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

Monthly Archives: February 2018

Difficulties breastfeeding?

Some say that Chinese herbal medicine offers a solution.

This Chinese multi-centre RCT included 588 mothers considering breastfeeding. The intervention group received the Chinese herbal mixture Zengru Gao, while the control group received no therapy. The primary outcomes were the percentages of fully and partially breastfeeding mothers, and a secondary outcome was baby’s daily formula intake.

At day 3 and 7 after delivery, significant differences were found in favour of Zengru Gao group on the percentage of full/ partial breastfeeding. At day 7, the percentage of full/ partial breastfeeding of the active group increased to 71.48%/20.70% versus 58.67%/30.26% in the control group, the differences remained significant. No statistically significant differences were detected on primary measures at day. While intake of formula differed between groups at day 1 and 3, this difference did not achieve statistical significance, but this difference was apparent by day 7.

The authors concluded that the Chinese Herbal medicine Zengru Gao enhanced breastfeeding success during one week postpartum. The approach is acceptable to participants and merits further evaluation.

To the naïve observer, this study might look rigorous, but it is a seriously flawed RCT. Here are just some of its most obvious limitations:

  • All we get in the methods section is this explanation: Participants were randomly allocated to the blank control group or the intervention group: Zengru Gao, orally, 30 g a time and 3 times a day. This seems to indicate that the control group got no treatment at all which means there was no blinding nor placebo control. The authors even comment on this point in the discussion section of their paper stating that because we included new mothers who received no treatment as a control group, we were able to prove that the improvement in breastfeeding was not due to the placebo effect. However, this is a totally nonsensical argument.
  • The experimental treatment is not reproducible. The authors state: Zengru Gao, a Chinese herbal formula, which is composed of 8 herbs: Semen Vaccariae, Medulla Tetrapanacis, Radix Rehmanniae Praeparata, Radix Angelicae Sinensis, Radix Paeoniae Alba,Rhizoma Chuanxiong, Herba Leonuri, Radix Trichosanthis. This is not enough information to replicate the study outside China where the mixture is not commercially available.
  • The primary outcome was the percentage of fully, and partially breastfeeding mothers. Breastfeeding was defined as mother’s milk given by direct breast feeding. Full breastfeeding meant that no other types of milk or solids were given. Partially breastfeeding meant that sustained latch with deep rhythmic sucking through the length of the feed, with some pause, on either/ or both breasts. We are not being told how the endpoint was quantified. Presumably women kept diaries. We cannot guess how accurate this process was.
  • As far as I can see, there was no correction for multiple testing for statistical significance. This means that some or all of the significant results might be false-positive.
  • There is insufficient data to show that the herbal mixture is safe for the mothers and the babies. At the very minimum, the researchers should have measured essential safety parameters. This omission is a gross violation of research ethics.
  • Towards the end of the paper, we find the following statement: The authors would like to thank the Research and Development Department of Zhangzhou Pien Tze Huang Pharmaceutical co., Ltd. … The authors declare that they have no competing interests. And the 1st and 3rd authors are “affiliated with” Guangzhou Hipower Pharmaceutical Technology Co., Ltd, Guangzhou, China, i. e. work for the manufacturer of the mixture. This does clearly not make any sense whatsoever.

I have seen too many flawed studies of alternative medicine to be shocked or even surprised by this level of incompetence and nonsense. Yet, I still find it lamentable. But, in my view, the worst is that supposedly peer-reviewed journals such as ‘BMC Complement Altern Med’ publish such overt rubbish.

It would be easy to shrug one’s shoulder and bin the paper. But the effect of such fatally flawed research is too serious for that. In our recent book MORE HARM THAN GOOD? THE MORAL MAZE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE, we discuss that such flawed science amounts to a violation of medical ethics:  CAM journals allocate peer review tasks to a narrow range of CAM enthusiasts who often have been chosen by the authors of the article in question. The raison d’être of CAM journals and CAM researchers is inextricably tied to a belief in CAM, resulting in a self-referential situation which is permissive to the acceptance of weak or flawed reports of clinical effectiveness… Defective research—whether at the design, execution, analysis, or reporting stage—corrupts the repository of reliable medical knowledge. Ultimately, this leads to suboptimal and erroneous treatment decisions…

The Royal London Homeopathic Hospital, recently re-named as the Royal London Hospital for Integrated Medicine (RLHIM), has been one of the most influential homeopathic hospitals in the world. It was founded in 1849 by Dr Frederick Foster Hervey Quin. In 1895, a new and larger hospital was opened on its present site in Great Ormond Street. Many famous homeopaths have worked there, including Robert Ellis Dudgeon, John Henry Clarke, James Compton Burnett, Edward Bach, Charles E Wheeler, James Kenyon, Margaret Tyler, Douglas Borland, Sir John Weir, Donald Foubister, Margery Blackie and Ralph Twentyman. In 1920, the hospital received Royal Patronage from the Duke of York, later King George VI, who also became its president in 1924, and in 1936, the Hospital was honoured by the Patronage of His Majesty the King gaining its ‘Royal’ prefix in 1947. Today, Queen Elizabeth II is the Hospital’s Patron.

On 18 June 1972, 16 of the hospital’s doctors and colleagues on board were killed in a plane crash. During the following years, several reductions in size and income took place. From 2002 to 2005, the hospital underwent a £20m redevelopment and, in 2010, its name was changed to Royal London Hospital for Integrated Medicine.

The hospital just published a new brochure for patients. It contains interesting information and therefore, I will quote directly from this document.

START OF QUOTES

The Royal London Hospital for Integrated Medicine (RLHIM) is part of University College London Hospitals NHS Foundation Trust and accepts all NHS referrals. GP referrals are by letter or via Choose and Book. Patients can also be referred by their NHS hospital consultant.

NHS Choices provides information and an opportunity to provide feedback about our service at www.nhs.uk
….

The General Medicine Service is led by three consultant physicians. The team also includes other doctors and nurses, a dietitian, a physiotherapist, an occupational therapist and a psychotherapist. The service sees patients with chronic and complex conditions. The team is trained in many areas of complementary medicine. These are used alongside orthodox treatment, allowing them to offer a fully integrated General Medicine service. The General Medicine Service offers a full range of diagnostic tests as well as a variety of treatments and advice on orthodox treatment.

From 3rd April 2018, The Royal London Hospital for Integrated Medicine (RLHIM) will no longer be providing NHS-funded homeopathic remedies for any patients as part of their routine care. This is in line with the funding policy of Camden Clinical Commissioning Groups, the local NHS body that plans and pays for healthcare services in this area.

Should you choose you will be able to purchase these medicines from the RLHIM pharmacy, while other homeopathic pharmacies may also be able to supply the medicines. You can speak to your clinician or the RLHIM pharmacy at your next visit about this…

Conditions commonly seen include:

  • Recurrent infections, such as colds, sore throats, cystitis, thrush, chest infections and bacterial infections
  • Some persistent symptoms where tests have not revealed a serious underlying disorder
  • Asthma or chronic obstructive pulmonary disease (COPD)
  • Digestive disorders, for example acid reflux, Irritable Bowel Syndrome and inflammatory bowel disease
  • Endocrine (glandular) disorders such as under-active thyroid
  • Type II diabetes
  • Some types of heart disease, high blood pressure and palpitations (requiring no orthodox treatment)
  • Chronic headache such as migraine or tension-type headache
  • Side effects of prescribed medications

END OF QUOTES

Clearly, the big news here is that the RLHIM has been forced to stop providing NHS-funded homeopathics. This could be indicative of what might soon happen throughout NHS England.

But there are other items that I find remarkable: “The General Medicine Service offers a full range of diagnostic tests as well as a variety of treatments and advice on orthodox treatment.” Call me a nit-picker, but this is not INTEGRATED! Integrated medicine means employing both alternative as well as conventional therapies in parallel. The best of BOTH worlds and all that…

In the same vein is the statement that they treat “some types of heart disease, high blood pressure and palpitations (requiring no orthodox treatment)” I am sorry, but this again is not INTEGRATED MEDICINE! I ask myself, is it ethical to mislead patients, colleagues, NHS officials and everyone else pretending to deliver ‘integrated medicine’, while in fact all they seem to offer is ‘alternative medicine’?

The RLHIM has recently dropped the term HOMEOPATHY from its name. Soon it might have to also abandon the term INTEGRATED, because it does not seem to be able to provide a safe level of conventional medicine.

How shall we then call it?

Suggestions please!

The authors of this systematic review aimed to summarize the evidence of clinical trials on cupping for athletes. Randomized controlled trials on cupping therapy with no restriction regarding the technique, or co-interventions, were included, if they measured the effects of cupping compared with any other intervention on health and performance outcomes in professionals, semi-professionals, and leisure athletes. Data extraction and risk of bias assessment using the Cochrane Risk of Bias Tool were conducted independently by two pairs of reviewers.

Eleven trials with n = 498 participants from China, the United States, Greece, Iran, and the United Arab Emirates were included, reporting effects on different populations, including soccer, football, and handball players, swimmers, gymnasts, and track and field athletes of both amateur and professional nature. Cupping was applied between 1 and 20 times, in daily or weekly intervals, alone or in combination with, for example, acupuncture. Outcomes varied greatly from symptom intensity, recovery measures, functional measures, serum markers, and experimental outcomes. Cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups. The majority of trials had an unclear or high risk of bias. None of the studies reported safety.

Risk of bias of included trials. “+” indicates low risk of bias, “−” indicates high risk of bias, and “?” indicates unclear risk of bias.

The authors concluded that no explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary for conclusive judgment on the efficacy and safety of cupping in athletes.

Considering the authors’ stated aim, this conclusion seems odd. Surely, they should have concluded that THERE IS NO CONVINCING EVIDENCE FOR THE USE OF CUPPING IN ATHLETES. But this sounds rather negative, and the JCAM does not seem to tolerate negative conclusions, as discussed repeatedly on this blog.

The discussion section of this paper is bar of any noticeable critical input (for those who don’t know: the aim of any systematic review must be to CRITICALLY EVALUATE THE PRIMARY DATA). The authors even go as far as stating that the trials reported in this systematic review found beneficial effects of cupping in athletes when compared to no intervention. I find this surprising and bordering on scientific misconduct. The RCTs were mostly not on cupping but on cupping in combination with some other treatments. More importantly, they were of such deplorable quality that they allow no conclusions about effectiveness. Lastly, they mostly failed to report on adverse effects which, as I have often stated, is a violation of research ethics.

In essence, all this paper proves is that, if you have rubbish trials, you can produce a rubbish review and publish it in a rubbish journal.

Rapidly rising in popularity, kratom is hailed by some as a readily available pain remedy that is safer than traditional opioids, an effective addiction withdrawal aid and a pleasurable recreational tonic. But kratom also is assailed as a dangerous and unregulated drug that can be purchased on the Internet, a habit-forming substance that authorities say can result in opioid-like abuse and death.

Last week, the Food and Drug Administration announced that the herbal supplement kratom possesses the properties of an opioid, thus escalating the government’s effort to slow usage of this alternative pain reliever. The FDA states that the number of deaths associated with kratom use has increased to a total of 44, up from a total of 36 since the FDA’s November 2017 report. In the majority of deaths that FDA attributes to kratom, subjects ingested multiple substances with known risks, including alcohol. The presence of multiple drugs makes it difficult to determine the role any one of them played.

So, what is kratom, and why might it be dangerous?

A recent review explains that the leaves of Mitragyna speciosa (commonly known as kratom), a tree endogenous to parts of Southeast Asia, have been used traditionally for their stimulant, mood-elevating, and analgesic effects. The plant’s active constituents, mitragynine and 7-hydroxymitragynine, have been shown to modulate opioid receptors, acting as partial agonists at mu-opioid receptors and competitive antagonists at kappa- and delta-opioid receptors. Both alkaloids are G protein-biased agonists of the mu-opioid receptor and therefore, may induce less respiratory depression than classical opioid agonists. The Mitragyna alkaloids also appear to exert diverse activities at other brain receptors (including adrenergic, serotonergic, and dopaminergic receptors), which may explain the complex pharmacological profile of raw kratom extracts. Kratom exposure alone has not been causally associated with human fatalities to date. However, further research is needed to clarify the complex mechanism of action of the Mitragyna alkaloids and unlock their full therapeutic potential.

Another review adds that, by the early 2000s, kratom was increasingly used in the US as a natural remedy to improve mood and quality of life and as substitutes for prescription and illicit opioids for managing pain and opioid withdrawal by people seeking abstinence from opioids. There has been no documented threat to public health that would appear to warrant emergency scheduling of the products and placement in Schedule I of the CSA carries risks of creating serious public health problems. Banning kratom, risks creating public health problems that do not presently exist.

A third review explains that there are no published human pharmacologic, pharmacokinetic, or drug interaction studies on kratom or mitragynine, making it virtually impossible to fully understand kratom‘s therapeutic potential and risks and the populations most likely to benefit or experience harm from its use. Kratom has been used to ameliorate opioid withdrawal symptoms but also induces withdrawal. Human pharmacologic, pharmacokinetic and clinical data are of low quality precluding any firm conclusions regarding safety and efficacy. Kratom does cause a host of adverse effects without clear guidance for how they should be treated. There are numerous assessments where people have been unable to stop using kratom therapy and withdrawal signs and symptoms are problematic. Kratom does not appear in normal drug screens and, when taken with other substances of abuse, may not be recognized.

A systematic review evaluated all studies on kratom use and mental health published between January 1960 and July 2017. Its findings indicate kratom‘s potential as a harm reduction tool, most notably as a substitute for opioids among people who are addicted. Kratom also enhances mood and relieves anxiety among many users. For many, kratom‘s negative mental health effects – primarily withdrawal symptoms – appear to be mild relative to those of opioids. For some users, however, withdrawal is highly uncomfortable and maintaining abstinence becomes difficult.

In Europe, as of 2011, kratom has become a controlled drug in Denmark, Latvia, Lithuania, Poland, Romania and Sweden. In the UK, since 2016, the sale, import, and export of kratom are prohibited.

On balance, my conclusion is that we urgently need more data and meanwhile should avoid this ‘herbal drug’.

 

Doctor Jonas is an important figure head of US ‘Integrative Medicine’. As we discussed in a recent post, he pointed out that many US hospital doctors fail to answer the following questions relating to their chronically ill patients:

  1. “What matters most for this patient?
  2. What is the person’s lifestyle like – their nutrition, movement and sleep?
  3. How does that patient manage their stress?
  4. Does that patient have a good support system at home?
  5. What supplements does that patient take? Has your patient seen any CAM practitioners to cope with their condition?
  6. Why do they want to get well?”

In my previous post, I tried to explain that this is embarrassing – embarrassing for doctor Jonas, I meant.

But Jonas also claims that most US hospital doctors he addressed during his lecture tour, were unable to answer these questions. And that might be embarrassing not for Jonas, but for those physicians. Let’s consider this possibility for a moment.

The way I see it, the doctors in question might not have answered to Jonas for the following reasons:

  • They felt that the questions were simply too daft to bother.
  • They were too polite to tell Jonas what they think of him.
  • They were truly unable to answer the questions.

Here I want to briefly deal with the last category.

I do not doubt for a minute that this category of physician exists. They have little interest in what matters to their patients, don’t ask the right questions, have no time and even less empathy and compassion. Yet nobody can deny that medical school teaches all of these qualities, skills and attitudes. And there is no doubt that good doctors practice them; it is not a choice but an ethical and moral imperative.

So, what went wrong with these doctors?

Probably lots, and I cannot begin to tell you what exactly. However, I can easily tell you that those doctors are not practicing good medicine. Similarly, I can tell you what these doctors ought to do: re-train and be reminded of what medical school has once taught them.

And what about those physicians who advocate ‘integrated medicine’ reminding everyone of the core values of healthcare?

Aren’t they fabulous?

No, they aren’t!

Why?

Because they too have evidently forgotten what they should have learnt at medical school. If not, they would not be able to pretend that ‘integrative medicine’ has a monopoly on core values of all healthcare. Their messages are akin to a new ‘school’ of ship-building insisting that it is beneficial to build ships that do not leak.

What I am trying to say in my clumsy way is this:

DOCTORS WHO PRACTICE BAD MEDICINE SHOULD RE-TRAIN – TOGETHER WITH THOSE PHYSICIANS WHO ADVOCATE ‘INTEGRATIVE MEDICINE‘, BECAUSE THEY BOTH HAVE FORGOTTEN WHAT THEY LEARNT AT MEDICAL SCHOOL.

It is not often that I come across an alternative therapy that I have never before heard of. And when I do, I am naturally interested. Emunctorology is such a term – even my spell-check flags it up as a misprint, but trust me, it isn’t.

The term, my dictionary tells me, comes from the Latin emungere = to wipe clean (mungere = to wipe). Emunctory, the dictionary further informs me, relates to a body organ having an excretory function. It follows, that emunctorology is the science of the excretory functions of the body.

That does not mean it is an alternative therapeutic approach, I hear you say.

True, but we all know how inventive alternative practitioners can be.

This article explains (brace yourself for some comic relief):

START OF QUOTE

The emunctories are described as organs of elimination that support the process of detoxification. There are 5 major emunctories:

  1. Liver
  2. Lung
  3. Gastrointestinal tract – small and large intestine
  4. Kidneys / urinary tract
  5. Skin

The science of detoxification, Emunctorology, teaches us the language to understand and manage this process of detoxification.

The process of detoxification can be divided into two aspects:

  • Depuration: the purification of tissues that begins at the cellular level; includes the purification of fluids, organs, membranes, fatty tissue, etc. This aspect involves the packaging and the shipping of toxins, morbid matter, or ama to the emunctories, organs of elimination.
  • Drainage: the efficient elimination of toxins from their location in the emunctories. This is the final step to remove the burden of disease causing agents from the body. Healthy drainage is a constant need to maintain a disease-free body.

Depuration: Packaging and shipping toxins for elimination

If we think about the familiar process of digestion: it involves digestion of food, separation of nutrition from waste, and elimination of waste. The digestive process that occurs in the intestines is the gross depuration process that is easy to observe. It is a very good indicator of overall health and resilience.

Beyond the intestines, nutrition is again digested in the liver: which is a producer of cholesterols, glycogen, as well as a security gateway for chemical toxins. Beyond the liver, each cell in the body has a cellular digestive system; which harvests energy, repairs the cells, and eliminates toxic waste. Healthy digestive function at the intestinal, liver, and cellular levels ensures efficient regeneration tissue and efficient elimination of waste; the process of depuration.

The toxins, ama or morbid matter in our body come from two pathways: 1) Endogenous, naturally produced waste from the body’s metabolic processes, like reactive oxygen species that cause oxidative damage, feces, urine, etc.; 2) Exogenous, all toxic substances that we get from our environment, food, and emotional influences. When the process of elimination of toxins is overwhelmed, toxins are “hidden away” in the body to protect vital organs like the brain.

These toxins are primarily hidden in fat cells (adipose tissue) of the body. Depending on available space and preference, toxins also become stored in bones, muscles, connective tissue, and even the myelin sheaths that wrap around nerves. From their location in these tissues, toxins begin to block or modify normal physiological functions.

For an effective depuration process, elimination of toxins from all of these tissues is essential.

Drainage: Elimination of toxins from the body

The process of elimination also occurs at cellular and whole-body level. The main organs of eliminations, emunctories are main external outlets of the waste products. Cellular and physiological processes are subtle, yet equally important for bringing toxins to the emunctories for elimination. So the complete process of drainage requires elimination of waste at cellular level and elimination of waste out of the emunctories.

Accumulation of toxins at the emunctories, without proper elimination can also cause many problems. For example: 1) Cigarette smoke, mold, bacteria, microbial toxins are all exogenous toxins for the lung – prolonged exposure to these leads to chronic lung inflammation. 2) Presence of heavy metals and other toxins can cause abnormal folding a proteins – a problem that is implicated in causing neurodegenerative diseases like Alzheimer’s disease, Parkinson’s disease, etc. 3) Reactive oxygen species are created as part of cellular energy building process; as well as a side-product of inflammation; excessive amount can cause damage to DNA, cell walls, nerves, etc.

Activation of Emunctories:

All emunctories, organs of elimination, are active at all times; constantly working to make ensure the best possible health and physiological balance. Their functions can be enhanced by targeted daily choices in activity, food, environment, and hydration. Here are some simple strategies for activation:

Lungs…

 

  1. Inhale through your nose, filling your lungs to full capacity.
  2. Hold the breath for 3 seconds, then slowly exhale through your mouth.
  3. Repeat this exercise 16 times, twice a day.

Liver/Pancreas…

 

  1. Eat 2-3 servings of green leafy vegetables daily.
  2. 2-3 servings of colorful seasonal vegetables.
  3. Eat 1-2 servings of seasonal fruits daily.

Gastrointestinal tract…

  1. Several servings of fresh fruits and vegetables daily (same used for liver detox) – provide fiber and probiotic gut bacteria for normal activity of the intestines promoting regular bowel movements.
  2. Eat regular fermented foods: Yogurt, kimchi, sauerkraut, sour cream, kefir, etc. this is nutrition for replenishing gut-bacteria.
  3. All adults should drink 6-8 glasses of water every day.

Kidney/urinary tract…

 

  1. Eliminate refined sugars from diet completely – 1-2 teaspoons of honey, daily is enough.
  2. Drink plenty of water: add lemon slices and/or mint leaves to alkalinize the water.
  3. Support probiotic intake: Yogurt, kimchi, sauerkraut, sour cream, kefir, as well as fresh fruits and vegetables, preferably home grown or picked up from farmers market; this is nutrition for replenishing gut-bacteria.

Skin…

 

  1. Sweat regularly:
    • 20-30 minutes of aerobic exercise, done 5 times per week;
    • Sweat in a sauna or steam room after exercise for 20-30mins.
  2. Skin brush: use skin brush to gently scrub off old, dead skin. Brushing towards the heart also helps to promote lymph flow; For example: start at the hand and brush towards the shoulder.
  3. Apply oil: perform self-massage with sesame oil for Vata dominant body type, coconut for Pitta and Olive oil for Kapha body types, 2-3 times per week; ideally 10 minutes before going in the sauna to sweat. The oil nourishes the skin and sweating helps to pull out fat-soluble toxins from skin layers.

Mind…

 

  1. Meditation is a way to help quiet the activity of the mind. Regular practice of about 20 minutes twice a day can help to clear the mind and reboot.
  2. Walking is a moderate level exercise that also gives an opportunity to rest the mind from being engaged in doing things. Regular walks in the natural settings like the woods, has been shown to improve mood, self-esteem, and even boost the immune system.
  3. Play time with family and friends: whether it is physical activity or creative projects – play time is an ideal way giving the mind a break from the daily grind.
  4. Sleep: 7-8 hours of sleep every night between the hours of 10pm-6am. This helps to align the hormonal activity in the body and the mind with circadian rhythm, the day-night cycle of nature.
  5. Infusing these simple activities into your daily and weekly routines can help to optimize your natural capacity for detoxification. This helps to sustain a good baseline of cleanliness for all your tissues, body and mind…

END OF QUOTE

So, now we know!

Before you rush off and fill you days with meditation, skin brushing, oiling, sleeping, walking, sweating, exercising, dieting, shopping colourful vegetables, breathing as instructed, etc. – or, heaven forbid, train as an ‘emunctorologist’ – you might remember that we have covered detox – and that’s what ‘Emunctorology’ essentially turns out to be – several times before on this blog. I think that my conclusions from last year still hold:

If your life-style is unhealthy, don’t think that detox will help, but change your ways.

If the air that you breathe or the water that you drink are polluted, don’t think that detox is the solution, but punish the government that is responsible for these disasters and vote for someone more responsible.

Detox, as used in alternative medicine, is stupid, unethical nonsense promoted by charlatans of the worst kind; don’t fall for it!!!

The Australian Acupuncture and Chinese Medicine Association Ltd (AACMA) is the “peak professional body of qualified acupuncture and Chinese herbal medicine practitioners in Australia. AACMA has represented the profession since 1973 and values high standards in ethical and professional practice.”

High standards in ethical and professional practice?

Really?

Somehow, I doubt it!

Why?

Because they recently wrote to ‘Friends of Science in Medicine‘ categorically stating that I have “undeclared links to the pharmaceutical industry”.

To set the record straight (yet again), I here provide a complete list of all my links to the pharmaceutical industry, plus all my sponsorships and inducements from BIG PHARMA and elsewhere :

END OF LIST

As erring is human but lying is unethical, I herewith want to give the The Australian Acupuncture and Chinese Medicine Association an opportunity to withdraw their statement and post an apology. To make sure they know about this invitation, I have sent them this blog via an email. Failing an apology I might take appropriate action and I will certainly declare the association to be neither professional nor ethical.

I am waiting – shall we say until one week from today?

Yesterday, I received a ‘LETTER FROM DR JONAS’ (the capital lettering was his) – actually, it was an email, and not a very personal one at that. Therefore I feel it might be permissible to share some of it here (you do remember Jonas, don’t you? I did mention him in a recent post: “Considering the prominence and experience of Wayne Jonas, the 1st author of this paper, such obvious transgression is more than a little disappointing – I would argue that is amounts to overt scientific misconduct.”)

Here we go:

As part of my book tour, I spent last month visiting hospitals and medical schools, talking to the doctors, nurses and students. I tell them to think of a chronically ill patient, and I ask:

“What matters most for this patient? What is the person’s lifestyle like – their nutrition, movement and sleep? How does that patient manage their stress? Does that patient have a good support system at home? What supplements does that patient take? Has your patient seen any CAM practitioners to cope with their condition? Why do they want to get well?”

Most can’t answer these questions. Providers may know the diagnosis and treatments a patient gets, but few know their primary determinants of health. They know ‘what’s the matter’, but not ‘what matters.’ …

END OF QUOTE

Let’s have a closer look at those items of which Jonas thinks they matter:

  1. What is the person’s lifestyle like – their nutrition, movement and sleep? Depending on the condition of the patient, these issues might indeed matter. And if they do, any good doctor will consider them. There is nothing new about this; it is stuff I learnt in medical school all those years ago.
  2. How does that patient manage their stress? The question supposes that all patients suffer from stress. I know it is fashionable to ‘have stress’, but not every patient suffers from it. If the patient does suffer, it goes without saying that a good doctor would consider it.
  3. Does that patient have a good support system at home? Elementary, my dear Watson! If a doctor does not know about this, (s)he has slept through medical school (where did you go to medical school Wayne, and what did you do during these 6 years?).
  4. What supplements does that patient take? That’s a good one. I suppose Jonas would ask it to see what further nonsense he might recommend. Most rational doctors would ask this question to see what (s)he must advise the patient to discontinue.
  5. Has your patient seen any CAM practitioners to cope with their condition? As above.
  6. Why do they want to get well? Most patients would assume we are pulling their leg, if we really asked this. Instead of a response, they might return a question: Why do you ask, do you think being ill is fun?

So, doctor Jonas’ questions might do well during lectures to a self-selected audience, but in reality they turn out to be a mixture of embarrassing re-discoveries from conventional medicine, platitudes and outright nonsense. “My goal is for integrative healthcare to become the standard of care…” says Jonas towards the end of his ‘LETTER’. I suppose, this explains it!

Thus Jonas’ ‘LETTER’ turns out to be yet another indication to suggest that the reality of ‘integrative medicine’ consists of little more than re-discoveries from conventional medicine, platitudes and outright nonsense.

The authors of this review aimed to present an overview of the literature on physicochemical research performed on homeopathic preparations with respect to publication quality and methods used. They searched major scientific databases to find relevant publications from its origin to the end of 2015. Publications were assessed using a scoring scheme, the Manuscript Information Score (MIS). Information regarding country of origin of the research and experimental techniques used was extracted.

The authors identified 183 publications. The rate of publication in the field was 2 per year from the 1970s until 2000. Afterward, it increased to over 5.5 publications per year. The quality of publications was seen to increase sharply from 2000 onward: before 2000, only 12 (13%) publications were rated as ‘‘high quality’’ (MIS ‡7.5); 44 (48%) publications were rated as ‘‘high quality’’ after 2000.

Countries with most publications were Germany (n=42, 23%), France (n=29, 16%), India (n=27, 15%), and Italy (n=26, 14%). Techniques most frequently used were electrical impedance (26%), analytical methods (20%), spectroscopy (20%), and nuclear magnetic resonance (19%).

The authors concluded that physicochemical research into homeopathic preparations is increasing both in terms of quantity and quality of the publications.

They also announce that there will be a further paper on the subject: In part 2, we aim to identify the most interesting experimental techniques. With this, we aim to be in a position to generate meaningful hypotheses regarding a possible mode of action of homeopathic preparations.

It might be relevant to ask who the authors are and where they come from. They are Klein SD, Würtenberger S, Wolf U, Baumgartner S, and Tournier A. And their affiliations are:

  • Institute of Complementary Medicine, University of Bern, Switzerland.
  • Scientific & Regulatory Affairs, Hevert-Arzneimittel GmbH & Co. KG, Germany.
  • Society for Cancer Research, Arlesheim, Switzerland.
  • Institute of Integrative Medicine, University of Witten/Herdecke, Germany.
  • Homeopathy Research Institute (HRI), London, United Kingdom.

In other words, they are without exception proponents of homeopathy, some burdened with considerable conflicts of interest in the subject. Personally, I think it unlikely that anything meaningful will ever come of this research. But unsurprisingly, the enthusiasts beg to differ: on facebook, the HRI claimed that this new systematic review is a major step towards developing clear and testable hypotheses regarding the mode of action of homeopathy.

In a previous blog-post I have tried to explain my reservations in some detail; please allow me to repeat them here:

… homeopaths have been keen to find more rational support for their theories. Thus they have developed several ‘sciency’ concepts to explain the mode of action of their highly diluted homeopathic remedies. For instance they postulated that water can form secondary structures that hold some information of the original substance (stock), even if it has long been diluted out of the remedy. Alternatively, they claimed that the shaking of the remedy generates nano-particles or silicone-particles which, in turn, are the cause of the clinical effects.

Today, I want to assume for a minute, that one of these theories is correct – they cannot all be right, of course. Homeopaths regularly show us investigations that seem to support them, even though it only needs a real expert in the particular field of science to cast serious doubt on them. I will nevertheless assume that, after potentisation, the diluent retains information via nano-particles or some other phenomenon. For the purpose of this mind-experiment, I grant homeopaths that, in this respect, they are correct. In other words, let’s for a moment assume that the ‘memory of water’ theory is correct.

As I have been more than generous, I want homeopaths to return the favour and consider what this would really mean: information has been transferred from the stock to the diluent. Does that prove anything? Does it show that homeopathy is valid?

Could the homeopaths who make this assumption be equally generous and answer the following questions, please?

  1. How does a nano-particle of coffee, for instance, affect the sleep centre in the brain to make the patient sleep? Or how does a nano-particle of the Berlin Wall or a duck liver affect anything at all in the human body? The claim that information has been retained by the diluent is no where near to an explanation of a rational mode of action, isn’t it?
  2. Most homeopathic remedies are consumed not as liquids but as ‘globuli’, i. e.  tiny little pills made of lactose. They are prepared by dropping the liquid remedy on to them. The liquid subsequently evaporates. How is it that the information retained in the liquid does not evaporate with the diluent?
  3. The diluent usually is a water-alcohol mixture which inevitably contains impurities. In fact, a liquid C12 remedy most certainly contains dimensions more impurities than stock. These impurities have, of course, also been vigorously shaken, i. e. potentised. How can we explain that their ‘potency’ has not been beefed up at each dilution step? Would this not necessitate a process where only some molecules in the diluent are agitated, while all the rest remain absolutely still? How can we explain this fantastic concept?
  4. Some stock used in homeopathy is insoluble (for instance Berlin Wall). Such stock is not diluted but its concentration in the remedy is initially lowered by a process called ‘trituration’, a process which consists in grinding the source material in another solid material, usually lactose. I have granted you that potentisation works in the way you think. But how is information transferred from one solid material to another?
  5. Everything we drink is based on water containing molecules that have been inadvertently potentised in nature a million times and therefore should have hugely powerful effects on our bodies. How is it that we experience none of these effects each time we drink?

Now, homeopaths, let me propose a deal.

If you can answer these questions satisfactorily, I will no longer doubt your memory of water theory. If you cannot do this, I think you ought to admit that all your ‘sciency’ theories about the mode of action of highly diluted homeopathic remedies are really quite silly – more silly even than Hahnemann’s idea of a ‘spirit-like’ effect.

HELLO HOMEOPATHS OF THIS WORLD…

SO FAR NOBODY HAS TAKEN UP MY OFFER.

BUT IT STILL STANDS!

HOW ABOUT IT?

You might remember: I have been badly misquoted in an article in THE DAILY TELEGRAPH. Based on a newly published scientific paper, the Telegraph article was about herbal medicines and their potential to interact with synthetic drugs. Towards its end, it cited me stating this:

Emeritus Professor Edzard Ernst, Britain’s first professor of complementary medicine at Exeter University said that doctors should make it clear to patients that they could not be taking herbal remedies alongside drugs.

Prof Ernst said there was no good evidence that they work and that doctors were ‘contributing to disinformation’ by turning a blind eye to the practice.

Not only did this not make any sense (I felt, it made me look like an idiot), but crucially I had never stated this nor had I even commented to a Telegraph journalist about this scientific paper. This was (27/1) when I wrote my blog-post about it.

Several friends persuaded me to file an official complaint – which I somewhat reluctantly did. Subsequently, I received an email from the paper’s ‘editorial compliance executive’ asking me to supply more details about my grievances. I complied with the request by pointing out that:

The following things are wrong with this passage:

1) I never said this.

2) I have not even been interviewed by your journalist and do not know where this quote is supposed to come from.

3) As far as I am aware, I also never stated anything like this anywhere else.

4) It is not and never has been my view that there is no good evidence that herbal remedies can never be combined with drugs.

5) It is not and never has been my opinion that there is no good evidence to suggest that herbal remedies work.

6) It is not and never has been my view that doctors were contributing to disinformation by turning a blind eye to the use of herbal remedies.

The response came swiftly:

The quoted words were recorded at a briefing at the SMC to launch your new book, More Harm than Good? The Moral Maze of Complementary and Alternative Medicine on 17th January 2018. 

We are aware that you have had correspondence with our Science Editor, Sarah Knapton who has since amended the online article to make this clear. 

We do however accept that one sentence was mistakenly attributed to you. We have therefore amended the online article and added a footnote to explain what has been updated.

This was most bizarre, I thought, because I did NOT  have a correspondence with Sarah Knapton, the author of the Telegraph article. On the plus-side, the Telegraph had indeed changed the passage in question; it now read (and did so until yesterday):

Emeritus Professor Edzard Ernst, Britain’s first professor of complementary medicine at Exeter University said there was a ‘potential for harm’.

“It’s a lazy way out of the problem,” he said at a briefing to launch his new book More Harm than Good? The Moral Maze of Complementary and Alternative Medicine. “In medicine you give treatment for a reason and if there is no reason for the homeopathic remedy why should you support it for the placebo treatment.

“As a good doctor you should be able to transmit a placebo effect any case. I just don’t see a reason, I see the potential for harm.” 

The research was published in the British Journal of Clinical Pharmacology.

CORRECTION: This article originally stated that Professor Edzard Ernst said there was no good evidence that herbal remedies work and that doctors were ‘contributing to disinformation’ by turning a blind eye to their usage. In fact, this was not said by Professor Ernst. The article has been amended.

I felt that this was a correction of one mistake by another mistake and pointed out that the briefing had been about homeopathy and NOT about herbal medicine or herb/drug interactions. Therefore I replied to the ‘editorial compliance executive’ insisting on further corrections and pointing out that such an utterly nonsensical comment might harm my reputation as an expert. I also posted a comment under the Telegraph article explainig that homeopathy is not herbal medicine.

Sadly, nothing happened.

So, a few days later, I sent a reminder to the ‘editorial compliance executive’.

And again nothing happened.

… until yesterday.

I had almost given up and was contemplating what to do next, when I received an email. It was not from the  ‘editorial compliance executive’, but from THE TELEGRAPH’s ‘Head of Editorial Compliance’. He wrote that he had listened to the tapes of the original briefing and realised that my comments were indeed made in a different context. Therefore, they had now erased all of the nonsensical stuff and replaced it with this text:

CORRECTION: This article originally stated​ ​that Professor Edzard Ernst​,​ professor of complementary medicine at Exeter Universit​y, ​had said there​ was​ ‘potential for harm’ ​in herbal remedies and ​that doctors were ‘contributing to disinformation’ by turning a blind eye to ​this.​ These comments did not in fact relate to ​interactions between herbal remedies​ and prescribed medication, and they have been removed. We apologise to the Professor for the error.   

I am pleased!

And I gratefully accept the apology.


This might be a long, convoluted and somewhat boring story, but I think it has at least two important elements to it:

  1. It may seem petty to complain, and complain, and send reminders when the complaint seems to be getting ignored (I certainly did not feel sure that I was doing the right thing). But occasionally, it is worth the effort – not because of the personal satisfaction (nice but not essential), but because the truth has a high value which should be respected.
  2. Wondering how all this mess came about, I am asking myself: Does the author of the Telegraph article perhaps genuinely not know the difference between herbal and homeopathic remedies? Obviously, I don’t know the answer to this question, but it would explain the mess she got herself (and me) into. And it would also suggest that it might be necessary to educate journalists about alternative medicine in general and homeopathy in particular (In case there is any interest, I offer to give a few informative lectures with opportunities to ask questions to London-based health writers and science journalists).
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