Monthly Archives: October 2017
Gastro-oesophageal reflux disease (GORD) is a common, benign condition. It can be treated by changing eating habits or drugs. Many alternative therapies are also on offer, for instance, acupuncture. But does it work? Let’s find out.
The objective of this meta-analysis was to explore the effectiveness of acupuncture for the treatment of gastro-oesophageal reflux disease (GORD). Four English and four Chinese databases were searched through June 2016. Randomised controlled trials investigating the effectiveness of manual acupuncture or electroacupuncture (MA/EA) for GORD versus or as an adjunct to Western medicine (WM) were selected.
A total of 12 trials involving 1235 patients were included. The results demonstrated that patients receiving MA/EA combined with WM had a superior global symptom improvement compared with those receiving WM alone with no significant heterogeneity. Recurrence rates of those receiving MA/EA alone were lower than those receiving WM with low heterogeneity, while global symptom improvement (six studies) and symptom scores (three studies) were similar. Descriptive analyses suggested that acupuncture also improves quality of life in patients with GORD.
The authors concluded that this meta-analysis suggests that acupuncture is an effective and safe treatment for GORD. However, due to the small sample size and poor methodological quality of the included trials, further studies are required to validate our conclusions.
I am glad the authors used the verb ‘suggest’ in their conclusions. In fact, even this cautious terminology is too strong, in my view. Here are 9 reasons why:
- The hypothesis that acupuncture is effective for GORD lacks plausibility.
- All the studies were of poor or very poor methodological quality.
- All but one were from China, and we know that all acupuncture trials from this country are positive, thus casting serious doubt on their validity.
- Six trials had the infamous ‘A+B versus B’ design which never generates a negative result.
- There was evidence of publication bias, i. e. negative trials had disappeared and were thus not included in the meta-analysis.
- None of the trials made an attempt to control for placebo effects by using a sham-control procedure.
- None used patient-blinding.
- The safety of a therapy cannot be assessed on the basis of 12 trials
- Seven studies failed to report adverse effects, thus violating research ethics.
Considering these facts, I think that a different conclusion would have been more appropriate: this meta-analysis provides no good evidence for the assumption that acupuncture is an effective and safe treatment for GORD.
This is the question asked by the American Chiropractic Association. And this is their answer [the numbers in square brackets were inserted by me and refer to my comments below]:
Chiropractic is widely recognized  as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints . Although chiropractic has an excellent safety record , no health treatment is completely free of potential adverse effects. The risks associated with chiropractic, however, are very small . Many patients feel immediate relief following chiropractic treatment , but some may experience mild soreness, stiffness or aching, just as they do after some forms of exercise . Current research shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours …
Some reports have associated high-velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection . However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease . These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon . Patients with this condition may experience neck pain and headache that leads them to seek professional care—often at the office of a doctor of chiropractic or family physician—but that care is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare—about one to three cases in 100,000 patients who get treated with a course of care . This is similar to the incidence of this type of stroke among the general population …
When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition . In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favorably with even the most conservative care options. For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) and prescription painkillers—are significantly greater than those of chiropractic manipulation …
Doctors of chiropractic are well trained professionals who provide patients with safe, effective care for a variety of common conditions. Their extensive education has prepared them to identify patients who have special risk factors  and to get those patients the most appropriate care, even if that requires referral to a medical specialist .
END OF QUOTE
- Appeal to tradition = fallacy
- …and every other condition that brings in cash.
- Not true.
- Probably not true.
- The plural of anecdote is anecdotes, not evidence.
- Not true, the adverse effects of spinal manipulation are different and more severe.
- Not true, they last 1-3 days.
- Not just ‘some reports’ but a few hundred.
- Which does not mean that spinal manipulation cannot provoke such events.
- True, but this does not mean that spinal manipulation cannot provoke such events.
- There are other estimates that gives much higher figures; without a proper monitoring system, nobody can provide an accurate incidence figure.
- Not true, see above.
- ‘Available’ is meaningless – ‘effective’ is what we need here.
- The difference between different treatments is not merely their safety but also their effectiveness; in the end it is the risk/benefit balance that determines their value.
- Not true, there are no good predictors to identify at-risk populations.
- Chiropractors are notoriously bad at referring to other healthcare professionals; they have a huge conflict of interest in keeping up their cash-flow.
So, is chiropractic a safe treatment?
My advice here is not to ask chiropractors but independent experts.
‘Chiropractic is safe’ is a statement by Dr Arleen Scholten (see below) and thousands of other chiropractors like her. This sentence seems to be a nice marketing slogan – but sadly it is far removed from reality:
- chiropractic causes mild to moderate adverse effects in about 50% of all patients;
- in addition, it caused many much more serious complications, including deaths.
How many such serious events have occurred is anyone’s guess. The reason for this uncertainty is that there is no monitoring system that would give us this information. About 500 serious complications have been published in the medical literature. But these published cases are just the tip of a much bigger iceberg. We have shown that under-reporting is close to 100%.
This means that the vast majority of these cases remain completely undocumented. Some appear in the popular press, like the one recently published in the DAILY MAIL:
A chiropractor has been arrested on suspicion of manslaughter after a retired bank manager died following treatment for backache.
John Lawler, 80, was undergoing routine treatment at a private clinic when he lost consciousness and appeared to have become paralysed from the shoulders down. He was taken straight to hospital but died the next day as a result of a ‘traumatic spinal cord injury.’
His wife of 55 years, Joan Lawler, 81, was in the chiropractor’s clinic with her husband and witnessed the incident. Police are investigating to establish whether or not criminal negligence was a factor in his death.
Dr Arleen Scholten, 40, the chiropractor who treated Mr Lawler, was arrested by police on suspicion of manslaughter and released pending further inquiries.
Mr Lawler, a former Barclays Bank manager, was an active and healthy grandfather who lived in York. It is understood he was taken ill on his third visit in a week to Chiropractic 1st – a clinic within walking distance of the family home. He was seen by Dr Scholten, a chiropractor and director of the company, on Friday, August 11 and was undergoing treatment on his back when the unexpected and fatal problem occurred.
Mr Lawler was taken to York District Hospital by ambulance before being transferred to Leeds General Infirmary when the seriousness of his condition became clear.
END OF QUOTE
DOCTOR Scholten tells us on her website that we get to help people who suffer from a variety of health issues. Naturally, chiropractic helps traditional neck and back problems, but chiropractic has also produced wonderful results with a variety of organic and systemic problems. Chiropractic is safe.*** Chiropractic is natural. And Chiropractic works!
Doctor Scholten also informs us that our children were all adjusted the day they were born, 2 were homebirths and I continue to check their spines regularly. There is a saying in Chiropractic ‘If the twig is bent so grows the tree’.
Say no more!
(*** my emphasis)
It was Alan Henness who persuaded me and helped me to start this blog. He probably feared that, after my retirement from my Exeter post, I might stop being a nuisance to Prince Charles and other quacks. The blog certainly prevented this possibility!
The very first post on my blog went live on 14 October 2012 – and exactly 5 years later we received the ‘Ockham Editor’s Choice Award’! I say ‘we’, because without Alan the blog would not exist, without the many comments by fans and critics it would not be such fun, and without the guest bloggers it would not be as good. And it is largely for this blog that I got the award, I guess.
In case you did not know about the Ockham Awards, here is what the website tells us:
The Skeptic Magazine’s Ockham Awards were founded because we wanted to draw attention to those people who work so hard to get a great message out there. The Ockhams recognise the effort and time that have gone into the community’s favourite skeptical blogs, skeptical podcasts, skeptical campaigns and outstanding contributors to the skeptical cause.
One of the most important elements of the awards are that the shortlists are selected by you – the public. The awards are always judged on a number of criteria:
2. Success of outreach, both in terms of absolute numbers (how many people did they reach?) and how ‘intrepid’ that outreach was (are they preaching to the choir or getting new people interested in skepticism?)
3. Relevance to the UK ‘scene’ and, therefore, the bulk of their readership. This doesn’t mean that the candidate has to necessarily be UK-based – last year’s winners included overseas and international short-listers – just that they should cover content that is relevant and known in the UK.
END OF QUOTE
In my initial post of 14/10/12, I stated:
“My blog is not going to provide just another critique of alternative medicine; it is going to be different, I hope. The reasons for this are fairly obvious: I have researched alternative medicine for two decades. My team and I have conducted about 40 clinical trials and published more than 100 systematic reviews of alternative medicine… For 14 years, we hosted an annual international conference for researchers in this field. I know many of the leading investigators personally, and I understand their way of thinking.”
Five years and more than 1 000 posts later, I am happy to report that:
- writing this blog has been much more fun than I originally expected,
- it also has been a steep and endless learning curve,
- I received more insults and personal attacks than ever before (and contrary to some detractors, not a farthing in payment from anyone),
- luckily, I also made many new friends.
I feel deeply honoured to have received the Award. It is a generous appreciation of our small efforts in decreasing the ignorance and stupidity that seems to be all around us today – sadly not just in the realm of alternative medicine (but that would be the subject of another blog).
I thank everyone who contributed to our blog’s success and hope you keep the comments coming.
According to its authors, the objective of this paper was “to demonstrate the need for using both alternative and conventional treatments to improve clinical outcomes in the treatment of schizoaffective disorder”.
Instead of doing anything remotely like this, the authors present two case histories:
- a 23-y-old female (case 1)
- and a 34-y-old female (case 2).
Both patients had been diagnosed with schizoaffective disorder of the bipolar type. Individualized homeopathic treatment was initiated for both patients, who were also on conventional medications. A Likert scale was used to evaluate the intensity of each patient’s symptoms at each follow-up, based on self-reporting.
During the course of treatment, both patients’ symptoms normalized, and they regained their ability to hold jobs, attend school (at the age of 23/34 ???), and maintain healthy relationships with their families and partners while requiring fewer pharmaceutical interventions.
The authors concluded that these two cases … illustrate the value of individualized homeopathic prescriptions with proper case management in the successful treatment of that disorder. Future large-scale, double-blind, placebo-controlled studies should investigate individualized homeopathic treatments for mental health concerns, because the diseases cause great economic and social burden.
The article was published in Altern Ther Health Med.by Grise DE, Peyman T, and Langland J who seem to be from the ‘Southwest College of Naturopathic Medicine, Tempe, Arizona’. Two of the authors have recently published similarly odd case reports:
- This case report demonstrates a successful approach to managing patients with type 2 diabetes mellitus (DM2). Botanical herbs (including Gymnema sylvestre) and nutrients (including alpha lipoic acid and chromium) were used alongside metformin to help improve insulin sensitization; however, the greatest emphasis of treatment for this patient centered on a low-carbohydrate, whole-foods diet and regular exercise that shifted the focus to the patient’s role in controlling their disease. Research on DM2 often focuses on improving drug efficacy while diet and lifestyle are generally overlooked as both a preventive and curative tool. During the 7 months of treatment, the patient’s hemoglobin A1c and fasting glucose significantly decreased to within normal ranges and both cholesterol and liver enzyme markers normalized. A significant body of evidence already exists advocating for disease management using various diets, including Mediterranean, low-carb, and low-fat vegan diets; however, no clear dietary standards have been established. This study supports the use of naturopathic medicine as well as dietary and lifestyle changes to develop the most efficacious approach for the treatment of DM2.
- This case report illustrates the improvement of an acupuncture-treated patient who incurred a severe traumatic brain injury (TBI) from a snowboarding accident. Over 4 years, the patient progressed from initially not being able to walk, having difficulty with speech, and suffering from poor eyesight to where he has now regained significant motor function, speech, and vision and has returned to snowboarding. A core acupuncture protocol plus specific points added to address the patient’s ongoing concerns was used. This case adds to the medical literature by demonstrating the potential role of acupuncture in TBI treatment.
- The current case study intended to evaluate the benefits of an alternative, multifaceted approach-including botanical and homeopathic therapies in conjunction with a low-FODMAP diet-in the treatment of small intestinal bacterial overgrowth (SIBO) and its associated symptoms. Design • The research team performed a case study. Setting • The study was conducted at SCNM Medical Center (Tempe, AZ, USA). Participant • The participant was a female patient at the SCNM Medical Center with chronic, daily, severe abdominal bloating and pain that particularly worsened after meals and by the end of the day. The patient also had a significant history of chronic constipation that had begun approximately 10 y prior to her experiencing the daily abdominal pain. Intervention • Based on a lactulose breath test for hydrogen and methane, the research team diagnosed the patient with a case of mild SIBO. The treatment approach was multifaceted, involving a low-FODMAP diet, antimicrobial botanical therapy, and homeopathic medicine. Results • The patient’s abdominal pain and bloating resolved with the treatment of the SIBO, although her underlying constipation, which was likely associated with other factors, remained. Conclusions • This case study supports an alternative, multifaceted approach to the treatment of SIBO and commonly associated symptoms.
- The study intended to examine the benefits of treating plantar warts with a topical, botanical blend that has had clinical success treating herpes simplex virus cold sores. Methods • A synergistic botanical blend was applied topically. Setting • The case report was completed at the Southwest College of Naturopathic Medicine (Tempe, Arizona, USA). Participant • The participant was a 24-y-old male soccer player, 177.8 cm tall, and weighing 69 kg with previously diagnosed, viral mosaic warts. Intervention • The patient used a pumice stone during bathing for the first week to remove dead tissue and ensure sufficient contact and entry of the botanical gel into infected tissue. After drying the area, the patient applied the botanical gel blend 1 to 2 times daily postshower, spreading it evenly across the surface of the entire lesion. The patient discontinued the exfoliation technique after the first week. Results • Within the first week of treatment, the patient noted changes to the infected area of the hallux epidermal tissue. The combination of exfoliation and application of the gel caused marked, visible differences in presentation by the fifth day of treatment. At 1-mo postintervention, or day 90, the epidermal tissue was asymptomatic and devoid of petechiae, malformations, or visible infection. Conclusions • The results of the current case study directly contrast with the drawbacks of commonly accepted, first-line interventions in the treatment of viral plantar warts and, in many respects, demonstrate better efficacy and fewer side effects than the standard of care. The positive results also highlight the necessity for additional study in the fields of sports medicine and podiatry to further establish the botanical blend when treating viral plantar in athletes, an overall at-risk population for the condition.
- This study intended to examine the benefits of treatment of a pediatric patient with natural supplements and an elimination diet for IgG food allergies. Design • The research team reported a case study. Setting • The study was conducted at Southwest Naturopathic Medical Center (Tempe, AZ, USA). Participant • The participant was a 10-y-old Caucasian female who had diagnoses of allergic rhinitis and reactive bronchospasm, the second of which was exacerbated by allergens such as wheat, perfumes, and seasonal flora. Intervention • Following testing for IgE- and IgG-reactive foods, the patient was treated with natural supplements to reduce her allergic responses and was instructed to make dietary changes to eliminate the IgG-reactive foods. Outcome Measures • The patient’s symptom severity was tracked starting 1 mo after her initial visit to Southwest Naturopathic Medical Center. The severity was based on the patient’s subjective reports about her congestion to her mother and on her mother’s observations of the effect of symptoms on her attention and school performance. The bronchospasm severity was based on the frequency of a sensation of wheezing and chest tightness, the frequency of inhaler use, and the occurrence of any exacerbation of symptoms with acute respiratory illness Results • After 1 mo, in which the patient used the natural supplements, she experienced a 90% improvement in coughing; a 70% improvement in nasal congestion; less chest tightness; and no need for use of loratadine, diphenhydramine, or albuterol. At the 8-mo follow-up visit, her nasal congestion was reported to be entirely gone. Conclusions • The case demonstrates the effectiveness of natural supplements and a diet eliminating IgG-reactive foods in the treatment and management of pediatric allergic rhinitis and reactive bronchospasm.
These articles are all quite similarly ridiculous, but the first one reporting two patients who felt better after taking individualised homeopathic remedies (together with conventional medicines) is, I think, the ‘best’. I suggest the authors continue their high-flying careers by publishing a series of further case reports on similar themes:
- How the crowing of the cock in the morning causes the sun to rise.
- The danger of WW 3 causes Americans to elect an idiot as president.
- Increase of CO2 emissions due to global warming.
- Immunisation neglect caused by measles outbreaks.
- Brexit vote due to economic downturn.
- Excessive alcohol consumption caused by hangover.
- Why does lying in bed cause tiredness?
Please feel free to suggest more ‘post hoc propter hoc’ research themes for our aspiring team of naturopathic pseudo-scientists to be published in Altern Ther Health Med.
Words like these are sure to persuade me that this chiropractic conference announcement is an invitation to abandon reason and dive into pure, unappetising BS. Reading the full text confirms my suspicion; here are a few quotes:
… Chiropractic practitioners are blazing new trails in pediatrics, neurology, neuroplasticity, and multisensory integration, pushing the understanding and possibilities of greater health potential for [autistic] children. This first-ever chiropractic pediatric CE program, with an emphasis on autism, will open the door to more chiropractors serving this precious group of children, taking the daunting fear out of this neurodevelopmental disorder and replacing it with optimism and hope.
AutismOne Online Media Director Candyce Estave said: “As a chiropractor, you’ve already displayed the courage to pursue a better way for your practice and your patients. You’ve shown your patients how supporting the healthy terrain and flow of the body underlies maintaining good health. But what about what’s called ‘autism’? How do you help the multitude of children and families who would love to seek your services for that? You can learn how at the AutismOne 2018 Conference!”
Chiropractic emphasizes the inherent recuperative power of the body to heal itself when it is free of nervous system interference and given the right conditions. Led by Steve Tullius, DC, the Chiropractic Pediatric Continuing Education Credit Program will bring together the best information from the chiropractic and other healing communities to prepare the practicing chiropractor with up-to-the-minute information, confidence, and resources to help children with autism get better. The CE program is co-sponsored by Sherman College of Chiropractic.
Dr. Jeanne Ohm, chiropractor since 1981 and director of the International Chiropractic Pediatric Association since 2002 says, “This year’s AutismOne Conference will offer essential fundamentals in caring for children with these special needs. I encourage all chiropractors to expand their practices and offer their vital services to this growing population in such dire need.”
END OF QUOTES
Blazing new trails in pediatrics, neurology, neuroplasticity, and multisensory integration?
Are they claiming that freeing autistic children from ‘nervous system interference’ (with spinal ‘adjustments’ no doubt) cures autism?
This assumption would put chiropractic firmly into the category of anti-scientific quackery. Seen from this perspective, the little footnote to the announcement is rather hilarious:
“Professionals from other scientific disciplines are also welcome to attend.”
Weleda, a leading manufacturer of homeopathic preparations, is, according to their own judgement, a ‘unique organisation – economically thriving, kind at heart and committed to the well-being of our planet, our environment and our people. We’ve grown into that role through the adoption of seven basic principles which are unchanging, binding for everyone who works with us, and which clearly underpin the way we work.’
The first of these 7 principles is the ‘Fair treatment of customers, partners and suppliers‘. Fair treatment and being ‘kind at heart’ would include telling the truth, wouldn’t it? But reading what Weleda state about homeopathy, one might wonder!
The Weleda article entitled ‘An introduction to Homeopathy’ contains many statements worthy of some critical analysis, I think. Here is a selection of 10 just quotes:
- … a [homeopathic] remedy [is] made from a natural substance… in a tiny dose which has been ‘potentised’ to be effective.
- Many people choose this approach for every-day family ailments, with a homeopathic ‘first aid kit’…
- … allopathic medicine works against the disease and its symptoms using “anti” drugs…
- Homeopathy works by stimulating the body’s own natural healing capacity.
- If you do experience complex, persistent or worrying symptoms then please seek the advice of a doctor who specialises in homeopathy.
- Today there are four homeopathic hospitals offering treatment under the National Health Service – in London, Glasgow, Liverpool and Bristol.
- Homeopathy can be used to treat the same wide range of illness as conventional medicine, and may even prove successful when all other forms of treatment have failed.
- … the fact that the remedies are widely used on animals dismisses the idea that the success of a treatment is all in the mind.
- Occasionally, symptoms become worse on first taking a homeopathic medicine. This is called an ‘aggravation’, and is a good sign that the remedy is working.
- … some homeopathic remedies will successfully treat many people with the same symptoms. For example, arnica is usually used for muscular bruising …
And here are my thoughts on these 10 statements:
- I had always thought that homeopathics can be made from any substance (including Berlin Wall) and not just natural ones. Moreover, the dose is often not ‘tiny’ but non-existent. Finally, the assumption that ‘potentisation’ renders remedies ‘effective’ is pure wishful thinking.
- A homeopathic ‘first aid kit’ is a contradiction in terms. If someone needs first aid, she surely must avoid homeopathy.
- The term ‘allopathy’ is a derogatory term created by Hahnemann to defame the heroic medicine of his time. The notion of ‘anti-drugs’ is popular in homeopathy, but evidently, it is pure nonsense.
- This notion is wishful thinking by homeopaths at its best; there is not a jot of evidence that it is true.
- If you do experience complex, persistent or worrying symptoms then please seek the advice of a doctor who practices evidence-based medicine but NOT homeopathy.
- This statement is untrue; a footnote to the article states ‘Copyright 2017 Weleda UK’, it is thus odd to see that Weleda is so ill-informed.
- The claim that homeopathy is a panacea is dangerous nonsense.
- This notion is endlessly being promoted by homeopaths. Sadly the repetition of a falsehood does not create a truth (see for instance here).
- ‘Homeopathic aggravations’ are a myth.
- Yes, homeopathic arnica is used for muscular bruising – but it not effective for that or any other indication.
It is only fair, I think, that I declare my conflicts of interest in relation to Weleda.
While at Exeter, I ran during 14 years an annual conference for researchers in alternative medicine. One year, I accepted a modest sponsorship from Weleda for this meeting [I forgot how much and which year precisely this was, possibly around 1999 and probably around £ 3 000].
More importantly, Weleda was one of the companies that financed the German journalist Claus Fritzsche who then spent much time and effort to attack and defame me. This story that ended tragically with Fritzsche’s suicide.
Needless to say that I regret both events.
Arguably, I therefore have two opposing conflicts of interest, one pro and one contra Weleda. This is why I tried to focus my comments purely on demonstrable facts. They show, I think, that Weleda’s claims about homeopathy should be take with more than a little pinch of salt – or perhaps even with a dose of NaCl, C200?
Reiki has been on my mind repeatedly (see for instance here, here, here and here). It is one of those treatments that are too crazy for words and too implausible to mention. Yet a new paper firmly claims that it is more than a placebo.
This review evaluated clinical studies of Reiki to determine whether there is evidence for Reiki providing more than just a placebo effect. The available English-language literature of Reiki was reviewed, specifically for
- peer-reviewed clinical studies,
- studies with more than 20 participants in the Reiki treatment arm,
- studies controlling for a placebo effect.
Of the 13 suitable studies,
- 8 demonstrated Reiki being more effective than placebo,
- 4 found no difference but had questionable statistical resolving power,
- one provided clear evidence for not providing benefit.
The author concluded that these studies provide reasonably strong support for Reiki being more effective than placebo. From the information currently available, Reiki is a safe and gentle “complementary” therapy that activates the parasympathetic nervous system to heal body and mind. It has potential for broader use in management of chronic health conditions, and possibly in postoperative recovery. Research is needed to optimize the delivery of Reiki.
These are truly fantastic findings! Reiki is more than a placebo – would have thought so? Who would have predicted that something as implausible as Reiki would one day be shown to work?
Now let’s start re-writing the textbooks of physics and therapeutics and research how we can optimize the delivery of Reiki.
Hold on – not so quick! Here are a few reasons why we might be sceptical about the validity of this review:
- It was published in one of the worst journals of alternative medicine.
- The author claimed to include just clinical trials but ended up including non-clinical studies and animal studies.
- Four trials were not double-blind.
- There was no critical assessment of the studies methodological quality.
- The many flaws of the primary studies were not mentioned in this review.
- Papers not published in English were omitted.
- The author who declared no conflict of interest has this affiliation: “Australasian Usui Reiki Association, Oakleigh, Victoria, Australia”.
I think we can postpone the re-writing of textbooks for a little while yet.
Orac recently lost his rag over JOHN WEEKS, editor of JCAM (see also here, here, here and here), and was less than appreciative of his recent comments on the Samueli-donation. Personally, I think that this was a bit harsh. To compensate the poor chap for such an injustice, I herewith offer John a place in my ‘Alt Med Hall of Fame’.
There he is in good company:
Deepak Chopra (US entrepreneur)
Cheryl Hawk (US chiropractor)
David Peters (osteopathy, homeopathy, UK)
Nicola Robinson (TCM, UK)
Peter Fisher (homeopathy, UK)
Simon Mills (herbal medicine, UK)
Gustav Dobos (various, Germany)
Claudia Witt (homeopathy, Germany and Switzerland)
George Lewith (acupuncture, UK)
John Licciardone (osteopathy, US)
have all been honoured in the same way.
But John is special!
I have mentioned him several times before (see here, here and here); what makes him special, in my view, is that he is such a shining example of an expert in ‘integrative medicine’. He calls himself a “a writer, speaker, chronicler and organizer whose work in the movement for integrative health” and proudly presents his lifetime achievement award (I urge you to read it – everyone who is anyone in the US quackery-cult pored a little praise over John – but be careful, you might feel acutely nauseous). Towards the end of this document, John adds some self-praise by summarising the many other ‘HONORS’ he has received:
- – For public education, American Association of Naturopathic Physicians (1988)
- – For role in historic regional accreditation of a college of natural health sciences, Bastyr College/now Bastyr University (1989)
- – Commencement speaker, Bastyr College (1989)
- – Honorary Doctor of Naturopathic Medicine, Bastyr University (1992)
- – For service, American Association of Naturopathic Physicians (1993)
- – For service, Washington Mental Health Counselors Association (1995)
- – Commencement speaker, Northwestern Health Sciences University (2010)
- – Honorary Doctor of Laws, National University of Health Sciences (2011)
- – Honorary Doctor of Naturopathic Medicine, Canadian College of Naturopathic Medicine (2012)
- – Commencement speaker, New York Chiropractic College (2013)
- – Champion of Naturopathic Medicine, American Association of Naturopathic Physicians (2013)
So what? I hear you say, what is so special about that?
I will tell you what is special:
- John is not a doctor,
- John is not a practitioner,
- John is not a scientist,
- John has not published anything that we might call research,
- John has not studied any healthcare-related subject,
- John has, as far as I can see, no real university degree at all.
I find this remarkable and wonderful! It shows us like few other things what to think of the alternative medicine-cult. Not only can truly anyone become president in the US (as the last election has demonstrated); in the US anyone can become a celebrated and honoured champion of alternative medicine as well!
Welcome in my ‘Hall of Fame’ John!
We all know Epsom salt, don’t we? This paper provides an interesting history of it: The purgative effect of the waters of Epsom, in southern England, was first discovered in the early seventeenth century. Epsom subsequently developed as one of the great English spas where high society flocked to take the medicinal waters. The extraction of the Epsom Salts from the spa waters and their chemical analysis, the essential feature of which was magnesium sulphate, were first successfully carried out by Doctor Nehemiah Grew, distinguished as a physician, botanist and an early Fellow of the Royal Society. His attempt to patent the production and sale of the Epsom Salts precipitated a dispute with two unscrupulous apothecaries, the Moult brothers. This controversy must be set against the backcloth of the long-standing struggle over the monopoly of dispensing of medicines between the Royal College of Physicians and the Worshipful Society of Apothecaries of London.
Epsom salt has the reputation of being very safe. But unfortunately, even something as seemingly harmless as Epsom salt can become dangerous in the hand of people who have little understanding of physiology and medicine. Indian doctors have just published a paper in (‘BMJ Case Reports’) with the details of a 38-year-old non-alcoholic, non-diabetic man suffering from gallstones. The patient was prescribed three tablespoons of Epsom salt to be taken with lukewarm water for 15 days for ‘stone dissolution’ by a ‘naturopathy practitioner’. He subsequently developed loss of appetite and darkening of urine from the 12th day of treatment and jaundice from the second day after treatment completion. The patient denied fevers, skin rash, joint pains, myalgia, abdominal pain, abdominal distension and cholestatic symptoms.
Examination revealed a deeply icteric patient oriented to time, place and person without an enlarged liver or stigmata of chronic liver disease. Liver function tests were abnormal, and a liver biopsy revealed sub-massive necrosis with dense portal-based fibrosis, mixed portal inflammation, extensive peri-venular canalicular and hepatocellular cholestasis with macro-vesicular steatosis and peri-sinusoidal fibrosis (suggestive of steato-hepatitis) without evidence of granulomas, inclusion bodies or vascular changes suggestive of acute drug-induced liver injury.
After discontinuation of Epsom salt and adequate hydration, the patient had an uneventful recovery with normalisation of liver function tests after 38 days. The Roussel Uclaf Causality Assessment score was strongly suggestive of Epsom salt-induced liver injury.
I was invited to provide a comment and stated that, in my view, this case reminds us:
1) that naturopaths prescribe a lot of nonsense,
2) that not everything which is promoted as natural is safe,
3) that treatments which apparently have ‘stood the test of time’ can still be rubbish, and
4) that even a relatively harmless remedy can become life-threatening, if one takes it at a high dose for a prolonged period of time.
Naturopaths have advocated Epsom salt for gall-bladder problems since centuries, yet there is no good evidence that it works. It is time that alternative practitioners abide by the rules of evidence-based medicine.
A quick Medline search reveals that there is only one further report of a serious adverse effect after Epsom salt intake: a case of fatal hypermagnesemia caused by an Epsom salt enema. A 7-year-old male presented with cardiac arrest and was found to have a serum magnesium level of 41.2 mg/dL (33.9 mEq/L) after having received an Epsom salt enema earlier that day. The medical history of Epsom salt, the common causes and symptoms of hypermagnesemia, and the treatment of hypermagnesemia are reviewed. The easy availability of magnesium, the subtle initial symptoms of hypermagnesemia, and the need for education about the toxicity of magnesium should be of interest to physicians.
… and to alternative practitioners, I hasten to add.