Edzard Ernst

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

The use of so-called alternative medicine (SCAM) are claimed to be associated with preventive health behaviors. However, the role of SCAM use in patients’ health behaviors remains unclear.

This survey aimed to determine the extent to which patients report that SCAM use motivates them to make changes to their health behaviours. For this purpose, a secondary analysis of the 2012 National Health Interview Survey data was undertaken. It involved 10,201 SCAM users living in the US who identified up to three SCAM therapies most important to their health. Analyses assessed the extent to which participants reported that their SCAM use motivated positive health behaviour changes, specifically: eating healthier, eating more organic foods, cutting back/stopping drinking alcohol, cutting back/quitting smoking cigarettes, and/or exercising more regularly.

Overall, 45.4% of SCAM users reported being motivated by SCAM to make positive health behaviour changes, including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers). Individual SCAM therapies motivated positive health behaviour changes in 22% (massage) to 81% (special diets) of users. People were more likely to report being motivated to change health behaviours if they were:

  • aged 18-64 compared to those aged over 65 years;
  • of female gender;
  • not in a relationship;
  • of Hispanic or Black ethnicity, compared to White;
  • reporting at least college education, compared to people with less than high school education;
  • without health insurance.

The authors concluded that a sizeable proportion of respondents were motivated by their SCAM use to undertake health behavior changes. CAM practices and practitioners could help improve patients’ health behavior and have potentially significant implications for public health and preventive medicine initiatives; this warrants further research attention.

This seems like an interesting finding! SCAM might be ineffective, but it motivates people to lead a healthier life. Thus SCAM has something to show for itself after all.

Great!

Except, there is another explanation of the results, one that might be much more plausible.

What if some consumers, particularly females who are well-educated and have no health insurance, one day decide that it’s time to do something for their health. Thus they initiate several things:

  • they start using SCAM;
  • they exercise more regularly;
  • they eat more healthily;
  • they consume organic food;
  • they stop smoking;
  • they stop boozing.

The motivation common to all these changes is their determination to do something about their health. Contrary to the authors’ wishful thinking, SCAM has little or even nothing to do with it. The notion was induced by SCAM practitioners who like to think that they play a role in disease prevention, by the leading questions of the interviewer, by recall bias, or by other factors..

What did the wise man say once upon a time?

CORRELATION IS NOT CAUSATION!

 

 

Professor Anthony Pelosi just published an intriguing paper. Here is the abstract:

During the 1980s and 1990s, Hans J Eysenck conducted a programme of research into the causes, prevention and treatment of fatal diseases in collaboration with one of his protégés, Ronald Grossarth-Maticek. This led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature with effect sizes that have never otherwise been encounterered in biomedical research. This article outlines just some of these reported findings and signposts readers to extremely serious scientific and ethical criticisms that were published almost three decades ago. Confidential internal documents that have become available as a result of litigation against tobacco companies provide additional insights into this work. It is suggested that this research programme has led to one of the worst scientific scandals of all time. A call is made for a long overdue formal inquiry.

The Guardian reported further details on this story sating that the work of one of the most famous and influential British psychologists of all time, Hans Eysenck, is under a cloud following an investigation by King’s College London, which has found 26 of his published papers “unsafe”.

In relation to so-called alternative medicine (SCAM), it is foremost this claim of Eysenck that is relevant:

It is argued that there is now suficient evidence to regard psychosocial variables, in
particular personality and stress, as important risk factors for cancer and coronary heart
disease (CHD), equal in importance to smoking, heredity, cholesterol level, blood pressure,
and other physical variables. Furthermore, it is now clear that both types of factors act
synergistically; that is, each by itself is relatively benign, but their effects multiply to produce
high levels of disease…

The claim (which Eysenck published many times over, for instance here) was picked up and promoted by many believers in SCAM. This might have been helped by Eysenck’s bizarre openness to all things paranormal. Today his belief of a link between personality/stress and cancer is deeply engrained in SCAM.

King’s College says the results and conclusions of the papers “were not considered scientifically rigorous” by its committee of inquiry. Prof Sir Robert Lechler, the provost at King’s, has contacted the editors of the 11 journals where the papers appeared, recommending they should be retracted.

Prof Anthony Pelosi, consultant psychiatrist at the Priory Hospital, Glasgow, whose own investigation prompted the inquiry by King’s, said their work “led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature, with effect sizes that have never otherwise been encountered in biomedical research”.

Among more than 3,000 people in the studies, Eysenck and his colleague claimed people with a “cancer-prone” personality were 121 times more likely to die of the disease than those without. Cancer-prone personalities were described as generally passive in the face of stress from outside.

Eysenck and Grossarth-Maticek apparently even had a cure for cancer. In one study, they gave 600 “cancer-prone” individuals a leaflet on how to be more “autonomous” and take control of their destiny. It contained such advice as: “Your aim should always be to produce conditions which make it possible for you to lead a happy and contented life.” It appeared to deliver miracles. Over 13 years, the 600 people randomly assigned to bibliotherapy, as it was called, had all-cause mortality of 32%, compared with 82% of 600 people not fortunate enough to receive a leaflet.

“I honestly believe, having read it so carefully and tried to find alternative interpretations, that this is fraudulent work,” said Pelosi, who is concerned Eysenck’s ideas still have a following. “His acolytes always bragged he was the most cited psychologist of all time… In the social sciences citation index, he was number three. Number two was Freud. Number one was Karl Marx. He was hugely prolific, widely cited and very influential… Many fringe medical practitioners hold the same conviction.”

Many paediatric oncology patients report use of so-called alternative medicine (SCAM), and naturopathic ‘doctors’ (NDs) often provide supportive paediatric oncology care. However, little information exists to formally describe this clinical practice. This survey was aimed at filling the gap. It was conducted with members of the ‘Oncology Association of Naturopathic Physicians’ (OncANP.org) to describe recommendations across 4 therapeutic domains:

  1. natural health products (NHPs),
  2. nutrition,
  3. physical medicine,
  4. mental/emotional support.

The researchers received 99 responses from practitioners with a wide variance of clinical experience and aptitude to treat children with cancer. 52.5% of respondents stated that they did, in fact, not treat such children. The three primary reasons for this decision were:

  1. lack of public demand (45.1%),
  2. institutional or clinic restrictions (21.6%),
  3. personal reasons/comfort (19.6%).

The 10 most frequently considered NHPs by those NDs who did treat childhood cancer patients were:

  • fish-derived omega-3 fatty acid (83.3%),
  • vitamin D (83.3%),
  • probiotics (82.1%),
  • melatonin (73.8%),
  • vitamin C (72.6%),
  • homeopathic Arnica (69.0%),
  • turmeric/curcumin (67.9%),
  • glutamine (66.7%),
  • Astragalus membranaceus (64.3%),
  • Coriolus versicolor/PSK (polysaccharide K) extracts (61.9%).

The top 5 nutritional recommendations were:

  • anti-inflammatory diets (77.9%),
  • dairy restriction (66.2%),
  • Mediterranean diet (66.2%),
  • gluten restriction (61.8%),
  • and ketogenic diet (57.4%).

The top 5 physical interventions were

  • exercise (94.1%),
  • acupuncture (77.9%),
  • acupressure (72.1%),
  • craniosacral therapy (69.1%),
  • and yoga (69.1%).

The top 5 mental/emotional interventions were:

  • meditation (79.4%),
  • art therapy (77.9%),
  • mindfulness-based stress reduction (70.6%),
  • music therapy (70.6%),
  • and visualization therapy (67.6%).

The Canadian authors concluded that the results of our clinical practice survey highlight naturopathic interventions across four domains with a strong rationale for further inquiry in the care of children with cancer.

Personally, I don’t see a ‘strong rationale’ for anything here. I was, however, struck by the fact that about half of the naturopaths (they are NOT doctors!) dare to treat children with cancer. Equally, I was impressed by the list of treatments they use for this purpose; most are pure quackery! Finally, I was struck by the reasons given by those naturopaths who laudably abstained from treating cancer: they did not take this decision because of the lack of evidence that naturopaths and the treatments they like to employ fail to do more good than harm.

Altogether, this survey confirmed my view that naturopaths should not be allowed near children, especially those suffering from cancer.

Four speakers have been announced for next year’s conference (25-26 April 2020) of the UK ‘Society of Homeopaths’ (SoH). It has the theme ‘All About Men’ (which is surprising considering the majority of homeopathy fans are women). The meeting will aim to provide a better understanding of men’s lives and illnesses in order for practitioners to help them seek homeopathic treatments with confidence.

One of the 4 speakers will be California-based chiropractor, homeopath and health coach Joel Kriesberg. The SoH’s announcement proudly states that “Joel Kreisberg is going to bring the very interesting tool, the Enneagram, which was originally devised by the famous philosopher, George Gurdjieff. This is the first time Joel has lectured in the UK and he is well respected and highly thought of by the likes of Karen Allen and Dana Ullman.”

(A note to the SoH: Gurdjieff did not devise the Enneagram, he popularised it; perhaps you want to correct this statement?)

But, what is the ENNEAGRAM?

According to Wikipedia, the Enneagram (from the Greek words ἐννέα [ennéa, meaning “nine”] and γράμμα [grámma, meaning something “written” or “drawn”[1]]), is a model of the human psyche which is principally understood and taught as a typology of nine interconnected personality types. Although the origins and history of many of the ideas and theories associated with the Enneagram of Personality are a matter of dispute, contemporary Enneagram claims are principally derived from the teachings of Oscar Ichazo and Claudio Naranjo. Naranjo’s theories were partly influenced by some earlier teachings of George Gurdjieff. As a typology the Enneagram defines nine personality types (sometimes called “enneatypes”), which are represented by the points of a geometric figure called an enneagram,[2] which indicate connections between the types. There are different schools of thought among Enneagram teachers, therefore their ideas are not always in agreement.

The Enneagram of Personality has been widely promoted in both business management and spirituality contexts through seminars, conferences, books, magazines, and DVDs.[3][4] In business contexts it is generally used as a typology to gain insights into workplace interpersonal-dynamics; in spirituality it is more commonly presented as a path to higher states of being, essence, and enlightenment. Both contexts say it can aid in self-awareness, self-understanding and self-development.[3]

 

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In a nutshell, the Enneagram is an obsolete personality test that has never been properly validated and is today used mostly by quacks and other dubious characters and institutions. Yet, this is what Kriesberg has to say on his website about the use of the Enneagram in homeopathy:

The Enneagram’s application to homeopathy and health coaching makes a dramatic difference as it allows practitioner to identify the client’s learning style quickly. As we engage the Enneagram, we are able to provide specific developmental paths and activities based on their Enneagram style. Healing is faster, deeper, and has longer-lasting results.

To teach all this, Kriesberg is offering classes that are grounded in Tinus Smits’ method for studying universal healing with homeopathy, in which direct experience of the Enneagram types is enhanced by the use of homeopathic remedies. 

Tinus Smits! … where have I heard this name before?

Ah yes, this is the homeopath who invented CEASE!

Smits became convinced that autism is caused by a child’s exposure to an accumulation of toxic substances and published several books about his theory. In his experience (as far as I can see, Smits never published a single scientific paper in the peer-reviewed literature) autism is caused by an accumulation of different toxins. About 70% is due to vaccines, 25% to toxic medication and other toxic substances, 5% to some diseases. According to the ‘like cures like’ principle of homeopathy, Smits claimed that autism must be cured by applying homeopathic doses of the substances which caused autism. Step by step all assumed causative factors (vaccines, regular medication, environmental toxic exposures, effects of illness, etc.) are detoxified with the homeopathically prepared substances that has been administered prior to the onset of autism. Smits and his followers believe that this procedure clears out the energetic field of the patient from the imprint of toxic substances or diseases.

I herewith congratulate the SoH on their forthcoming conference – an event that must not be missed! They have managed to pack an unprecedented amount of unethical nonsense into just one lecture!

 

Traditional Chinese Medicine (TCM) is a term created by Mao lumping together various modalities in an attempt to pretend that healthcare in the People’s Republic of China (PRC) was being provided despite the most severe shortages of conventional doctors, drugs and facilities. Since then, TCM seems to have conquered the West, and, in the PRC, the supply of conventional medicine has hugely increased. Today therefore, TCM and conventional medicine peacefully co-exist side by side in the PRC on an equal footing.

At least this is what we are being told – but is it true?

I have visited the PRC twice. The first time, in 1980, I was the doctor of a university football team playing several games in the PRC, including one against their national team. The second time, in 1991, I co-chaired a scientific meeting in Shanghai. On both occasions, I was invited to visit TCM facilities and discuss with colleagues issues related to TCM in the PRC. All the official discussions were monitored by official ‘minders’, and therefore fee speech and an uninhibited exchange of ideas are not truly how I would describe them. Yet, on both visits, there were occasions when the ‘minders’ were absent and a more liberal discussion could ensue. Whenever this was the case, I did not at all get the impression that TCM and conventional medicine were peacefully co-existing. The impression that I did get was that their co-existence resembled more a ‘shot-gun marriage’.

During my time running the SCAM research unit at Exeter, I had the opportunity to welcome several visiting researchers from the PRC. This experience seemed to confirm my impression that TCM in the PRC was less than free. As an example, I might cite one acupuncture project I was once working on with a scientist from the PRC. When it was nearing its conclusion and I mentioned that we should now think about writing it up to publish the findings, my Chinese colleague said that being a co-author was unfortunately not an option. Knowing how important publications in Western journals are for researchers from the PRC, I was most surprised by this revelation. The reason, it turned out, was that our findings failed to be favourable for TCM. My friend explained that such a paper would not advance but hinder an academic career, once back in the PRC.

Suspecting that the notion of a peaceful co-existence of TCM and conventional medicine in the PRC was far from true, I have always been puzzled how the myth could survive for so many years. Now, finally, it seems to crumble. This is from a recent journalistic article entitled ‘Chinese Activists Protest the Use of Traditional Treatments – They Want Medical Science’ which states that thousands of science activists in the PRC protest that the state neglects its duty to treat its citizens with evidence-based medicine (here is the scientific article this is based on):

Over a number of years, Chinese researcher Qiaoyan Zhu, who has been affiliated with the University of Copenhagen’s Department of Communication, has collected data on the many thousand science activists in China through observations in Internet forums, on social media and during physical meetings. She has also interviewed hundreds of activists. Together with Professor Maja Horst, who has specialized in research communication, she has analyzed the many data on the activists and their protests in an article that has just been published in the journal Public Understanding of Science:

“The activists are better educated and wealthier than the average Chinese population, and a large majority of them keep up-to-date with scientific developments. The protests do not reflect a broad popular movement, but the activists make an impact with their communication at several different levels,” Maja Horst explained and added: “Many of them are protesting individually by writing directly to family, friends and colleagues who have been treated with – and in some cases taken ill from – Traditional Chinese Medicine. Some have also hung posters in hospitals and other official institutions to draw attention to the dangers of traditional treatments. But most of the activism takes place online, on social media and blogs.

Activists operating in a regime like the Chinese are obviously not given the same leeway as activists in an open democratic society — there are limits to what the authorities are willing to accept in the public sphere in particular. However, there is still ample opportunity to organize and plan actions online.

“In addition to smaller groups and individual activists that have profiles on social media, larger online groups are also being formed, in some cases gaining a high degree of visibility. The card game with 52 criticisms about Traditional Chinese Medicine that a group of activists produced in 37,000 copies and distributed to family, friends and local poker clubs is a good example. Poker is a highly popular pastime in rural China so the critical deck of cards is a creative way of reaching a large audience,” Maja Horst said.

Maja Horst and Qiaoyan Zhu have also found examples of more direct action methods, where local activist groups contact school authorities to complain that traditional Chinese medicine is part of the syllabus in schools. Or that activists help patients refuse treatment if they are offered treatment with Traditional Chinese Medicine.

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I am relieved to see that, even in a system like the PRC, sound science and compelling evidence cannot be suppressed forever. It has taken a mighty long time, and the process may only be in its infancy. But there is hope – perhaps even hope that the TCM enthusiasts outside the PRC might realise that much of what came out of China has led them up the garden path!?

 

Spinal manipulation is a treatment employed by several professions, including physiotherapists and osteopaths; for chiropractors, it is the hallmark therapy.

  • They use it for (almost) every patient.
  • They use it for (almost) every condition.
  • They have developed most of the techniques.
  • Spinal manipulation is the focus of their education and training.
  • All textbooks of chiropractic focus on spinal manipulation.
  • Chiropractors are responsible for most of the research on spinal manipulation.
  • Chiropractors are responsible for most of the adverse effects of spinal manipulation.

Spinal manipulation has traditionally involved an element of targeting the technique to a level of the spine where the proposed movement dysfunction is sited. This study evaluated the effects of a targeted manipulative thrust versus a thrust applied generally to the lumbar region.

Sixty patients with low back pain were randomly allocated to two groups: one group received a targeted manipulative thrust (n=29) and the other a general manipulation thrust (GT) (n=31) to the lumbar spine. Thrust was either localised to a clinician-defined symptomatic spinal level or an equal force was applied through the whole lumbosacral region. The investigators measured pressure-pain thresholds (PPTs) using algometry and muscle activity (magnitude of stretch reflex) via surface electromyography. Numerical ratings of pain and Oswestry Disability Index scores were collected.

Repeated measures of analysis of covariance revealed no between-group differences in self-reported pain or PPT for any of the muscles studied. The authors concluded that a GT procedure—applied without any specific targeting—was as effective in reducing participants’ pain scores as targeted approaches.

The authors point out that their data are similar to findings from a study undertaken with a younger, military sample, showing no significant difference in pain response to a general versus specific rotation, manipulation technique. They furthermore discuss that, if ‘targeted’ manipulation proves to be no better than ‘general’ manipulation (when there has been further research, more studies), it would challenge the need for some current training courses that involve comprehensive manual skill training and teaching of specific techniques. If simple SM interventions could be delivered with less training, than the targeted approach currently requires, it would mean a greater proportion of the population who have back pain could access those general manipulation techniques. 

Assuming that the GT used in this trial was equivalent to a placebo control, another interpretation of these results is that the effects of spinal manipulation are largely or even entirely due to a placebo response. If this were confirmed in further studies, it would be yet one more point to argue that spinal manipulation is not a treatment of choice for back pain or any other condition.

When Samuel Hahnemann translated Cullen’s ‘Treatise on Materia Medica’ in 1790, he learnt of Cullen’s explanation of the actions of Peruvian (or China) bark, Cinchona officinalis, a malaria treatment. Hahnemann disagreed with it and decided to conduct experiments of his own. He thus ingested high doses of Cinchona and noticed that subsequently he developed several of the symptoms that are characteristic of malaria. This is how Hahnemann later described his experience:

I took for several days, as an experiment, four drams of good china daily. My feet and finger tips, etc., at first became cold; I became languid and drowsy; my pulse became hard and quick; an intolerable anxiety and trembling (but without rigor); trembling in all limbs; then pulsation in the head, redness in the cheeks, thirst; briefly, all those symptoms which to me are typical of intermittent fever, such as the stupefaction of the senses, a kind of rigidity of all joints, but above all the numb, disagreeable sensation which seems to have its seat in the periosteum over all the bones of the body – all made their appearance. This paroxysm lasted for two or three hours every time, and recurred when I repeated the dose and not otherwise. I discontinued the medicine and I was once more in good health.

Hahnemann described what de facto was the 1st homeopathic proving. Despite the fact that Hahnemann misinterpreted the event, provings thus became the very basis of homeopathy. At Hahnemann’s time, it was highly uncommon for doctors to test their medicines in this way. So, one might wonder: where did the idea come from?  Is it his very own innovation, or did he get the idea from someone else?

In 1777, Hahnemann had studied medicine in Vienna. The medical school was at the time strongly influenced by Gerard van Swieten (1700-1772) He was the innovator of a new way of medical thinking and is honoured for this legacy to the present day in Vienna.

 

Van Swieten’s aim was to put medicine on new scientific foundations based on objective clinical observation, botanical and chemical research, and the introduction of new, powerful remedies.

One of the pupils of this school was Anton Störck (1731-1803). He became the director of Austrian public health and medical education, appointed by Empress Maria Theresia. Störck was the first medical scientist to systematically test the effects of medicines, including poisonous plants (e.g., hemlock, henbane, meadow saffron).

 

In numerous cases, Störck used himself as a subject in his experiments to determine adverse effects and tolerable dose levels. One of his pupils was Joseph Quarin who fully adopted his teacher’s concepts. He later rose to considerable prominence in the Viennese medical establishment.

 

Hahnemann’s clinical teacher at Vienna was Joseph Quarin. Hahnemann’s idea of  ‘homeopathic provings’ are thus to a significant extent influenced by Störck’s innovation.

A team of 42 authors from various disciplines (mostly medicine and philosophy) have published an appeal to broaden the definition of evidence. They reached several overlapping conclusions with implications for policy and practice in research and clinical care, which they summarised as follows:

1. ‘Evidence’ is typically evidence of causation. Common terms used in EBM, such as ‘intervention’, ‘outcome’ or ‘increased risk’, are relevant to evidence-based decision making only insofar as they point to causal matters: causal interventions and their effects. Although there is growing reluctance to make causal claims in areas of uncertainty, the correct response to such uncertainty is not to avoid talking about causation but instead to improve our methods of understanding it.

2. Establishing causation often requires the use of multiple methods since no single method will be universally applicable or perfect for this purpose. This means that statistical approaches, in particular randomised controlled trials and systematic reviews, cannot uncover all causally relevant information, contrary to their widespread assumed status as the universal gold standards of EBM.

3. An understanding of causal mechanisms can help to determine whether an intervention works (ie, its efficacy shown in experiment or effectiveness in clinical practice). In addition, we should strive to understand how an intervention works (ie, its mechanism) and how it can be made to work (ie, the conditions under which it works best). Understanding mechanisms is essential for both of these. For instance, a medical intervention that works experimentally might not do so when combined with a negatively interacting substance.

4. Although animal experiments can shed light on causal mechanisms, other types of evidence can add to our understanding. This is because causal mechanisms are complex, involving multiple causal interactions of various factors. These factors play roles in the effectiveness of the treatment and in interactions between the treatment and the individual patient.

5. Given the multiplicity of methods (cf 2) and a wide interpretation of what counts as a mechanism (cf 3 and 4), causation should be understood in non-reductionist terms. That is, the scope of relevant causal interactions extends beyond the molecular, pharmacological and physiological levels of interaction. Any thorough causal account should also include higher-level factors, such as the behaviour of tissues, whole organs and individuals, including psychological and social factors.

6. ‘Causal evidence’ should be extended to include different types of evidence, including case studies and case reports, which can in some cases provide valuable information for understanding causation and causal mechanisms. This is particularly important when dealing with rare disorders, marginal groups or outliers.

7. Patient narratives and phenomenological approaches are useful tools for looking beyond evidence such as symptoms and outcomes, and to elucidate the core causes or sources for chronic and unexplained conditions.

8. Causation has a non-negligible temporal aspect. Whether of long or short duration, a causal interaction cannot be fully understood from a ‘snapshot’, but requires both backwardlooking perspectives (towards the origin) and forward-looking perspectives (towards the outcome).

These points are well worth considering, in my view. As we have often discussed on this blog, causation is the key. The authors see their paper as a philosophical analysis that ought to have a direct impact on the practice of medicine. If we are to understand what is meant by ‘evidence’, what is the ‘best available evidence’ and how to apply it in the context of medicine, they write, we need to tackle the problem of causation head on. In practice, this means understanding the context in which evidence is obtained, as well as how the evidence might be interpreted and applied when making practical clinical decisions. It also means being explicit about what kind of causal knowledge can be gained through various research methods. The possibility that mechanistic and other types of evidence can be used to add value or initiate a causal claim should not be ignored. 

Their plea has much scope for being misunderstood by enthusiasts of so-called alternative medicine (SCAM). And I am keen to hear what you think about the 8 points raised here.

Once upon a time, arsenic has been used widely for medicinal and other purposes. Now that we know how toxic it is, few people would voluntarily take it – except of course fans of homeopathy. In homeopathy, arsenic is an important and popular remedy.

Here is what HOMEOPATHY PLUS tell us about its therapeutic potential:

Arsenic is a toxic chemical element, historically used as a poison. It is safe to use with infants through to the elderly when prepared in homeopathic potencies. Those who need Arsenicum are prone to hypochondriasis and are intolerant of untidiness and disorder. They are anxious, critical, and restless, and dislike being alone but may be irritable with company. Restlessness may be followed by exhaustion which is out of proportion to their illness. They fear illness and disease, death, and being alone. Discharges tend to be acrid and burning. Burning pains paradoxically feel better for heat (except the headache which is better for cold applications). Thirst is for sips of warm drinks but cold drinks worsen. Symptoms worsen between midnight and 2 AM.

Colds and Hayfever

    • Red, puffy, burning eyes that feel better for hot compresses.
    • Watery, nasal discharge that burns and reddens the nostrils and lip.
    • Frequent sneezing with no relief.

Coughs

    • Worsened by cold air or cold drinks.
    • Rapid, difficult breathing, with wheezing (asthma).
    • Coughs or wheezing worse for lying down and better for sitting upright.
      Headaches
    • Burning, throbbing pain.
    • Worsened by heat and relieved by cold applications or cool air (though rest of body will be chilly and rugged up).

Skin Problems

    • Eczema with burning, itching, dry skin.

Digestive Problems

    • Thirst for frequent small sips of water.
    • Burning stomach pains eased by drinking milk.
    • Offensive, burning, scalding diarrhoea.
    • A key remedy for food poisoning or gastroenteritis.

Fever

    • Hot head and cold body.
    • Chilly and want to be rugged up.

Sleep

    • Restless and anxious – insomnia between midnight and 2 AM
    • Dreams of robbers

For Pets

    • Chilly, anxious pets.
    • Itchy, dry skin eruptions in chilly, anxious animals.

Where do I find it?

Arsenicum album (Ars.) is available from our online store as a single remedy and is also included in the following Complexes (combination remedies): Anxiety; Common Cold – Watery; Hay Fever; Insomnia; Mouth Ulcer; Panic Stop; Sinus Pain; Winter Defence.

Important

While above self-limiting or acute complaints are suitable for home treatment, see your healthcare provider if symptoms worsen or fail to improve. Chronic or persistent complaints, which may or may not be mentioned above, require a different treatment and dosage protocol so are best managed by a qualified homeopath for good results.

Dosage Instructions

For acute and self-limiting complaints, take one pill or five drops of the remedy every 30 minutes to 4 hours (30 minutes for intense symptoms, 4 hours for milder ones). Once an improvement is noticed, stop dosing and repeat the remedy only if symptoms return. If there is no improvement at all by three doses, choose a different remedy or seek professional guidance. Chronic symptoms or complaints require a course of professional treatment to manage the changes in potencies and remedies that will be required.

So, arsenic is safe to use with infants through to the elderly when prepared in homeopathic potencies!

True of false?

We recently discussed a case of homeopathic arsenic poisoning from India. Now a similar one has been reported from Switzerland. A Swiss doctor published a case report of chronic arsenic poisoning associated with the intake of a homeopathic remedy.

For about 4 years the patient had taken globules of a freely purchasable homeopathic remedy containing inorganic arsenic (iAs) diluted to D6 (average arsenic content per single globule: 0.85 ± 0.08 ng). She took the remedy because it was advertised for gastrointestinal confort. In the previous 7 months, she had taken 20 to 50 globules daily (average 30 ng arsenic daily).

She complained of nausea, stomach and abdominal cramps, diarrhoea and flatulence, headache, dizziness, anxiety, difficulty concentrating, insomnia, snoring, leg cramps and fatigue, loss of appetite, increased thirst and sweating, reduced diuresis, weight gain, paleness and coolness of both hands with a furry feeling of the hands, eczema of the hands, arms and legs, conjunctivitis and irregular menstruation.

The physical and laboratory examinations showed a body mass index of 30 kg/m2, acne vulgaris, bilateral spotted leukonychia, eczema of hands, arms and legs, non-pitting oedema of the legs, elevated plasma alkaline phosphatase activity, folate deficiency and severe vitamin D3 insufficiency. The arsenic concentration in her blood was <0.013 µmol/l, and arsenic was undetectable in her scalp hair. The total iAs concentration was 116 nmol/l in the morning urine and 47 nmol/l in the afternoon urine.

The urinary arsenic concentration decreased and the patient’s complaints improved upon interruption of the arsenic globules, vitamin D3, thiamine and folic acid supplementation, and symptomatic therapy.

The author concluded that an avoidable toxicant such as inorganic arsenic, for which no scientific safe dose threshold exists, should be avoided and not be found in over-the-counter medications.

The author rightly states that causality of this association cannot be proven. However, he also stresses that a causal link between chronic iAs exposure and the patient’s nonspecific systemic symptoms is nevertheless suggested by circumstantial evidence pointing to the disappearance of CAsI signs and symptoms after therapy including interruption of the exposure. In his (and my) view, this renders causality most likely.

 

systematic review of the evidence for effectiveness and harms of specific spinal manipulation therapy (SMT) techniques for infants, children and adolescents has been published by Dutch researchers. I find it important to stress from the outset that the authors are not affiliated with chiropractic institutions and thus free from such conflicts of interest.

They searched electronic databases up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1–18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed.

Of the 1,236 identified studies, 26 studies were eligible. In all but 3 studies, the therapists were chiropractors. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in 4 infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment.

The authors concluded that, based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.

We have often noted that, in chiropractic trials, harms are often not mentioned (a fact that constitutes a violation of research ethics). This was again confirmed in the present review; only 4 of the controlled clinical trials reported such information. This means harms cannot be evaluated by reviewing such studies. One important strength of this review is that the authors realised this problem and thus included other research papers for assessing the risks of SMT. Consequently, they found considerable potential for harm and stress that under-reporting remains a serious issue.

Another problem with SMT papers is their often very poor methodological quality. The authors of the new review make this point very clearly and call for more rigorous research. On this blog, I have repeatedly shown that research by chiropractors resembles more a promotional exercise than science. If this field wants to ever go anywhere, if needs to adopt rigorous science and forget about its determination to advance the business of chiropractors.

I feel it is important to point out that all of this has been known for at least one decade (even though it has never been documented so scholarly as in this new review). In fact, when in 2008, my friend and co-author Simon Singh, published that chiropractors ‘happily promote bogus treatments’ for children, he was sued for libel. Since then, I have been legally challenged twice by chiropractors for my continued critical stance on chiropractic. So, essentially nothing has changed; I certainly do not see the will of leading chiropractic bodies to bring their house in order.

May I therefore once again suggest that chiropractors (and other spinal manipulators) across the world, instead of aggressing their critics, finally get their act together. Until we have conclusive data showing that SMT does more good than harm to kids, the right thing to do is this: BEHAVE LIKE ETHICAL HEALTHCARE PROFESSIONALS: BE HONEST ABOUT THE EVIDENCE, STOP MISLEADING PARENTS AND STOP TREATING THEIR CHILDREN!

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