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

Monthly Archives: May 2018

Switzerland seems to be something like the ‘promised land’ for homeopaths – at least this is what many homeopaths seem think. However, homeopaths’ thinking is rarely correct, and the situation of homeopathy in Switzerland is not quite what they believe it to be.

This article explains (my English explanations are below for all those you cannot do German):

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Die Schweiz bekommt die steigenden Gesundheitskosten einfach nicht in den Griff. In den 20 Jahren zwischen 1996 und 2016 haben sie sich um rund 255,2 Prozent erhöht…
Einer der Gründe für den Anstieg: Seit 2017 sind Komplementärmedizinische Methoden wie beispielsweise Homöopathie auch in der Grundversorgung inbegriffen. Das Volk hatte im Jahr 2009 einen entsprechenden Verfassungsartikel angenommen. Damals hoffte man noch, dass mit dem erleichterten Zugang zur Komplementärmedizin die Gesundheitskosten sinken würden.
Doch es kam anders. Die Komplementärmedizin verursachte letztes Jahr zusätzliche Kosten von 30 Millionen Franken, wie Sandra Kobelt, Sprecherin Krankenkassenverbandes Santésuisse, gegenüber BLICK bestätigt.

Die Komplementärmedizin sorgt entsprechend weiter für Diskussionen. Auch, weil zum Beispiel die Wirkung der beliebten Globuli-Kügeli bis heute höchst umstritten bleibt. Doch auch sie werden laut neuem Gesetz in jedem Fall von der Krankenkasse bezahlt, sofern sie von einem Homöopathen mit medizinischem Fachausweis verschrieben wurden…

Aus wissenschaftlicher Sicht macht diese Bevorzugung der Homöopathie wenig Sinn. Denn: In einem Statement aus dem Jahr 2017 bestritten insgesamt 25 europäische Wissenschaftsvereinigungen die Wirksamkeit von Globuli. Darunter auch die Akademien der Wissenschaft Schweiz, die mit den Schweizer Hochschulen zusammenarbeiten. Sie halten fest, dass Homöopathie sogar gefährlich sein kann, da zu ihren Gunsten eine schulmedizinische Therapie aufgeschoben oder gar abgelehnt wird.

Dieser Meinung ist auch Beda Stadler, der ehemalige Leiter des Instituts für Immunologie an der Uni Bern. «Globuli verursachen nur unnötige Gesundheitskosten», sagt er. Man habe das Volk 2009 getäuscht, indem man ihm erzählte, Globuli wären ja günstig. «Doch viele Allergiker setzen die Globuli nicht ab, nachdem sie keine Wirkung festgestellt haben. Stattdessen schlucken sie noch zusätzlich medizinische Tabletten – das verursacht doppelte Kosten», so Stadler.

Homöopathin und Ärztin Doktor Gisela Etter hält dagegen. «Ich erlebe jeden Tag, wie Homöopathie bei Allergikern wirkt. Bei vielen treten die Symptome nach einiger Zeit überhaupt nicht mehr auf», sagt sie. Das Problem: Den Wirkungsmechanismus der Globuli kann die Medizinerin nicht erklären. «Das ist mit den herkömmlichen Naturwissenschaften gar nicht möglich», so Etter…

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Let me try to translate the key points of this article:

  • The costs for healthcare have exploded in Switzerland; an increase of > 255% during the last 10 years.
  • One reason for this development is that, since 2017, the Swiss get various alternative therapies reimbursed, including homeopathy.
  • That move has cost 30 000 000 Francs last year.
  • The efficacy of homeopathic remedies is controversial.
  • Yet they are being paid for by Swiss health insurances, provided they are prescribed by a qualified doctor.
  • This does not make sense from a scientific perspective.
  • In 2017, 25 European scientific societies, including the Swiss academies, stated that homeopathy does not work and can even be dangerous, if it replaces effective treatments.
  • Beda Stadler, former director of the Institute of Immunology, Uni Bern said “Globuli only cause unnecessary healthcare costs”
  • Homoeopath Gisela Etter said “I see every day how homeopathy works for allergies… to explain the mechanism of action is not possible with conventional science.”

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I suppose, we will have to wait for some unconventional science then!

Many charities in the UK (and most other countries) openly promote bogus treatments. After having been reminded of this fact regularly, the UK Charity Commission have decided to look into this issue. Arguably, such charities – I have previously discussed ‘YES TO LIFE’  as an example (in total there are several hundred ‘SCAM charities’ operating in the UK today)-  do not provide a valuable public service and should therefore not benefit from such status and tax privileges. While the commission is contemplating, an article in the NEW SCIENTIST provided more information on this important issue. Here are a few excerpts:

A commission briefing document says the most important issue is the level of evidence it will require to judge whether a provider of complementary therapy dispenses services of benefit to public health, thereby qualifying legally for charitable status. The document says that at present, suitable evidence includes peer-reviewed research in recognised medical journals such as The Lancet or the BMJ, or recognition by the Department of Health or other government regulatory bodies. Personal testimonies and anecdotal evidence are not sufficient to demonstrate efficacy, says the commission, and nor are non-scientific articles and features promoting methods, treatments or therapies.

However, organisations such as the Good Thinking Society have presented evidence that these standards are not being applied rigorously, meaning some organisations may have been granted charitable status without the necessary evidence that their therapies are of benefit to public health. The commission is reassessing how its existing guidelines are enforced. It is also seeking guidance on how to deal with conflicting or inconsistent evidence, or evidence that certain therapies might cause harm – by displacing conventional therapies, for example.

Complementary providers argue that it’s unfair to be judged purely on evidence in mainstream medical journals, as demanded by the Good Thinking Society. “We know there’s a well-being factor with some complementary medicines which could be palliative, or a placebo effect,” says Jayney Goddard, director of The Complementary Medical Association. “These include massage or meditation, for example, which have tremendously supportive effects, but if the evidence isn’t forthcoming, it means those charities currently offering them might not be able to in future.” If the consultation does ultimately result in revocation of charitable status for some providers, Goddard argues that this would make it harder for them to raise donations and benefit from tax breaks that make their services more affordable.

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The argument of Jayney Goddard borders on the ridiculous, of course. If treatment X improves well-being beyond placebo and generates more good than harm, it is clearly effective and the above debate does not even apply. But it obviously does not suffice to claim that treatment X improves well-being, it is mandatory to demonstrate it with sound evidence. If, on the other hand, treatment X has not been shown to be effective beyond placebo, it must be categorised as unproven or bogus. And promoting bogus treatments/ideas/concepts (including diverting patients from evidence-based treatments and undermining rational thought in our society at large) is unquestionably harmful both to individual patients and to society as a whole.

SCAM charities are thus dangerous, unethical and an obstacle to progress. They not only should lose their charitable privileges as a matter of urgency, but they should also be fined for endangering public health.

 

 

Does acupuncture increase birth rates after IVF?

You might be correct when pointing out that this is a rhetorical question.

Why should acupuncture increase the live birth rates after in vitro fertilization (IVF)?

Because it re-balances yin and yang?

Give me a break!!!

Yet acupuncture is widely used by women undergoing IVF, and therefore, we perhaps ought to know whether it works.

Laudably someone has conducted a trial so that we know the answer.

This study determined the efficacy of acupuncture compared with a sham acupuncture control performed during IVF on live births. It was designed as a single-blind, parallel-group RCT, including 848 women undergoing a fresh IVF cycle, and conducted at 16 IVF centres in Australia and New Zealand between June 29, 2011, and October 23, 2015, with 10 months of pregnancy follow-up until August 2016.

The women received either acupuncture (n = 424) or a sham acupuncture control (n = 424). The first treatment was administered between days 6 to 8 of follicle stimulation, and two treatments were administered prior to and following embryo transfer. The sham control used a non-invasive needle placed away from acupuncture points. The primary outcome was live birth, defined as the delivery of one or more living infants at greater than 20 weeks’ gestation or birth weight of at least 400 g.

Among the 848 women, 24 withdrew consent, and 824 were included in the study, 607 proceeded to an embryo transfer, and 809 (98.2%) had data available on live birth outcomes. Live births occurred among 74 of 405 women (18.3%) receiving acupuncture compared with 72 of 404 women (17.8%) receiving sham control.

The authors concluded that among women undergoing IVF, administration of acupuncture vs sham acupuncture at the time of ovarian stimulation and embryo transfer resulted in no significant difference in live birth rates. These findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF.

This is a clear result and technically a fairly decent study. I say ‘fairly decent’ because, had the result been positive, one would have to question the efficacy blinding as well as the fact that the acupuncturists might have (inadvertently?) influenced their verum-patients such that they were less anxious and thus produced better outcomes. Moreover, the trial was under-powered, and its publication so long after the end of the study is odd, in my view.

There have, of course, been plenty of trials and even systematic reviews of this topic. Here are the conclusions of the three most recent reviews:

Yet the authors state that “the evidence for efficacy is conflicting”.

Why?

The above conclusions seem crystal clear and not at all conflicting!

Is it because the authors needed to justify the no doubt huge costs for their study?

Is it because conducting such a trial while the evidence is already clear (and negative) is arguably not ethical?

Is it because the authors needed this alleged ‘uncertainty’ for getting their trial in a major journal?

I am, of course, not sure – but I am quite sure of one thing: the evidence that acupuncture is useless for IVF was already pretty clear when they started their study.

And pretending otherwise amounts to telling porkies, doesn’t it?

And telling porkies is unethical, isn’t it?

Systematic research on complaints about chiropractors, osteopaths, and physiotherapists is rare. We have often heard chiropractors claim that complaints against them are extremely rare events.

But is this true?

Two recent investigations might go some way towards answering this question.

The aim of the first investigation was to understand differences in the frequency and nature of formal complaints about Australian practitioners in these professions in order to inform improvements in professional regulation and education.

This retrospective cohort study analysed all formal complaints about all registered chiropractors, osteopaths, and physiotherapists in Australia lodged with health regulators between 2011 and 2016. Based on initial assessments by regulators, complaints were classified into 11 issues across three domains: performance, professional conduct, and health. Differences in complaint rate were assessed using incidence rate ratios. A multivariate negative binomial regression model was used to identify predictors of complaints among practitioners in these professions.

Patients and their relatives were the most common source of complaints about chiropractors, osteopaths and physiotherapists. Concerns about professional conduct accounted for more than half of the complaints about practitioners in these three professions. Regulatory outcome of complaints differed by profession. Male practitioners, those who were older than 65 years, and those who practised in metropolitan areas were at higher risk of complaint. The overall rate of complaints was higher for chiropractors than osteopaths and physiotherapists (29 vs. 10 vs. 5 complaints per 1000 practice years respectively, p < 0.001). Among chiropractors, 1% of practitioners received more than one complaint – they accounted for 36% of the complaints within their profession. Overall, nearly half of the complaints (47.7%) involved chiropractors, even though chiropractors make up less than one-sixth (13.9%) of the workforce across these three professions.

The authors concluded that their study demonstrates differences in the frequency of complaints by source, issue and outcome across the chiropractic, osteopathic and physiotherapy professions. Independent of profession, male sex and older age were significant risk factors for complaint in these professions. Chiropractors were at higher risk of being the subject of a complaint to their practitioner board compared with osteopaths and physiotherapists. These findings may assist regulatory boards, professional associations and universities in developing programs that avert patient dissatisfaction and harm and reduce the burden of complaints on practitioners.

 

The aim of the second study was to describe claims reported to the Danish Patient Compensation Association and the Norwegian System of Compensation to Patients related to chiropractic from 2004 to 2012.

All finalized compensation claims involving chiropractors reported to one of the two associations between 2004 and 2012 were assessed for age, gender, type of complaint, decisions and appeals. Descriptive statistics were used to describe the study population. The results show that 338 claims were registered in Denmark and Norway between 2004 and 2012 of which 300 were included in the analysis. 41 (13.7%) were approved for financial compensation. The most frequent complaints were worsening of symptoms following treatment (n = 91, 30.3%), alleged disk herniations (n = 57, 19%) and cases with delayed referral (n = 46, 15.3%). A total financial payment of €2,305,757 (median payment €7,730) were distributed among the forty-one cases with complaints relating to a few cases of cervical artery dissection (n = 11, 5.7%) accounting for 88.7% of the total amount.

The authors concluded that chiropractors in Denmark and Norway received approximately one compensation claim per 100.000 consultations. The approval rate was low across the majority of complaint categories and lower than the approval rates for general practioners and physiotherapists. Many claims can probably be prevented if chiropractors would prioritize informing patients about the normal course of their complaint and normal benign reactions to treatment.

In their discussion section the authors make the following comments: A particular concern after cervical SMT is dissection of the vertebral and carotid arteries. Seventeen claims concerning CAD were reported in this data, 14 in Denmark and three in Norway, and 11 of these were approved for financial compensation (64.7% approval rate) representing by far the highest approval rate across all complaint categories… chiropractors generally seem to receive more claims per consultation than GPs and physiotherapists, the approval rate is substantially lower and a similar trend is observed in Norway. However, it is also evident that approved claims within chiropractic bear a higher financial burden than their peers. These numbers are clearly highly influenced by the cases related to CAD. Several reasons might explain a higher complaint rate within chiropractic but this remains speculation and we do not have hard evidence supporting any of the following suggestions: (1) chiropractic treatment might be perceived as more aggressive than that of GPs and physiotherapists (2) maybe scepticism towards chiropractic among medical physicians and physiotherapists could encourage more patient complaints (3) a higher out-of-pocket expense for chiropractic services compared with GP and physiotherapist services might influence the higher number of complaints (4) chiropractors do not adequately inform patients about normal side effects and reactions and patients regard these as serious and relevant for compensation claims (5) chiropractors encourage patients to report AE more frequently than GPs and physiotherapists.

So, are complaints against chiropractors rarities?

I don’t think so.

THE CONVERSATION recently carried an article shamelessly promoting osteopathy. It seems to originate from the University of Swansea, UK, and is full of bizarre notions. Here is an excerpt:

To find out more about how osteopathy could potentially affect mental health, at our university health and well-being academy, we have recently conducted one of the first studies on the psychological impact of OMT – with positive results.

For the last five years, therapists at the academy have been using OMT to treat members of the public who suffer from a variety of musculoskeletal disorders which have led to chronic pain. To find out more about the mental health impacts of the treatment, we looked at three points in time – before OMT treatment, after the first week of treatment, and after the second week of treatment – and asked patients how they felt using mental health questionnaires.

This data has shown that OMT is effective for reducing anxiety and psychological distress, as well as improving patient self-care. But it may not be suitable for all mental illnesses associated with chronic pain. For instance, we found that OMT was less effective for depression and fear avoidance.

All is not lost, though. Our results also suggested that the positive psychological effects of OMT could be further optimised by combining it with therapy approaches like acceptance and commitment therapy (ACT). Some research indicates that psychological problems such as anxiety and depression are associated with inflexibility, and lead to experiential avoidance. ACT has a positive effect at reducing experiential avoidance, so may be useful with reducing the fear avoidance and depression (which OMT did not significantly reduce).

Other researchers have also suggested that this combined approach may be useful for some subgroups receiving OMT where they may accept this treatment. And, further backing this idea up, there has already been at least one pilot clinical trial and a feasibility study which have used ACT and OMT with some success.

Looking to build on our positive results, we have now begun to develop our ACT treatment in the academy, to be combined with the osteopathic therapy already on offer. Though there will be a different range of options, one of these ACT therapies is psychoeducational in nature. It does not require an active therapist to work with the patient, and can be delivered through internet instruction videos and homework exercises, for example.

Looking to the future, this kind of low cost, broad healthcare could not only save the health service money if rolled out nationwide but would also mean that patients only have to undergo one treatment.

END OF QUOTE

So, they recruited a few patients who had come to receive osteopathic treatments (a self-selected population full of expectation and in favour of osteopathy), let them fill a few questionnaires and found some positive changes. From that, they conclude that OMT (osteopathic manipulative therapy) is effective. Not only that, they advocate that OMT is rolled out nationwide to save NHS funds.

Vis a vis so much nonsense, I am (almost) speechless!

As this comes not from some commercial enterprise but from a UK university, the nonsense is intolerable, I find.

Do I even need to point out what is wrong with it?

Not really, it’s too obvious.

But, just in case some readers struggle to find the fatal flaws of this ‘study’, let me mention just the most obvious one. There was no control group! That means the observed outcome could be due to many factors that are totally unrelated to OMT – such as placebo-effect, regression towards the mean, natural history of the condition, concomitant treatments, etc. In turn, this also means that the nationwide rolling out of their approach would most likely be a costly mistake.

The general adoption of OMT would of course please osteopaths a lot; it could even reduce anxiety – but only that of the osteopaths and their bank-managers, I am afraid.

One thing one cannot say about George Vithoulkas, the ueber-guru of homeopathy, is that he is not as good as his word. Last year, he announced that he would focus on publishing case reports that would convince us all that homeopathy is effective:

…the only evidence that homeopathy can present to the scientific world at this moment are these thousands of cured cases. It is a waste of time, money, and energy to attempt to demonstrate the effectiveness of homeopathy through double blind trials.

… the international “scientific” community, which has neither direct perception nor personal experience of the beneficial effects of homeopathy, is forced to repeat the same old mantra: “Where is the evidence? Show us the evidence!” … the successes of homeopathy have remained hidden in the offices of hardworking homeopaths – and thus go largely ignored by the world’s medical authorities, governments, and the whole international scientific community…

… simple questions that are usually asked by the “gnorant”, for example, “Can homeopathy cure cancer, multiple sclerosis, ulcerative colitis, etc.?” are invalid and cannot elicit a direct answer because the reality is that many such cases can be ameliorated significantly, and a number can be cured…

And focussing on successful cases is just what the great Vithoulkas now does.

Together with homeopaths from the  Centre for Classical Homeopathy, Vijayanagar, Bangalore, India, Vithoulkas has recently published a retrospective case series of 10 Indian patients who were diagnosed with dengue fever and treated exclusively with homeopathic remedies at Bangalore, India. This case series demonstrates with evidence of laboratory reports that even when the platelets dropped considerably there was good result without resorting to any other means.

The homeopaths concluded that a need for further, larger studies is indicated by this evidence, to precisely define the role of homeopathy in treating dengue fever. This study also emphasises the importance of individualised treatment during an epidemic for favourable results with homeopathy.

Bravo!

Keeping one’s promise must be a good thing.

But how meaningful are these 10 cases?

Dengue is a viral infection which, in the vast majority of cases, takes a benign course. After about two weeks, patients tend to be back to normal, even if they receive no treatment at all. In other words, the above-quoted case series is an exact description of the natural history of the condition. To put it even more bluntly: if these patients would have been treated with kind attention and good general care, the outcome would not have been one iota different.

To me, this means that “to precisely define the role of homeopathy in treating dengue fever” would be a waste of resources. It’s role is already clear: there is no role of homeopathy in the treatment of this (or any other) condition.

Sorry George.

Few alternative fads have survived as long as the current Kombucha boom. Since decades, it is being hyped as the best thing since sliced bread. Consequently, it has become popular and is now being promoted as a veritable panacea, allegedly curing asthma, cataracts, diabetes, diarrhoea, gout, herpes, insomnia and rheumatism and purported to shrink the prostate and expand the libido, reverse grey hair, remove wrinkles, relieve haemorrhoids, lower hypertension, prevent cancer, and promote general well-being. Kambucha is believed to stimulate the immune system, and help with HIV infection. And – sure enough – it is ideal for detox!!!

One author goes even further and lists no less than 17 indications:

It’s good for your gut:

1. Kombucha contains naturally fermenting probiotics that help maintain healthy gut flora by increasing the number of beneficial organisms.
2. It preserves nutrients and breaks them down into an easily digestible form, which allows you to absorb them better.
3. It enhances the absorption of minerals, particularly calcium, iron, zinc, magnesium, phosphorous and copper.
4. Healthy gut flora improves digestion, fights candida overgrowth, improves mental clarity and stabilizes moods.
5. A healthy gut can also be attributed to reducing or eliminating depression an anxiety.
6. Kombucha contains numerous strains of yeasts and up to 20 different bacterial species (and possibly many more!).

It detoxifies the body:

7. The enzymes and bacterial acids in kombucha ease the burden on the liver by reducing pancreatic load.
8. Kombucha contains glucuronic acid, which binds to toxins and increases their excretion through the kidney or intestines.
9. In 1951, a popular Russian study found that the daily consumption of kombucha was correlated with an extremely high resistance to cancer.
10. It contains vitamin C, a potent detoxifier.

It supports the nervous system:

11. Kombucha contains vitamin B, which has been associated with reducing blood pressure and supporting the nervous system.

It’s anti-ageing and supports the joints:

12. Kombucha contains glucosamines, which are vital for the treatment and prevention of arthritis.
13. Kombucha allegedly eliminates grey hair, increases sex drive and improves eyesight.
14. Kombucha concentrates the antioxidants found in tea. Antioxidants not only fight the environmental toxins known as free radicals, which contribute to illness and disease, but help slow the aging process.
15. Theoretically, powerful antioxidant nutrients can prevent and lessen wrinkles by promoting skin elasticity.

It’s anti-microbial

16. Kombucha is anti-microbial due to it’s acetic and organic acids, proteins, enzymes and bacteriocins. It exerts anti-microbial activity against pathogenic bacteria like E coli and Salmonella. Incidentally, green tea kombucha has a high anti-microbial effect than when made with black tea.

It decreases sugar cravings

17. Emmet from Remedy told us that customers often comment that kombucha reduces their sugar cravings. “My take on this is that kombucha provides a natural energy boost and is therefore a handy antidote for when cravings kick in. It’s also a great way to break the soft drinks habit.”

END OF QUOTE

Sadly, none of these claims are based on anything that even vaguely resembles evidence. My own systematic review of 2003 aimed at locating and critically evaluating all human medical investigations of kombucha regardless of study design. However, no clinical studies were found relating to the efficacy of this remedy. Several case reports and case series raise doubts about the safety of kombucha. They include suspected liver damage, metabolic acidosis and cutaneous anthrax infections. One fatality was on record. I therefore concluded that on the basis of these data it was concluded that the largely undetermined benefits do not outweigh the documented risks of kombucha. It can therefore not be recommended for therapeutic use.

Since then no clinical trials have been published; but more information on the risks of Kombucha has emerged. A case report of a 54-year-old asthmatic woman, for instance. She presented to hospital with a 10-day history of breathlessness. On examination, she was tachypnoeic with mild wheeze. She had preserved peak flows and was saturating at 100% on room air. Investigations revealed severe metabolic lactic acidosis. On further questioning, it transpired that she drank kombucha tea, which has been linked to lactic acidosis. She made a full recovery with supportive management and cessation of the tea.

A case of hepatotoxicity has also been related to Kombucha consumption. Another case report tells the story of a 22 year old male, newly diagnosed with HIV, who became short of breath and febrile within twelve hours of Kombucha tea ingestion. He subsequently became combative and confused, requiring sedation and intubation for airway control. Laboratories revealed a lactate of 12.9 mmol/L, and serum creatinine of 2.1 mg/dL. The authors concluded that consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis.

But how can a simple tea like Kombucha cause such serious problems? The answer lies in the method of preparation which carries the risk of contamination: the Kombucha material is incubated at room temperature in a sugar-containing liquid for 7–12 days. It is hardly surprising that, under such conditions, human pathogens may grow. It follows that, depending on the method of preparation and standards of hygiene, some Kombucha teas may be entirely innocent whilst others carry the risk of contamination and infection. Contaminated batches may act like a ‘biological chain letter’.

Considering all this, here are my instructions for making Kombucha and enjoying it safely.

You will need:

  • 3 litres of filtered water
  • 10 green or black teabags
  • 1 SCOBY (symbiotic culture of bacteria and yeast)
  • ½ a cup of sugar

And this is what you need to do:

Boil the filtered water.

Pour over the teabags in a large container.

Add the sugar to the tea, and allow time to brew and cool (about two hours).

Pour the brewed tea into a large, jar and add the SCOBY.

Cover jar with cheesecloth, muslin or paper towel and secure with a rubber band.

Leave to brew for a week or more to taste.

Pour the kombucha into bottles

… and bin the lot.

Yesterday, it was announced that homeopaths can easily and quickly earn a sizable amount of money.

The announcement was made during the German sceptics conference ‘Skepkon‘ in Koeln. As I could not be present, I obtained the photo via Twitter.

So, if you are a homeopath or a fan of homeopathy, all you have to do – as the above slide says – is to reproducibly identify homeopathic remedies in high potency. The procedure for obtaining the money has to follow three pre-defined steps:

  1. Identification of three homeopathic preparations in high potency according to a proscribed protocol.
  2. Documentation of a method enabling a third party to identify the remedies.
  3. Verification of the experiment by repeating it.

Anyone interested must adhere to the full instructions published by the German sceptics GWUP:

1. Review of test protocol

Together with a representative of GWUP, the applicants review and agree on this protocol prior to the start of the test. Minor changes may be applied if justified, provided they are mutually agreed to in advance and do not affect the validity of the test, especially the blinding and randomization of the samples. In any case we want to avoid that the results get compromised or their credibility impeached by modifications of the protocol while the test is already under way. After mutual confirmation, the test protocol is binding for the whole duration of the test and its evaluation.

2. Selection of drugs

The applicant proposes which three drugs should be used in the trial. This gives them the opportunity to select substances that they think they could distinguish particularly well as homeopathic remedies. The potency may be selected freely as well, whereby the following conditions must be observed:

– all drugs must be available as sugar globules of the same grade (“Globuli” in German);
– the same potency, namely D- or C-potency above D24 / C12, is used for all three drugs;
– all drugs can be procured from the same producer.

3. Procurement of samples

The samples will be purchased by GWUP and shipped from the vendor directly to the notary who will perform the randomization. GWUP will purchase sufficient numbers of packages to complete the series of 12 samples according to the randomization list. The procurement will ensure that the samples derive from different batches of production as follows.

3.1. Common remedies

Common remedies, i.e. remedies sold in high numbers, will be procured from randomly selected pharmacies from the biggest cities in Germany (Berlin, Hamburg, Munich, Cologne, Frankfurt, Stuttgart…). Each pharmacy supplies a bottle for each of the three selected remedies and ships it directly to the notary in charge of randomization. If the applicants need a sample of known content for calibration, then this will be procured from yet another pharmacy in another German city.

3.2. Special remedies

If due to low sales it is possible that the above procedure is not sufficient to have all samples from different batches, a randomly selected pharmacy will be appointed to produce all the samples from raw materials purchased from the producer. GWUP will procure the mother tinctures, the raw sugar pills, and bottles and packages, to be shipped directly to the respective pharmacy who then will do the potentization, label the bottles and send them to the notary. If there are extra samples of known content required for calibration, then an extra set of samples will be produced. One set of samples will be kept in a sealed package for future reference.

The applicant and GWUP mutually agree on which procedure is used before the start of procurement. If more than 10 grams of globules per sample are required for the procedure used for inentification, the applicant has to indicate this in advance, and GWUP will take this into account.

4. Randomization / blinding

The randomization and blinding is done by a sworn-in public notary in Würzburg, Germany, who is selected by a random procedure. Würzburg is chosen because the first part of the task is to be evaluated at the University of Würzburg, for all participants based in Europe. For overseas applicants, the location will be mutually agreed on.

The notary receives a coding list showing how the three drugs A, B and C are to be distributed among the twelve samples. This list is compiled by the GWUP representative by throwing dice. The notary also determines which drug is assigned to which letter by throwing dice. Note that the drugs may not be present in the set in equal numbers.

The notary completely removes the original label from the bottle and replaces it with the number without opening the bottle. The randomization protocol is deposited in a sealed envelope with the notary public without a copy being made beforehand. The notary disposes of surplus packs. If special remedies are processed, one set of marked samples is sealed and forwarded to GWUP for later reference in a sealed package.

The coded bottles are sent from the notary to the applicant without individual packaging and documentation. The applicant confirms receipt of the samples.

5. Identification

The applicant identifies which of the 12 bottles contains which drug, using any method and procedure of his choice. There is no limit as to the method used for identification, and this well may be a procedure not currently recognized by modern science. However, GWUP at the start requires a short and rough outline of how the applicant wants to proceed, and GWUP reserves the right to reject applications whose sincerity for scientific work seems questionable.

The applicant is also required to specify a period of time within which they will be able to produce their results. This period may not exceed six months. If it expires without the applicant being able to show their results, the outcome will be considered negative. However, the candidate may apply for an extension in good time before the deadline, if they can provide a reasonable explanation and is not caused by the respective identification process as such.

The applicant is explicitly advised to observe ethics standards, and to procure the consent of an appropriate ethics committee if their method involves testing on humans or animals.

6. Result Pt. 1

If reasonable, the applicant may present their findings as part of the PSI-Tests held annually by GWUP at the University of Würzburg. The applicant’s result will be compared to the coding protocol from the notary. The number of bottles in which the notary’s record corresponds to the applicant’s details is determined. The result includes a description of the method used, if possible with meaningful intermediate data such as measurement protocols or symptom lists of drug provings.

The first part of the test is considered a success if the content of no more than one bottle is identified incorrectly and a description of the procedure is produced.

7. Result Pt. 2 and 3: Replication and Verification

Replication of the test is to ensure that a successful first result was not caused by chance alone. In addition, the procedure explained by the applicant is to be verified in a way depending on its nature. The objective is to verify that the identification was indeed performed by using this very method, and that the description is complete and suitable for a third party to achieve the same outcome.

For replication, steps 2 to 5 will be repeated. Applicants may select to use the same drugs as before. In this case they will then procured from another manufacturer or prepared by a different pharmacy with raw material from a different supplier. Alternatively, the candidate may indicate three new drugs which then can be obtained from the original vendor.

For a successful replication the same precision as before is required, that is, that only one out of 12 bottles may be identified incorrectly.

The evaluation and presentation of these results may take place at any location, press or other media may be invited to the event as agreed to by the applicant and GWUP.


Is anyone going to take up this challenge?

Personally, I don’t hold my breath.

Many years ago (at a time when homeopaths still saw me as one of their own), I had plans to do a similar but slightly less rigorous test as part of a doctoral thesis for one of my students.

Our investigation was straight forward: we approached several of the world’s leading/most famous homeopaths and asked them to participate. Their task was to tell us which homeopathic remedy they thought was easiest to differentiate from a placebo. Subsequently we would post them several vials – I think the number was 10 – and ask them to tell us which contained the remedy of their choice (in a C30 potency), and which the placebo (the distribution was 50:50, and the authenticity of each vial was to be confirmed by a notary). The experimental method for identifying which was which was entirely left to each participating homeopath; they were even allowed to use multiple, different tests. Based on the results, we would then calculate whether their identification skills were better than pure chance.

Sadly, the trial never happened. Initially, we had a positive response from some homeopaths who were interested in participating. However, when they then saw the exact protocol, they all pulled out.

But times may have changed; perhaps today there are some homeopaths out there who actually believe in homeopathy?

Perhaps our strategy to work only with ‘the best’ homeopaths was wrong?

Perhaps there are some homeopaths who are less risk-adverse?

I sure hope that lots of enthusiastic homeopaths will take up this challenge.

GOOD LUCK! And watch this space.

‘HELLO’ is, of course, a most reliable source of information when it comes to healthcare (and other subjects as well, I am sure). Therefore, I was thrilled to read their report on Meghan Markle’s list of supplements which, ‘HELLO’ claim, she takes for “calming any stress or nerves ahead of the royal wedding on 19 May.” The list includes the following:

  • Magnesium,
  • Vitamin B-12,
  • Multivitamins,
  • ‘Cortisol Manager’ (30 tablets cost US$ 65)
  • Ashwagandha.

Not only does ‘HELLO’ provide us with this most fascinating list, it tells us also what exactly these supplements are best used for:

Magnesium helps to keep blood pressure normal, increase energy, relieves muscle aches and spasms, and calms nerves, all of which will be beneficial to Meghan. Meanwhile, B12 drops will ensure Meghan doesn’t become deficient in the vitamin due to her diet, which is largely plant-based and contains very little animal products, which are one of the main sources of B12.

A multivitamin will provide Meghan with her recommended daily intake of various vitamins and minerals, while Cortisol Manager is a “stress hormone stabiliser”, which is designed to support the body’s natural rise and fall of cortisol, helping promote feelings of relaxation and aid better sleep. The supplement contains L-Theanine, Magnolia, Epimedium and Ashwagandha – although Meghan said she sometimes takes additional doses of the herb, likely at periods of high stress.

Ashwagandha is a herb that helps to moderate the body’s response to stress, bringing inner calm and also boosting energy. The supplement comes from the root of the ashwagandha plant and can be taken in tablet form…

I hope I don’t spoil the Royal wedding if I run a quick reality check on these supplements. Assuming she is generally healthy (she certainly looks it), and now being aware that Meghan eats a mostly plant-based diet, here are the most likely benefits of the above-listed supplements/ingredients:

  • Magnesium: NONE
  • Vitamin B-12: DEBATABLE
  • Multivitamins: NONE
  • L-Theanine: NONE
  • Magnolia: NONE
  • Epimedium: NONE
  • Ashwagandha: NONE

Personally, I find Ashwagandha the most intriguing of all the listed ingredients, not least because Meghan said she sometimes takes additional doses of the herb. Why might that be? There is very little reliable research on this (or any of the other above-listed) remedy; but I found one placebo-controlled study which concluded that Ashwagandha “may improve sexual function in healthy women”.

Before my readers now rush out in droves to the next health food shop, I should issue a stern warning: the trial was flimsy and the results lack independent confirmation.

PS

She also seems to have a weakness for homeopathy

Guest post by Frank van der Kooy

TCM and the importance of having a Minister of Health with knowledge of health!

An analogy

You’re sitting on a beach when suddenly not far from you, you notice a commotion. Your fear is confirmed when you see lifeguards dashing into the ocean and moments later they drag a lifeless body of a young child from the waves. Because the lifeguards are well trained, they manage to revive the child, resulting in a collective sigh of relief from the gathered crowd. Happy endings like this make people feel good – it is good news. But this is not where it ends. Suddenly you hear screaming and to your shock you witness something truly amazing. The parents of this boy sprints down the beach, bursts through the crowd, all the while shouting that they will save their child. To your amazement they pull the child, still gasping for air, from the arms of the lifeguards back into the ocean where they hold his head under water until he drowns!

I don’t know if anything like this has ever happened but I’m almost convinced that the crowd, after recovering from their shock, will most likely attack the parents and more people might die that day.

Now, one of the hallmarks of a fake healthcare system is the fact that just about everything works. Think of rhino horn, acupuncture, homeopathy etc. but also something such as slapping therapy – everything works. Surely, if you allow a practitioner into your clinic to provide people, including children, slapping therapy then you acknowledge that it works? If not, you are intentionally misleading your patients (interesting catch 22.) But let me explain the analogy. These parents suffer from a level of delusion that most people simply cannot understand and sadly this type of scenario plays out far more often than most people would like. And if the Chinese Communist Party (CCP) has its way, these tragedies will increase significantly and it might even become quite common. Take for example the tragic slapping death tragedy.

The poor parents were misled into believing that they can cure their 6yo son of diabetes type 1 by attending an expensive ‘slapping therapy’ workshop in Sydney. The child was taken off his medication (out of professional care) and was slapped (allowing the sea to finish the job) in the belief that this will cure him. It did not, and the child died. The slapping therapist and the parents are now facing court, but this should be seen as treating the symptom while the cause, the people responsible for creating this level of delusion, are continuing to relentlessly disseminate their misinformation regarding ‘integrative medicine’.

From the website of ‘Master’ Hongchi Xiao. Left, an 8yo boy who suffers from a serious kidney disease, right, the leg a 13yo suffering from diabetes. The type of injuries caused by the slapping therapy is easily visible (it is unknown if these children survived or how many victims Master Xiao made).

The unseen war that’s being fought

To use war terminology might be a bit far-fetched but I don’t think it’s unreasonable. This war is being fought between an army of pseudoscientists (backed by the CCP and others) and a few scientists (backed by, uhm, no one) and it’s about the ‘integration’ of fake medicine and medical procedures with evidence-based healthcare under the umbrella term – ‘Integrative medicine’. For most people, hitting a young defenceless child to such a degree that he dies of his injuries and/or lack of medication, is surely a heinous crime. But others apparently see this practice to be okay, and these deaths should be considered ‘collateral damage’. After all, many innocent people die in war zones, and although undesirable it is an inadvertent consequence of achieving the greater good – to win the war.

Slapping therapy is part of the pseudoscientific Traditional Chinese Medicine (TCM) industry, and because of the sheer economic size of this industry, the CCP decided to revive it, protect it and promote it nationally but also internationally. Any critique of TCM within China is met with the long arm of the law. Quite recently a Chinese doctor was jailed for three months after he wrote an opinion piece regarding the dangers of a specific TCM remedy. So, TCM is here to stay and is also one way of how the CCP is exerting its influence overseas.

Their current excursion is to steamroll over science (and the few scientists willing to defend it) via some Australian universities (who in turn derives financial benefit) by creating ‘scientific’ legitimacy for TCM and thereby increase their Australian (and western) market penetration. They use the billions of dollars that Australian universities receive from (Chinese) international students as a silent threat in order to keep these universities in check and dancing to their tune. Via some Australian academics, they have infiltrated and now have the support of Australian regulators and politicians. All in all, it is going quite well with their plans to internationalise TCM.

The main problem is that they have vast resources which most scientists don’t have. Take for example the National Institute of Complementary Medicine (NICM). They’re about 50 people with Western Sydney University (WSU) pumping millions of taxpayer dollars into their coffers every year. Controversial companies such as Blackmores also donates millions and much more money is flowing in from China – all of these resources are being used to integrate dis/unproven complementary and alternative medicine, with a specific focus on TCM. For example; the clinic, Tasly Healthpac, that promoted and hosted the slapping therapy workshop was founded and is managed by Dr Ven Tan whereas Prof Alan Bensoussan, director of the NICM, collaborated with Dr Tan to integrate fake healthcare (slapping, acupuncture, TCM etc.). A MoU was signed between Tasly and the NICM in 2011, which states that the NICM will provide “assistance in the development of an Integrative Care Model: to assist the Tasly Healthpac Centre of Excellence in Integrative medicine so that its structure aims to integrate TCM and western medical diagnostics and treatments in an integrated, patient centred way.”

Clockwise from left. Dr Ven Tan; Master Hongchi Xiao, the slapping therapist; Prof Alan Bensoussan giving a speech in Beijing after receiving a prestigious prize for his work on integrating TCM; the signing of a MoU witnessed by Prof Bensoussan (standing left) and Dr Tan (standing 3rd from the right).

Facing this tsunami of misinformation, and defending the battlefront, you have a few lonely scientists. Nobody is pumping millions into warning people about fake healthcare systems, because there is no money to be made from it, and hence with their meagre resources, they simply do it because their conscience demands it.

I have written about the Australian academics who facilitated the CCPs plans to internationalise TCM, mainly by lobbying for the national registration of TCM practitioners, and also about the Australian politicians (former trade minister Andrew Robb and PM Tony Abbott etc.) who were lobbied to include a free flow of TCM practitioners into Australia under the Free Trade Agreement signed in 2015. TCM producers such as Tong Ren Tang were, of course, elated with this arrangement because “….we will have an increasingly wider road, and open more and more branch stores in Australia.”

In this article, I will focus on the role of the former Minister of Health for New South Wales, Ms Jillian Skinner, and her role in this calamity.Former PM Tony Abbott (red tie) and Dr Ven Tan (to the right of Mr Abbott) here in his capacity as Executive Vice Chairman of the CCP-linked ‘Australia-China Economics, Trade & Culture Association’

The Minister of Health and the tale of two letters

Two letters were sent to Min. Skinner, one warning her about integrating TCM (and other disproven and unproven healthcare systems), the other letter promoting TCM. So which one had an impact?

A word of warning

Any health minister would surely understand the dangers in supporting the principles of TCM which is that disease is caused by disturbances in your (pseudoscientific) life force, or Chi, that flows through ‘meridians’. Inserting needles (acupuncture), taking Chinese herbs or slapping yourself all ‘aim’ to influence and/or restore your life force and cure you of whatever ails you. That some herbs might be beneficial is a given but it is because they contain very specific compounds (and very few do) – this has nothing to do with your life force! Supporting the integration of pseudoscientific healthcare with real healthcare is very dangerous as was illustrated by the slapping therapy death. Hence, one might expect that the minister would be accompanying Dr Tan/Prof Bensoussan to the police station, because something like this should surely not be allowed?

To warn the Minister about the NICMs modus operandi I’ve sent her a letter and attached a 6000-word document detailing my concerns (a shortened version can be found here). It can be summed up as follow:

The NICM supports and promote any form of complementary, alternative or traditional (CAT) medicine and do not advise the public, as claimed, about the dangers of disproven CAT medicines such as homeopathy, TCM etc. because most of their funding depends mainly on misleading the public.

In my email dated 4 February 2016 I stated that; ‘These concerns are of such a nature that I believe the public is in danger of suffering injury or even death as a result. I have shared my concerns with the NICM management as well as the vice-chancellor of WSU (in June 2015). Needless to say, the WSU management do not share my concerns and hence my urgent call on your office to investigate this matter further.’

One example in my letter, to illustrate the problem, was the NICMs response to the well-known NHMRCs report regarding the ineffectiveness and dangers of homeopathy. It is fascinating how they pumped misinformation, via their partner ‘Complementary Medicines Australia’, into the world. Their response, entitled “The Five Fundamental Flaws of the NHMRCs Homeopathy report” is currently being used by homeopaths around the world to ignore the urgent advice that ‘Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness”. The press release ends with the ‘wise’ words “Homeopathy has been around for hundreds of years, and I am sure will be around a lot longer than some of the critics.”

People, including children, die because of this misinformation. But for some reason, the courts only take action when children are involved. Here is another tragic example of a 9-month old baby that died. And just recently the Australian government even ignored the recommendations of a new review and decided that; “Homeopathic products will continue to be sold in Australian pharmacies, despite a long-awaited review warning the government the practice could compromise the health of consumers.” Obviously, their lobbying has been quite successful to date!

But this shows that the NICM and their partners will defend just about any fake ‘medicine’ including TCM because they derive funding from it. This cunning ability to mislead the public, regulators and politicians was at least rewarded with the Bent Spoon award for quackery in 2017 – for what it’s worth.

A letter with impact

The NICMs job regarding TCM is to open the floodgates into Australia (and the world), but to do this they need the support from Australian politicians and hence, Alan and people like Marcus Blackmore (CEO of Blackmores), endlessly lobby politicians (you can read about this here). Here you can find one such letter (May 2014) written by the NICM and send to Min. Skinner. This letter contains the predictable praises of the integrative medicine industry, the ‘importance’ of integrating CAT with conventional healthcare, and the world-class standards of the NICM etc. but there is one sentence that stands out above the rest. And this is what it’s all about;

“….NICM needs this positioning if it is to help consumers and health professionals choose safe and effective complementary medicine (and discard ineffective treatments)…”

If you consider the fact that they were involved with the slapping therapy workshop (people died), their response to the NHMRC Homeopathy report (people died), and even that one of their business partners were send to jail after being caught importing rhino horn into Australia (endangered animals died) – all of the above ineffective remedies or treatments, then this sentence is not misleading, it is a blatant lie.

The slapping therapy death occurred in April 2015, and although I noticed it in the newspaper at the time, I was not aware that the NICM was intricately involved (I was actually quite busy trying to get out of there). What came as a shock a couple of years later was when I accidentally came across a travel itinerary of Min Skinner. It turns out that she invited Dr Tan and Prof Bensoussan to accompany her, not to a police station, but to China in April 2016, barely 2 months after I’ve send my letter to her office. The reason for this trip was to garner support for their plans to integrate TCM with conventional healthcare in Australia. To quote from her travel itinerary “To assist the University of Western Sydney’s National Institute of Complementary Medicine (NICM) secure investor and donor support for the NICM’s integrative Chinese medicine facility medicine/treatment on the Westmead Campus and related complementary medicine research initiatives.”

Left. Minister Skinner (seated in red) signing a MoU with Vice Governor of Shandong Province, the Hon Wang Suilian. Right. Min Skinner (in red) witnessing the signing a MoU between TCM producer Tong Ran Teng and Ramsay Healthcare.

Their trip to China also caught the attention of the media because she decided that integrating quackery was more important than solving real health problems in Australia. “Ms Skinner defended the trip, taken with NSW Chief Health Officer Kerry Chant, saying it led to an agreement between Westmead Hospital and Shandong’s Qilu Hospital designed to ­ enhance … understanding of traditional Chinese medicine” and “The MOU will establish formal links between Westmead Hospital and Shandong’s Qilu Hospital and is designed to enhance NSW’s understanding of traditional Chinese medicine.”

But here is a fun fact. Close to 100% of clinical trials on TCM conducted in China gives positive results, coupled to the fact that any scientific criticism of TCM can see you get jailed, then surely, the minister must know that they are dealing with a fake healthcare system? Apparently not, or they just ignore the obvious because the potential economic stimulus seemingly overrides the political risks associated with causing a number of preventable deaths. It is a scary thought that former Min Skinner now serves as a director at the Children’s Cancer Institute (I requested her contact details from the institute in order to give her the opportunity to respond but no response was received thus far.)

But did the NICM break the law?

Min. Skinner eventually responded (Nov 2016) but then only by referring me to the Federal Minister of Health, Sussan Ley (who also resigned around this time), but by then the damage was already done. Clearly, the NICM managed to get funding from China because they will be moving into their new TCM hospital pretty soon. This hospital will be co-occupied (and managed) by the CCP linked Beijing University of Chinese Medicine (BUCM). In their document ‘some brief notes regarding the BUCM collaboration’ they state; “It represents an unprecedented opportunity for the advancement of Chinese medicine in Australia, including the development of the Chinese medicine market in the West; promoting Chinese heritage and culture; and integrating Chinese medicine with the Australian healthcare system.”

But did they do anything illegal? I am no expert in the law but I believe that providing misleading and/or false information to ministers, who then based on this promote the integration of ineffective healthcare might indeed break the law – especially when this results in the death of members of the public. Did they provide former Trade Minister Andrew Robb (discussed here) and Min Skinner with correct and unbiased info about what TCM is? Well, their letter tells me that they did not. As far as I can tell, neither of these former ministers have a background in science, and as such, can easily be misled when it comes to complex scientific issues. But then again, you need to be receptive to these ideas and propaganda, because at the end of the day they signed off on it.

I sometimes just wonder where all of this will end. If organisations such as the NICM (they are not the only ones) are not reeled in now, how will the Australian (or western) healthcare system look like in 10-20 years’ time? They are masters of deceit with a clear intention to mislead the public for the sake of making money. For example; their new TCM ‘hospital’ in Westmead will not be called exactly that, they have chosen a much more mundane and misleading name; ‘Western Sydney Integrative Health Centre’ – it will fool many, because it is right next to the southern hemispheres’ biggest health complex and it is backed by an Australian university to give it even more credibility.

Concluding remarks

I used the phrase ‘China Power and Influence’ in this article as well as in two previous articles that you can find here and here. But this is only one side of the bigger picture because most people are well aware that China, as an upcoming super-power, wants to exert its influence in various ways in various countries. But I do hope that I’ve managed to highlight that TCM is also part of this and as such, a threat, not only to the health of people, but also wildlife. The reasons why China included TCM in their plans are probably complex and likely multifactorial and I will attempt to deal with this question in a next article.

But the main message that I wanted to get across is that although China is the source of TCM, and hence the problem, any country can quite easily recognise it as such and say; ‘no thank you, we will stick with modern evidence-based healthcare, but will gladly collaborate with you in other areas.’ This has not happened in Australia. And this is the message. There are Australian citizens in positions of power who has gone out of their way to legitimise and normalise TCM in Australia and hence aided the CCP in executing their plans for the sake of, mainly money.  Some people are capable of doing strange things for money and some even have the ability to completely switch off their conscience.

All of this is now playing out in Australia (where and how it will end is anyone’s guess), but will this be all that different than what is happening regarding TCM in other western countries?  I fear not.

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