Edzard Ernst

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

The aim of this systematic review and network meta-analysis was to identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.

The screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. All randomised trials with exercise arms for participants meeting clinical cut-offs for major depression were included.

A total of 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for

  • walking or jogging,
  • strength training,
  • mixed aerobic exercises,
  • and tai chi or qigong.

The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.

The authors concluded that exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.

As far as I can see, there are two main problems with these findings:

  1. Because too many of the studies are less than rigorous, the results are not quite as certain as the conclusions would seem to imply.
  2. Patients suffering from a major depressive disorder are often unable (too fatigued, demotivated, etc.) to do and/or keep up vigorous excerise over any length of time.

What I find furthermore puzzling is that, on the one hand, the results show that – as one might expect – the effects are proportional to the intensity of the excercise but, on the other hand tai chi and qugong which are both distinctly low-intensity turn out to be effective.

Nonetheless, this excellent paper is undoubtedly good news and offers hope for patients who are in desperate need of effective, safe and economical treatments.

These days – 11 years after the closure of my department at Exeter – it is not often that I co-author a peer-reviewed paper. All the more reason, I think, to celebrate when it does happen:

Our review was aimed at determining the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD.

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators. We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence.

We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates.

We concluded that despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.

Some people will say that meditation is not a form of so-called alternative medicine (SCAM) but rather an aspect of lifestyle used for relaxation and well-being. As such, it should not be scrutinized like a therapy. This might be partly true, but as soon as proper health claims are made for meditation or similar modalities, they do need to be tested like any other therapy, in my view.

As our review demonstrates, meditation and similar treatments are not nearly as well supported by evidence as their proponents try to make us believe. In other words, the often-voiced claims that such therapies are effective for the primary and secondary prevention of cardiovascular disease are largely unfounded.

A recent post of mine seems to have galvanized concerns about my image and general attitude towards so-called alternative medicine (SCAM). Here are the comments I am referring to:

Hanjo Lehmann

…you should take care of your image: not being a man who just hates anything that smells like “alternative medicine” but rather an experienced scientist and physician who sees things with appropriate skepticism.

Eelco_G

Edzard preaches for his own parish and does not reach the people he would like to reach. A little more wisdom and ability to put things into perspective would earn him much more respect.

Mike Grant

Hanjo made some valid points Edzard. Perhaps you should suppress your ego?

Socrates

If you want to persuade people it’s not enough just to be right. There are times to be antagonistic and times to be more understanding. And sweeping generalisations can get people’s backs up unnecessarily.

Please allow me to take this opportunity to explain my attitude, motivation, image, etc. a little better.

After SCAM and SCAM-research had previously been a mere hobby of mine, I took the Exeter chair in ‘complementary medicine’ in 1993. Ever since, I spent my time studying the subject. Between 1993 and 2012, I headed the worldwide most productive department of SCAM research. My team published several books for healthcare professionals and well over 1 000 peer-reviewed papers on SCAM. I personally gave about 500 lectures on SCAM to all sorts of audiences all over the world. None of these books, papers, lectures, etc. are in any way dismissive of SCAM. They are, I hope, rigorously scientific.

What I am trying to point out is this: for 20 odd years I have done more that anyone else to persuade, to be understanding, to promote sound evidence, to abstain from opinion, to suppress my “ego”, to reach people interested in SCAM, to see things with “appropriate skepticism”, to be polite, to avoid stepping on anyone’s toes, to be politically correct – while conducting the best science that the circumstances allowed.

What did it get me?

Was my work acclaimed by the SCAM community?

No.

Did my research receive the funding I had been promised?

No.

Did I manage to persuade the SCAM-community to think more critically?

No.

Did even my own university show any appreciation?

No, more than once, my peers even tried to influence the nature and/or direction of my research.

In 2012, I retired from my Exeter post because Charles’ intervention had been allowed to completely destroy my department.

Was I disappointed?

Yes, the only department worldwide that independently and critically investigated SCAM had ceased to exist. This certainly is disappointing!

Was I bitter?

No, on the contrary, I had voluntarily taken the decision to retire and I soon felt relieved to no longer have anyone breathing down my neck. I was looking forward to carrying on my work, free of the pressures and irritating voices trying to tell me what outcomes were expected of me. I was delighted to be free of the tedious task to fund-raise. I was happy to be relieved of all the tedious amount of admin.

Now, more than 10 years later, my work gives me great fun every day and often laugh tears about certain aspects of SCAM. Those who think or hope that I am a bitter old fool I must disappoint bitterly.

After retiring, I wrote a series of books and started this blog. On the very first post, dated 14/10/2012, I explained my decision:

Why another blog offering critical analyses of the weird and wonderful stuff that is going on in the world of alternative medicine? The answer is simple: compared to the plethora of uncritical misinformation on this topic, the few blogs that do try to convey more reflected, sceptical views are much needed; and the more we have of them, the better.

I am telling you all this to explain that

  • I have little patience with people who feel compelled to tell me what to do.
  • For me a blog is something entirely different than a peer-reviewed paper – the former is written quickly and tends to be be light-hearted, ironic, sarcastic, provocative, exaggerated, journalistic, etc., while the latter usually is carefully worded, scientific and bone-dry.
  • With my blog, I try to create an entertaining counterbalance to the plethora of uncritical misinformation on SCAM.
  • Therefore, I am deliberately critical of SCAM.
  • I do not hate anyone or anything.
  • I am not in the slightest concerned about my image.
  • I know very well what I am doing and quite confident that, during the last 30 years, I have reflected on issues around SCAM more deeply than most.

So, to those who still are concerned about my image or my approach to SCAM I say THANKS for your advice – but no thanks. And of those who doubt my science I ask, please study my peer-reviewed papers.

PS

Of course, none of this means that I make no mistakes, or that am not frequently troubled by self-doubt. So, please do carry on criticising me and my work, but don’t assume that I worry about my image.

Guest post by Ken McLeod

This week a Coroner’s Inquest into the death of Jarrad Antonovich resumes [1] in Byron Bay, New South Wales, Australia. Meanwhile, pending the outcome of Inquests and other investigations, the NSW Health Care Complaints Commission has imposed interim prohibition order on Mr Soulore Solaris, ‘….a Counsellor who facilitates Ayahuasca ceremonies.’

Under section 41AA of the Health Care Complaints Act 1993 (Act), Mr Solaris: “….must not under any circumstances provide, or cause to be provided, any health services, either in paid employment or voluntary, to any member of the public.” [2] This applies until 11 March 2024, when the matter will be reconsidered.

So what is all this about? To go back a while, Mr Antonovich died from a perforated oesophagus after consuming ayahuasca and kambo frog toxin in October 2021, at the age of 46, while attending the ‘Dreaming Arts festival’, a six-day retreat at Arcoora near Kyogle in northern New South Wales. At the festival he had consumed ayahuasca and participated in a “Kambo” ceremony, involving secretions harvested from an Amazonian tree frog.

Ayahuasca is a psychedelic substance made from boiling plants that is used in ritualistic ceremonies in the Amazon basin. [3] Ayahuasca contains chemicals of concern, such as N,N-Dimethyltryptamine (DMT), a highly psychedelic substance and a Schedule I drug under the Convention on Psychotropic Substances. Ayahuasca is illegal in many countries, and it is illegal to sell, import, produce and possess it in Australia. [4]

Kambo is made from secretions harvested from an Amazonian tree frog. Kambo is usually used in a group setting, called a Kambo circle or Kambo ceremony. Wikipedia lists a whole smorgasbord of dangerous consequences, including tachycardia, nausea, vomiting, diarrhea, psychosis, SIADH, kidney damage (including acute renal failure), pancreas damage, liver damage including toxic hepatitis, dermatomyositis, esophageal rupture, seizures, and death. [5]

The Australian Therapeutic Goods Administration has listed it as a schedule 10 poison, in the category for “substances of such danger to health as to warrant prohibition of sale, supply and use”. [6]

Earlier in the Inquest we heard that:

  • – While Jarrad Antonovich‘s condition worsened there was resistance to calling for an ambulance. An ambulance was finally called at 11.30pm and took an hour to arrive because of the remote location.
  • -One ambulance officer reported that a female told them to “move away from Jarrad because it was affecting his aura” and no one told them he had consumed Kambo. [7]
  • -The event organiser Soulore “Lore” Solaris described Jarrad Antonovich’s death as ‘beautiful.’ [8]
  • -Fred Woller, the site manager at Arcoora, was unaware those running the event did not have any medical training. [9]
  • -Soulore “Lore” Solaris said Mr Antonovich ”…. had good support, a couple of kinesiologists with him and they couldn’t find anything wrong,” [10]
  • -Mr Antonovich “was surrounded by people who loved him and an Aboriginal elder called Uncle Andrew who was chanting sacred songs and calling the spirit out of his body” and “the koalas were making a special sound that is known to the elders when the land accepts a spirit”.
  • -“Mr Solaris has stated that he has plans to leave Australia for Brazil to visit his teachers.” [11]

We will keep you informed.

REFERENCES

  • 1 Court Lists http://tinyurl.com/3fzjd6uy
  • 2 Health Care Complaints Commission http://tinyurl.com/yh76rzc6
  • 3 The Guardian http://tinyurl.com/328manjt
  • 4 Wikipedia https://en.wikipedia.org/wiki/Legal_status_of_ayahuasca_by_country
  • 5 Wikipedia https://en.wikipedia.org/wiki/Kambo_(drug)
  • 6 The Guardian http://tinyurl.com/2s398psy
  • 7 The Guardian http://tinyurl.com/328manjt
  • 8 ABC http://tinyurl.com/5n7ejydy
  • 9 The Guardian http://tinyurl.com/59wa3rmn
  • 10 ABC http://tinyurl.com/5n7ejydy
  • 11 Byron Bay Echo http://tinyurl.com/44n78s2w

The French ‘National Assembly’ has yesterday adopted a major law aimed at reinforcing the prevention and combat against sectarian aberrations in France. This marks a significant step forward in strengthening the protection of citizens against abuse and manipulation by charlatans, gurus and other sectarian movements.

This bill, the result of particularly fruitful work and debate in both chambers, reflects the Government’s commitment to meeting the expectations of the victims of these sectarian movements.

Some of the key measures voted through by parliamentarians include:

  • The enshrinement in law of the powers of MIVILUDES (Interministerial Mission of Vigilance and Combat against Sectarian Aberrations);
  • The reinforcement of the penal response with the creation of the offence of placing or maintaining in a state of psychological or physical subjection;
  • The creation of an offence of incitement to abandon or refrain from treatment, or to adopt practices which clearly expose the person concerned to a serious health risk;
  • Support for victims, with the extension of the categories of associations that can bring civil action;
  • Information for the judiciary, with the introduction of an “amicus curiae” role for certain government departments in legal cases relating to cults.

Despite sometimes heated debates, particularly around article 4, fuelled by the opinion of the Conseil d’Etat, the adoption of this law by the National Assembly bears witness to a shared desire to protect the rights and freedoms of individuals while providing better protection for our fellow citizens against sectarian aberrations.

This bill is part of a multi-annual national strategy for 2023-2027 resulting from the conference on sectarian aberrations held in spring 2023. It is a major step towards strengthening the penal arsenal and protecting victims.

_______________

Sabrina Agresti-Roubache, Secretary of State for Citizenship and Urban Affairs, commented:

“Long-awaited by victim support associations, this text aims to strengthen our legal arsenal in the fight against sectarian aberrations. I’m delighted that all the articles have been adopted, particularly Article 4, which creates an offence of incitement to abandon or abstain from treatment. There have been some passionate debates in the Chamber, but I’d like to reiterate the basis of this bill: the State is not fighting against beliefs, opinions or religions, but against all forms of sectarian aberrations, these dangerous behaviors which represent a threat to our social cohesion and put lives at risk.”

_______________

Obviously, we shall have to see how the new law will be applied. But, in any case, it is an important step into the right direction and could put an end to much of so-called alternative medicine that endangers the health of French consumers.

Other nations should consicer following the Franch example.

Millions of US adults use so-called alternative medicine (SCAM). In 2012, 55 million adults spent $28.3 billion on SCAMs, comparable to 9% of total out-of-pocket health care expenditures. A recent analysis conducted by the US National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) suggests a substantial increase in the overall use of SCAM by American adults from 2002 to 2022. The paper published in the Journal of the American Medical Association, highlights a surge in the use of SCAM particularly for pain management.

Data from the 2002, 2012, and 2022 National Health Interview Surveys (NHISs) were employed to evaluate changes in the use of 7 SCAMs:

  1. yoga,
  2. meditation,
  3. massage therapy,
  4. chiropractic,
  5. acupuncture,
  6. naturopathy,
  7. guided imagery/progressive muscle relaxation.

The key findings include:

  • The percentage of individuals who reported using at least one of the SCAMs increased from 19.2% in 2002 to 36.7% in 2022.
  • The use of yoga, meditation, and massage therapy experienced the most significant growth.
  • Use of yoga increased from 5% in 2002 to 16% in 2022.
  • Meditation became the most popular SCAM in 2022, with an increase from 7.5% in 2002 to 17.3% in 2022.
  • Acupuncture saw an increase from 1% in 2002 to 2.2% in 2022.
  • The smallest rise was noted for chiropractic, from 79 to 86%

The analyses also suggested a rise in the proportion of US adults using SCAMs specifically for pain management. Among participants using any SCAM, the percentage reporting use for pain management increased from 42% in 2002 to 49% in 2022.

Limitations of the survey include:

  • decreasing NHIS response rates over time,
  • possible recall bias,
  • cross-sectional data,
  • differences in the wording of the surveys.

The NCCIH researchers like such surveys and tend to put a positive spin on them, i.e. SCAM is becoming more and more popular because it is supported by better and better evidence. Therefore, SCAM should be available to everyone who wants is.

But, of course, the spin could also turn in the opposite direction, i.e. the risk/benefit balance for most SCAMs is either negative or uncertain, and their cost-benefit remains unclear – as seen regularly on this blog. Therefore, the fact that SCAM seems to be getting more popular is of increasing concern. In particular, more consideration ought to be given to the indirect risks of SCAM (think, for instance, only of the influence SCAM practitioners have on the vaccination rates) that we often discuss here but that the NCCIH conveniently tends to ignore.

Some of these irritating skeptics claim that so-called alternative medicine (SCAM) is useless. They are wrong, of course! SCAM’s incredible uselulness is never more obvious that on Valentine’s Day. Here are just a few exaples that will make even the most hard-nosed skeptic reconsider:

Since acupuncture helps in promoting the circulation of blood, it may increase your sexual drive as well. As a result, you may experience intense and enhanced orgasms. When Qi (Chi) gets blocked, it may hamper healthy circulation in the body, which is why an acupuncture session may help in getting you back in touch with your sensual side.

Homeopathy: Nuphar Luteum is a homeopathic remedy for low libido in men. It helps when there is a decline in sexual desire, a lack of physical stamina, or difficulty keeping an erection during sexual engagement. Damiana is a popular homeopathic remedy for low libido in women. It can help enhance sexual desire and stimulate the reproductive system. Damiana is also known for its positive effects on reducing anxiety and promoting a sense of relaxation.The fundamental causes of low libido must be recognized before selecting the appropriate homeopathic cure. A complete study of your physical, mental, and emotional conditions can help you determine what is causing your diminished sexual desire. A qualified homeopath will consider these factors and select a remedy that matches your unique constitution.

Meditation: No matter how healthy you are, being stressed out can affect your libido. Some research suggests that women may be particularly susceptible to the effects stress can have on one’s sex life. Men, on the other hand, may use sex to relieve stress. Sometimes, these differences in the approach can cause conflict, ultimately increasing stress between partners. Meditation can help relieve stress.

Bach flower remedies: N°44™ Libido. Organic drop composition with the original Bach Flower Remedies of Dr. Bach The Original N°44-Composition contains the 7 Bach Flowers: Wild RoseFlower of joy of life; HornbeamFlower of drive and energy; GentianFlower of encouragement; ImpatiensFlower of inner calmness; LarchFlower of self-assurance; PineFlower of forgiveness; Crab AppleFlower of purification.

Herbal remedies: VigRX is a male enhancement supplement that was developed over 15 years ago and has gone on to become the World’s biggest selling and most popular product of its generation. Ingredients such as Asian Ginseng & Ginkgo Biloba have made these capsules very potent. If you then consider the other 6 nutrients which are then fused together, it makes this blend unique and the reason why so many people have ordered it time and time again and made it the brand of choice for most men.

Massage: Touching is a powerful thing, especially in areas other than your fun bits. ResearchTrusted Source shows that the act of physically touching your partner helps create intimacy and relieve stress. Which means, in the bigger picture of many sexual dysfunctions, touch could help dissolve mental or emotional blockages. Especially for women who feel expected to live up to or act out certain expectations.

Chiropractic: Are you suffering from a mediocre sex life? Do you find intercourse painful or uninteresting? If so, chiropractic care might be something to consider. This holistic form of medicine can help improve your sex life in many ways, including boosting your libido and reducing back or neck pain. Below you’ll find more information about how chiropractic can be beneficial.

Crystal therapy: Which stones stimulate your libido? Carnelian. “Connected to vital energies, carnelian helps to recharge the sacred chakra and to watch over its balance. It helps stimulate sexual energy, energize female organs and take care of a good internal balance in woman.” Garnet. “A stone of vitality and physical energy, garnet works directly on sexual desire. It revives passions, strengthens intimate bonds and stimulates the libido.” Sunstone. “Sunstone brings self-confidence and assurance and helps overcome complexities and blockages. It soothes the mind and helps to promote confidence in one’s sexual life.”

And lastly: perineum sunning is linked to increased sexual energy, improved sexual health and boosted libido. … But please make sure that your neighbors are out when you do it in your garden!

Happy Valentine, everyone!

As we have often discussed on this blog, chiropractic spinal manipulations can lead to several complications and can result in vascular injury, including traumatic dissection of the vertebral arteries with often dire consequences – see, for instance, here:

 

This recent paper is a most unusual addition to the list. It is a case report of a 43-year-old woman who was admitted to the emergency department after performing a self-chiropractic spinal manipulation. She experienced headache and vomiting and was unresponsive with severe hypertension at the time of hospital admission. Clinical computerized tomography angiography showed narrowing of the right vertebral artery but was inconclusive for dissection or thrombosis.

The patient died a short while later. At autopsy, subacute dissection of the right vertebral artery was identified along with cerebral edema and herniation. A small peripheral pulmonary thromboembolism in the right lung was also seen. Neuropathology consultation confirmed the presence of diffuse cerebral edema and acute hypoxic-ischemic changes, with multifocal acute subarachnoid and intraparenchymal hemorrhage of the brain and spinal cord.

The authors concluded that this case presents a unique circumstance of a fatal vertebral artery dissection after self-chiropractic manipulation that, to the best of our knowledge, has not been previously described in the medical literature.

This pilot study is “delving into the potential benefits of Reiki therapy as a complementary intervention for the treatment and management of stress and anxiety”.

A total of 31 volunteers self-reporting stress, anxiety, or psychological disorders were enrolled. Health-related quality of life (HRQoL) was assessed using the 36-Item Short Form Health Survey (SF-36) Questionnaire for anxiety and depression. Pre- and post-treatment HRQoL scores were meticulously compared, and the significance of the disparities in these scores was meticulously computed.

Analysis was restricted to volunteers who completed the 3-day Reiki sessions. Statistically significant enhancements were discerned across all outcome measures, encompassing positive affect, negative affect, pain, drowsiness, tiredness, nausea, appetite, shortness of breath, anxiety, depression, and overall well-being (P<0.0001).

The authors concluded that the constancy and extensive scope of these improvements suggest that Reiki therapy may not only address specific symptoms but also contribute significantly to a predominant escalation of mental and physical health.

This study is almost comical.

Amongst all the many forms of so-called alternative medicine (SCAM), Reiki is perhaps the most ridiculous scam. It is a form of paranormal or ‘energy healing’ popularised by Japanese Mikao Usui (1865–1926). Rei means universal spirit (sometimes thought of as a supreme being) and ki is the assumed universal life energy. It is based on the assumptions of Traditional Chinese Medicine and the existence of ‘chi’, the life-force that is assumed to determine our health.

Reiki practitioners believe that, with their hands-on healing method, they can transfer ‘healing energy’ to a patient which, in turn, stimulates the self-healing properties of the body. They assume that the therapeutic effects of this technique are obtained from a ‘universal life energy’ that provides strength, harmony, and balance to the body and mind. There is no scientific basis for such notions, and reiki is therefore not plausible.

Reiki is used for a number of conditions, including the relief of stress, tension and pain. There have been several clinical trials testing its effectiveness. Those that are rigorous fail to show that the treatment is effective – and those that are dripping with bias, like the one discussed here, tend to produce false-positive results.

The present study has many flaws that are too obvious to even mention. While reading it, I asked myself the following questions:

  • How could a respectable university ever allow this pseudo-research to go ahead?
  • How could a respectable ethics committee ever permit it?
  • How could a respectable journal ever publish it?

The answers must be that, quite evidently, they are not respectable.

 

Medical Acupuncture is the name of a quarterly journal published for the ‘American Academy of Medical Acupuncture’ that publishes around 60 pro-acupuncture articles every year. Its editor is Richard C. Niemtzow, M.D., Ph.D., M.P.H. Richard is a retired US Air Force colonel who was the first full-time physician acupuncturist in the US Armed Forces. He is probably best known for his invention called ‘BATTLE FIELD ACUPUNCTURE’, a form of ear-acupuncture allegedly reducing pain in emergency situations.

Medline lists 79 papers (mostly published in 3rd class journals such as ‘Medical Acupuncture’) in Niemtzow’s name. Only one of them – 21 years ago – was a clinical trial. Here it is:

Purpose: We performed a pilot trial to assess the response of lower urinary tract symptoms and prostate specific antigen (PSA) to acupuncture in a population of patients biopsy negative for prostate cancer.

Materials and methods: A total of 30 patients were randomly assigned to 1 of 3 study groups, including observation for 3 months with 6 blood samples for PSA at set intervals, 9 sessions of acupuncture in 3 months to points of the kidney-bladder distinct meridian expected to treat the prostate with 6 blood samples for PSA at set intervals and 9 sessions of acupuncture in 3 months to points not expected to treat the prostate with 6 blood samples for PSA at set intervals. The effect of acupuncture on lower urinary tract symptoms was assessed monthly using the International Prostate Symptom Score.

Results: Trend analysis (repeated measures ANOVA) revealed no significant changes in the 3-month period in the randomized arms. Statistical analysis showed p = 0.063 for the International Prostate Symptom Score, p = 0.945 for PSA and p = 0.37 for the free-to-total PSA ratio.

Conclusions: Acupuncture to the kidney-bladder distinct meridian neither relieves lower urinary tract symptoms nor impacts PSA.

Yes, an acupuncture study with a negative result!

Niemtzow has, as far as I can see, never himself conducted a study of ‘battle field acupuncture’. In fact, there only very few trials of ‘battle field acupuncture‘. The most recent (albeit lousy) study even suggest that it is less effective than electroacupuncture (EA): EA was more effective than ‘battle field auricular acupuncture’ at reducing pain severity, but both similarly improved physical and mental health scores.

This does not stop Niemtzow to continue praising acupuncture in dozens of papers, particularly his ‘battle field’ version and especially in his ‘own’ journal. The most recent example has just been published; allow me to present an excerpt to you:

In December of 2023, I had the opportunity to visit the Van Gogh Museum in Amsterdam. The only day I had for this visit was characterized by a pouring and chilling rain. This did not stop the crowds of people visiting this famous exhibition. I reminded myself that Van Gogh was a troubled spirit. He lived a short tumultuous life characterized by cutting off his left ear lobe and he spent a sojourn in an asylum. Yet, his art emerged in all its beauty and splendor to become famous in the world. Despite all his troubles, he contributed a precious collection of magnificent art. Many individuals would not have surfaced out of personal disorders to produce such a wonderful gift to society. However, history tells us that many sensational contributions originated from people embroiled in mental health illnesses.

Medical Acupuncture published more than 13 years ago the acupuncture ‘‘diagnosis’’ of Vincent Van Gogh. The article, which is worth rereading, discussed the Five-Element pattern associated with the artist’s hallucinations, alcoholism, severe depression, insomnia, anxiety, dizziness, headaches, nightmares, etc. The author, Vera Kaikobad, LAc, stated: ‘‘It is poignant to realize that a few needles in the hands of a skilled acupuncturist may have spared this great artist such torment and perhaps saved his life.’’ Feasibly, in 2024 we should not only examine our patients for their physical complaints; we should venture into their mental health status as well. A back or neck pain is important, but so is anxiety, insomnia, etc. In promoting mental health, we may assist many patients who are perhaps capable of contributing to the well-being of the world. It is our responsibility as acupuncturists not to think of our patients as a neck or back pain, etc.; instead, we must see them as whole persons having spiritual and physical needs that must be addressed.

I feel that, overall, this remarkable effort justifies Niemtzow’s admission to my ALTERNATIVE MEDICINE HALL OF FAME.

WELCOME, RICHARD!

And let me introduce you to the rest of the 24 laureates:

  1. Helmut Kiene (anthroposophical medicine)
  2. Helge Franke (osteopathy, Germany)
  3. Tery Oleson (acupressure , US)
  4. Jorge Vas (acupuncture, Spain)
  5. Wane Jonas (homeopathy, US)
  6. Harald Walach (various SCAMs, Germany)
  7. Andreas Michalsen ( various SCAMs, Germany)
  8. Jennifer Jacobs (homeopath, US)
  9. Jenise Pellow (homeopath, South Africa)
  10. Adrian White (acupuncturist, UK)
  11. Michael Frass (homeopath, Austria)
  12. Jens Behnke (research officer, Germany)
  13. John Weeks (editor of JCAM, US)
  14. Deepak Chopra (entrepreneur, US)
  15. Cheryl Hawk (chiropractor, US)
  16. David Peters (osteopathy, homeopathy, UK)
  17. Nicola Robinson (TCM, UK)
  18. Peter Fisher (homeopathy, UK)
  19. Simon Mills (herbal medicine, UK)
  20. Gustav Dobos (various SCAMs, Germany)
  21. Claudia Witt (homeopathy, Germany/Switzerland)
  22. George Lewith (acupuncture, UK)
  23. John Licciardone (osteopathy, US)
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