Monthly Archives: May 2016
In 2010, we published an investigation of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.
We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain.
At the time, we concluded that the majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.
Have things changed since?
I fear not! I regularly come across websites of chiropractors where they happily make bogus claims. On this website, for instance, chiropractor Karen Smith claims that muscles in the upper neck affect the ear canals. “We don’t actually treat the ear infection, or the symptoms. What we do is, we assist the body’s natural healing ability,” says Smith. “So if there’s something going on with the joints and the muscles soft tissue, the nerves coming out that supply those muscles, those muscles can’t relax, so then they’re almost tight and in spasm, so that can’t allow the drainage to happen properly.”
When fluid builds up in the ears, it’s a breeding ground for bacteria and infection. Smith says specific, gentle adjustments, can help the body drain those fluids through the nose. “What we do is we get some motion in the upper neck, with my hands, or I might use an instrument as well,” says Smith. “There’s a few other techniques that we can do. We can do some sinus drainage. We can drain some of the fluid in the ear.”
A simple ear pull technique can also help. “So what we do is, we just take the ear of the child and we do a little pull and that can actually drain the fluid as well,” says Smith. Smith says a child’s overall health and immune system impacts how quickly they see results from the treatment. In some cases, relief can be instant. “What we notice right after an adjustment is a lot of times you’ll actually see the fluid drain through the nose,” says Smith… Smith says she also treats adults who have had chronic ear issues as a child or who are experiencing pain in the ear.
When I or others expose such nonsense, the apologists say that these are just a few ‘rotten apples’, and that the chiropractic profession is fast progressing. Yet, I very much doubt this claim. For any fast progression, one would want to see the profession taking decisive and effective action against the ‘rotten apples’. This is clearly not happening, at least not to an extend that would stop such dangerous quackery.
What practical lesson can be learnt from such insights?
The only responsible advice I can think of is this: IF YOU OR YOUR CHILD IS ILL, AVOID CONSULTING A CHIROPRACTOR.
Shiatsu is a popular alternative therapy with a remarkable void of research. According to one of the rare reviews on the subject, Shiatsu is a form of Japanese massage, working on the meridian system of the body; the energetic pathways along which the acupuncture points are placed. The theory for shiatsu is based in the system of traditional Chinese medicine, understood in China for over 2000 years. Shiatsu can be valuable for reintegrating the body, mind and spirit, helping with the general energy level of the body as well as specific symptoms… Feelings of deep relaxation, support and increased vitality are common following a shiatsu treatment. The method, strength and frequency of treatment can be varied to suit individual need…
If this seems an optimistic evaluation to you, have a look on the Internet where bogus claims for Shiatsu abound. But such uncritical nonsense is, of course, neither informative nor responsible. In a previous post, I have been a little more critical about the value of Shiatsu and concluded that is an unproven therapy. I reached this conclusion mainly because, for our Oxford Handbook of Complementary Medicine (2008), we systematically researched the evidence and found very little of it. In fact, we concluded that NO CONVINCING DATA AVAILABLE TO SUGGEST THAT SHIATSU IS EFFECTIVE FOR ANY CONDITION.
Since then, a systematic review has been published. The Shiatsu studies found comprised just one single RCT, three controlled non-randomised, one within-subjects study, one observational study and 3 uncontrolled studies investigating mental and physical health issues. The authors, who usually are very much in favour of alternative therapies, concluded that more research is needed, particularly for Shiatsu, where evidence is poor.
This seems to indicate that our verdict of 2008 is still not far off the mark.
And what about the risks?
On this aspect of Shiatsu, it is even harder to find reliable information. One website, for instance, warns that certain individuals should take caution and consult a physician before receiving shiatsu. For example, there’s some concern that shiatsu may have harmful effects in pregnant women, patients who have recently undergone chemotherapy or radiation, and people with such conditions as osteoporosis, heart disease, and blood clotting disorders. Additionally, shiatsu should not be performed directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures. Shiatsu should also be avoided immediately after surgery, and by people with infectious skin disease, rash, or open wounds.
But what about adverse reactions and complications?
Another website, tells us that, when performed properly, shiatsu is not associated with any significant side effects. Some people may experience mild discomfort, which usually disappears during the course of the treatment session.
So, is Shiatsu without side-effects?
The answer, I am afraid, is NO – but has to dig deep to find even a tentative answer to this question.
A prospective, 6 months cohort, pragmatic study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK) has been published by UK authors in 2009 . Data were collected via postal questionnaires, including on client-perceived negative responses. Shiatsu was delivered by the practitioner in routine practice. 633 clients provided full follow-up data, a response rate of 67%. A prevalence rate of 12-22 per 100 of client-perceived ‘negative responses’ was found across the three countries. Transitional effects accounted for 82% of all the client-described ‘negative’ responses. Nine clients (1.4% of the total), relating to 10 sets of written comments, reported a negative response that was classified as ‘a potentially adverse event or effect’ that might represent a risk to client safety.
In addition there are much more serious complications such as strokes. These might be extreme rarities – but who knows? Nobody! Why? Because, as with most alternative therapies, there is no reporting or monitoring system for such events. Therefore the true prevalence is anyone’s guess.
The bottom line, I am afraid, is all too familiar: There is no good evidence for effectiveness and some evidence of risk – which can only mean one thing: the proven benefits do not outweigh the potential harm.
I just came across this website entitled 11 HARD QUESTIONS ABOUT CHIROPRACTIC PHYSICIANS. The title fascinated me; I am always in favour of addressing hard questions. I therefore read the 11 questions with interest; and I quite liked them. However, the answers provided by the author, a chiropractor of course, struck me as being more than a little uncritical towards chiropractic (feel free to click on the above link and see for yourself). Therefore, I decided to try my own answers (except for No 5). And then – being in the swing of it – I added a few more supplementary questions as well.
In other words, the first 11 questions are the ones posed by the chiro but the 4 additional ones are mine, and so are all the answers. Here we go:
Question No 1: What can a chiropractic physician do for me that another doctor can’t?
Nothing.
Question No 2: Does chiropractic therapy really work?
No. The best evidence available today fails to show that chiropractic spinal manipulations work for any condition. If one is generous, one might make an exception for back pain, but even for this symptom, the evidence is flimsy.
Question No 3: What other types of health problems can chiropractic treatment help?
None.
Question No 4: What does a chiropractic physician do to find my problem?
He/she often uses non-validated diagnostic techniques that are prone to give fantasy-results. You might also get extensive X-rays – mostly because the chiropractor wants to pay for the expensive equipment.
Question No 5: What therapies do chiropractic physicians use?
Chiropractic physicians may use manual and physical therapies including manipulation of the spine and joints of the arms and legs. Supportive therapies may also include massage, myofascial release, and therapeutic modalities such as ultrasound, electric stimulation and diathermy. Rehabilitative measures are often used such as specific corrective exercises to stabilize your problem. (This is the only answer I roughly agreed with, and I therefore left it unchanged.)
Question No 6: What is the standard length of treatment?
This depends mainly on the patient’s ability to pay. As a rule of thumb, as many treatments as possible will be given. Many chiros even advocate ‘maintenance treatment’ which means you receive regular spinal manipulations even when there is nothing wrong with you. The little porky they give you as an explanation is that this prevents future illnesses.
Question No 7: Is chiropractic care covered by insurance?
Because of very active lobbying by chiro interest groups, it may well be.
Question No 8: If I need a referral, how do I ask my doctor to refer me to a chiropractic physician?
Chiros are presently trying very hard to be accepted as ‘primary care physicians’; this means you can consult them directly without the need of a referral.
Question No 9: If I go see a chiropractor do I need to keep on going?
Only if you believe the nonsense about maintenance treatment they often tell you (see above) for which there is not a jot of convincing evidence.
Question No 10: What training do chiropractors have?
Not enough to realise that their spinal adjustments fail to generate more good than harm.
Question No 11: How should I select a good chiropractic physician?
If you are ill, it’s best to see are real doctor and avoid chiros.
AND NOW MY SUPPLEMENTARY QUESTIONS
No 1 Are chiros really physicians?
The definition of a physician is : ‘A person trained and licensed to practice medicine; a medical doctor’. Therefore, the answer is no.
No 2 What are the risks of spinal manipulations or adjustments, the main treatments used by chiros?
~50% of all patients have mild to moderate adverse effects that last 2-3 days.
In addition, several hundred cases of severe complications have been noted, including strokes and deaths.
No 3 How are such adverse outcomes monitored?
There is no effective monitoring system at all.
No 4 Is such an omission responsible or ethical?
No.
Reiki is one of the most popular types of ‘energy healing’. Reiki healers believe to be able to channel ‘healing energy’ into patients’ body thus enabling them to get healthy. If Reiki were not such a popular treatment, one could brush such claims aside and think “let the lunatic fringe believe what they want”. But as Reiki so effectively undermines consumers’ sense of reality and rationality, I feel I should continue informing the public about this subject – despite the fact that I have already reported about it several times before, for instance here, here, here, here, here and here.
A new RCT, published in a respected journal looks interesting enough for a further blog-post on the subject. The main aim of the study was to investigate the effectiveness of two psychotherapeutic approaches, cognitive behavioural therapy (CBT) and a complementary medicine method Reiki, in reducing depression scores in adolescents. The researchers from Canada, Malaysia and Australia recruited 188 adolescent depressed adolescents. They were randomly assigned to CBT, Reiki or wait-list. Depression scores were assessed before and after 12 weeks of treatments/wait list. CBT showed a significantly greater decrease in Child Depression Inventory (CDI) scores across treatment than both Reiki (p<.001) and the wait-list control (p<.001). Reiki also showed greater decreases in CDI scores across treatment relative to the wait-list control condition (p=.031). Male participants showed a smaller treatment effects for Reiki than did female participants. The authors concluded that both CBT and Reiki were effective in reducing the symptoms of depression over the treatment period, with effect for CBT greater than Reiki.
I find it most disappointing that these days even respected journals publish such RCTs without the necessary critical input. This study may appear to be rigorous but, in fact, it is hardly worth the paper it was printed on.
The results show that Reiki produced worse results than CBT. That I can well believe!
However, the findings also suggest that Reiki was nevertheless “effective in reducing the symptoms of depression”, as the authors put it in their conclusions. This statement is misleading!
It is based on the comparison of Reiki with doing nothing. As Reiki involves lots of attention, it can be assumed to generate a sizable placebo effect. As a proportion of the patients in the wait list group are probably disappointed for not getting such attention, they can be assumed to experience the adverse effects of their disappointment. The two phenomena combined can easily explain the result without any “effectiveness” of Reiki per se.
If such considerations are not fully discussed and made amply clear even in the conclusions of the abstract, it seems reasonable to accuse the journal of being less than responsible and the authors of being outright misleading.
As with so many papers in this area, one has to ask: WHERE DOES SLOPPY RESEARCH END AND WHERE DOES SCIENTIFIC MISCONDUCT BEGIN?
A recent comment to a blog-post about alternative treatments for cancer inspired me to ponder a bit. I think it is noteworthy because it exemplifies so many of the comments I hear in the realm of alternative medicine on an almost daily basis. Here is the comment in question:
“Yes…it appears that the medical establishment have known for years that chemotherapy a lot of the time kills patients faster than if they were untreated…what’s more, it worsens a person’s quality of life in which many die directly of the severe effects on the endocrine, immune system and more…cancers often return in more aggressive forms metastasising with an increased risk of apoptosis. In other words it makes things worse whereas there are many natural remedies which not only do no harm but accumulating evidence points to their capacity to fight cancer…some of it is bullshit whilst some holds some truth!! So turning away from toxic treatments that kill towards natural approaches that are showing more hope with the backing of trials kinda reverses the whole argument of this article.”
The comment first annoyed me a bit, of course, but later it made me think and consider the differences between conspiracy theories, assumptions, opinions, evidence and scientific facts. Let’s tackle each of these in turn.
CONSPIRACY THEORIES
A conspiracy theory is an explanatory or speculative theory suggesting that two or more persons, or an organization, have conspired to cause or cover up, through secret planning and deliberate action, an event or situation typically regarded as illegal or harmful.
Part of the above comment bears some of the hallmarks of a conspiracy theory: “…the medical establishment have known for years that chemotherapy a lot of the time kills patients faster than if they were untreated…” The assumption here is that the conventional healthcare practitioners are evil enough to knowingly do harm to their patients. Such conspiracy theories abound in the realm of alternative medicine; they include the notions that
- BIG PHARMA is out to kill us all in order to maximize their profits,
- the ‘establishment’ is suppressing any information about the benefits of alternative treatments,
- vaccinations are known to be harmful but nevertheless being forced on to our children,
- drug regulators are in the pocket of the pharmaceutical industry,
- doctors accept bribes for prescribing dangerous drugs
- etc. etc.
In a previous blog-post, I have discussed the fact that the current popularity of alternative medicine is at least partly driven by the conviction that there is a sinister plot by ‘the establishment’ that prevents people from benefitting from the wonders of alternative treatments. It is therefore hardly surprising that conspiracy theories like the above are voiced regularly on this blog and elsewhere.
ASSUMPTION
An assumption is something taken for granted or accepted as true without proof.
The above comment continues stating that “…[chemotherapy] makes things worse whereas there are many natural remedies which not only do no harm but accumulating evidence points to their capacity to fight cancer…” There is not proof for these assertions, yet the author takes them for granted. If one were to look for the known facts, one would find the assumptions to be erroneous: chemotherapy has saved countless lives and there simply are no natural remedies that will cure any form of cancer. In the realm of alternative medicine, this seems to worry few, and assumptions of this or similar nature are being made every day. Sadly the plethora of assumptions or bogus claims eventually endanger public health.
OPINION
An opinion is a judgment, viewpoint, or statement about matters commonly considered to be subjective.
The above comment continues with the opinion that “…turning away from toxic treatments that kill towards natural approaches that are showing more hope with the backing of trials kinda reverses the whole argument of this article.” In general, alternative medicine is based on opinions of this sort. On this blog, we have plenty of examples for that in the comments section. This is perhaps understandable; evidence is usually in short supply, and therefore it often is swiftly replaced with often emotionally loaded opinions. It is even fair to say that much of alternative medicine is, in truth, opinion-based healthcare.
EVIDENCE
Evidence is anything presented in support of an assertion. This support may be strong or weak. The strongest type of evidence is that which provides direct proof of the truth of an assertion.
One remarkable feature of the above comment is that it is bar of any evidence. In a previous post, I have tried to explain the nature of evidence regarding the efficacy of medical interventions:
The multifactorial nature of any clinical response requires controlling for all the factors that might determine the outcome other than the treatment per se. Ideally, we would need to create a situation or an experiment where two groups of patients are exposed to the full range of factors (e. g. placebo effects, natural history of the condition, regression towards the mean), and the only difference is that one group does receive the treatment, while the other one does not. And this is precisely the model of a controlled clinical trial.
Such studies are designed to minimise all possible sources of bias and confounding. By definition, they have a control group which means that we can, at the end of the treatment period, compare the effects of the treatment in question with those of another intervention, a placebo or no treatment at all.
Many different variations of the controlled trial exist so that the exact design can be adapted to the requirements of the particular treatment and the specific research question at hand. The over-riding principle is, however, always the same: we want to make sure that we can reliably determine whether or not the treatment was the cause of the clinical outcome.
Causality is the key in all of this; and here lies the crucial difference between clinical experience and scientific evidence. What clinician witness in their routine practice can have a myriad of causes; what scientists observe in a well-designed efficacy trial is, in all likelihood, caused by the treatment. The latter is evidence, while the former is not.
Don’t get me wrong; clinical trials are not perfect. They can have many flaws and have rightly been criticised for a myriad of inherent limitations. But it is important to realise that, despite all their short-comings, they are far superior than any other method for determining the efficacy of medical interventions.
There are lots of reasons why a trial can generate an incorrect, i.e. a false positive or a false negative result. We therefore should avoid relying on the findings of a single study. Independent replications are usually required before we can be reasonably sure.
Unfortunately, the findings of these replications do not always confirm the results of the previous study. Whenever we are faced with conflicting results, it is tempting to cherry-pick those studies which seem to confirm our prior belief – tempting but very wrong. In order to arrive at the most reliable conclusion about the efficacy of any treatment, we need to consider the totality of the reliable evidence. This goal is best achieved by conducting a systematic review.
In a systematic review, we assess the quality and quantity of the available evidence, try to synthesise the findings and arrive at an overall verdict about the efficacy of the treatment in question. Technically speaking, this process minimises selection and random biases. Systematic reviews and meta-analyses [these are systematic reviews that pool the data of individual studies] therefore constitute, according to a consensus of most experts, the best available evidence for or against the efficacy of any treatment.
SCIENTIFIC FACTS
Scientific facts are verified by repeatable careful observation or measurement (by experiments or other means).
Some facts related to the subject of alternative medicine have already been mentioned:
- chemotherapy prolongs survival of many cancer patients;
- no alternative therapy has achieved anything remotely similar.
The comment above that motivated me to write this somewhat long-winded post is devoid of facts. This is just one more feature that makes it so typical of the comments by proponents of alternative medicine we see with such embarrassing regularity.
My last post was about a researcher who manages to produce nothing but positive findings with the least promising alternative therapy, homeopathy. Some might think that this is an isolated case or an anomaly – but they would be wrong. I have previously published about researchers who have done very similar things with homeopathy or other unlikely therapies. Examples include:
But there are many more, and I will carry on highlighting their remarkable work. For example, the research of a German group headed by Prof Gustav Dobos, one of the most prolific investigator in alternative medicine at present.
For my evaluation, I conducted a Medline search of the last 10 of Dobos’ published articles and excluded those not assessing the effectiveness of alternative therapies such as surveys, comments, etc. Here they are with their respective conclusions and publication dates:
SYSTEMATIC REVIEW COMPARING DIFFERENT YOGA STYLES (2016)
RCTs with different yoga styles do not differ in their odds of reaching positive conclusions. Given that most RCTs were positive, the choice of an individual yoga style can be based on personal preferences and availability.
SYSTEMATIC REVIEW OF YOGA FOR WEIGHT LOSS (2016)
Despite methodological drawbacks, yoga can be preliminarily considered a safe and effective intervention to reduce body mass index in overweight or obese individuals.
REVIEW OF INTEGRATIVE MEDICINE IN GYNAECOLOGICAL ONCOLOGY (2016)
…there is published, positive level I evidence for a number of CAM treatment forms.
SYSTEMATIC REVIEW OF MINDFULNESS FOR PSYCHOSES (2016)
Mindfulness- and acceptance-based interventions can be recommended as an additional treatment for patients with psychosis.
RCT OF CABBAGE LEAF WRAPS FOR OSTEOARTHOSIS (2016)
Cabbage leaf wraps are more effective for knee osteoarthritis than usual care, but not compared with diclofenac gel. Therefore, they might be recommended for patients with osteoarthritis of the knee.
SYSTEMATIC REVIEW OF HERBAL MEDICINES FOR COUGH (2015)
This review found strong evidence for A. paniculata and ivy/primrose/thyme-based preparations and moderate evidence for P. sidoides being significantly superior to placebo in alleviating the frequency and severity of patients’ cough symptoms. Additional research, including other herbal treatments, is needed in this area.
SYSTEMATIC REVIEW OF DIETARY APPROACHES FOR METABOLIC SYNDROME (2016)
Dietary approaches should mainly be tried to reduce macronutrients and enrich functional food components such as vitamins, flavonoids, and unsaturated fatty acids. People with Metabolic Syndrome will benefit most by combining weight loss and anti-inflammatory nutrients.
SYSTEMATIC REVIEW OF MIND BODY MEDICINE FOR CORONARY HEART DISEASE (2015)
In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs.
CRANIOSACRAL THERAPY (CST) FOR BACK PAIN (2016)
CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.
REVIEW OF INTEGRATED MEDICINE FOR BREAST CANCER (2015)
Study data have shown that therapy- and disease-related side effects can be reduced using the methods of integrative medicine. Reported benefits include improving patients’ wellbeing and quality of life, reducing stress, and improving patients’ mood, sleeping patterns and capacity to cope with disease.
Amazed?
Dobos seems to be an ‘all-rounder’ whose research tackles a wide range of alternative treatments. That is perhaps unremarkable – but what I do find remarkable is the impression that, whatever he researches, the results turn out to be pretty positive. This might imply one of two things, in my view:
- all alternative therapies are effective,
- the ‘Trustworthiness Index’ of Prof Dobos is unusual.
I let my readers chose which possibility they deem to be more likely.
Homeopathy is not blessed with many geniuses, it seems. Therefore, it is all the more noteworthy that there is one who seems to be so extraordinarily gifted that everything she touches turns to gold.
Her new and remarkable study intended to measure the efficacy of individualized homeopathic treatment for binge eating in adult males.
This case study was a 9-week pilot using an embedded, mixed-methods design. A 3-week baseline period was followed by a 6-week treatment period. The setting was the Homeopathic Health Clinic at the University of Johannesburg in Johannesburg, South Africa. Through purposive sampling, the research team recruited 15 Caucasian, male participants, aged 18-45 y, who were exhibiting binge eating. Individualized homeopathic remedies were prescribed to each participant. Participants were assessed by means of (1) a self-assessment calendar (SAC), recording the frequency and intensity of binging; (2) the Binge Eating Scale (BES), a psychometric evaluation of severity; and (3) case analysis evaluating changes with time.
Ten participants completed the study. The study found a statistically significant improvement with regard to the BES (P = .003) and the SAC (P = .006), with a large effect size, indicating that a decrease occurred in the severity and frequency of binging behaviour during the study period.
The authors concluded that this small study showed the potential benefits of individualized homeopathic treatment of binge eating in males, decreasing both the frequency and severity of binging episodes. Follow-up studies are recommended to explore this treatment modality as a complementary therapeutic option in eating disorders characterized by binge eating.
While two of the three authors have not ventured into trials of homeopathy before, the third and senior author (Janice Pellow from the Department of Homoeopathy, University of Johannesburg, South Africa) already has several homeopathic studies to her name. They seem all quite similar:
Number 1 was a clinical trial that concluded:
The study was too small to be conclusive, but results suggest the homeopathic complex, together with physiotherapy, can significantly improve symptoms associated with chronic low back pain due to osteoarthritis.
Number 2 was an RCT which concluded:
The homeopathic complex used in this study exhibited significant anti-inflammatory and pain-relieving qualities in children with acute viral tonsillitis.
Number 3 was a pilot study concluding:
Findings suggest that daily use of the homeopathic complex does have an effect over a 4-week period on physiological and cognitive arousal at bedtime as well as on sleep onset latency in psychophysiological onset insomnia sufferers.
Number 4 was an RCT that concluded:
The homeopathic medicine reduced the sensitivity reaction of cat allergic adults to cat allergen, according to the skin prick test.
See what I mean? Five studies and 5 positive results!
Considering that they were obtained with different types of homeopathy, with different patients suffering from different conditions, with different trial designs and with different sets of co-workers, this is an even more remarkable achievement. In the hands of Janice Pellow, homeopathy seems to work under all circumstances and for all conditions.
I feel a Noble Prize might be in the air.
Pity that she would not score all that highly on my (self-invented) TI.
I have written about ‘EVIDENCE BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE’ (EBCAM), on of the leading alt med journals before (for instance here and here). To my embarrassment, I must admit to having been a member of its founding editorial-board; but I left when things started looking suspicious. In the latter post, I pointed out that:
- The peer-review system of EBCAM is farcical: potential authors who send their submissions to EBCAM are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job. It goes without saying that such a system is prone to all sorts of serious failures; in fact, this is not peer-review at all, in my opinion, it is an unethical sham.
- As a result, most (I estimate around 80%) of the articles that currently get published on alternative medicine are useless rubbish. They tend to be either pre-clinical investigations which never get followed up and are thus meaningless, or surveys of no relevance whatsoever, or pilot studies that never are succeeded by more definitive trials, or non-systematic reviews that are wide open to bias and can only mislead the reader.
Strong words? Yes, ‘useless rubbish’ is not exactly meant as a compliment. Perhaps you want to judge for yourself – here are the last 20 articles published in EBCAM in 2015:
Kathy Lee SM, Yoon KH, Park J, Kim HS, Woo JS, Lee SR, Lee KH, Jang HH, Kim JB, Kim WS, Lee S, Kim W.
Evid Based Complement Alternat Med. 2015;2015:625645. doi: 10.1155/2015/625645. Epub 2016 Jan 11.
- PMID:
- 26881000
Azmi NH, Ismail M, Ismail N, Imam MU, Alitheen NB, Abdullah MA.
Evid Based Complement Alternat Med. 2015;2015:153684. doi: 10.1155/2015/153684. Epub 2015 Dec 22.
- PMID:
- 26858770
Scientific Evidence for Korean Medicine and Its Integrative Medical Research.
Park W, Mollahaliloglu S, Linnik V, Chae H.
Evid Based Complement Alternat Med. 2015;2015:967087. doi: 10.1155/2015/967087. Epub 2015 Dec 30. No abstract available.
- PMID:
- 26843887
Acupuncture for Lateral Epicondylitis: A Systematic Review.
Tang H, Fan H, Chen J, Yang M, Yi X, Dai G, Chen J, Tang L, Rong H, Wu J, Liang F.
Evid Based Complement Alternat Med. 2015;2015:861849. doi: 10.1155/2015/861849. Epub 2015 Dec 30. Review.
- PMID:
- 26843886
Li M, Han Z, Bei W, Rong X, Guo J, Hu X.
Evid Based Complement Alternat Med. 2015;2015:643102. doi: 10.1155/2015/643102. Epub 2015 Dec 30.
- PMID:
- 26843885
Silva FC, de Souza JG, Reichert AM, Antonangelo RP, Suzuki R, Itinose AM, Marek CB.
Evid Based Complement Alternat Med. 2015;2015:762373. doi: 10.1155/2015/762373. Epub 2015 Dec 28.
- PMID:
- 26823673
Hou PW, Hsu HC, Lin YW, Tang NY, Cheng CY, Hsieh CL.
Evid Based Complement Alternat Med. 2015;2015:495684. doi: 10.1155/2015/495684. Epub 2015 Dec 28. Review.
- PMID:
- 26823672
Antibacterial and Cytotoxic Activity of Compounds Isolated from Flourensia oolepis.
Joray MB, Trucco LD, González ML, Napal GN, Palacios SM, Bocco JL, Carpinella MC.
Evid Based Complement Alternat Med. 2015;2015:912484. doi: 10.1155/2015/912484. Epub 2015 Dec 27.
- PMID:
- 26819623
Wei Y, Ma LX, Yin SJ, An J, Wei Q, Yang JX.
Evid Based Complement Alternat Med. 2015;2015:878164. doi: 10.1155/2015/878164. Epub 2015 Dec 27. Review.
- PMID:
- 26819622
The Role of CAM in Public Health, Disease Prevention, and Health Promotion.
Hawk C, Adams J, Hartvigsen J.
Evid Based Complement Alternat Med. 2015;2015:528487. doi: 10.1155/2015/528487. Epub 2015 Dec 24. No abstract available.
- PMID:
- 26819621
Yangjing Capsule Ameliorates Spermatogenesis in Male Mice Exposed to Cyclophosphamide.
Zhao H, Jin B, Zhang X, Cui Y, Sun D, Gao C, Gu Y, Cai B.
Evid Based Complement Alternat Med. 2015;2015:980583. doi: 10.1155/2015/980583. Epub 2015 Dec 21.
- PMID:
- 26798404
Singsai K, Akaravichien T, Kukongviriyapan V, Sattayasai J.
Evid Based Complement Alternat Med. 2015;2015:970354. doi: 10.1155/2015/970354. Epub 2015 Dec 21.
- PMID:
- 26798403
Chung HS, Hwang I, Oh KJ, Lee MN, Park K.
Evid Based Complement Alternat Med. 2015;2015:913158. doi: 10.1155/2015/913158. Epub 2015 Dec 22.
- PMID:
- 26798402
Liu X, Kanthimathi MS, Heese K.
Evid Based Complement Alternat Med. 2015;2015:828159. doi: 10.1155/2015/828159. Epub 2015 Dec 22. No abstract available.
- PMID:
- 26798401
The Consumption of Bicarbonate-Rich Mineral Water Improves Glycemic Control.
Murakami S, Goto Y, Ito K, Hayasaka S, Kurihara S, Soga T, Tomita M, Fukuda S.
Evid Based Complement Alternat Med. 2015;2015:824395. doi: 10.1155/2015/824395. Epub 2015 Dec 21.
- PMID:
- 26798400
Xuejuan Z, Jietao Z, Di H, Yu Z, Xiaozi G, Yunfa L, Lihua D.
Evid Based Complement Alternat Med. 2015;2015:527219. doi: 10.1155/2015/527219. Epub 2015 Dec 22.
- PMID:
- 26798399
Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study.
Hesse T, Holmes LG, Kennedy-Overfelt V, Kerr LM, Giles LL.
Evid Based Complement Alternat Med. 2015;2015:508958. doi: 10.1155/2015/508958. Epub 2015 Dec 22.
- PMID:
- 26798398
Mao S, Li C.
Evid Based Complement Alternat Med. 2015;2015:349721. doi: 10.1155/2015/349721. Epub 2015 Dec 22.
- PMID:
- 26798397
Shen CC, Yang YC, Chiao MT, Chan SC, Liu BS.
Evid Based Complement Alternat Med. 2015;2015:278951. doi: 10.1155/2015/278951. Epub 2015 Dec 21.
- PMID:
- 26798396
Mohd Sairazi NS, Sirajudeen KN, Asari MA, Muzaimi M, Mummedy S, Sulaiman SA.
Evid Based Complement Alternat Med. 2015;2015:972623. doi: 10.1155/2015/972623. Epub 2015 Dec 17. Review.
- PMID:
- 26793262
I think the above estimation that 20% of ECAM’s articles are not rubbish cannot be that far from the truth.
But this is not what puzzles me most about ECAM. What I fail to understand is why so many researchers send their papers to this journal. In 2015, EBCAM published just under 1000 (983 to be exact) papers. This is not far from half of all Medline-listed articles on alternative medicine (2056 in total).
To appreciate these figures – and this is where it gets not just puzzling but intriguing, in my view – we need to know that EBCAM charges a publication fee of US$ 2500. That means the journal has an income of about US$ 2 500 000 per annum!
The figure is, of course, not quite as high as that because EBCAM waives charges for authors from countries classified by the World Bank as Low-income economies or Lower-middle-income economies as of July 2015, and which have a 2014 gross domestic product of less than 200 billion US dollars. But the total amount cannot be far from US$ 2 million per year.
Now, such affluence might, of course, be good news. The journal could, for instance, put large amounts of money into alt med research. We all know that, in alt med, research funds are scarce, and that support would therefore be most welcome. Alas, I could not find any trace of such charitable activity.
GOOD REASONS TO BE PUZZLED, I THINK.