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

Monthly Archives: March 2020

It’s getting crowded in my ‘Corona-Virus Quackery Club’ (CVQV). So far, we have the:

Now a potentially smelly addition is joining. This website explains:

Hindu Mahasabha leader Swami Chakrapani Maharaj has claimed coronavirus can be cured by cow urine or cowdung.

“Consuming cow urine and cow dung will stop the effect of infectious coronavirus,” he had said. But, can coronavirus actually be cured through cow urine or cowdung? Here’s what Swami Chakrapani Maharaj said when I contacted him.

“Cow urine is a natural remedy to a number of diseases, be it cancer or any other deadly disease. The urine of a cow contains natural ingredients and those act as a medicine/drug to cure illness.”

When asked how cow urine should be consumed by those infected with coronavirus, Swami Chakrapani Maharaj said urine or dung of only Indian cows should be used for treatment. Moreover, the cow you trust for coronavirus treatment should not be eating trash from the street.

Commenting further, Swami Chakrapani Maharaj said cow urine or cowdung had even proved to be useful at the time of Bhopal gas tragedy, as houses that had cowdung stuck on walls were the ones that stayed unaffected by the gas tragedy.

“In the case of coronavirus, patients should drink cow urine and chant Shiva mantras. In other cases, patients can apply cowdung on their head or complete body, as it a natural remedy,” Chakrapani Maharaj said.

Apparently this is quite common in India. Yes, all the other SCAMs for corona are just ineffective – this one clearly manages to achieve more: it is ineffective and disgusting!

So, welcome to the CVQC, dung and urine quacks.

I have been alerted to the fact that the latest issue of ‘Homeopathy 4 Everyone’ is packed with what I might call the criminal promotion of homeopathy for coronavirus. Here are a list of and links to the articles in question:

The editorial is by Alan Schmuckler. Here are a few excerpts:

… homeopathy has a proven track record of preventing disease, whether it be bacterial or viral. It has protected people from polio, smallpox, diphtheria, scarlet fever, meningococcal meningitis, leptospirosis and various influenzas.  Homeopathic remedies have successfully treated virtually every epidemic disease that occurred over the last 200 years, including the 1918 influenza pandemic. Treating this disease will require keen observation but if we remain calm, and work as a community, we will be able to reason it through. Most importantly, we will have a means of prevention that will become clear as more cases are evaluated.

There will be the usual critics, but they are simply misinformed. The bottom line is, homeopathy is effective, safe and cheap and doesn’t interfere with other treatments.  In a situation where there is no other proven alternative, it is illogical not to use it.

To those in the Pharmaceutical industry, who know homeopathy works and have been trying to sabotage it, this is a good time to rethink your plan. If you could put away your greed and support homeopathy, you might save your own life and your loved ones, along with countless millions…

The degree of delusion which becomes evident in these lines is frightening. And the actions of these homeopaths are, in my view, criminal.

My ‘Corona-Virus Quackery Club’ (CVQC) is getting rather popular. The current members,

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen

and chiropractors,

are now thinking of admitting the essential oil salesmen. It seems that many of them find it impossible to resist the chance to make a fast buck on the fear many consumers currently have. Take this website for instance:

If you have a breathing aid or respiratory device, use it to reduce breathing difficulties. Alternatively, you can use a breathing ointment like Breathe and Focus Oil. Formulated with menthol, eucalyptus, rosemary and thyme essential oils, this phyto-aromatherapy ointment helps ease breathing difficulties commonly associated with cold, flu, cough, asthma and pneumonia. Gently massage a few drops of Breathe and Focus Oil to your chest and apply 1 to 2 drops to a tissue or handkerchief then inhale the aroma. Repeat as often as necessary.

Studies showed that eucalyptus essential oil contains cineole that helps reduce inflammation and infection in the lungs. Eucalyptus Radiata essential oil has antiviral effects against coronavirus SARS. Rosemary essential oil has been shown to be effective against Klebsiella pneumoniae, a bacteria which causes pneumonia in humans and animals. Thyme essential oil has been shown to have antiviral activities against Influenza A virus (H1N1), while menthol with its cooling-effect has also been shown to reduce breathing difficulties. These essential oils may help you dealing with Covid-19 disease.

Another website even has the promising title ‘What can you try to cure from coronavirus ….’ and it tells us that:

Black cumin can boost immunity, especially in patients with impaired immune systems. According to research, 1 gram Seed capsules, twice daily for four weeks can improve T-cell ratio between positive and negative up to 72%. Increased immunity plays an important role in the healing of colds, influenza, AIDS, and other diseases related to the immune system.

But there is more – so much more that I can here only present a very small selection of that is on offer.

Recommended antiviral essential oils for healthy adults:

  • Cinnamon bark
  • Clove bud
  • Eucalyptus globulus/radiata
  • Lemon
  • Lemon myrtle
  • Manuka
  • Melissa
  • Niaouli
  • Ravensara
  • Ravintsara
  • Rosemary
  • Saro
  • Tea tree
  • Thyme thymol & linalool

Yet another website includes the claim: “The most powerful anti-virus essential oils to provide defence (sic) against coronavirus include:

  • Basil
  • Bergamot
  • Cajuput
  • Cedarwood Virginian
  • Cinnamon
  • Clove Bud
  • Eucalyptus Globulus, Radiata and Smithii
  • Juniper Berry
  • Lavender Spike
  • Laurel leaf
  • Lemon
  • Manuka
  • Niaouli
  • Peppermint
  • Ravensara
  • Ravintsara
  • Rosemary
  • Sage
  • Tea Tree
  • Thyme Sweet Thyme White.”

I know, this is confusing! I do sympathise with the difficulty of choosing between all these recommendation; therefore, let me help you. Here is the full list of essential oils proven to prevent or treat a corona-virus infection:

Yes, that’s right: NO ESSENTIAL OIL HAS EVER BEEN FOUND TO BE EFFECTIVE AGAINST THIS OR ANY OTHER VIRUS INFECTION!

The FDA agree and have therefore sent out letters to seven US companies warning them to stop selling products that claim to cure or prevent COVID-19 infections, stating that such products are a threat to public health because they might prompt consumers to stop or delay appropriate medical treatment.

WELCOME TO THE CVQC, ESSENTIAL OIL SALESMEN!

I have almost got used to seeing that any health crisis brings the worst out of charlatans. In the present pandemic, this has been true for SCAM merchants such as the:

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen

and, of course, the chiropractors.

Perhaps one can even forgive such behaviour on an individual level – sadly, it seems to be a human trait to turn every misery into a business opportunity. But when professional organisations behave in this manner, I have less understanding.

In that context, this press release by the INTERNATIONAL CHIROPRACTORS ASSOCIATION seems revealing:

March 16, 2020 (Falls Church, VA) In these challenging times associated with the COVID-19 Pandemic, the International Chiropractors Association (ICA) is issuing a statement reaffirming chiropractic as an essential healthcare service. Everyone is under extraordinary levels of stress.

Chiropractic Services represent an essential and necessary component of the health care program of millions of patients of all ages and all walks of life in the United States and worldwide. Timely and consistent access to chiropractic care is essential to the maintenance of the health and wellbeing of this patient population, particularly during times of stress.

The association encourages jurisdictions at all levels to acknowledge and respect that chiropractic is an essential healthcare service even during a pandemic.

It is important to recognize that as of mid-March 2020, there are no recognized cures in conventional medicine or alternative health approaches for COVID-19. There are no vaccines, no drugs, no natural remedies, no alternative therapies that have been tested and the outcomes peer reviewed to meet any evidence-based standard. The public has the right to seek their own pathway to health and well-being. For millions of Americans, that pathway includes regular chiropractic care. For individuals such as those recovering from injury or suffering back pain, chiropractic care is essential on their road to recovery.

ICA President, Stephen P. Welsh, DC, FICA stated, “While Coronavirus-19 has everyone’s attention, it cannot be forgotten that health promotion and non-opioid pain management through chiropractic adjustments of the subluxation is essential and should not be curtailed or restricted because of this pandemic. With churches, schools, restaurants, museums being closed, the ICA reminds authorities that the offices of doctors of chiropractic should be treated no differently than the offices of medical doctors – as an essential health care service.”

Did I state that I have less understanding for this? To be honest, I feel slightly sick reading the press release!

The ICA state that one of their objectives is to ‘promote the highest professional, technical, and ethical standards for the doctor of chiropractic while safeguarding the professional welfare of its members and the public.’ I highly recommend that the ICA take a step back and inform themselves what professionalism and ethics really mean.

Some homeopaths are so deluded that I am tempted to characterise them as criminally stupid. This does, in my view, apply to those homeopaths who continue to advise their patients to treat or prevent coronavirus infections homeopathically. This website is only one example of many:

So what homeopathic remedy should I take for Coronavirus?

If you are living in an area which is not yet affected by Coronavirus, you should not be taking any remedy for now.

Based on the analysis above, I believe Bryonia alba 6CH or 30CH, can serve as a prophylactic.

It can be given (only to affected population) once a day, till days become warmer and the epidemic subsides (hopefully). People are mobile in endemic or epidemic areas should take the medicine daily. People who are in self quarantine and not having social contact, can take it for 3-5 days and then take it if and when they venture out. If a patient has flu-like symptoms, you can take the same remedy in 6 or 30 potency, 6 hourly. If the vitality is very low, more freuent repetition may be required. Also consider Camphora in such a case.

If a patient develops tightness in chest and shortness of breath, Lycopodium 30CH is likely to help.

The remedy suggestions are based on the available data. Homeopathy needs much deeper individualization, and clinical experience of treating Coronavirus Covid-19 patients with homeopathy, may bring up a different group of remedies.

Some recent data from Iran shows that many patients are showing sudden collapse. Dr. Rajan Sakaran as well as Dr. Sunirmal Sarkar have suggested that Camphora be considered as a medicine and prophylactic there. So if Covid-19 patients in your country are showing signs of sudden collapse with respiratory distress, vertigo and cold sweat, you may consider Camphora.

I do not recommend self-medication. You can show this article to your homeopath for a better clinical judgment that he/she will make for you.

If you suspect yourself to have Corona virus infection, please consult the concerned medical authorities in your country immediately.

If you have a flu-like illness and wish to take homeopathic treatment, please consult a qualified homeopathy doctor in person.

As I already stated: there are many websites with similarly barmy information. If you don’t believe me, see for yourself and run a quick google search.

Some people will say that this is not so bad – if it does not help, it cannot harm!

I would disagree.

Harm is being done by these charlatans in several ways. Firstly, the truth is a most valuable asset, and we must not allow homeopaths to vandalise it. Secondly, if patients believe in these bogus claims, they might take effective preventative measures less seriously and thus increase the danger for us all. Thirdly, anyone following the idiotic advice of homeopaths would have to forge out money for their service, and that money could be put to better use elsewhere.

My conclusion is that these homeopaths try to profit from the panic of vulnerable people. They are therefore crooks of the worst kind.

The ‘Corona-Virus Quackery Club’ (CVQC) is enjoying a fast-growing membership. As mentioned in previous posts, it consists of:

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen.

Chiropractors have been keen to join since weeks. They have a long tradition of claiming that their ‘adjustments’ boost the immune system, and therefore it was to be expected that they also jump on the corona-bandwagon.

Some chiropractors seem to believe that the corona-virus pandemic is a fine business opportunity or, as one put it, the perfect opportunity to have a heart to heart with patients about their immune and nervous systems! Remember, if germs automatically caused disease, the human race wouldn’t be around to debate the issue. Many forget that Louis Pasteur, the father of the germ theory recanted his belief. On his deathbed he observed, “It’s the soil, not the seed.” In other words, without the right environment, germs can do little harm.

Chiropractors and other health care workers are at greater risk due to patient or client interactions and are encouraged to take extra precautions when it comes to cleaning and disinfecting surfaces and skin or close contact.

“Every chiropractic practice has been touched by coronavirus [fears],” says Bill Esteb, DC, who has created and is circulating a coronavirus and chiropractic guide on how to avoid contracting the virus.

“We wanted to create a tool that chiropractors could use as a conversation springboard. Chiropractors need to remind their patients that germs don’t automatically cause disease. And that ‘catching’ the coronavirus, or anything else, requires a hospitable environment.”

The only way to catch anything, says Esteb, is to become a hospitable host. Flipping the message, Esteb in his coronavirus and chiropractic guide says here is “How to Catch the Coronavirus”:

  • Eat a Poor Diet — Make sure your body lacks the vitamins, minerals, enzymes and micronutrients needed to keep itself in good repair.
  • Avoid Adequate Rest — Stay up late and use sugar, tobacco, coffee and energy drinks as needed.
  • Become Dehydrated — Reduce the effectiveness of your natural defense mechanisms by shunning adequate water.
  • Stop Exercising — Reduce the efficiency of your lymphatic system, which requires movement to circulate this important germ-fighting fluid.
  • Think Negative Thoughts — Worry that you’ll be a victim. Closely monitor news reports about outbreaks, fearing the advancing pandemic.
  • Rarely Wash Your Hands — Use your dirty hands and fingers to rub your eyes, pick your nose or wipe your lips.
  • Skip Your Chiropractic Adjustments — Handicap your nervous system, the master system that controls your entire body. Wait until symptoms are clearly present.

“Following these suggestions is the way to become a suitable host for any number of germs or microbes,” Esteb says. “The tongue-in-check approach keeps the subject light. It stimulates more instructive patient conversations. It helps reduce appointment cancellations.

“Most people have an inappropriate fear of germs. And while this poster and patient handout won’t eliminate it, use it to explore the value of ongoing chiropractic care as a preventive strategy.”

——–

The Internet is full with messages of this type. Here is just one example: The best defense for the Corona Virus is to be healthy when you are exposed to the virus. Get adjusted to boost your immune system. Check out this video blog on what you can do to be healthy and prepare your body to fight off the corona virus.

——–

Perhaps the worst excesses can be found on Twitter:

James Langford 
@JamesLangford15·

Did you know that a properly aligned body supports and activates our immune system. During this time of concern from the corona virus, making sure your body is healthy is the best way to combat this illness. #health #immunesystem
Oxford Chiropractic
@OxfordChiropra1·

Scared of the corona virus? Practice a little preventative care like mama always used to tell you and get your spine adjusted!!! It’s boosts your immune by 200%!!!!! Why aren’t we talking… instagram.com/p/B9pjMqdATmBn
——–
So, considering this concerted effort, I am happy to announce that, from today, my friends the chiros are official members of the CVQC.
CONGRATULATIONS GUYS!
PS
Whether Boris Johnson will be allowed in, depends on future announcements; so far, his chances are not bad.

Boris Johnson said we should take the coronavirus ‘on the chin’ and count on ‘herd-immunity’. This, he claimed, is what his scientific advisers recommended.

I find this very hard to believe and have many doubts and questions.

To start with, I doubt that this is what Johnson’s scientific advisers recommend – it is a solution that SOME of his scientific advisers recommend. And it is a solution that seems easy to follow. It is, however, by no means the only strategy for tacking the pandemic; it is just one of several options.

The fact that all other countries have opted for other solutions, suggests to me that it is an unusual path to go down to. The modellers who obviously like it had to make a number of assumptions; that’s what modellers always have to do and rarely tell us about. But what if not all of these assumptions are correct?

The herd-immunity strategy counts on the fact that, once a certain percentage of the population has taken the infection ‘on the chin’, it is immune and therefore the transmission of the virus within such a population will be dramatically reduced or even zero. The percentage of the population needed for that to happen depends on how contagious the virus is. For the measles virus, herd immunity requires 90% of the population to be immune. For the coronavirus, the figure is said to be 60 – 70%. Is that an assumption or a fact? If it is a current fact, would the figure change, if the virus mutates? Could it be that a mutated virus can re-infect formerly immune people?

But let’s postulate that the herd-immunity assumption is both correct and stable. Johnson’s herd-immunity strategy would thus require that about 40 million Brits get infected with the virus to generate the required herd-immunity. Assuming a mortality rate of 1 – 2%, this means that Johnson is cheerfully accepting 400 000 – 800 000 fatalities.

But, as I said, this scenario is based on wild assumptions. It applies only if the virus does not mutate. And it only applies, if we do not run out of intensive care (IC) beds. However, running out seems possible, perhaps even likely, considering that we have only about half of the French and just one third of the German IC capacity. Sod’s law has it that both might happen. In this case, we might easily have far in excess of 800 000 fatalities. How should we take that ‘on the chin’, Mr Johnson?

Sadly, this is not all; I have further doubts about our PM’s ideas.

The present strategy regarding diagnosis of coronavirus cases is to self-isolate once suspicious symptoms start. Even if someone is seriously ill (with high fever etc.), they are told to stay at home and sit it out. This means we will never know whether these patients had or had not suffered from a coronavirus infection. How then can we ever be sure that the 60% target of infection has been reached? And if we are uncertain about it, how can we be sure that herd-immunity will work in the way the modellers predicted?

Moreover, we now know that people who caught the virus are infective BEFORE they develop symptoms. If that is so, the strategy of self-isolation will be far less effective than predicted. And, given this fact, are we not much more likely to have a sharp peak of cases early on which would make us run out of IC capacity? When that happens, even the pessimistic death rates might turn out to be too optimistic.

It seems to me that Johnson’s herd-immunity strategy is risky to the point of being reckless. It also seems to me that there are very good reasons why other countries have not adopted it.

But what is the solution?

In my view, the solution cannot be to uncritically adopt the theories and assumptions of modellers. This is not a computer game; we are talking about human lives, many human lives!

I wish I new what the best solution is – but I don’t. I merely fear that ‘taking it on the chin’ is not a solution at all. In any case, a wise move for Johnson and his team might be to consider that foreigners might be at least as clever as they are. Subsequently they could carefully study the actions of those countries which managed to bring down their death-rates despite being attacked by the coronavirus.

Papillomas of dogs are benign growths caused by the canine papillomavirus. The oral mucosa and commissures of the lip are most frequently involved. Papillomas often regress spontaneously within a few weeks, and treatment is usually not necessary.

This Indian study tested the combination of 4 homeopathic drugs (Sulfur 30C, Thuja 30C, Graphites 30C, and Psorinum 30C) in 16 dogs affected with oral papillomatosis which was not undergone any previous treatment. Dogs affected with oral papillomatosis, which have not undergone any initial treatment and fed with a regular diet. They were randomly divided into two groups, namely, homeopathic treatment group (n=8) and placebo control group (n=8). The homeopathic combination and placebo (distilled water) was administered orally twice daily for 15 days. Clinical evaluation in both groups of dogs was performed by the same investigator during 12 months. Dogs were clinically scored for oral lesions on days 0, 5, 7, 10, 15, 20, 25, 30, 45, 60, 90, 120, and 150 after initiation of treatment.

The homeopathic treatment group showed early recovery with a significant reduction in oral lesions reflected by clinical score (p<0.001) in comparison to placebo-treated group. Oral papillomatous lesions regressed in the homeopathic group between 7 and 15 days, whereas regression of papilloma in the placebo group occurred between 90 and 150 days. The homeopathic treated group was observed for 12 months post-treatment period and no recurrence of oral papilloma was observed.

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The authors concluded that the current study proves that the combination of homeopathy drugs aids in fastening the regression of canine oral papilloma and proved to be safe and cost-effective.

This could well become the worst SCAM study of 2020. In case you have not already spotted its flaws, here are some of them:

  • the trial was truly tiny; thus the results could easily be false-positive;
  • to make any conclusion about safety after treating 16 subjects is nonsensical;
  • cost-effectiveness was not assessed and therefore conclusions about it are not warranted; if, however, one made a ‘back of the envelope’ calculation, one would be hard-pressed to not find tap water more cost-effective than 4 homeopathic remedies;
  • the graph looks to me very suspect – could it be that someone has been busy prettifying the data?

Nevertheless, I think this paper is remarkable, if only in the way it teaches us how NOT to formulate conclusions of a study. Even if we had 200 dogs in this trial, its findings would not PROVE the efficacy of the intervention. Proof is something a single trial will never deliver. Proof is a debatable concept even after several independent replications, particularly when dealing with something as implausible as homeopathy.

In any case, if your dog has papillomas, do me a favour and avoid homeopathic vets!

This ‘Manifesto of the European Committee for Homeopathy (ECH) and the European Federation of Homeopathic Patients Associations (EFHPA)‘ has just been published. It is worth considering in more detail, I think. So, I will first reproduce the document in its entirety and subsequently provide some critical assessment of it.

Homeopathy: a solution for major healthcare problems in the EU

  • Helps to reduce the need of antibiotics in human and veterinary health care, thus reducing the problem of antimicrobial resistance [i],[ii]
  • Increases quality of life and reduces severity of complaints in patients with chronic disease, when integrated in health care [iii],[iv],[v],[vi],[vii],[viii]
  • Can reduce the use of long-term conventional prescription drugs, when integrated in health care [ix]

Homeopathy: safe and cost-effective with a high patient satisfaction

  • Can lead to lower health care costs, when integrated in health care, [x],[xi],[xii],
  • Is safe, with high patient satisfaction [xiii],[xiv],[xv],[xvi]
  • Patients using homeopathy have better outcomes than users of conventional treatment, with similar costs [xvii]
  • Quality, safety and correct labelling of homeopathic products is guaranteed by Directive 2001/83 EC

 EU consumers expect and demand homeopathy as part of their health care

  • Reported as the most used medical complementary medicine in Europe [xviii]
  • Three out of four European citizens know about homeopathy and out of them 29% use it for their day-to day health care [xix]

 Scientific evidence of the highest calibre confirms the clinical efficacy of homeopathic   medicine

There is convincing evidence for biological efficacy of homeopathic medicine

  • Irrefutable scientific evidence has been published on the positive effects of homeopathic products in laboratory settings [xxvii],[xxviii]

References

[i] Grimaldi-Bensouda L, Bégaud B, Rossignol M, et al. Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: the EPI3 cohort study in France 2007-2008. PLoS One. 2014 Mar 19;9(3):e89990

[ii] Camerlink I, Ellinger L, Bakker EJ, Lantinga EA. Homeopathy as replacement to antibiotics in the case of Escherichia coli diarrhoea in neonatal piglets. Homeopathy. 2010 Jan;99(1):57-62

[iii] Witt CM, Lüdtke R, Baur R, Willich SN. Homeopathic medical practice: long-term results of a cohort study with 3981 patients. BMC Public Health 2005; 5:115

[iv]  Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med 2005; 11:793–798

[v] Mathie RT, Robinson TW. Outcomes from homeopathic prescribing in medical practice: a prospective, research-targeted, pilot study. Homeopathy 2006; 95:199–205

[vi] Thompson EA, Mathie RT, Baitson ES, et al. Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals. Homeopathy 2008; 97:114–121

[vii] Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?–Results from a long term observational study BMC Public Health 2008;8:413

[viii] Rossi E, Endrizzi C, Panozzo MA, Bianchi A, Da Frè M. Homeopathy in the public health system: a seven-year observational study at Lucca Hospital (Italy). Homeopathy 2009; 98:142–148

[ix] Grimaldi-Bensouda L, Abenhaim L, Massol J, et al. EPI3-LA-SER group. Homeopathic medical practice for anxiety and depression in primary care: the EPI3 cohort study. BMC Complement Altern Med. 2016 May 4; 16:125

[x] Kooreman P, Baars EW. Patients whose GP knows complementary medicine tend to have lower costs and live longer. Eur J Health Econ. 2012 Dec;13(6):769-76

[xi] Baars EW, Kooreman P. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open. 2014 Aug 27;4(8):e005332

[xii] Colas A, Danno K, Tabar C, Ehreth J, Duru G. Economic impact of homeopathic practice in general medicine in France. Health Econ Rev. 2015;5(1):55

[xiii] Van Wassenhoven M, Galen Y. An observational study of patients receiving homeopathic treatment. Homeopathy 2004 Jan;93(1):3-11

[xiv] Marian F, Joost K, Saini KD, von Ammon K, Thurneysen A, Busato A. Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine. BMC Complement Altern Med. 2008 Sep 18; 8:52

[xv] Witt C, Keil T, Selim D, et al. Outcome and costs of homoeopathic and conventional treatment strategies: a comparative cohort study in patients with chronic disorders. Complement Ther Med. 2005;13(2):79-86

[xvi] Marian F, Joost K, Saini KD, von Ammon K, Thurneysen A, Busato A. Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine. BMC Complement Altern Med. 2008 Sep 18; 8:52

[xvii] Bornhöft G, Wolf U, von Ammon K, Righetti M, Maxion-Bergemann S, Baumgartner S, Thurneysen AE, Matthiessen PF. Effectiveness, safety and cost-effectiveness of homeopathy in general practice – summarized health technology assessment.Forsch Komplementmed. 2006;13 Suppl 2:19-29. Epub 2006 Jun 26. Review

[xviii] Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos K Ͳ Rey, Vas J, von Ammon K, Hegyi G, Dragan S, Uehleke B, Fønnebø V, Lewith G. CAM use in Europe. The patients’ perspective.Part I: A systematic literature review of CAM prevalence in the EU. 2012. Online retrieved 19-11-2019. https://cam-europe.eu/wp-content/uploads/2018/09/CAMbrella-WP4-part_1final.pdf

[xix] Report of the European Commission, 1997. Online retrieved 15-12-2019 via https://www.hri-research.org/resources/essentialevidence/use-of-homeopathy-across-the-world/

[xx] Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-4.

[xxi] Cucherat M, Haugh MC, Gooch M, Boissel JP.Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol. 2000 Apr;56(1):27-33

[xxii] Hahn RG. Homeopathy: meta-analyses of pooled clinical data. Forsch Komplementmed. 2013;20(5):376-81

[xxiii] Mathie RT, Van Wassenhoven M, Jacobs J et al. Model validity and risk of bias in randomised placebo-controlled trials of individualised homeopathic treatment. Complement Ther Med. 2016 Apr; 25:120-5

[xxiv] Mathie RT, Lloyd, SM, Legg, LA, Clausen J, Moss S, Davidson JR, Ford: Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2014 Dec 6; 3:142

[xxv] Mathie RT, Clausen J. Veterinary homeopathy: systematic review of medical conditions studied by randomised placebo-controlled trials. Vet Rec. 2014 Oct 18;175(15):373-81.

[xxvi] Mathie RT, Clausen J. Veterinary homeopathy: meta-analysis of randomised placebo-controlled trials. Homeopathy. 2015 Jan;104(1):3-8.

[xxvii] Tournier A, Klein SD, Würtenberger S, Wolf U, Baumgartner S. Physicochemical Investigations of Homeopathic Preparations: A Systematic Review and Bibliometric Analysis-Part 2. J Altern Complement Med. 2019 Jul 10

[xxviii] Witt CM, Bluth M, Albrecht H, Weisshuhn TE, Baumgartner S, Willich SN. The in vitro evidence for an effect of high homeopathic potencies–a systematic review of the literature. Complement. Ther Med. 2007 Jun;15(2):128-38

_____________________________________

Did I state above that the manifesto is worth considering in more detail? I need to retract or modify this statement.

Here are the considerations that are relevant, in my view:

  • The statements in the manifesto are based on wishful thinking and do not reflect the reality based on the best evidence available today.
  • The manifesto is the result of a mixture of cherry-picking and/or misinterpreting the evidence.
  • Most of the cited studies have been discussed on this blog in previous posts which disclose their flaws and/or erroneous conclusions.

So, instead of discussing all the tedious details yet again, I will present here a corrected version of the manifesto:

Homeopathy: no solution for major healthcare problems in the EU

  • Does not help to reduce the need of antibiotics in human and veterinary health care, thus reducing the problem of antimicrobial resistance
  • does not increases quality of life and reduces severity of complaints in patients with chronic disease, when integrated in health care
  • Cannot reduce the use of long-term conventional prescription drugs, when integrated in health care

Homeopathy: neither safe nor cost-effective with a high patient satisfaction

  • Cannot lead to lower health care costs, when integrated in health care
  • Is unsafe
  • Patients using homeopathy have no better outcomes than users of conventional treatment, but cause higher costs
  • Quality and correct labelling of homeopathic products is guaranteed by Directive 2001/83 EC

 Some EU consumers expect and demand homeopathy as part of their health care

  • Reported as a much-used complementary medicine in Europe
  • Three out of four European citizens know about homeopathy and out of them many use it for their day-to day health care

 Scientific evidence of the highest calibre fails to confirm the clinical efficacy of homeopathic   medicine

  • Clinical effects of homeopathic medicines have been confirmed by systematic reviews and meta- analyses to be no better than placebo

There is no convincing evidence for biological efficacy of homeopathic medicine

  • No irrefutable scientific evidence has been published on the positive effects of homeopathic products in laboratory settings

The objective of this analysis was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. The researchers employed a retrospective cohort design for analysis of health claims data from three contiguous US states for the years 2012-2017.

They included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. Two cohorts of subjects were thus identified:

  1. patients who received both primary care and chiropractic care,
  2. Patients who received primary care but not chiropractic care.

The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients of chiropractic care filled an opioid prescription, as compared with recipients.

The authors concluded that patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.

Similar findings have been reported before and we have discussed them on this blog (see here, here and here). As before, one has to ask: WHAT DO THEY ACTUALLY MEAN?

The short answer is NOTHING MUCH! And certainly not what many chiros make of them.

They do not suggest that chiropractic care is a substitute for opioids in the management of spinal pain.

Why?

There are several reasons. Perhaps the most important ones are that such analyses lack any clinical outcome data, and that comparing one mistake (opioid-overuse) whith what might be another (chiropractic care) is a wrong apporoach. Imagine a scenario where half to the patients had received, in addition to their usual care, the services of:

  • a paranormal healer,
  • a crystal therapist,
  • a shaman,
  • or a homeopath.

Nobody would be surprised to see a very similar result, particularly if all of these practitioners were in the habit of discouraging their patients from using conventional drugs. Or imagine a scenario where half of all patients suffering from spinal pain are entered into an environment where they receive no treatment at all. Who would not expect that this regimen does not dramatically reduce the risk of filling an opioid prescription? But would that indicate that zero treatment is a good solution for managing spinal pain?

The thing is this:

  • If you want to reduce opioid use, you need to prescribe less opioids (for instance, by re-educating doctors to do as they have been told in med school and curb over-prescribing).
  • If you discourage patients to use opioids (as many other healthcare professionals would), many will not use opioids.
  • If you want to know whether chiropractic is effective in managing spinal pain, you need to conduct a well-designed clinical trial.

Or, to put it simply:

CORRELATION IS NOT CAUSATION!

 

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