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

Monthly Archives: February 2019

Homeopathy has been criticised since it first emerged 200 years ago. First, people mocked its utter implausibility. More recently, critics have pointed out that, despite 200 years of research, there is no good evidence that highly diluted remedies are anything other than placebos. In some countries, this has led to a ban of the public reimbursement of homeopathy.

In its homeland, Germany, homeopathy had a relatively long free ride. Vocal opposition only emerged a few years ago. But now it has become effective, sales figures (in excess of half a billion Euros) have started to drop and understandably, the German homeopathy-lobby is on high alert. Their latest attempt to sway public opinion is most revealing (if you read German, I highly recommend reading it in full).

A group of pro-homeopathy organisations and individuals make a series of accusations that seem like the frantic nonsense uttered in pure desperation and panic. The aim is no longer to attempt informing the public; the aim has now degenerated into a vile defamation of the critics. Amongst other claims, the lobbyists defame the critics by claiming that:

  • the current criticism of homeopathy is an expression of ‘ignorance’;
  • critics are wilfully misleading the public by dishonestly publishing wrong information;
  • critics monopolise their paradigm and that this amounts totalitarianism;
  • critics are not prepared to enter into a productive discussion;
  • critics merely follow a currently fashionable trend of arguing against homeopathy;
  • critics misrepresent scientific facts;
  • all of Prof Ernst’s homeopathy research is fraudulent (‘unserioes’);
  • critics are dogmatic ideologists and totalitarians.

The lobbyists further claim that:

  • leading universities in the US and elsewhere are on the side of homeopathy;
  • homeopathy is not in conflict with the principles of evidence-based medicine;
  • German law is on the side of homeopathy;
  • medical pluralism which includes homeopathy is in the interest of the patient;
  • only homeopaths are able to generate unbiased assessments of homeopathy;
  • homeopathy is an important part of integrated medicine for the benefit of the patient;
  • the Swiss example is something Germany should aim for;
  • Robert Hahn’s analysis invalidated the research of critics;
  • the Australian NHMRC-report is invalid;
  • homeopathy is fully dedicated to science;
  • placebos (such as homeopathic remedies?) are helpful interventions;
  • across the globe, the view is now accepted that integrative medicine must become the basis for good healthcare;
  • the German law forbids the authorities to regulate against homeopathy.

The arguments voiced here are by no means new; they have been voiced in every other country that has or is/was about to limit or abolish the public reimbursement of homeopathy. All they amount to, in fact, is a well-rehearsed, often-repeated and equally often refuted pack of lies and misleading statements. One has the impression of listening to a broken record.

Yet, many people will consider seriously what clearly is the last line of the defence of the indefensible, and they might ask themselves: who can we believe? For non-experts the confusion must be profound.

In all such cases, my advice is this: ask yourself who might be less motivated to mislead you, independent academics and sceptics with no ties to any industry, or the clinicians, their lobbyists and associations who all make their living via the multi-million industry of the SCAM in question?

 

By Guest Blogger Carlos Orsi, Instituto Questão de Ciência – Brazil

Elizabeth spent her whole adult life on yoga, follows a raw vegetable diet full of detox juices, studies acupuncture, and all of a sudden, in spite of this super healthy New age lifestyle, she is diagnosed with bowel and liver cancer, stage 4. After one course of chemotherapy and one of radiotherapy, both the main tumour and the metastasis vanished! She considers herself fully healed. A victory for Science, of course! Or isn’t it?

Not accordingly to the interpretation of “Heal”, Netflix’s recent documentary.

Even after Elizabeth’s doctor suggested that maybe the quick and relatively simple remission might be due to a misdiagnosis made at the beginning, that overestimated the severity of the tumour, the film insists that the actual reason for Elizabeth’s recovery was the release of negative emotions and energy. Those, they say, had accumulated for decades, ever since the day when the patient, still a small child, was humiliated by her kindergarten mates for bringing a pack of crackers for Show and Tell.

Produced, directed, written, and hosted by Kelly Noonan Gores (American actor that can be seen on the episode “Sex, Lies and Silicone” from the series CSI, New York), “Heal” tells the stories of two women struggling with disease. While Elizabeth deals with her cancer, Eva suffers from a mysterious type of rash, undiagnosed by doctors. Eva, of course, is also searching for a cure.

The documentary features both women -either talking about their ailments or consulting with alternative doctors and practitioners – and interviews with authors of mystical self-help best-sellers, such as Deepak Chopra, Bruce Lypton and Kelly Turner.

For those not familiar with these celebrities, Chopra is the one who claims that the human body is a “field of energy and awareness”, and that it is possible to stop the process of aging, and even reverse it, using meditation, physical exercise and plain strong will. There is a parody twitter account, @WisdomOfChopra, that produces nonsense phrases, indistinguishable from the pseudo-sayings of this mighty guru. There is even a scientific paper (http://journal.sjdm.org/15/15923a/jdm15923a.html) showing clearly that everything Chopra says is actually identical to random nonsense.

Lypton, on the other hand, believes that since gene regulation – the study of which genes are active and which are not within the cells on a given moment – depends partly on environmental signals, then it obviously should be possible to turn genes on and off by sheer will and power of the mind. Kelly Turner has travelled the world interviewing cancer survivors who faced the worst prognoses, asking them how they assessed their own healing process. It makes sense of course, if you consider it wise asking lottery winners how they pick the numbers!

More self-help celebrities lend their grace to “Heal”. Rob Wergin, the “Divine conduit”, who claims to channel healing energy directly from God to the patients, and the so-called “medical medium” Anthony Williams, both show up in the documentary and even John of God, the famous Brazilian medium healer, features a small part. Heal was filmed in 2017, before John of God was tried and arrested for the sexual harassment and rape of over 400 women. Too bad no fortune-teller or tarot reader predicted this and warned the producer beforehand…

Quantum Physics, Buddha and Epigenetics

One guru/coach/master/whatever in the film cites the phrase “each men and women are the architects of their own health”, and attributes it to Buddha. That is false, Sidarta Gautama, the Buddha who taught in India around 500 BCE probably never said that. The statement, however, immersed in an atmosphere of profound “wisdom” and absolute certainty, is the hallmark of the documentary as a whole: every mention of science, epigenetics, physics or placebo effect is either false, twisted or out of context.

Let’s start with Physics: all the practitioners in the film seem to believe that the Matter and Energy equivalence, as described in the Theory of Relativity, together with certain aspects of Quantum Physics, somehow validate a kind of dualism in the world, where matter and soul would be separate entities. These scientific theories, in the film’s assessment, would also validate the predominant role of spirit over mundane things: if everything is about energy, then the physical world is nothing but an illusion, easily manipulated by sheer will.

No need to mention just how wrong this line of thinking is. Energy, in Quantum Physics, is a physical property of the world. It can be measured and manipulated with the appropriate tools, and it does not represent any kind of abstract or divine power.

Both in logic and rhetoric, this misuse of words is called “equivocation”: using the same word in the same argument several times, but with different meanings, pretending not to notice the change.

The stars of the film seem fascinated by examples that some mental states correlate with physiological states, but do not seem to realise that this does not mean mind rules over matter, but rather that the mind is also subject to physiological changes.

More scientific concepts are twisted during the show: epigenetics and the placebo effect are hyped all the way to the moon and back. Epigenetics – which deals with the cellular mechanisms responsible for turning genes on and off – is pictured as the key to positive thinking in cellular biology: “If I change my perception, my mind changes my beliefs about life, I change the signals that are going in and adjusting the functions of the cell”, says Bruce Lypton, author of “Biology of Belief”, looking straight into the camera.

Lypton jumps to the conclusion that if different hormones can make identical stem cells differentiate in different organs, by turning genes on and off, then surely thoughts can have the exact same effect, in any kind of cell! Of course, if there was any truth to this, it should be possible to differentiate an ear from a finger, or regenerate a lost member, just by wishful thinking.

A similar explanation is given by the author of “You are the placebo”. Joe Dispenza argues that if the placebo effect, generated by a combination of classic conditioning and self-suggestion, can make the body produce opioid-like molecules for pain, then surely faith and belief can make the body produce virtually anything necessary to heal. The writer claims to have healed himself of a severe spinal injury, using nothing but visualizations and positive thinking.

To sum up

Heal’s leading claims state that all illnesses are self-inflicted, result from emotional stress (bad emotions create “density” which weakens the immune system and causes cancer), and are as such, self-healing. And of course, we know that because of Quantum Physics, Epigenetics and blah-blah-blah.

There is a slight attempt – very slight indeed – not to blame the patients. It is mentioned at a certain point that the patients are not to blame for their own diseases; it is the modern lifestyle that poisons us all. The overall message, however, is very clear: everything happens for a reason, and it is all in your head. Noonan Gores tries to sell the documentary as a message of hope. Sadly, it is but a message of despair and guilt.

Perhaps the most naïve demonstration of this message is Kelly Turner’s idea -as stated in her book Radical Remission – that people who recover from malignant tumours have “found the cure to their own cancer”. Collecting and cataloguing these survivors’ “habits” makes no sense unless you compare them to a control group: a group pf people who shared the same habits and lifestyle, and did not recover.

The film also shows a man who presents himself as a brain cancer patient. He takes part in a very emotional sequence, where he shares a “mystical moment” in Rob Wergin’s arms. Everyone in the room looks really moved, and it is clear that the patient believes himself cured. But was he? The film conveniently stops right there.

Eva, the second protagonist, with the mysterious rash, has no closure either, and finishes the documentary exactly at the same place where she began: no diagnosis nor treatment – or so they say. One doctor put her on steroids, another gave her antibiotics. The holistic therapist that helped her go through childhood issues and release negative emotion did not seem to help either.

The main – and only – cure shown in “Heal” is Elizabeth’s, who treated her cancer with chemotherapy and radiotherapy. The producer, however, refuses to connect the dots and give credit to “Western medicine”. Western medicine is after all, an aggressive monster, and full credit is given to alternative medicine alone. The reality of course, lies on the other end: the adoption of alternative therapies actually increases the risk of death in cancer patients (https://jamanetwork.com/journals/jamaoncology/article-abstract/2687972 ).

The true “power of the mind”, it seems, lies in ignoring the obvious and falling desperately in love with a pseudoscientific fantasy. A cruel fantasy for those who fall, a very lucrative one for those who sell.

Today is WORLD CANCER DAY. A good reason, I feel, to remind everyone of the existence of CAM-CANCER, an initiative that I have been involved with from its start (in fact, I was one of its initiators). Essentially, we – that is an international team of CAM-experts – conduct systematic reviews of CAMs often advertised for cancer. We then offer them as a free web resource providing the public with evidence-based information about all sorts of CAMs for cancer.

CAM-Cancer follows a strict methodology to produce CAM-summaries of high quality. Writing, review and editorial processes all follow pre-defined methods and the CAM-Cancer editorial team and Executive Committee ensure that CAM-summaries comply with the guidelines and templates. We are independent from commercial funders and strive to be as objective as possible. Most of the experts are more enthusiastic about the value of CAM than I am, but we do our very best to avoid letting sentiments get in the way of rigorous scientific assessments.

So far, we have managed to publish a respectably large and diverse array of summaries. Here is the full list:

A

B

C

D

E

F

G

H

I

L

M

N

O

P

Q

R

S

T

U

V

Y

___________________________________________________

Let me pick out just one of the summaries, Gerson therapy. This topic has led to fierce debates on my blog. The ‘key points’ of the CAM-CANCER summary are as follows:

  • Gerson therapy uses a special diet, supplements and coffee enemas with the aim of detoxifying and stimulating the body’s metabolism.
  • No substantial evidence exists in the scientific literature to support the claims that the Gerson therapy is an effective alternative therapy for cancer.
  • Some evidence exists to suggest that elements of the therapy (coffee enemas in particular) are potentially dangerous if used excessively.
  • The specific safety problems, advice to stop conventional cancer therapies and the lack of substantial evidence for efficacy outweigh any benefits associated with the Gerson therapy.

I think this is clear enough and it certainly corresponds well with what I previously wrote about Gerson on this blog. The style of presentation might be different, but the information and conclusions are almost identical.

Altogether, our CAM-CANCER summaries are well-informed, concise, and strictly evidence-based. On this WORLD CANCER DAY, I therefore warmly recommend them to everyone and sincerely hope you make good use of them, for instance, by telling other interested parties about this little-known but precious resource.

Spinal epidural haematoma (SEH) is an uncommon but serious emergency condition. A team of emergency physicians reported the case of a SEH associated with traditional massage initially presenting with delayed lower paraplegia.

A 20-year-old man was seen with bilateral lower extremity weakness and numbness, symptoms that had started three hours prior to presentation. He had received a Thai massage by a friend three days before. Magnetic resonance imaging revealed a spinal epidural lesion suspicious for haematoma extending from C6 to T2 levels. Emergent surgical intervention for cord decompression was performed. An epidural haematoma with cord compression at C6-T2 levels was identified intra-operatively. No evidence of abnormal vascular flow or AV malformations was identified. The authors concluded that, similar to chiropractic manipulation, massage may be associated with spinal trauma. Emergency physicians must maintain a high index of suspicion for spinal epidural haematomas in patients with a history of massage or chiropractic manipulation with neurologic complaints, because delays in diagnosis may worsen clinical outcome.

Thai massage therapists typically use no lubricants. The patient remains clothed during a treatment. There is constant body contact between the therapist – who, in the above case, was a lay person – and the patient.

The authors of this case report rightly stress that such adverse events are rare – but they are by no means unknown. In 2003, I reviewed the risks and found 16 reports of adverse effects as well as 4 case series on the subject (like for all other manual therapies, there is no reporting system of adverse effects). The majority of adverse effects were – like the above case – associated with exotic types of manual massage or massage delivered by laymen. Professionally trained massage therapists were rarely implicated. The reported adverse events include cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, haematoma, leg ulcers, nerve damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes. In the majority of these instances, there was little doubt about a cause-effect relationship. Serious adverse effects were associated mostly with massage techniques other than ‘Swedish’ massage.

For patients, this means that massage is still amongst the safest form of manual therapy (best to employ qualified therapists and avoid the exotic versions of massage because they are not supported by evidence and carry the highest risks). For doctors, it means to be vigilant, if patients present with neurological problems after having enjoyed a massage.

Chiropractors believe that their spinal manipulations bring about a reduction in pain perception, and they often call this ‘manipulation-induced hypoalgesia’ (MIH). It is unknown, however, whether MIH following high-velocity low-amplitude spinal manipulative therapy is a specific and clinically relevant treatment effect.

This systematic review was an effort in finding out.

The authors investigated changes in quantitative sensory testing measures following high-velocity low-amplitude spinal manipulative therapy in musculoskeletal pain populations, in randomised controlled trials. Their objectives were to compare changes in quantitative sensory testing outcomes after spinal manipulative therapy vs. sham, control and active interventions, to estimate the magnitude of change over time, and to determine whether changes are systemic or not.

Fifteen studies were included. Thirteen measured pressure pain threshold, and 4 of these were sham-controlled. Change in pressure pain threshold after spinal manipulative therapy compared to sham revealed no significant difference. Pressure pain threshold increased significantly over time after spinal manipulative therapy (0.32 kg/cm2, CI 0.22–0.42), which occurred systemically. There were too few studies comparing to other interventions or for other types of quantitative sensory testing to make robust conclusions about these.

The authors concluded that they found that systemic MIH (for pressure pain threshold) does occur in musculoskeletal pain populations, though there was low quality evidence of no significant difference compared to sham manipulation. Future research should focus on the clinical relevance of MIH, and different types of quantitative sensory tests.

An odd conclusion, if there ever was one!

A more straight forward conclusion might be this:

MIH is yet another myth to add to the long list of bogus claims made by chiropractors.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories