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

Monthly Archives: February 2016

Over the years, I have received so many insults, attacks and legal challenges that I could start writing blog posts only about them and the issues involved. Recently someone asked me during the discussion part of a public lecture: “How did you manage to deal with all this aggression emotionally?” My answer was meant as a joke but, in a way, it is also true: ” You only need to become a masochist, and you enjoy every minute of it.”

Today, most of these attacks make me laugh because they are so stupid and mad. They merely show that the author has run out of arguments. In other words, they signal a victory which is, I think, quite enjoyable.

Recently I found such a victory of reason over madness on this website. It is not a new post but somehow I had missed it; and it is so remarkable that I have to reproduce it here without the slightest alteration. Here it is, enjoy!

Edzard Ernst himself admitted that he tried learning homeopathy, acupuncture, herbalism and chiropractic but never completed any course on them. He had 2 months of classes and 6 months of homeopathy training in Germany. In Germany, where homeopathy is regulated, it is a prerequisite to pass an exam by a Governing Medical Council, which he did not do. He had never wrote an exam. He has zero qualifications in homeopathic medicine but still falsely claims that he has been trained as a homeopath. 

Without having a required medical qualification, he illegally practiced Homeopathy and admitted in a national newspaper (UK Guardian, 3/4/2012) that he was “….impressed with the results achieved by Homeopathy. Many of my patients seemed to improved dramatically….”.
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Edzard Ernst published two papers in favour of homeopathy
1. Phlebology
Complementary Treatment of Varicose Veins: A Randomised, Placebo-controlled, Double-blind Trial”
Edzard Ernst, T. Saradeth, K.L. Resch, 1990, 157-163.
Three doses of a popular German combination of eight homeopathic medicines were given daily for 24 days. Measures were venous filling time, leg volume, and subjective symptoms. The study found that venous filling time improved in those given the homeopathic medicines by 44%, while it deteriorated in the placebo group by 18%. Other measures also had significant differences.
Linde OR=2.6 in favour of homeopathy, Linde Quality=1
2. Journal of Clinical Gastroenterology
Homeopathy for post-operative ileus (1997)
Barnes, Edzard Ernst
6 trials, 776 patients, medicines: Opium, Arnica, Raphanus sativus, China, Pyrogenum. Two of the four studies that also measured time to first faeces reported a positive effect for homeopathy. A meta-analysis of all six included studies revealed a statistically significant effect in favour of homeopathy for time to first flatus. This effect remained even with the exclusion of the two low quality studies. A significant effect in favour of homeopathy was also found for time to first flatus when a homeopathic remedy of less than 12C potency was used. 
Conclusion: “There is some evidence to support the administration of a homeopathic remedy immediately after surgery to reduce the duration of ileus”
4 out of 6 trials are of best quality. AMSTAR score=6/11

By fraud he became a Professor of Complementary medicine in University of Exeter (an accredited University in UK) in 1993 by fooling them (How can you become a Professor of Complementary medicine when you have zero qualifications in complementary medicine?). It would be interesting to know who appointed Edzard as Professor. Did he tell porky pies to get the job?

Some called him a failed Homeopath. Fear of failure made him skeptic. Fate made him ‘skeptic without k’, get famous as an authority after failing as CAMventional practitioner. He co-authored a book “Trick or Treatment”.  It was full of half-truths which were exposed in a book by William Alderson titled ‘Halloween Science’.

His downfall started in 2005 when “Ernst breached the professional code of scientific behaviour by leaking under-review paper before publication” (as a reviewer of a Journal Lancet). It was deplored by the journal and the scientific community.

He was exposed in year 2007 by Alliance for Natural Health. He is considered to be The Rachel Maddow of Alternative Health

He got potentised when he was forced to put down his papers at University of Exeter as Professor of Complementary Medicine in 2011, two years ahead of his official retirement. Immediately after his retirement, a homeopathy clinic was established in the University.

He was removed from editorial board of a reputed Elsevier Journal in 2013. It was a fall from grace.

He is fighting a losing battle against Prince Charles who is going to have the last laugh.

Chris Wilkinson has dedicated a law in his name titled “Ernst First Law”. It says, “Endlessly repeat what they want to hear and the septics will keep sending me their blessings and I shall be king.”

More about him at http://safe-medicine.blogspot.co.uk/2015/09/the-contribution-of-professor-edzard.html

DID I PROMISE TOO MUCH?

The article then goes on by throwing more mud, lies and attacks at two of my friends: Simon Singh and David Colquhoun. Some might think that we should sue the author – I would disagree: we need to encourage such people to publish more of this stuff because it is not only hilarious but also such a sweet victory of reason over madness.

Over the years, I had to get used to some abominably poor research in alternative medicine, particularly homeopathy. This new paper takes the biscuit, in my fairly well-informed opinion.

The article in question reports a survey investigating the management of paediatric tonsillopharyngitis, with a focus on natural remedies. For that purpose, 138 paediatricians, general practitioners and ear-nose-throat (ENT) specialists from 7 countries were sent a self-made, non-validated questionnaire.

The results indicate that a rapid strept test (RST) to diagnose acute tonsillopharyngitis was routinely used by 41% of the respondents. The use of RST allowed 200 diagnosis/year compared with 125 diagnosis/year for clinicians who did not use this tool. Homeopathic remedies were prescribed as a supportive therapy by 62% of participants. Among different homeopathic remedies, SilAtro-5-90 was the most frequently prescribed. In the chronic setting, homeopathy was suggested as a supportive therapy by 59% of all participants, phytotherapy by 28% and vitamins/nutritional supplementation by 37%.

The authors of this paper concluded from these results that the management of tonsillopharyngitis in paediatric patients still remains empiric. Natural remedies, and homeopathy in particular, are used in the management of URTIs. An integrative approach to these infections may help reduce excessive antibiotic prescription.

No wonder that homeopathy and research into it are the laughing stock of the scientific community!

A survey of this nature is already a fairly daft idea. What could it possibly show? That health care professionals who like homeopathy answer, while the vast majority don’t!

But the pinnacle of silliness must be the conclusions drawn from such ‘research’. Let’s take them step by step:

  1. the management of tonsillopharyngitis in paediatric patients still remains empiric – this is not true nor is it borne out by the data generated.
  2. Natural remedies, and homeopathy in particular, are used in the management of URTIs – this may be true, but it has been known before; we therefore do not need to waste time and effort to re-state it.
  3. An integrative approach to these infections may help reduce excessive antibiotic prescription – this is not supported by the data and it also seems nonsensical: if it truly successful in reducing antibiotic prescribing, it is arguably no longer integrative but alternative.

So?

Say no more!

Chronic pain is a common and serious problem for many patients. Treatment often includes non-pharmacological approaches despite the mostly flimsy evidence to support them. The objective of this study was to measure the feasibility and efficacy of hypnosis (including self-hypnosis) in the management of chronic pain in older hospitalized patients.

A single center randomized controlled trial using a two arm parallel group design (hypnosis versus massage). Inclusion criteria were chronic pain for more than 3 months with impact on daily life activities, intensity of > 4; adapted analgesic treatment; no cognitive impairment. Fifty-three patients were included. Pain intensity decreased significantly in both groups after each session. Average pain measured by the brief pain index sustained a greater decrease in the hypnosis group compared to the massage group during the hospitalization. This was confirmed by the measure of intensity of the pain before each session that decreased only in the hypnosis group over time. Depression scores improved significantly over the time only in the hypnosis group. There was no effect in either group 3 months post hospitals discharge.

The authors concluded that hypnosis represents a safe and valuable tool in chronic pain management of hospitalized older patients. In hospital interventions did not provide long-term post discharge relief.

So, hypnotherapy is better than massage therapy when administered as an adjunct to conventional pain management. As it is difficult to control for placebo effects, which might be substantial in this case, we cannot be sure whether hypnotherapy per se was effective or not.

Who cares? The main thing is to make life easier for these poor patients!

There are situations where I tend to agree with this slightly unscientific but compassionate point of view. Yes, the evidence is flimsy, but we need to help these patients. Hypnotherapy has very few risks, is relatively inexpensive and might help badly suffering individuals. In this case, does it really matter whether the benefit was mediated by a specific or a non-specific mechanism?

We all hope that serious complications after chiropractic care are rare. However, this does not mean they are unimportant. Multi-vessel cervical dissection with cortical sparing is an exceptional event in clinical practice. Such a case has just been described as a result of chiropractic upper spinal manipulation.

Neurologists from Qatar published a case report of a 55-year-old man who presented with acute-onset neck pain associated with sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain.

Magnetic resonance imaging revealed bilateral internal carotid artery dissection and left extracranial vertebral artery dissection with bilateral anterior cerebral artery territory infarctions and large cortical-sparing left middle cerebral artery infarction. This suggests the presence of functionally patent and interconnecting leptomeningeal anastomoses between cerebral arteries, which may provide sufficient blood flow to salvage penumbral regions when a supplying artery is occluded.

The authors concluded that chiropractic cervical manipulation can result in catastrophic vascular lesions preventable if these practices are limited to highly specialized personnel under very specific situations.

Chiropractors will claim that they are highly specialised and that such events must be true rarities. Others might even deny a causal relationship altogether. Others again would claim that, relative to conventional treatments, chiropractic manipulations are extremely safe. You only need to search my blog using the search-term ‘chiropractic’ to find that there are considerable doubts about these assumptions:

  • Many chiropractors are not well trained and seem mostly in the business of making a tidy profit.
  • Some seem to have forgotten most of the factual knowledge they may have learnt at chiro-college.
  • There is no effective monitoring scheme to adequately record serious side-effects of chiropractic care.
  • Therefore the incidence figures of such catastrophic events are currently still anyone’s guess.
  • Publications by chiropractic interest groups seemingly denying this point are all fatally flawed.
  • It is not far-fetched to fear that under-reporting of serious complications is huge.
  • The reliable evidence fails to demonstrate that neck manipulations generate more good than harm.
  • Until sound evidence is available, the precautionary principle leads most critical thinkers to conclude that neck manipulations have no place in routine health care.

On this blog, I have repeatedly tried to alert consumers and patients to the risks of herbal medicine. The risks include:

A new paper throws more light on the latter issue which has been not well-studies so far.

The objective of this study was to investigate the relationship between the use of medicinal plants and medication adherence in elderly people. The authors conducted an observational, cross-sectional study of elderly residents in Cuité-PB, Northeastern Brazil, through a household survey. A stratified proportional and systematic random sample of 240 elders was interviewed in their homes and the use of pharmaceutical medicines and of medicinal plants was assessed by direct examination. The association of medication adherence with socio-demographic, clinical, medication and use of medicinal plants was analysed with multiple logistic regression.

The results showed that medication non-adherence increases with use of herbal medicines (adjusted odds ratio 2.022, 95% CI 1.059–3.862, p = 0.03), as well as with the number of different medicinal plants used (adjusted odds ratio 1.937, 95% CI 1.265–2.965, p = 0.002).

The authors concluded that this study provides first-hand evidence that the use of herbal medicines is associated with poor medication adherence. Given the high frequency of the use of herbal medicines, further research into the mechanisms of this association is justified.

This conclusion is well-put, I think. If these findings are confirmed in other populations, we are confronted with a somewhat paradoxical situation: combining herbal and synthetic medicines can reduce adherence to the synthetic drugs and, in cases where adherence is not affected, it could increase the risk of herb/drug interactions.

Natural Pharmacy Business reported that the UK homeopathic pharmacy, Helios, has just launched 5 new combination remedies. Nothing exciting about that, you might say. But wait, these products have licences from the UK regulator and are thus allowed to make therapeutic claims. A spokesperson for Helios was quoted as stating about the new products that ‘…we can actually say what they do, making it easier for customers to recommend or choose what is needed.’

A closer look at the Helios website reveals more details. The 5 remedies are described as follows:

1) Helios Injury 30c – Arnica, Rhus tox and Ruta grav are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of pains and minor trauma associated with minor injuries, bruises, strains and sprains as well as minor emotional trauma associated with the above. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency.

2) Helios Sleep 30c – Avena sativa, Coffea, Passiflora and Valarian are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of temporary sleep disturbances wherever you are. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency. This product is not recommended for children under 18, please call us for advice for use in children.

3) Helios ABC 30c  – Aconite, Belladonna and Chamomilla are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of minor feverish illness and/or minor earache in children up to 12 years and for symptoms associated with teething in infants or toddlers. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency. Remedies for babies may be dissolved in half a teaspoon of previously boiled, cooled water.

4) Helios Stress Relief 30c –  Aconite, Arg nit and Arsenicum are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of symptoms associated with mild stress. The remedy comes in lactose free, organic sucrose pills in our easy to use 4gm single dose dispenser in 30c potency. This product is not recommended for children under 18, please call us for advice for use in children.

5) Helios Hay Fever 30c –  Allium cepa, Euphrasia and Sabadilla are combined to form a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of Hay Fever. The remedy comes in lactose free, organic sucrose pills in our easy to use single dose dispenser in 30c potency.

So, now they are entitled to tell us what these remedies actually do!!!

Interesting!

Interesting, because what they do tell us is actually not true. If you look critically at the evidence, you are inevitably going to arrive at entirely different verdicts about the effectiveness of these remedies: THEY ACTUALLY DO NOTHING!

(No, buying them does something to you bank balance, but that’s all)

Consumers are being seriously ripped off and misled here to believe that these homeopathics might actually be needed in cases of illness: THE TRUTH IS THAT THERE IS NO CONDITION FOR WHICH THEY HAVE BEEN PROVEN TO BE EFFECTIVE!

Why did the regulator grant them a licence and allow them to make such claims?

Perhaps someone from the MHRA has the kindness to enlighten us.

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