providers of spinal manipulation have similar or better dimension scores compared to the 2016 medical data base of the Agency for Healthcare Research and Quality. (158)

On balance we can state with confidence that the published, indexed evidence places conventional chiropractic management of infantile colic as safe and effective in the manner clearly documented as clinical methods in the European Medical literature.

I find it hard to decide where to begin. The problem is that there is almost nothing right with this review.

Let’s start with the title, MEDICAL MANAGEMENT OF INFANTILE COLIC AND OTHER CONDITIONS WITH SPINAL MANIPULATION: A NARRATIVE REVIEW OF THE EUROPEAN MEDICAL LITERATURE’. What do they mean with ‘other conditions’? As the review does, in fact, include plenty of non-European papers, this title is simply nonsensical.

Next is the objective: it states that there is good evidence for spinal manipulation as a treatment of infantile colic. The authors thus managed to disclose their bias in the very first sentence of their paper.

The rest of the abstract is similarly incompetent. Crucially, we do not learn what inclusion/exclusion criteria the authors applied and how they evaluated the methodological quality of the included studies. Remarkably, this information is also not provided anywhere else in the paper. Thus, this article lacks all the essential elements of a scientific review and turns out to be little more than a highly biased opinion piece. In fact, it is worse; the introduction, for instance, begins with what I can only call a rant: Within Australia there is a government-manufactured controversy regarding the management of infants by chiropractors…

The results section is equally remarkable. Here are a few direct quotes to give you a flavour:

Forty-five papers were accepted as valid clinical reports of the management of infantile colic by medical manipulation (Table 1). There are over 60 papers relating to infantile colic on ICL; we do not report these. The Chiropractic Resource Organisation (CRO) website essentially carries the same papers as ICL. Many of these listings are case reports and outcome-based studies. (33, 34) Reference lists were also obtained from indexed papers as well a range of medical and chiropractic textbooks. (35 – 37)

The truth is that the 45 papers are not ‘valid clinical reports’ but a mixture of comments, case reports, opinion pieces, observational studies and a few clinical trials. The latter are identical with those discussed in proper systematic reviews of the subject. There is thus no reason for arriving at different conclusions than these reviews. But, of course, the authors do exactly that, and they do not explain why. They claim that European doctors use spinal manipulation routinely for colicky babies; this is not true (I am a European doctor and have never seen this happening). They claim that unearthing the European literature revealed more positive evidence; this is also not true: this literature was not hidden but it simply does not measure up to the standard required for evidence and was thus not included in previous reviews.

The authors could not identify any original research study report that rejected spinal manipulation of infants for colic on the grounds of being unsafe or with negative clinical outcomes.

As the authors did cite a few (by no means all) review papers that clearly showed the risks of spinal manipulation, one must ask what this statement was intended for. Was it to give the false impression that chiropractic spinal manipulations are safe?

The criticism of commentators seems to be that chiropractic care for infantile colic is no better than a placebo (147), the same finding for a common colic medication. (148) In other words, chiropractic care is equal to or just as effective as placebo and medication and therefore becomes the preferred clinical option on
the basis of safety and the absence of potential adverse effects. (63,149-151)

I fail to understand the logic behind this argument. The authors seem to admit that chiropractic care is a placebo therapy. To any reasonable person, this means that any benign and cost-free intervention (such as a gentle massage or cuddle by a parent) is preferable to an expensive and potentially harmful chiropractic treatment.

Chiropractic has been examined with rigour and found safe. Our interpretation of this evidence is that there is virtually no danger to infants from carefully applied manual methods by qualified providers and perhaps the best of both worlds is concomitant care among chiropractors and medical practitioners.

This conclusion is not supported by the evidence presented, and the authors do not explain how they arrived at it.

In addition to such irrational passages, we find plenty of nonsensical or factually incorrect statements in the authors’ pseudo-review. Here are a few examples that I found amusing:

Spinal manipulation as it is known today was brought to European medical doctors by chiropractors and osteopaths, (105) and since then it has become an entrenched medical practice in most European countries, particularly Germany. In Europe, the use of spinal manipulation within the medical profession for the management of infantile colic has been a well-recognised procedure for some decades. (38,43,63,106)

The chiropractic vertebral subluxation is recognised in the medical literature (107) contrary to unsupported claims that it cannot be identified. It is this type of mechanical spinal lesion that has been identified to address as a vertebrogenic factor under this model.

However, my favourite bit is this direct quote:

The evidence is that “Infantile colic is an easily identified childhood entity that has no clear treatment guidelines. The management of infantile colic varies among physicians, and families are often frustrated by the medical community’s inability to prescribe a cure for colic.”

The authors quote here from my own review, and remarkably it is the only quote from it. The authors otherwise ignore it completely and, crucially, they do also not list it as one of the 45 included papers. Why? To answer this question, we need to see what my review says. Here is its very short abstract:

Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

Call me biased, but I do believe that this is much closer to the truth than the lengthy pseudo-review above.

Let me finish this post by revealing who its authors are.

  • Peter Rome, Chiropractor, retired
  • John Waterhouse, Private practice of chiropractic
  • Glenn Maginness, Private practice of chiropractic
  • Phillip Ebrall, Tokyo College of Chiropractic

No funding was received for this study.

No author declared a conflict of interest (at least, this is what they claim).

No further contact details were provided.

My conclusion of all this:

We have to search long and far before we find a SCAM article that is more misleading and less competent than this one.

You might remember my post from last October:

On Twitter and elsewhere, homeopaths have been celebrating: FINALLY A PROOF OF HOMEOPATHY HAS BEEN PUBLISHED IN A TOP SCIENCE JOURNAL!!!

Here is just one example:

#homeopathy under threat because of lack of peer reviewed studies in respectable journals? Think again. Study published in the most prestigious journal Nature shows efficacy of rhus tox in pain control in rats.

But what exactly does this study show (btw, it was not published in ‘Nature’)?

The authors of the paper in question evaluated antinociceptive efficacy of Rhus Tox in the neuropathic pain and delineated its underlying mechanism. Initially, in-vitro assay using LPS-mediated ROS-induced U-87 glioblastoma cells was performed to study the effect of Rhus Tox on reactive oxygen species (ROS), anti-oxidant status and cytokine profile. Rhus Tox decreased oxidative stress and cytokine release with restoration of anti-oxidant systems. Chronic treatment with Rhus Tox ultra dilutions for 14 days ameliorated neuropathic pain revealed as inhibition of cold, warm and mechanical allodynia along with improved motor nerve conduction velocity (MNCV) in constricted nerve. Rhus Tox decreased the oxidative and nitrosative stress by reducing malondialdehyde (MDA) and nitric oxide (NO) content, respectively along with up regulated glutathione (GSH), superoxide dismutase (SOD) and catalase activity in sciatic nerve of rats. Notably, Rhus Tox treatment caused significant reductions in the levels of tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) as compared with CCI-control group. Protective effect of Rhus Tox against CCI-induced sciatic nerve injury in histopathology study was exhibited through maintenance of normal nerve architecture and inhibition of inflammatory changes. Overall, neuroprotective effect of Rhus Tox in CCI-induced neuropathic pain suggests the involvement of anti-oxidative and anti-inflammatory mechanisms.

END OF QUOTE

I am utterly under-whelmed by in-vitro experiments (which are prone to artefacts) and animal studies (especially those with a sample size of 8!) of homeopathy. I think they have very little relevance to the question whether homeopathy works.

But there is more, much more!

It has been pointed out that there are several oddities in this paper which are highly suspicious of scientific misconduct or fraud. It has been noted that the study used duplicated data figures that claimed to show different experimental results, inconsistently reported data and results for various treatment dilutions in the text and figures, contained suspiciously identical data points throughout a series of figures that were reported to represent different experimental results, and hinged on subjective, non-blinded data from a pain experiment involving just eight rats.

Lastly, others pointed out that even if the data is somehow accurate, the experiment is unconvincing. The fast timing differences of paw withdraw is subjective. It’s also prone to bias because the researchers were not blinded to the rats’ treatments (meaning they could have known which animals were given the control drug or the homeopathic dilution). Moreover, eight animals in each group is not a large enough number from which to draw firm conclusions, they argue.

As one consequence of these suspicions, the journal has recently added the following footnote to the publication:

10/1/2018 Editors’ Note: Readers are alerted that the conclusions of this paper are subject to criticisms that are being considered by the editors. Appropriate editorial action will be taken once this matter is resolved.

_____________________________________________________

Well, it took a while, but now there is some news about this case:

‘Science Reports’, just published a retraction note:

Retraction of: Scientific Reports https://doi.org/10.1038/s41598-018-31971-9, published online 10 September 2018

Following publication, the journal received criticisms regarding the rationale of this study and the plausibility of its central conclusions. Expert advice was obtained, and the following issues were determined to undermine confidence in the reliability of the study.

The in vitro model does not support the main conclusion of the paper that Rhus Tox reduces pain. The qualitative and quantitative composition of the Rhus Tox extract is unknown. Figures 1G and 1H are duplicates; and figures 1I and 1J are duplicates. The majority of experimental points reported in figure 3 panel A are duplicated in figure 3 panel B. The collection, description, analysis and presentation of the behavioural data in Figure 3 is inadequate and cannot be relied upon.

As a result the editors are retracting the Article. The authors do not agree with the retraction.

___________________________________________________________________

Does that mean the suspect paper has been declared fraudulent?

I think so.

In any case: another victory of reason over unreason!

Let’s be clear: pseudoscience kills. And they are being employed with total impunity thanks to European laws that protect them.

They kill thousands of people, with names and family. People such as Francesco Bonifaz, a 7-year-old boy whose doctor prescribed homeopathy instead of antibiotics. He died in Italy [1]. People like Mario Rodríguez, who was 21 years old and was told to use vitamins to treat his cancer. He died in Spain [2]. People like Jacqueline Alderslade, a 55-year-old woman whose homeopath told her to stop taking her asthma medication. She died in Ireland [3]. People like Cameron Ayres, a 6-month-old baby, whose parents did not want to give their child “scientific medicine” [4]. He died in England. People like Victoria Waymouth, a 57-year-old woman who was prescribed a homeopathic medication to treat her heart problem. She died in France [5]. People like Sofia Balyaykina, a 25-year-old woman, who had a cancer that was curable with chemotherapy but was recommended an “alternative treatment”, a mosquito bite treatment.  She died in Russia [6]. People like Erling Møllehave, a 71-year-old man whose acupuncturist pierced and damaged his lung with a needle. He died in Denmark [7]. People like Michaela Jakubczyk-Eckert, a 40-year-old-woman whose therapist recommended the German New Medicine to treat her breast cancer. She died in Germany [8]. People like Sylvia Millecam, a 45-year-old woman whose New Age healer promised to cure her cancer. She died in Netherlands [9].

European directive 2001/83/CE has made –and still makes— possible the daily deceiving of thousands of hundreds of European citizens [10]. Influential lobbies have been given the opportunity to redefine what a medicine is, and now they are selling sugar to sick people and making them believe it can cure them or improve their health. This has caused deaths and will continue to do so until Europe admits an undeniable truth: scientific knowledge cannot yield under economic interests, especially when it means deceiving patients and violating their rights.

Europe is facing very serious problems regarding public health. Over-medicalization, multiresistant bacteria or the financial issues of the public systems are already grave enough, and there is no need to add to that gurus, fake doctors or even qualified doctors who claim they can cure any disease by manipulating chakras, making people eat sugar or employing “quantic frequencies”. Europe must not only stop the promotion of homeopathy but also actively fight to eradicate public health scams, which implicate more than 150 pseudo-therapies in our territory. Thousands of citizens lives depend on that. In fact, according to recent research, 25.9 % of Europeans have used pseudo-therapies last year. In other words, 192 million patients have been deceived [11].

Some believe there is a conflict between freedom of choice for a treatment and the removal of pseudo-therapies, but this is not true. According to article 25 of the Universal Declaration of Human Rights, every person has a right to medical care. Lying to patients in order to sell them useless products that could kill them breaks the right to true information about their health. This way, even if a citizen has a right to refuse medical treatment when properly informed, it is also true that nobody has the right to lie to obtain profit at the expense of someone else’s life. Only in a world in which lying to a sick person would be considered ethical, could we allow homeopathy—or any other pseudo-therapy—to continue to be sold to citizens.

Effective treatments being replaced by false ones is not the only danger of pseudo-therapies. Obvious delays in therapeutic care occur when a person gets false products instead of medication at the early stages of a disease. Many times, it is already too late by the time they get treated with proper medicine. Moreover, several of these practices have serious effects on their own and may cause damage or even death because of their side effects.

Many pseudo-therapists argue that “the other medicine” comes with side effects as well, which is true indeed. However, the difference resides in that pseudo-therapies cannot cure a disease or improve your health, and because of that patients assume risks in exchange of promises that are a scam, according to the full weight of the scientific evidence available. Lying to a sick person is not another type of medicine, it is simply lying to a sick person.

Every country has to face the issue with pseudo-therapies in its own ways. Yet it is not acceptable that European laws protect the distortion of scientific facts so that thousands of citizens can be deceived or even lead to their deaths.

We, the signatories of this manifest, therefore declare that:

  1. Scientific knowledge is incompatible with what pseudo-therapies postulate, as in the case of homeopathy.
  2. European laws that protect homeopathy are not admissible in a scientific and technological society that respects the right of the patients not to be deceived.
  3. Homeopathy is the most known pseudo-therapy, but it is not the only one nor the most dangerous one. Others, such as acupuncture, reiki, German New Medicine, iridology, biomagnetism, orthomolecular therapy and many more, are gaining ground and causing victims.
  4. Measures must be taken to stop pseudo-therapies, since they are not harmless and result in thousands of people affected.
  5. Europe needs to work towards creating legislation that will help stop this problem.

Europe being concerned about the misinformation phenomena but at the same time protecting one the most dangerous types of it, health misinformation, is just not coherent. This is why the people signing this manifesto urge the governments of European countries to end a problem in which the name of science is being used falsely and has already costed the life of too many.

Sign the manifesto

References:

[1] Homeopathy boy died of encephalitis. Redazione ANSA, 2017.http://www.ansa.it/english/news/general_news/2017/05/29/homeopathy-boy-died-of-encephalitis-3_13e02493-4e62-4787-9162-12d831121ef6.html

[2] Grieving dad sues over ‘cure cancer with vitamins’ therapy, The local. Emma Anderson, 2016.

https://www.thelocal.es/20160412/grieving-father-sues-naturopath-over-son-cure-cancer-vitamins-leukaemia

[3] Asthmatic ‘told to give up drugs’. The Irish News, 2001.

https://www.independent.ie/irish-news/asthmatic-told-to-give-up-drugs-26063764.html

[4] Homeopaths warn of further tragèdies. BBC News, 2000.

http://news.bbc.co.uk/2/hi/health/702699.stm

[5] Alternative cure doctor suspended. BBC News, 2007. http://news.bbc.co.uk/2/hi/uk_news/england/london/6255356.stm

[6] Футболист рассказал трагичную историю жены. Она умерла от рака в 25 лет. Sport24, 2018.

https://sport24.ru/news/football/2018-08-28-futbolist-rasskazal-tragichnuyu-istoriyu-zheny-ona-umerla-ot-raka-v-25-let

[7] Mand døde efter akupunktur – enke vil nu lægge sag an mod behandleren, TV2, 2018.

http://nyheder.tv2.dk/samfund/2018-01-23-mand-doede-efter-akupunktur-enke-vil-nu-laegge-sag-an-mod-behandleren

[8] The price of refusing science-based medical and surgical therapy in breast càncer, Science Blogs, 2012. https://scienceblogs.com/insolence/2012/08/30/the-price-of-refusing-science-based-medical-and-surgical-therapy-in-breast-cancer

[9] Psychic ‘misled actress to hopeless cancer death’. Expatica. 2004

http://web.archive.org/web/20070208144309/http://www.expatica.com/actual/article.asp?subchannel_id=19&story_id=4821

[10] Directiva 2001/83/CE del parlamento europeo y del consejo:6 de noviembre de 2001

https://www.boe.es/doue/2001/311/L00067-00128.pdf

[11] Use of complementary and alternative medicine in Europe: Health-related and sociodemographic determinants. Scandinavian Journal of Public Health. Laura M. Kemppainen et al. 2018.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989251/

Green tea is said to have numerous health benefits. Recently, a special green tea, matcha tea, is gaining popularity and is claimed to be more powerful than simple green tea. Matcha tea consumption is said to lead to higher intake of green tea phytochemicals compared to regular green tea.

But what is matcha tea? This article explains:

The word matcha literally means “powdered tea”. Drinking a cup or two of the tea made from this powder could help you tackle your day feeling clear, motivated and energized, rather than foggy, stressed out, and succumbing to chaos.

Matcha tea leaves are thrown a lot of shade (literally). They’re grown in the dark. The shade growing process increases matcha’s nutrients, especially chlorophyll, a green plant pigment that allows plants to absorb energy from sunlight. Chlorophyll is rich in antioxidants, and gives matcha it’s electrifying green colour. Shade growing also increases the amount of L-theanine, which is the amino acid known for promoting mental clarity, focus, and a sense of calm. It’s called nature’s “Xanax” for a reason.

The high amino acid content is also what gives matcha it’s signature umami taste. Umami is the “fifth” taste that describes the savory flavor of foods like miso, parmesan cheese, chicken broth, spinach, and soy sauce. You know you’ve got a premium matcha when you taste balanced umami flavors, hints of creaminess, and the slightest taste of fresh cut grass. You shouldn’t need to add any sweetener to enjoy sipping it. When choosing a high quality matcha powder, it’s important to remember: a strong umami flavour = higher in amino acids = the more L-theanine you’ll receive.

Once matcha leaves are harvested, they get steamed, dried, and ground up into a fine powder that you can mix with hot or cold water. The key difference here is that you’re actually consuming the nutrients from the entire leaf— which is most concentrated in antioxidants, amino acids, and umami flavour. This is unlike traditional brewed tea, where you’re only drinking the dissolvable portions of the leaf that have been steeped in water.

The article also names 5 effects of matcha tea:

1. Promotes Relaxation, Mood, and Mental Focus

2. Supports Healthy Cognitive Function

3. Supports Detoxification

4. Fights Physical Signs of Aging

5. Promotes a Healthy Heart

None of the sources provided do actually confirm that matcha tea conveys any of these benefits in humans. My favourite reference provided by the author is the one that is supposed to show that matcha tea is a detox remedy for humans. The article provided is entitled Low-dose dietary chlorophyll inhibits multi-organ carcinogenesis in the rainbow trout. Who said that SCAM-peddlers have no sense of humour?

Joking aside, is there any evidence at all to show that matcha tea has any health effects in humans? I found two clinical trials that tested this hypothesis.

Trial No1:

Intake of the catechin epigallocatechin gallate and caffeine has been shown to enhance exercise-induced fat oxidation. Matcha green tea powder contains catechins and caffeine and is consumed as a drink. We examined the effect of Matcha green tea drinks on metabolic, physiological, and perceived intensity responses during brisk walking. A total of 13 females (age: 27 ± 8 years, body mass: 65 ± 7 kg, height: 166 ± 6 cm) volunteered to participate in the study. Resting metabolic equivalent (1-MET) was measured using Douglas bags (1-MET: 3.4 ± 0.3 ml·kg-1·min-1). Participants completed an incremental walking protocol to establish the relationship between walking speed and oxygen uptake and individualize the walking speed at 5- or 6-MET. A randomized, crossover design was used with participants tested between Days 9 and 11 of the menstrual cycle (follicular phase). Participants consumed three drinks (each drink made with 1 g of Matcha premium grade; OMGTea Ltd., Brighton, UK) the day before and one drink 2 hr before the 30-min walk at 5- (n = 10) or 6-MET (walking speed: 5.8 ± 0.4 km/hr) with responses measured at 8-10, 18-20, and 28-30 min. Matcha had no effect on physiological and perceived intensity responses. Matcha resulted in lower respiratory exchange ratio (control: 0.84 ± 0.04; Matcha: 0.82 ± 0.04; p < .01) and enhanced fat oxidation during a 30-min brisk walk (control: 0.31 ± 0.10; Matcha: 0.35 ± 0.11 g/min; p < .01). Matcha green tea drinking can enhance exercise-induced fat oxidation in females. However, when regular brisk walking with 30-min bouts is being undertaken as part of a weight loss program, the metabolic effects of Matcha should not be overstated.

Trial No 2:

Matcha tea is gaining popularity throughout the world in recent years and is frequently referred to as a mood-and-brain food. Previous research has demonstrated that three constituents present in matcha tea, l-theanine, epigallocatechin gallate (EGCG), and caffeine, affect mood and cognitive performance. However, to date there are no studies assessing the effect of matcha tea itself. The present study investigates these effects by means of a human intervention study administering matcha tea and a matcha containing product. Using a randomized, placebo-controlled, single-blind study, 23 consumers participated in four test sessions. In each session, participants consumed one of the four test products: matcha tea, matcha tea bar (each containing 4g matcha tea powder), placebo tea, or placebo bar. The assessment was performed at baseline and 60min post-treatment. The participants performed a set of cognitive tests assessing attention, information processing, working memory, and episodic memory. The mood state was measured by means of a Profile of Mood States (POMS). After consuming the matcha products compared to placebo versions, there were mainly significant improvements in tasks measuring basic attention abilities and psychomotor speed in response to stimuli over a defined period of time. In contrast to expectations, the effect was barely present in the other cognitive tasks. The POMS results revealed no significant changes in mood. The influence of the food matrix was demonstrated by the fact that on most cognitive performance measures the drink format outperformed the bar format, particularly in tasks measuring speed of spatial working memory and delayed picture recognition. This study suggests that matcha tea consumed in a realistic dose can induce slight effects on speed of attention and episodic secondary memory to a low degree. Further studies are required to elucidate the influences of the food matrix.

Not impressed?

Me neither!

However, I was impressed when I looked up the costs of matcha tea: £17.95 for 30 g of powder does not exactly seem to be a bargain. So, matcha tea does after all help some people, namely all those engaged in flogging it to the gullible SCAM fraternity.

 

Homeopathy is harmless; after all, the typical homeopathic remedy contains no active ingredient! Such claims can be seen abundantly. Sadly, however, they are not true. The remedies might be mostly (but, depending on potency and proper quality control, not totally) risk-free, yet homeopathy can and does kill patients. There is a depressingly long list of fatalities to prove this point. And here is another sad case that confirms it; this short article provides the essential facts:

The parents of a seven-year-old boy who died after they decided to treat his otitis only with homeopathy were convicted of manslaughter Thursday.

Francesco, from Cagli near Pesaro, died on May 27 2017 from bilateral bacterial otitis.

His parents were found guilty of complicity in aggravated culpable manslaughter.

They were given a suspended sentence of three months in jail.

The parents entrusted their son’s care to Pesaro homeopathic doctor Massimiliano Mecozzi, who is set to go on trial on September 24.

The homeopath advised treatment with homeopathic products instead of the antibiotics which would have saved him, the court found.

Francesco died after the otitis degenerated into encephalitis.

Another article offers a few more details about the case:

Francesco suffered from otitis media. The doctor Massimiliano Mecozzi (55) treated the child exclusively with homeopathic remedies. When the parents brought Francesco to the hospital a few days later, it was already too late: The boy died soon afterwards. According to “Corriere della Sera”, the parents decided to not give their child antibiotics since he was only three years old. Francesco’s illness had begun with a severe cold and fever, and his frequented the homeopathic doctor Mecozzi who discouraged the parents from bringing their child to a hospital. “He scared them by claiming that the doctors would give medicaments to Francesco that would make him deaf or would damage his liver. He promised them that Francesco will recover soon”, said grandfather Maurizio to “Il Mattino”.

But Francesco’s condition worsened over the course of the following days, and the infection spread to the head. When the parents brought their son to the emergency admission, a festering abscess had already formed. Francesco was brought to a hospital in Ancona for an emergency operation. An antibiotic shock therapy didn’t help at this point either, and the child died.

According the “Corriere”, the physician had a questionable career: After having been temporarily expelled from the physician’s association, he even worked as a doorman and as an allrounder in a supermarket. Then he came into contact with a religious community in Varese, whose founders have been accused of fraud. When the physician’s association in Pesaro inquired to his occupation as a homeopath, Mecozzi replied: “I have no interest in telling you about it.”

And a further article adds even more details: the 7 year-old boy was hospitalized in an intensive care unit at the Hospital Salesi of Ancona. The child, born in Cagli (Pesaro), had been treated with homeopathy instead of antibiotics and had arrived in hospital in a serious condition. The child subsequently went into a neurological coma; an EEG revealed the absence of electrical activity, and brain death was certified. The death occurred as the result of an ear infection treated with homeopathy.

Such cases are tragic but (hopefully!) rare. They are due to the neglect (failure to provide adequate medical care) by a homeopath. Obviously, such neglect does not always have to be fatal. I would guess that milder forms of medical neglect through homeopathy are, in fact, extremely common (nobody knows the exact figure). One could even argue that, by definition, homeopathic treatment amounts to medical neglect which falls into three overlapping categories:

  • In the majority of cases, it has no or very little symptomatic consequences. For instance, if a homeopath prescribes a homeopathic remedy for a self-limiting condition, such as a common cold, and the patient soon improves due to the benign nature of the condition (often thinking that homeopathy was effective). There is, however, invisible harm such as the expense of the remedies and the false trust into a bogus therapy created by this experience (which might prove to be extremely harmful later on).
  • In many instances, the neglect does cause unnecessary suffering of patients because the optimally effective treatment of their disease is not administered or delayed. Many doctor homeopaths would argue that this is not usually true because, for such patients, they also prescribe conventional treatments in parallel. But even if this were true, these clinicians would still cause harm through the waste of resources.
  • In a sizable but unknown number of cases, homeopathy does cause very serious harm and, as the above case shows, even deaths.

The point I am trying to make is this: we usually only hear of the dramatic cases of neglect through homeopathy (or other forms of ineffective SCAM). What we tend to forget is that such cases are only the extreme end of a much wider spectrum, and that all clinicians who prescribe homeopathy are guilty of neglect. The symptomatic harm done ranges from almost zero to 100%, and the damage caused is merely a question of degree.

 

 

 

 

PS

Before some homeopathy-fan comments, “but the harm from conventional therapies is sooooooooo much more significant!!!”, let me stop you in your tracks by recommending you consider the concept of risk/benefit balance.

So-called alternative medicine (SCAM) is a seriously dangerous option for cancer patients who aim at curing their cancer with it. One cannot warn patients often and strongly enough, I believe. But when it comes to supportive cancer treatment (care that does not aim at changing the natural history of the disease), SCAM might have a place. I said ‘might’ because its exact role is far from clear.

The aim of this study was to investigate the effects of a complex, nurse-led, supportive care intervention using SCAM on patients’ quality of life (QoL) and associated patient-reported outcomes. In this prospective, pragmatic, bicentric, randomized controlled trial, women with breast or gynaecologic cancers undergoing a new regimen of chemotherapy (CHT) were randomly assigned to routine supportive care plus intervention (intervention group, IG) or routine care alone (control group, CG). The intervention consisted of SCAM applications and counseling for symptom management, as well as SCAM information material. The primary endpoint was global QoL measured with the EORTC-QLQ-C30 before and after SCAM.

In total, 126 patients were randomly assigned into the IG and 125 patients into the CG. The patients’ medical and socio-demographic characteristics were homogenous at baseline and at follow-up. No group effects on QoL were found upon completion of CHT, but there was a significant group difference in favour of the IG, 6 months later. IG patients did also experience significant better emotional functioning and less fatigue.

The authors concluded that the tested supportive intervention did not improve patients’ QoL outcomes directly after CHT (T3), but was associated with significant QoL improvements when considering the change from baseline to the time point T4, which could be assessed 6 months after patients’ completion of CHT. This delayed effect may have resulted due to a strengthening of patients’ self-management competencies.

A prospective, pragmatic, bicentric, randomized controlled trial! Doesn’t this sound rigorous? In fact, this term merely hides a trial that was destined to generate a positive result. As it followed the infamous A+B versus B design, it hardly had a chance to not come out positive.

The only thing I find amazing is that the short-term results failed to be statistically significant. Far too many SCAM researchers, it seems to me, view science as a tool for promoting their dubious ideas.

The use of SCAM with the aim of improving QoL might be helpful. But this assumption cannot be accepted on the basis of opinion; we need good science to find out which forms of SCAM are worth employing. Sadly, studies like the above are not in this category.

If you ask me, it is high time that this misleading nonsensical and unethical pseudo-research stops!

Spinal manipulation is an umbrella term for numerous manoeuvres chiropractors, osteopaths, physiotherapists and other clinicians apply to their patients’ vertebral columns.  Spinal manipulations are said to be effective for a wide range of conditions. But how do they work? What is their mode of action? A new article tries to address these questions. here is its abstract:

Spinal manipulation has been an effective intervention for the management of various musculoskeletal disorders. However, the mechanisms underlying the pain modulatory effects of spinal manipulation remain elusive. Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin. In this article, we reviewed the relevance of various neurophysiological theories with respect to the findings of mechanistic studies that demonstrated neural responses following spinal manipulation. This article also discussed whether these neural responses are associated with the possible neurophysiological mechanisms of spinal manipulation. The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more. However, the clinical relevance of these changes in relation to the mechanisms that underlie the effectiveness of spinal manipulation is still unclear. In addition, there were some major methodological flaws in many of the reviewed studies. Future mechanistic studies should have an appropriate study design and methodology and should plan for a long-term follow-up in order to determine the clinical significance of the neural responses evoked following spinal manipulation.

I have to admit, this made me laugh. Any article that starts with the claim spinal manipulation is an effective intervention and speaks about its observed clinical effects without critically assessing the evidence for it must be ridiculous. The truth is that, so far, it is unclear whether spinal manipulations cause any therapeutic effects at all. To take them as a given, therefore discloses a bias that can only be a hindrance to any objective evaluation.

Yet, perhaps unwittingly, the paper raises an important question: do we need to search for a mode of action of treatments that are unproven? It is a question, of course, that is relevant to all or at least much of SCAM.

Do we need to research the mode of action of acupuncture?

Do we need to research the mode of action of energy healing?

Do we need to research the mode of action of reflexology?

Do we need to research the mode of action of homeopathy?

Do we need to research the mode of action of Bach flower remedies?

Do we need to research the mode of action of cupping?

Do we need to research the mode of action of qigong?

In the absence of compelling evidence that a mode of action (other than the placebo response) exists, I would say: no, we don’t. Such research might turn out to be wasteful and carries the risk of attributing credibility to treatments that do not deserve it.

What do you think?

 

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