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

Monthly Archives: February 2018

Many hard-nosed sceptics might claim that there is no herbal treatment for upper respiratory infections that makes the slightest difference difference. But is this assumption really correct?

According to my own research of 2004, it is not. Here is the abstract of our systematic review:

Acute respiratory infections represent a significant cause of over-prescription of antibiotics and are one of the major reasons for absence from work. The leaves of Andrographis paniculata (Burm. f.) Wall ex Nees (Acanthaceae) are used as a medicinal herb in the treatment of infectious diseases. Systematic literature searches were conducted in six computerised databases and the reference lists of all papers located were checked for further relevant publications. Information was also requested from manufacturers, the spontaneous reporting schemes of the World Health Organisation and national drug safety bodies. No language restrictions were imposed. Seven double-blind, controlled trials (n = 896) met the inclusion criteria for evaluation of efficacy. All trials scored at least three, out of a maximum of five, for methodological quality on the Jadad scale. Collectively, the data suggest that A. paniculata is superior to placebo in alleviating the subjective symptoms of uncomplicated upper respiratory tract infection. There is also preliminary evidence of a preventative effect. Adverse events reported following administration of A. paniculata were generally mild and infrequent. There were few spontaneous reports of adverse events. A. paniculata may be a safe and efficacious treatment for the relief of symptoms of uncomplicated upper respiratory tract infection; more research is warranted.

A. Paniculata (Burm.f.) Wall ex Nees (Acanthaceae family), also known as nemone chinensi, Chuān Xīn Lián, has traditionally been used in Indian and Chinese herbal medicine mostly as an antipyretic for relieving and reducing the severity and duration of symptoms of common colds and alleviating fever, cough and sore throats, or as a tonic to aid convalescence after uncomplicated respiratory tract infections. The active constituents of A. paniculata include the diterpene, lactones commonly known as the andrographolides which have shown anti-inflammatory, antiviral, anti-allergic, and immune-stimulatory activities. A. Paniculata has also been shown, in vitro, to be effective against avian influenza A (H9N2 and H5N1) and human influenza A H1N1 viruses, possibly through blocking the binding of viral hemagglutinin to cells, or by inhibiting H1N1 virus-induced cell death.

But our systematic review was published 14 years ago!

We need more up-to-date information!

And I am pleased to report that a recent paper provided exactly that.

This systematic review included published and unpublished RCTs. Quasi-RCTs, crossover trials, controlled before and after studies, interrupted time series (ITS) studies, and non-experimental studies were not included due to their potential high risk of bias.

Thirty-three trials involving 7175 patients with ARTIs were included. Their methodological quality was restricted as randomisation was not well documented; 73% of the trials included were not blinded; where ITT analysis were performed, loss to follow-up data were counted as no effect; and most trials were published without a protocol available.

Findings suggested limited but consistent evidence that A. Paniculata improved cough and sore throat when compared with placebo. A. Paniculata (alone or plus usual care) had a statistically significant effect in improving overall symptoms of ARTIs when compared to placebo, usual care, and other herbal therapies. A. Paniculata in pillule tended to be more effective in improving overall symptoms over A. Paniculata in tablet. Evidence also suggested that A. Paniculata (alone or plus usual care) shortens the duration of cough, sore throat and sick leave/time to resolution when compared versus usual care. Reduction in antibiotic usage was seldom evaluated in the included trials.

The authors concluded that A. Paniculata appears beneficial and safe for relieving ARTI symptoms and shortening time to symptom resolution. However, these findings should be interpreted cautiously owing to poor study quality and heterogeneity. Well-designed trials evaluating the effectiveness and potential to reduce antibiotic use of A. Paniculata are warranted.

In case you wonder about conflicts of interest: there were none with my 2004 paper, and the authors of the new review state that this paper presents independent research funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the author(s) and not necessarily those of the NIHR, the NHS or the Department of Health.

Yes, the RCTs are not all of top quality.

And yes, the effect size is not huge.

But maybe – just maybe – we do have here an alternative therapy that does help against a condition for which conventional drugs are fairly useless!?!

Virologists have discovered the very virus that is threatening the survival of the UK. It is a Coxsackie virus, to be precise, a mutation of the one responsible for HAND FOOT AND MOUTH DISEASE. In contrast to the Coxsackie A 16, the new ‘Coxsackie Brexit Strong’ (‘Coxsackie BS’ for short) seems to attack mostly adult Brits. By no means everybody is affected, and the scientists have already identified important risk factors:

  • being English,
  • being a nationalist,
  • white colour,
  • male gender,
  • age 60 and older,
  • low intelligence,
  • affluence,
  • cronyism,
  • aversion to Frogs,
  • dislike of Huns,
  • unusual dress-sense,
  • propensity of fill own pockets,
  • urge to invest in tax-heavens.

The infected individuals display a wide range of symptoms, including the compulsory repetition of slogans such as:

  • Brexit is Brexit!
  • We want our country back!!
  • The will of the people!!!
  • Get over it!!!!
  • Strong and stable!!!!!
  • The treasury are fiddling the figures!!!!!!

The disease is dangerously progressive, and its victims show increasing breakdown of reason, critical thinking, insight into facts, common sense, understanding of economics, ability to consider the views of experts, as well as further cognitive functions. Other significant symptoms, particularly of the later stages of the condition, is the urge to become the laughing-stock of other nations, galloping jingoism, and depicting uninfected individuals as ‘Remoaners’.

The danger for the UK arises from the fact that victims are eager to take over high places, for instance in politics. As the disease progresses, they become more and more ruthless in pursuing their aim to ‘MAKE BRITAIN GERAT AGAIN’. They tend to make false promises, lie in Parliament, avoid questions, withhold information, engage in intrigues, attempt to turn the BBC into a propaganda machine in the style of Josef Goebbels etc. … and, when confronted with the truth, shrug it off with an imbecilic smile.

The virus, it is assumed, affects the brain’s newly discovered ‘honesty-centre’ and turns it into a malignant ‘xenophobia centre’. The victim feels no pain; instead (s)he is taken over by an ever-increasing sense of righteousness and an urge to behave like a ‘little Englander’. In some badly affected individuals, this phenomenon shows itself in a bizarre dress-sense (e. g. ‘Victorian undertaker’).

Several concerned scientists have issues a nation-wide alert stating: ‘This is a national emergency! If the virus remains unchecked, the UK will go straight back into the Dark Ages.’

Virologists are currently working tirelessly trying to find a cure; experts say that it will take months to make meaningful progress. “We are working flat out, but our immunisation might come too late – not least because, due to insufficient funding, we have to work on a shoestring”, said one desperate scientist.

By contrast, enthusiasts from the alternative medicine scene claim to have found the solution: homeopathy!

Researchers at ‘British Science in Homeopathy’ (or ‘BS Homeopathy’) have re-analysed Hahnemann’s Organon in full detail and extrapolated that, based on the guru’s words, they can produce an effective remedy in a timely fashion. In fact, they already have exposed distilled water to the sound of recorded speeches by Hitler, Mussolini, the KKK and Trump. According to homeopathy’s ‘dislike cures dislikes’ principle, this procedure generates a novel ‘mother tincture’, fittingly called ‘Brexit Solution’, or BS for short.

Currently, the homeopaths are potentising this remedy and are organising its large-scale production. However, a fly has been discovered in the homeopathic ointment: a heated debate has erupted amongst these experts whether to employ ‘BS C30’ or ‘BS C200’ for the planned nation-wide emergency immunisation programme. Proponents of the ‘BS C200’ solution insist that such a dramatically high potency is needed in our present acute emergency, while members of the ‘C30 camp’ caution that it might cause a severe homeopathic aggravation which would lead to an outbreak of open hostilities in Europe. “After 70 years of peace, it would be foolish to risk it”, one senior homeopath has been quoted saying.

This is a question most clinicians must have asked themselves. The interest of patients in this area is enormous, and many do seek advice from their doctor, nurse, pharmacist, midwife etc. In a typical scenario, a patient might plug up her courage (yes, for many it does take courage) and ask:

What about therapy xy for my condition? My friend suffers from the same problem, and she says the treatment works very well.

The way I see it, there are essentially 4 options for formulating a reply:

1.       Uncompromisingly negative

2.       Evidence-based

3.       Open-minded

4.       Uncritically promotional

Let me explain and address these 4 options in turn.

1.       Uncompromisingly negative

I know that it can be tempting to be wholly dismissive and simply state that all alternative medicine is rubbish; if it were any good, it would have been adopted by conventional medicine. Therefore, alternative medicine is never an alternative; it is by definition implausible, ineffective and often dangerous.

Even if all of this were true, the uncompromisingly negative approach is not helpful, in my experience. Patients need and deserve some empathy and understanding of their position. If we brusque them, they feel insulted and go elsewhere. Not only would we then lose a patient, but we would run a high risk of exposing her to a practitioner who promotes quackery. The disservice seems obvious.

2.       Evidence-based

Clinicians might consider their patient’s question and reply to it by explaining what the current best available evidence tells us about the therapy in question. This can be done with empathy and compassion. For instance (if that is true), the clinician can explain that the treatment in question lacks a scientific basis, that it has nevertheless been tested in clinical trials which sadly do not show that it works. Crucially, the clinician should subsequently explain what effective treatments do exist and discuss a viable treatment plan with the patient.

The problem with this approach is that many, if not most conventional clinicians are fairly clueless about the evidence as it relates to the plethora of alternative therapies. Therefore, an honest discussion around the current best evidence is often difficult or impossible.

3.       Open-minded

This is the approach many clinicians today use as a default position. They basically tell their patient that there is not a lot of evidence for the treatment in question. However, it seems harmless, and therefore – if the patient is really keen on going down this route – why not? This type of response is, I fear, given regardless of the therapy in question and it largely ignores the evidence – some alternative treatments do work, some don’t, some are fairly safe, some aren’t.

Condoning alternative medicine in this way gives the impression of being ‘open-minded’ and ‘patient-centred’. It has the considerable advantage that it does not require any hard work, such as informing oneself about the current best evidence. It’s disadvantage is that it neither correct nor ethical.

4.       Uncritically promotional

Many clinicians go even one decisive step further. Under the banner of ‘integrative medicine’, they openly recommend using ‘the best of both worlds’ as being ‘holistic’, ’empathetic’, ‘patient-centred’, etc. By this, they usually mean employing as many unproven or disproven treatments as alternative medicine has to offer.

This approach gives the impression of being ‘modern’ and in tune with the wishes of patients. Its disadvantages are, however, obvious. Introducing bogus treatments into clinical routine can only render it less effective, more expensive, and less safe. Integrative medicine is therefore not in the best interest of patients and arguably unethical.

Conclusion

So, how should we advise patients on alternative medicine? I know what I would say and probably most of my readers can guess. But I do not want to prejudge the issue; I prefer to hear your views, please.

If you ask me, the field of alternative medicine is plagued with surveys; too many are published and most are complete, meaningless rubbish which serve merely the purpose of being misinterpreted as a means of popularising bogus treatments. Yet, every now and then, a decent and informative article appears – like this survey from Canada.

It yields a number of fascinating findings:

  • More than three-quarters of Canadians (79%) had used at least one from of CAM sometime in their lives in 2016 (74% in 2006 and 73% in 1997). British Columbians were most likely to have used an alternative therapy during their lifetime (89%), followed by Albertans (84%) and Ontarians (81%).
  • More than half (56%) of Canadians had used at least one CAM therapy in the year prior to the 2016 survey, compared to 54% in 2006 and 50% in 1997.
  • In 2016, massage was the most common type of therapy that Canadians used over their lifetime with 44 percent having tried it, followed by chiropractic care (42%), yoga (27%), relaxation techniques (25%), and acupuncture (22%).
  • The most rapidly expanding therapies over the past two decades were massage, yoga, acupuncture, chiropractic care, osteopathy, and naturopathy.
  • High dose/mega vitamins, herbal therapies, and folk remedies were in declining use over that same time period.
  • The most likely users of CAM over the past 12 months in 2016 were from the 35- to 44-year-old age group (61%). The use of CAM diminished with age, and generally rose with both income and education. These trends are similar to those observed in 2006 and 1997.
  • The majority of people choosing to use CAM in the 12 months preceding the 2016 survey did so for “wellness”.
  • Canadians spent an estimated $8.8 billion on CAM in the last 12 months ($8.0 billion in 2005/06 and $6.3 billion in 1996/97.
  • Of the $8.8 billion spent in 2016, more than $6.5 billion was spent on providers of CAM, while another $2.3 billion was spent on herbs, vitamins, special diet programs, books, classes, and equipment.
  • The majority of Canadians believe that CAM should be paid for privately and not by provincial health.

The strengths of this survey are that it is methodologically rigorous, and that it provides longitudinal data (this is in sharp contrast to the plethora of CAM surveys published recently). Many of its findings confirm what has already been known. Yet some results are new and noteworthy.

To many readers of this blog, the high CAM-usage will be disturbing. However, I am mildly encouraged by the results of this survey.

  • Firstly, the choice of CAM by Canadians seems rather more reasonable than that by other nations. Canadians seem to avoid the more ridiculous types of CAM, such as homeopathy or para-normal healing.
  • Secondly, many Canadians seem to view CAM not as medicine, but as a sort of luxurious pampering that they use to relax and feel well. Consequently, most are not pushing to get it reimbursed which I find more sensible than consumers’ attitudes in many other countries.

I have recently moved to Cambridge. Once I had unpacked my boxes etc., I decided to have a look at what Cambridge offers in terms of homeopathy. My hope was that, being a town dominated by higher education and top science, Cambridge would be free (or almost free) of quackery.

This hope was sadly disappointed. The first website I came across was this one:

Homeopathy can be used to treat a wide range of complaints…

  • mental and emotional states (eg OCD, depression, anxiety, panic attacks, irritability, etc)
  • respiratory tract disorders (eg asthma, bronchitis, laryngitis, rhinitis, sinusitis, hayfever, etc)
  • digestive problems (eg IBS, IBD, heartburn, colic, constipation, candidiasis, etc)
  • skin conditions (eg eczema, psoriasis, acne, warts, molluscum, urticaria, herpes etc)
  • musculo-skeletal complaints (eg rheumatoid arthritis, osteoarthritis, fibromyalgia, etc)
  • hormonal problems (eg thyroid disorders, menstrual and menopausal complaints,  etc)
  • male and female reproductive issues (eg PCOS, infertility, endometriosis, fibroids, etc)
  • sex related issues (eg physical and psychological issues,  diminished libido, etc)
  • complaints of pregnancy (eg nausea, fatigue, emotional upset, etc)
  • complaints of babies and children (including behavioural issues)
  • acute and/or recurring illnesses (eg ear infections, tonsillitis, cystitis, childhood diseases, etc)
  • disorders affecting the immune system (eg autoimmune disorders, allergies, etc)
  • side effects of conventional drugs (eg nausea of chemotherapy, skin burns of radiotherapy, etc)
  • and many more (eg ME,  chronic fatigue,  glandular fever, migraines, headaches, insomnia, etc)…

You would be forgiven for finding this list worrying – I certainly do. But there was an assurance:

Each homeopath at the Centre holds a Licentiate qualification from a respected homeopathic college and has many years experience. All are registered with at least one professional body, whose code of ethics and conduct they adhere to.

It seems that the code of ethics of these professional bodies has nothing against making bogus therapeutic claims.

Cambridge also offers training and education in homeopathy – even homeopathic first aid courses for lay people:

Courses typically cover the following topics:

  • The principles of homeopathic first aid
  • How to choose the right remedy
  • Understanding homeopathic potency
  • How to treat conditions such as colds, flu, fever
  • How to treat conditions such as insect bites, bee and wasp stings
  • How to treat food poisoning and other digestive ailments, acute tendon inflammations caused by overuse of parts of the body (tennis elbow, frozen shoulder, ‘keyboard’ wrist) and exam nerves…

Whether you are looking after yourself or looking after your family, knowledge of homeopathic first aid equips you with safe, simple and proven treatments for many common ailments and conditions…

The course fee is £90 and includes a booklet and refreshments. Fees are payable in two instalments.

A choice of homeopathic first aid kits is available on the course…

And there is more!

Take this website, for instance:

The healing process using clinical homeopathy, shortly explained

The homeopathic case-taking will assess a patient in respect to the position of the symptoms and vitality on the two charts above.

When faced with disease and symptoms, the body does not heal in a haphazard, accidental way, but according to a deep biological intelligence. A true healing process will mirror the body’s own healing strategies. It will not be about a specific herb or remedy but about understanding and helping the way our mind and body heal themselves.

The healing process can broadly be divided into five stages. For some cases, the focus is only needed in one or two stages, but in others, the healing process will require all five. Depending on the individual and the situation, each stage will be best done one-by-one but sometimes several stages can be achieved simultaneously.

1. Symptom Relief

What drives most patients to a health practitioner is relief from some kind of pain, discomfort or lack of freedom on a physical or psychological level. All systems of medicine are involved with alleviating these symptoms. While, this is the primary focus of conventional medicine, holistic treatment such as homeopathy will also seek to unravel deeper causes and promote lasting changes in your level of health.

2. Revitalisation

As the body has devoted parts of its energy to eliminate an illness, there is usually a loss in vitality and internal resources suffered by the individual. In order to have an effective response, it is important to ensure that the body has the right nutrients and resources to promote health. This is often overlooked by conventional medicine and also many holistic practitioners. Providing nutrients and support to a sick body will help with the recovery.

3. Detoxification

Very often, the body cannot function properly if there are high levels of damaging toxins or free radicals within the lymphatic system or at a tissue or cellular level. Toxins are often found at an area where disease occurs or has occurred. Toxins can be external (virus, metals, chemicals) or internal accumulations of the body’s own by-products. These wastes slowly and inexorably weaken the organism on all levels, generating both chronic disease states and acute illness. Clearing debris from cells, tissues and organs relieves the body of a tremendous burden and allow the body to work as it should…

But the proverbial biscuit is taken by another Cambridge institution, The Quantum Medicine of our Time:

LOOKING-GLASS MEDICINE is pioneering work in Homeopathy energy healing, and particularly in medicine. It possesses the capacity to heal the mental, emotional, and physical illnesses (refer to Case Studies under the title “Publication”). This energy form of medicine culminated a synthesis of the healing laws and principles of Homeopathy and Jungian psychology of the archetypes, and of which also incorporates the human energy system (the chakras) in both theories and practice. Counselling is an integral part of this healing process for one to achieve deep healing.

My working and researching, over the years, in how individuals whose life/psyche impacted severely by trauma can be healed has given rise to Looking-Glass Medicine’s sound theoretical foundation in terms of congruence and consistency in its healing system and healing outcome. It is this unique three-dimensional energy healing system’s capacity to heal from the personal unconscious that these patients’ healing outcome is INNER TRANSFORMATION that shifts their negative/harmful behaviour patterns into life affirming ones. Particularly, many of them were severely traumatised…

Einstein says, “The field is the sole governing agency of the particle.” Particle is matter, which is determined ultimately by the field as in how things manifest. Our body in disease and health is influenced and impacted by the individual energy field, the vibratory frequencies, 


in our evolution of consciousness…

——————————————————————————————

There would be much more but, at this point, I stopped my searches and asked myself, HOW IS IT THAT A MAJOR CENTRE OF EDUCATION AND SCIENCE IS ALSO HOME TO SOME OF THE WORST QUACKERY?

Is it that excellence in science always attracts an excess in pseudo-science?

I am not sure.

Perhaps there is a much simpler explanation: Cambridge is a fairly wealthy town, and quackery always thrives where there is money to be earned with it.

 

PS

I will soon give a talk in Cambridge about homeopathy. If you are a Cambridge homeopath, please reserve the date. This could be fun!

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