In 2007, we published a systematic review summarizing the efficacy of homeopathic remedies used as a sole or additional therapy in cancer care. We have searched the literature using the databases: Amed (from 1985); CINHAL (from 1982); EMBASE (from 1974); Medline (from 1951); and CAMbase (from 1998). Randomized and non-randomized controlled clinical trials including patients with cancer or past experience of cancer receiving single or combined homeopathic interventions were included. The methodological quality of the trials was assessed by Jadad score. Six studies met our inclusion criteria (five were randomized clinical trials and one was a non-randomized study); but the methodological quality was variable including some high-standard studies. Our analysis of published literature on homeopathy thus found insufficient evidence to support the clinical efficacy of homeopathic therapy in cancer care.
Meanwhile, more trials have emerged, not least a dubious study by Frass et al which is currently under investigation. This means that a new evaluation of the totality of the available evidence might be called for. I am pleased to report that such an assessment has just been published.
In this systematic review, the researchers included clinical studies from 1800 until 2020 to evaluate evidence of the effectiveness of homeopathy on physical and mental conditions in patients during oncological treatment.
In February 2021 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL, and Medline) to find studies concerning the use, effectiveness, and potential harm of homeopathy in cancer patients.
From all 1352 search results, 18 studies with 2016 patients were included in this SR. The patients treated with homeopathy were mainly diagnosed with breast cancer. The therapy concepts include single and combination homeopathic remedies (used systemically or as mouth rinses) of various dilutions. Outcomes assessed were the influence on toxicity of cancer treatment (mostly hot flashes and menopausal symptoms), time to drain-removal in breast cancer patients after mastectomy, survival, quality of life, global health and subjective well-being, anxiety, and depression as well as safety and tolerance.
The included studies reported heterogeneous results: some studies described significant differences in quality of life or toxicity of cancer treatment favoring homeopathy, whereas others did not find an effect or reported significant differences to the disadvantage of homeopathy or side effects caused by homeopathy. The majority of the studies have low methodological quality.
The authors concluded that, for homeopathy, there is neither a scientifically based hypothesis of its mode of action nor conclusive evidence from clinical studies in cancer care.
I predict that, if we wait another 15 years, we will have even more studies. I also predict that some of them will be less than reliable or even fake. Finally, I predict that the overall result will still be mixed and unconvincing.
Why can I be so sure?
- Because homeopathy lacks biological plausibility as a treatment of cancer (or any other condition).
- Because highly diluted homeopathic remedies are pure placebos.
- Because homeopathy has developed into a cult where one is no longer surprised to see studies emerging that are too good to be true.
I have previously reported that a Canadian naturopath, Jason Klop, is under investigation for selling fecal Microbiota transplants to treat autistic children. Now, there is a new twist in this story.
On Twitter, J.N. Stea summarized it nicely:
This naturopath is fighting a judge so that he can charge parents about $15,000 to give his nephew’s poop to children as a treatment for autism. His lawyer argues that he should be allowed to since naturopathy isn’t scientific anyway.
Klop’s lawyer defends the naturopath against an investigation into his business of selling fecal microbiota transplants to families of autistic children. The College of Naturopathic Physicians (CoN) had banned Klop for selling, advertising, and manufacturing pills made from human feces claiming that Klop has been engaging in conduct not acceptable for a naturopathic physician. Klop’s lawyer, Jason Gratl, argued this was difficult to prove in a field that has a few restrictions and some ambiguous boundaries.
“What does it take to be a naturopath and do something that is not appropriate in a field so wide-ranging and open to interpretation?” the lawyer, Gratl, asked the court suggesting that the lack of scientific evidence supporting the use of fecal Microbiota Transplants (FMT) to treat autism is not necessarily relevant in this instance.
“Naturopaths can rely on science in certain aspects, but they are not bound to science,” Gratl said. He explained that naturopathic practices could be based on anecdotes and historical knowledge. Later, he pointed out that the field also includes homeopathy, which, some believe, involves magical thinking. It is definitely not scientific in its core.” After describing the case as a “tragedy”, Gratl called the allegations against his client “entirely unverfounded and scurrilous.”
I suspect it is nothing new to most readers, yet I find it gratifying to hear from a lawyer that naturopathy
- is not science,
- relies on anecdote instead of evidence,
- and involves magical thinking.
I do think, however, that despite all this, naturopaths should not be allowed to do any odd nonsense that comes to their minds and fills their bank accounts quickly.
Guest post by Ken McLeod
Believe it or not, there are practitioners of a health system with little or no evidence of efficacy and safety who are registered with the Australian Health Practitioner Registration Agency. That is, so-called Traditional Chinese Medicine, whose practitioners are registered alongside evidence-based practitioners such as doctors, nurses, pharmacists, and dentists.
Governments who framed the relevant legislation evidently hoped that registration would enable the public to have confidence that they would be treated with evidence-based medicine. Such confidence is misplaced, as has been shown in The Skeptic and elsewhere many times.
Here’s another example of the failure of the health practitioner registration system.
Jamie Lloyd Allan is registered with AHPRA with the Chinese Medical Registration Number CMR0002096457, with no endorsements. He practices at his clinic in eastern Sydney. He advertises at his website meridianremedies.com.au.
And some of his claims are deeply worrying. Allan claims that he uses “Chinese Herbal medicine & Acupuncture in conjunction with testing and removal of accumulated toxins and heavy metals, developing comprehensive individualised herbal antimicrobial and detoxification protocols.”
He claims that “toxins and heavy metals … enter our bodies, disrupt normal healthy cell behaviour, impair our immune system, often contribute and sometimes cause many different types of illnesses and health conditions.”
His claims are designed to generate unfounded worries in people, offering a smorgasbord of claims how he can help people learn [the words and spelling are his]:
• how mercury from common amalgam fillings can be passed from mother to child to grandchild and why preconception detoxification is important;
• how to assess a dentist to know your [sic] getting the best and safest care during amalgam removal;
• about mercury/autism connection, heavy metal accumulation and neurological diseases such as Alzheimer’s, Parkinson’s and Dementia;
• more about mercury, aluminium, cadmium and lead toxicity;
• how heavy metal accumulation acts as an antenna for electromagnetic radiation from devices such as wifi, cell phone, cordless phones, thus focusing the frequencies on the areas where the metals are stored, causing changes in the proteins and even DNA;
• the science behind electromagnetic radiation and how it affects human cells;
• Glyphosate toxicity, and how many of us have it and how it affects our health, and lots more.
Allan goes into the alleged toxicity of mercury amalgam fillings further at his blog. I should not have to say it, but his claims are baseless and have been debunked many times. The US Food and Drug Administration has said that existing evidence shows that dental amalgam is not harmful to the general population (tinyurl.com/589mbrr6). And as Scientific American said “Mercury and Autism: Enough Already! The science shows that they have nothing to do with each other and never have.” (tinyurl.com/mwwdxxak)
Allan also writes extensively on “EMF Sensitivity Wi-Fi and Cell Phone radiation – Heavy Metals and EMF Sensitivity and Autism” – he claims “Autism rates double every 5 years and the only thing that parallels that in our environment is the increase of man made Electro magnetic Radiation and fields largely in the high frequencies from cell phone Wi-Fi, smart meters and other Electro magnetic devices.’ This is unconscionable; scaring potential clients with this, while conveniently forgetting that correlation does not mean causation.
Allan also offers the following techniques as a “Detox for autism”:
• Sauna or heat therapy (far infrared is best) Cold shower straight after to close pores and wash of toxins
• Clay plasters, Clay on scars, then shower
• Ionic Foot Cleanses, Detox baths, Takara foot Pads, or raw white potato strapped on soles of feet
• Fibre + Enemas or colonics, slippery elm, keep bowls [sic] moving
• Liver gall bladder flush with lemon oil
• Exercise, dry skin brush
• Chi Machine for lymph drainage and movement to parasympathetic dominance
• Olive or other healthy oils for swish and spit
• Genetic, vitamin, mineral testing to guide your diet and supplements
• Western and Chinese Herbs to detox bowls [sic], liver, kidney, lymph
• Homeopathic drops & plenty of water orally
• Laser Energetic detox
• Ozonized bath, Epson salt bath
• Enema for detox reactions in kids
• Stronger detox agents DMPS, DMSA, EDTA can be used in case of high-level toxicity. For children, the use of the above mention techniques over DMPS, DMSA and EDTA is preferred first.
“Raw white potato strapped on soles of feet”!! Come on! This is lunacy. And enemas for children? And what qualifications does Allan hold to diagnose and administer these dangerous pharmaceuticals?
Luckily, Allan offers the perfect scanner to diagnose what’s wrong with you, the Oligoscan.
As described, “This a [sic] spectrographic-based test. Every element on the periodic table has its own unique absorption spectra, meaning that different elements absorb certain wavelengths of light, and reflect others. The spectra of lead will be different from that of mercury, or calcium, or any other element. The Oligoscan shines a laser on different points on the hand, and based off of [sic] which wavelengths of light are absorbed or reflected back, the levels of different metals and minerals in the cells of your hand can be determined. This is similar to how astronomers can analyze the wavelengths of light emitted by distant stars to determine their chemical make-up.
“The Oligoscan has the advantage of testing the levels of metals that are actually in your cells, not what you are able to excrete. It tests the heavy metal load of the tissues. This is important because heavy metals have a affinity [sic] for tissues and are often store [sic] there and not in the blood. It can also measure aluminium, which most other tests will miss. Oligoscan results tend to correlate with other accurate tests.”
A search of the TGA’s register of therapeutic goods did not find the Oligoscan listed.
Clearly, Allan is engaged in a process of scaring potential clients with misinformation, then offering diagnostic and treatment processes that are deceptive, ineffective and dangerous, and not listed with the TGA; for all of which he is not qualified.
A complaint was sent to the NSW Health Care Complaints Commission describing the above issues. (In NSW and Queensland, complaints concerning health care practitioners, registered and unregistered, are lodged with the relevant State authorities, the HCCC and OHO respectively.) We added that “This should not be treated as merely a case of misleading advertising; Allan is clearly endangering the public, so I recommend a thorough audit of his practice, and when my allegations are found to be proven, suitable disciplinary action taken and entered on the AHPRA register.”
The HCCC responded saying “Following consultation with the Chinese Medicine Council of New South Wales, it was decided to refer this matter to the Australian Health Practitioner
Regulation Agency (AHPRA) as AHPRA is the designated agency to manage concerns about advertising. We did not identify any other issues that would require further action by the Commission.” (We approached the Chinese Medicine Council of NSW – their response is quoted in the sidebar.)
The HCCC continued: “The Commission obtained a written response from Mr Allan. In his response to the Commission, Mr Allan stated that he had no record of providing any care and treatment to you.
“Mr Allan acknowledged that his website may have created a misunderstanding about what actual treatments are offered at his clinic, and what was on his website for educational purposes only.
“Mr Allan noted that he has never owned an Oligoscan or used it at his clinic, he has therefore removed that information from his website.
“Mr Allan confirmed that he does not offer the techniques under the heading ‘detox for autism’ at his clinic, the information was for educational purposes only, and he has now removed this information from his website.
“Further, Mr Allan has confirmed that he has removed the information on his website about Glyphosate Toxicity, Toxicity of Mercury Amalgam fillings, Nutrition for Autism, and all avenues of receiving mercury toxicity.
“Mr Allan also stated that he has since edited the information on EMF Sensitivity Wi-Fi and Cell Phone radiation – Heavy Metals and EMF Sensitivity Autism, as well as editing the information contained on the home and about pages of his website.
“Mr Allan stated that he has left the resources section with all the raw studies, and some information contained in other sections, as he feels that they are of use for anybody wanting to learn more about this specialised area.”
So, in spite of the detailed evidence and a call for a thorough audit of his practice, this was treated as merely a case of misleading advertising. This is standard operating procedure; the regulatory authorities cannot get over the divide between advertising and clinical practice. This has been shown in the hundreds of complaints sent to regulators; misleading advertising of dangerous practices and misinformation is simply treated as an advertising issue. The regulators cannot accept that if a practitioner advertises a therapy then they are more than likely using those therapies and, when those therapies have been found to be ineffective, they are engaging in practice in their clinics that deserves more than the dismissive response we received.
The public deserve much better than that.
Note: All of the quotes above were from Allan’s website until he removed them. The relevant pages have, nonetheless, can be accessed via the WayBack Machine, and can be supplied if required.
The Chinese Medicine Council’s position
The Chinese Medical Council were referred to the issues in the main article and were asked the following questions:
• Is the advice and those therapies [offered by Allan] of any concern to the Council?
• Should the complaint to the NSW Health Care Complaints Commission have led to an audit of his practice and when the allegations are proven, should there have been disciplinary action?
A spokesperson for the Chinese Medicine Council of NSW replied: “The Chinese Medicine Council of NSW (the Council) works in collaboration with the NSW Health Care Complaints Commission (HCCC) to receive and manage complaints about registered practitioners in
NSW. Our paramount legal obligation is to protect the public. We deal with practitioners whose conduct, performance or health may represent a risk to the public or is not in the public interest.
“We do this by assessing complaints, promoting compliance with professional standards and delivering programs to ensure practitioners provide safe care to the public and their patients. We do not have the legal power to discipline a NSW practitioner or to deregister them.
“By law, the Council cannot provide information about an individual practitioner. Only information that is publicly available can be disclosed, such as information recorded on the national register of practitioners which is maintained by the Australian Health Practitioner Regulation Agency (AHPRA), or publication of the outcomes of NCAT [New South Wales Civil and Administrative Tribunal] proceedings.
“Changes to a registered health practitioner’s registration status, such as the imposition of conditions or suspension, are published on the AHPRA online public register.
“The Council will not be making any further public comments at this time.
So, the Chinese Medicine Council have taken no action to protect the public and made no real comment. At least they have promised “Only information that is publicly available can be disclosed”, a statement of breathless inanity.
*‘first published in the Australian Skeptic magazine of June 2022.
This multi-center, open-label, randomized controlled trial assessed the effects of anthroposophic treatments on toxicity related to intensive-phase chemotherapy treatment in children aged 1-18 with the primary outcome of the toxicity sum score. Secondary outcomes were chemotherapy-related toxicity, overall and event-free survival after 5 years in study patients.
The main sponsorship for the study was provided by: Helixor Heilmittel GmbH & Co. KG, Rosenfeld. Additional finacial support was provided by: WALA Heilmittel GmbH, Bad Boll/Eckwälden; Weleda AG, Schwäbisch Gmünd: Mahle Stiftung, Stuttgart; Software AG Stiftung, Darmstadt; Stiftung Helixor, Rosenfeld; and Injex Pharma AG, Berlin.
The intervention and control groups were both given standard chemotherapy according to malignancy & tumor type. The intervention arm was provided with anthroposophic supportive treatment (AST); given as anthroposophic base medication (AMP), as a base medication for all patients, and additional on-demand treatment tailored to the patient in the intervention groups. The control was given no AMP. The toxicity sum score (TSS) was assessed using NCI-CTC scales.
The AST consisted of base AMP including Helixor®, and on-demand supplementary AMP given as needed for symptoms. Administration of the AST intervention and chemotherapy protocol were tailored for each type of pediatric malignancy included in the trial. This included both the base and the on-demand AMP, which were administered based on acute symptoms during intensive chemotherapy. The intervention group started the AST between the day of randomization and day 10 of the first chemotherapy cycle.
Data of 288 patients could be analyzed. The analysis did not reveal any statistically significant differences between the AST and the control group for the primary endpoint or the toxicity measures (secondary endpoints). Furthermore, groups did not differ significantly in the five-year overall and event-free survival follow-up.
The authors concluded that their findings showed that AST was able to be safely administered in a clinical setting, although no beneficial effects of AST between group toxicity scores, overall or event-free survival were shown.
In their discussion section, the authors explain the findings more clearly: “In the long term follow up, the explorative analysis of the data available for the 5-year follow up found no indications that efficacy of chemotherapy was influenced by AST. For long-term toxicities there were also no indications of an influence of AST.”
Question: what do we call a treatment that has neither adverse nor beneficial effects?
Could it be
A study by an international team of researchers estimated the proportion of healthcare interventions tested within Cochrane Reviews that are effective according to high-quality evidence.
They selected a random sample of 2428 (35%) of all Cochrane Reviews published between 1 January 2008 and 5 March 2021 and extracted data about interventions within these reviews that were compared with placebo, or no treatment, and whose outcome quality was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). They then calculated the proportion of interventions whose effectiveness was based on high-quality evidence according to GRADE, had statistically significant positive effects and were judged as beneficial by the review authors. They also calculated the proportion of interventions that suggested harm.
Of 1567 eligible interventions, 87 (5.6%) had high-quality evidence on first-listed primary outcomes, positive, statistically significant results, and were rated by review authors as beneficial. Harms were measured for 577 (36.8%) interventions, 127 of which (8.1%) had statistically significant evidence of harm. Our dependence on the reliability of Cochrane author assessments (including their GRADE assessments) was a potential limitation of our study.
The authors drew the following conclusions: While many healthcare interventions may be beneficial, very few have high-quality evidence to support their effectiveness and safety. This problem can be remedied by high-quality studies in priority areas. These studies should measure harms more frequently and more rigorously. Practitioners and the public should be aware that many frequently used interventions are not supported by high-quality evidence.
Proponents of so-called alternative medicine (SCAM) are fond of the ‘strawman’ fallacy; meaning they like to present a picture of conventional medicine that is overtly negative in order for SCAM to appear more convincing (Prince Charles, for instance, uses this trick every single time he speaks about SCAM). Therefore I am amazed that this paper has not been exploited in that way by them. I was expecting headlines such as
Evidence-based medicine is not supported by evidence
Less than 6% of all conventional treatments are supported by sound evidence.
Why did they not have a field day with this new paper then?
As the article is behind a paywall, it took me a while to get the full paper (thanks Paul). Now that I have read it, I think I understand the reason.
In the article, the authors provide figures for specific types of treatments. Let me show you some of the percentages of interventions that met the primary outcome (high quality, statistically significant effect, and authors interpret as effective):
- pharmacological 73.8%
- surgical 4.6%
- exercise 5.8%
- diet 1.2%
- alternative 0.0%
- manual therapies 0.0%
So, maybe the headlines should not be any of the above but:
No good evidence to support SCAM?
SCAM is destroying the evidence base of medicine.
I only now learned of the death of one of the most bizarre proponents that the cult of homeopathy has ever produced in its 200-year history. From his official obituary, one would not suspect much weirdness:
John R. Benneth passed away Nov. 9, 2021 in Chico, Calif., after a long battle with Parkinson’s disease.
John shepherded the Pixieland Theatre in Lincoln City for many years, writing, directing, and acting in plays that kept audiences coming back. He appeared often on stage in Portland and became a familiar face in local and national commercials. In the mid-1980s he was the host, writer, and creative force behind The Portland Underground, a weekly, live, late-night local access show. He gave many local actors a chance to stretch their improv talents on that and his earlier show, Mysterious Planet. His was the voice of both Portland Talk Radio’s controversial Jack Hammer, and Kandu the Mystic. He later performed regularly as Mark Twain in Virginia City, Nev., and on cruises on Lake Tahoe. John started working as a private investigator in Portland in 1978, and in 1982, he founded the National Missing Children’s Locate Center, helping parents to find their children across the U.S. He later became internationally known for his research into and advocacy for Homeopathic Medicine and was invited to present a treatise on the subject at London’s Oxford University in 2010.
John was a member of both Hawthorne and Washington Masonic lodges and the Scottish Rite of Portland.
He was preceded in death by his parents, John and Bettiana Benneth; and by his wife, Catherine Benneth. He is survived by his brother, David; and his four sons, Horatio, Merlin, Cyrano and Evan.
The ‘Bolen report’ offers a little more, albeit weirdly unreliable information:
John Benneth, PG Hom.- London (Hons) is the renowned discoverer of the link between Homeopathy and Conventional Ionic Chemistry.
The first to accept a notorious challenge to Homeopathy, he forced the James Randi Educational Foundation (JREF), in 1999, to back down from a spurious offer to award $1,000,000 for a test identifying homeopathic solutes from their liquid aqueous vehicles.
In 2010, by invitation of Nobel laureate physicist Brian Josephson at Cambridge’s Cavendish Laboratory, he presented the Supramolecular Chemistry of the Homeopathic Remedy revealing structural changes and the physics of hydrolysis and molecular self assembling chain reactions.
He is the author of Ebola Prophylaxis and Cure detailing the use of FDA approved homeopathic pharmaceuticals in the treatment of hemorrhagic fevers, presented in advance of the reported successful use of homeopathic remedies to cure Ebola.
He is a proponent for the use of homeopathic pharmaceuticals to cure sepsis and other dire conditions for conventional use in hospital emergency and intensive care, and the Ionic Vaccine for the safe and effective non-molecular prevention of epidemic diseases.
To estimate the true extent of Benneth’s eccentricity, we need to read some of the posts by John himself johnbenneth.wordpress.com. Alternatively, we might access some of his appearances on youtube, quackometer, or even just a post I published several years ago.
I am sad that John is gone. I always thought he was mad like a hatter, but he had me in stitches whenever our paths crossed.
An epidemiological study from the US just published in the BMJ concluded that “the mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008.”
In a BMJ editorial, Steven Woolf comments on the study and provides further evidence on how politics influence health in the US. Here are his concluding two paragraphs:
Political influence on US mortality rates became overt during the covid-19 pandemic, when public health policies, controlled by states, were heavily influenced by party affiliation. Republican politicians, often seeking to appeal to President Trump and his supporters, challenged scientific evidence and opposed enforcement of vaccinations and safety measures such as masking. A macabre natural experiment occurred in 2021, a year marked by the convergence of vaccine availability and contagious variants that threatened unvaccinated populations: states led by governors who promoted vaccination and mandated pandemic control measures experienced much lower death rates than the “control” group, consisting of conservative states with lax policies and large unvaccinated populations. This behavior could explain why US mortality rates associated with covid-19 were so catastrophic, vastly exceeding losses in other high income countries.
Observers of health trends in the US should keep their eye on state governments, where tectonic shifts in policy are occurring. While gridlock in Washington, DC incapacitates the federal government, Republican leaders in dozens of state capitols are passing laws to undermine health and safety regulations, ban abortion, limit LGBT+ rights, and implement more conservative policies on voting, school curriculums, and climate policy. To understand the implications for population health, researchers must break with custom; although scientific literature has traditionally avoided discussing politics, the growing influence of partisan affiliation on policies affecting health makes this covariate an increasingly important subject of study.
What has this to do with so-called alternative medicine (SCAM)?
Not a lot.
Except, of course, that Trump has been quite sympathetic to both quackery and quacks (see, for instance, here and here). Moreover, the embarrassing Dr. Oz, America’s charlatan-in-chief, is now a Republican candidate for the US senate. And the creation of the NHI office for alternative medicine, currently called NCCIH, was the idea of the Republican senator, Tom Harkin.
I think we get the drift: on the US political level, SCAM seems to be a right-wing thing.
Am I claiming that SCAM is the cause of the higher mortality in Republican counties?
Do I feel that both are related to irresponsible attitudes towards healthcare issues?
It seems that no ancient treatment is daft enough for some researchers of so-called alternative medicine (SCAM) to not pick it up. Even bloodletting is back, it seems!
The aim of this study was to investigate the effects of therapeutic phlebotomy on ambulatory blood pressure in patients with grade 1 hypertension. In this randomized-controlled intervention study, patients with unmedicated hypertension grade 1 were randomized into an intervention group (phlebotomy group; 500 mL bloodletting at baseline and after 6 weeks) and a control group (waiting list) and followed up for 8 weeks. The primary endpoint was the 24-h ambulatory mean arterial pressure between the intervention and control groups after 8 weeks. Secondary outcome parameters included ambulatory/resting systolic/diastolic blood pressure, heart rate, and selected laboratory parameters (e.g., hemoglobin, hematocrit, erythrocytes, and ferritin). Resting systolic/diastolic blood pressure/heart rate and blood count were also assessed at 6 weeks before the second phlebotomy to ensure safety. A per-protocol analysis was performed.
Fifty-three hypertension participants (56.7 ± 10.5 years) were included in the analysis (n = 25 intervention group, n = 28 control group). The ambulatory measured mean arterial pressure decreased by -1.12 ± 5.16 mmHg in the intervention group and increased by 0.43 ± 3.82 mmHg in the control group (between-group difference: -1.55 ± 4.46, p = 0.22). Hemoglobin, hematocrit, erythrocytes, and ferritin showed more pronounced reductions in the intervention group in comparison with the control group, with significant between-group differences. Subgroup analysis showed trends regarding the effects on different groups classified by serum ferritin concentration, body mass index, age, and sex. Two adverse events (AEs) (anemia and dizziness) occurred in association with the phlebotomy, but no serious AEs.
The authors concluded that therapeutic phlebotomy resulted in only minimal reductions of 24-h ambulatory blood pressure measurement values in patients with unmedicated grade 1 hypertension. Further high-quality clinical studies are warranted, as this finding contradicts the results of other studies.
This paper requires a few short comments:
- The effect on blood pressure was not ‘minimal’, as the authors pretend, it was non-existent (i.e. not significant and due to chance only).
- This lack of effect had to be expected considering human physiology.
- The fact that hemoglobin, hematocrit, erythrocytes, and ferritin all change after bloodletting is equally expected.
- Mild adverse effects are also no surprise.
- What is a surprise, however, that such a trial was ever conducted and passed by an ethics committee. Any medic who has not slept through his/her cardiovascular physiology lectures could have predicted the results quite accurately. And running a trial where the result is well-known before the study has started can hardly be called ethical.
In India, the homeopathic remedy, Arsenicum Album 30C (prepared from arsenic trioxide) is widely prescribed and publicly supplied to adults and children for preventing COVID infections. Inorganic arsenic, known as the “king of poisons” is a highly toxic substance with the potential to cause acute as well as chronic injury to multiple organ systems, mainly skin, lung, liver, and kidneys.
Indian researchers present three cases of acute liver injury, leading to the death of one patient with underlying non-alcoholic steatohepatitis (NASH) cirrhosis, after consumption of the homeopathic remedy AA30 for COVID-19 prevention.
A 70-year-old man with compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and diabetes mellitus consumed the homeopathic IB AA30 as prescribed for 12 weeks prior to the onset of symptoms. He presented with jaundice and abdominal distension within four weeks after the onset of loss of appetite and well-being. The patient was not on any other hepatotoxic agents, over-the-counter medications, or herbal and dietary supplements. Investigations revealed the presence of conjugated hyperbilirubinemia, ascites, and abnormal coagulation, suggestive of acute-on-chronic liver failure (ACLF). Further investigations to identify known causes of acute deterioration of underlying cirrhosis were performed, including a transjugular liver biopsy. All competing causes for acute liver injury were meticulously ruled out. These included infections-tests for immunoglobulin M (IgM) for viral hepatitis A and E; hepatitis B surface antigen and IgM antibody to hepatitis B core antigen; nucleic acid tests via polymerase chain reaction for hepatitis C; IgM for herpes zoster and herpes simplex, cytomegalovirus, parvovirus, Epstein-Barr virus. Complete auto-antibody testing for autoimmune hepatitis (AIH) was negative. The Roussel Uclaf Causality Assessment (RUCAM) demonstrated “probable” (score 7) drug-induced liver injury (DILI) and simplified AIH score was less than 5, revealing the cause of acute liver injury leading to ACLF as the homeopathic remedy, AA30. The liver biopsy revealed multiacinar hepatocyte necrosis, lymphocytic, neutrophilic, and eosinophilic inflammation in the absence of interface hepatitis, which were predominantly portal-based in the background of cirrhosis, suggestive of DILI. Analysis of drugs consumed could not be performed in view of inadequate sample availability. The patient and family consented to arsenic analysis in nail and hair samples which revealed extremely high levels of the heavy metal, supportive of arsenic toxicity and associated liver injury in the patient. Evaluation of hair and hair samples of two family members (below detection limits, method detection limit being 0.1 mg/kg), staying in the same household did not reveal levels signifying cluster arsenic poisoning from water or soil sources. The patient succumbed to complications related to ACLF, nine months after the initial diagnosis.
A 68-year-old male with systemic hypertension controlled on telmisartan who ingested AA30 as prescribed for four weeks prior to the onset of symptoms. There was no associated jaundice or cholestatic symptoms, but liver tests revealed acute hepatitis with an elevation of liver enzymes. The patient was not on any other hepatotoxic agents, over-the-counter medications, or herbal and dietary supplements. Further investigations did not reveal the presence of underlying chronic liver disease or portal hypertension. All competing causes for acute liver injury were meticulously ruled out similar to the extensive workup that was done in case one. The RUCAM demonstrated “probable” (score 8) DILI and simplified AIH score was less than 5, revealing the cause of acute non-icteric hepatitis as the homeopathic remedy, AA30. The liver biopsy revealed perivenular hepatocyte necrosis, with predominantly portal-based mixed cellular inflammation consisting of plasma cells, eosinophils, lymphocytes, and scattered neutrophils. Additionally, ballooning of hepatocytes was marked with scattered rosettes and moderate interphase hepatitis in the presence of mild portal and sinusoidal fibrosis suggestive of DILI. Acute hepatitis resolved after drug withdrawal and finite course of steroids within three months, without any recurrence on follow-up.
A 48-year-old overweight woman consumed homeopathic AA30 pills as COVID-19 preventive for one week prior to the onset of her symptoms of cholestatic jaundice. Prior to the development of jaundice, she had nonspecific gastrointestinal symptoms such as nausea and progressive loss of appetite. Liver tests revealed conjugated hyperbilirubinemia with highly raised liver enzymes. The patient was not on any other hepatotoxic prescription drugs, over-the-counter medications, or herbal and dietary supplements. Further investigations did not reveal the presence of underlying chronic liver disease or portal hypertension. All competing causes for acute liver injury were meticulously ruled out similar to the extensive workup that was done in case one. The RUCAM demonstrated “probable” (score 7) DILI and simplified AIH score was less than 5, revealing the cause of acute cholestatic hepatitis as the homeopathic remedy, AA30. The liver biopsy revealed spotty, focal hepatocyte necrosis, with predominantly portal-based neutrophilic and eosinophil-rich inflammation, moderate steatosis, and mild interface hepatitis with underlying mild perisinusoidal fibrosis, suggestive of DILI. The acute cholestatic hepatitis resolved after drug withdrawal and a finite course of steroids within six months, without any recurrence on follow-up.
The chemical analysis and toxicology (inductively coupled optical emission spectroscopy and triple-quadrupole gas chromatography with tandem mass spectroscopy method) on two sets of AA30 samples retrieved from case three revealed D-mannose, melezitose, and arsenic respectively, demonstrating batch-to-batch variation due to poor manufacturing practices.
The authors draw the following conclusions: Health regulatory authorities, physicians, general and patient population must be aware of the potential harms associated with the large-scale promotion of untested, alternative medical systems during a medical emergency so as to prevent an “epidemic” of avoidable DILI within the ongoing pandemic. Even though ultra-diluted homeopathic remedies, found ineffective as shown in large-scale meta-analysis, are considered safe for use due to the absence of any active compound beyond 12C dilution. Nonetheless, poor manufacturing practices, use of concentrated tincture formulations, and adulteration and contamination of homeopathic remedies can still pose considerable toxicity in predisposed persons. From a scientific and evidence-based standpoint, it is imperative that the general population and at-risk persons understand that vaccination, and not untested, misleading IBs, remains the best available armamentarium against COVID-19 which helps in fighting back the pandemic.
If you have been following my blog for a while, you probably know the answer to this question. A recent article published in JAMA re-emphasizes it in an exemplary fashion:
According to National Health and Nutrition Examination Survey data, 52% of surveyed US adults reported using at least 1 dietary supplement in the prior 30 days and 31% reported using a multivitamin-mineral supplement. The most commonly cited reason for using supplements is for overall health and wellness and to fill nutrient gaps in the diet. Cardiovascular disease and cancer are the 2 leading causes of death and combined account for approximately half of all deaths in the US annually. Inflammation and oxidative stress have been shown to have a role in both cardiovascular disease and cancer, and dietary supplements may have anti-inflammatory and antioxidative effects.
Objective To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the efficacy of supplementation with single nutrients, functionally related nutrient pairs, or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population, as well as the harms of supplementation.
Population Community-dwelling, nonpregnant adults.
Evidence Assessment The USPSTF concludes with moderate certainty that the harms of beta carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer. The USPSTF also concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with single or paired nutrients (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined.
Recommendation The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement)
The report also elaborates on potential harms:
For many of the vitamins and nutrients reviewed, there was little evidence of serious harms. However, an important harm of increased lung cancer incidence was reported with the use of beta carotene by persons who smoke tobacco or have occupational exposure to asbestos.
Excessive doses of vitamin supplements can cause several known adverse effects; for example, moderate doses of vitamin A supplements may reduce bone mineral density, and high doses may be hepatotoxic or teratogenic. Vitamin D has potential harms, such as a risk of hypercalcemia and kidney stones, when given at high doses. The potential for harm from other supplements at high doses should be carefully considered.
There is nothing new here, of course. I (and others) have been trying to get these points across for many years. But it is nevertheless most gratifying to see the message repeated by a top journal such as JAMA. I hope JAMA is more successful than I was in changing the behavior of the often all too gullible public!