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

Monthly Archives: April 2020

Guest post by Christian Lehmann

It’s the end of February. We see the first death, in the Oise department, near Paris, of a French citizen who has not recently travelled abroad. For doctors concerned about what is happening in China, this is the red alert. In spite of of the little notices posted by the health minister, Agnes Buzyn, at airports, the coronavirus has made it onto French soil. Nobody knows at that point how it will spread. Almost nobody, apart from those responsible for it, yet knows that France has completely run down its stocks of masks. Doctors themselves do know that the health service has only held out, for as long as it has, on the backs of its care personnel. Some are assessing the scale of what is to come.

The announcement by Didier Raoult about the spectacular effectiveness of a synthetic antimalarial, chloroquine, has brought enormous relief, followed immediately for many of us health professionals by growing doubts about an accumulation of errors: Raoult denies any toxicity, urges people to “fall upon” a medication requiring sensitive handling. When we locate the Chinese article on which Didier Raoult is basing his crisis communication, we are stupefied. No need for specialised knowledge in statistical methodology to understand that there is something seriously wrong. No numerical data. Nobody knows what dosage has been given, to what type of patient, nor how many have been treated. The article has not been “peer reviewed”, that is to say reviewed by professional equals; decoded, it has the effect of a simple announcement. So of course at this chaotic time we tell ourselves that, given a revelation of such importance, the Chinese wanted to act as quickly as possible, to inform the whole world. And Didier Raoult, who routinely advises, as he explains with delicious modesty, the Chinese, « the world’s best virologists », has probably been entitled to the first fruits of this revelation.

On Youtube, on 28 February, he posts a weird interview, “Why would the Chinese be mistaken?”, in which he repeatedly takes up his interviewer with obvious irritation. “No, that’s not the question that you should be asking me. You should be asking me….” An informal group of doctors and tweeters pass around the link. We are rubbing our eyes in disbelief. What Didier Raoult is passing off as an interview is nothing more then an audience accorded to one of his media aides. We advise him, sarcastically, to make a professional cut of the video before broadcasting it. An hour later the video disappears and returns in a more professional form which could create the illusion of a genuine interview. And rapidly, in the Press which is beginning to turn its microphones towards the Professor from Marseille, he modifies his stance, without ever acknowledging the radical changes.

Chloroquine, spectacular and miraculous only yesterday, disappears as if by magic, replaced from one day to the next by hydroxychloroquine (Plaquenil), a different medicine, less common. Though its chemical structure is close to that of the antimalarial medication, hydroxychloroquine is used primarily in rheumatic conditions such as rheumatoid polyarthritis, or immune conditions such as lupus. So at least it isn’t lying around in large quantities in medicine cabinets. And its cardiac toxicity, very real, is slightly lower then that of chloroquine. Didier Raoult puts forward HCQ as an immense discovery, continuing in his usual manner to ridicule his detractors. “The doctors who criticise me are neither in my field nor up to my weight”. He flays the inaction of embittered petty health officials, only fit to follow the diktats of the authorities, who, bogged down in their catastrophic crisis management, dare not intervene. And his posturing as a refractory Gaul, a loudmouth taking on the system, gains sympathy, from those to whom he gives hope, from those who understand that the State does not tell them everything, and from those looking for a hero to fit in with their stereotypes: the man on his own against the establishment, the White Knight taking on Big Pharma, the Hippocratic colossus besieged by hordes of soulless ants.

No one among those who hold out their microphones to him, not one asks him the question which we are all asking, GPs, cardiologists, pharmaceutical specialists, emergency specialists, resuscitation specialists – by what sleight of hand has Didier Raoult exchanged his miracle medicine, in 48 hours, openly and publicly? And how is it that no one has noticed the sleight-of-hand? Has this man who makes such a big deal of his image on social networks suddenly become aware of the risk of being confronted about chloroquine with a justifiable public outcry and with deaths by self-medication?

While the World Health Organisation is sounding alarm bells, in the context of overall mistrust with regard to scientific opinion, of confrontation with regard to government, of growing awareness ( belated and sometimes disproportionate) of the influence of Big Pharma, and as the initial fear gives way to real panic for some with the registration of each new case, Didier Raoult piles up Facebook likes, fans, sites to his glory. And for us, fearful, begins the long registration of flagrant mistruths delivered as revealed truths, which this professor will never have the honestly to set right.

For Didier Raoult, a minimum of intellectual integrity would demand that he admits having changed horses in midstream. That he admits that the concern of his despised detractors was well founded, with respect to chloroquine to which many have access without knowing its dangers ( Nivaquine is very often used in suicides). And, because Didier Raoult withdraws nothing, he continues to stash away all the profits of his media coverage. Every supporter of the Wise Man of Marseille piles in with testimony. Their brother, sister, uncle, the father-in-law of their hairdresser has been taking the Professor’s medicine ( Which one? ) for eight years in Africa and has never had a problem, so that’s the real proof that his detractors are just jealous, or, even worse, backed by “the lobbies”.

And untiringly we repeat the fundamental truths:

  • Yes chloroquine has existed for years
  • Yes it is widely used
  • But for a different treatment, the prevention of malaria
  • And in dosages 5 to 10 times smaller
  • And in large dosages it causes cardiac arrest
  • And it has never been effective in fighting a virus
  • Not this virus nor any other
  • And the same is true for hydroxychloroquine
  • In fact it’s rather the opposite

In fact what is being patiently stated by the upholders of the scientific method is very counter-intuitive, almost inaudible, because they are telling worried and disorientated people, who have put their trust and their hope in one man, that in his assertions………nothing makes sense.

There are uncounted different forms of bogus so-called alternative medicines (SCAMs), and many have been discussed on this blog. What do I mean by ‘bogus’? A bogus SCAM is one, in my view, that is being promoted for conditions for which it does not demonstrably generate more good than harm.

Ten popular examples are:

  • alternative cancer ‘cures’,
  • applied kinesiology,
  • Bach Flower Remedies,
  • CEASE,
  • chiropractic,
  • detox treatments,
  • homeopathy,
  • osteopathy,
  • paranormal or energy healing techniques,
  • slimming aids.

These treatments are diverse in many ways: history, basic assumption, risks, etc. But they nevertheless tend to have certain features in common:

  1. Most SCAMs originate from the ideas developed by a single, often charismatic individual who proclaimed to have seen the light. Think of Gerson, Bach, Palmer, Hahnemann, Still.
  2. They are recommended by enthusiasts as a panacea, a ‘cure all’.
  3. They are heavily promoted by celebrities, hyped by the press and marketed via books or the Internet, but they are far less or not at all supported by published studies in the peer-reviewed medical literature.
  4. The clinical trials of SCAM that have been published are flimsy, lack independent replication, yet are celebrated by proponents as though they represent robust evidence.
  5. SCAMs target either the most desperately ill patients who understandably tend to cling to every straw they can find. Or they go for the ‘worried well’ who have nothing truly wrong with them and plenty of cash to waste.
  6. Proponents of SCAM use scientific-sounding terminology, while simultaneously displaying a profoundly anti-scientific attitude.
  7. Entrepreneurs of SCAM are efficient at selling false hope at excessive prices.
  8. SCAMs sometimes seem to work because many of the therapists are skilled at maximising the placebo-response.
  9. SCAM is awash with conspiracy theories, for instance, the notion that ‘the establishment’ is supressing SCAM. (If a SCAM ever showed real promise, it would rapidly scrutinised by researchers and, if effectiveness were confirmed, adopted by conventional medicine. The notion of an alternative cure for any disease is idiotic, because it presupposes that conventional healthcare professionals shun a potentially valuable treatment simply because it emerged from elsewhere.)
  10. Most SCAMs can do direct harm. For instance, oral treatments can be toxic or interact with prescription drugs. Or spinal manipulations can cause a stroke. Or acupuncture can cause a pneumothorax.
  11. SCAMs are dangerous even if they do not cause direct harm. There are many examples of people who died needlessly early because they used SCAM as an alternative to conventional medicine (Steve Jobs is a prominent example).
  12. Moreover, SCAMs cause harm by undermining the principles of EBM and, more importantly, by undermining rational thinking in our society.
  13. SCAM practitioners violate fundamental rules of medical ethics on a daily basis. One could even argue that the ethical practice of SCAM is rarely possible.

 

These are exceptional times and they need exceptional measures. Therefore, I am yet again deviating from my policy of focussing exclusively on SCAM and welcome my French colleague Dr Lehmann posting a series of articles on the hydroxychloroquine story.

Guest post by Christian Lehmann

 

THE ELEPHANT IN THE ROOM

This pandemic diary was begun just before lock down, already four weeks ago, and yet I have scarcely touched on the elephant in the room. Our personal elephant is called Didier Raoult. White-haired with age, venerable in appearance, he has been number one in the press, constantly in capitals in online news headlines, waking hopes, feeding passions. And arousing the interest of a plethora of epidemiologists of renown, from Valerie Boyer to Donald Trump, by way of Alain Soral and Alexandre Benalla.

Everything begins on 25 February 2020, when the microbiology professor from Marseille posts his famous video “Coronavirus, game over”, since more modestly re-baptised “Coronavirus, towards a way out of the crisis?”.

Standing in front of a student audience out of camera, Didier Raoult reveals “a last-minute scoop, a very important piece of news”: the Chinese, whom he regularly advises, rather than seeking a vaccine or new products have been “repositioning”, trying old molecules, “known, old, without toxicity,” among them chloroquine, which has shown itself to be effective in a daily dose of 500 mg per day “with a spectacular improvement and it is recommended for all clinically positive cases of coronavirus. This is excellent news, it is probably the easiest respiratory infection of all to treat” Here, the whole roomful laughs, with pleasure, with relief, and I remember sharing these sentiments, briefly, but completely. Because this was 26th of February, because like others I felt confusedly that the reassurances with which Agnes Buzyn ( then the French Health Minister) was inundating us were built on sand, and that the virus would only laugh at little notices in airports.

I knew Didier Raoult only by name, as a columnist in Point, I had read some of his articles and I had felt simultaneously soothed by his smooth eloquence, attracted by some of his iconoclastic stances, but also sometimes rather irritated by his Mandarin-style fake cool posturing. At the end of February, I immediately reposted the video in the medical forums, on the walls of worried friends, explaining that, if the suggestions of Didier Raoult were confirmed, we would have escaped with a scare which would soon be dispelled by this “magic bullet”, this “game changer”.

Then between two consultations in my GP’s office, later that afternoon, I watched that video “Game Over” again. How could such an important piece of news have reached me by means of a Youtube video? Where were the overseas publications, the much vaunted Chinese study, the releases from AgenceFrancePresse, Reuters, the first articles from the New York Times and the Guardian, proclaiming from the rooftops that the pandemic we had so much feared was in fact only a technical hitch, easily controllable by a widely available drug. It was at that second viewing that I balked. As a GP who had worked in cardiac resuscitation some years ago, I was brought up short by hearing Didier Raoult talking up a medicine “well known, and devoid of any toxicity”. If chloroquine or Nivaquine, to give it its commercial name, is celebrated for the prevention of malaria, it is also a medicine known for its frightening toxicity as soon as the dose is exceeded, with the risk of irreversible visual damage and extremely serious problems with cardiac rhythm which can prove fatal. To say that chloroquine is without toxicity problems is in fact an error, all the more so because the dose suggested by “the Chinese”, without an iota of proof at this stage, is five times larger than the customary dose, 500 mg instead of 100 mg.

Deeply uneasy, I’m in discussion with doctor friends on Twitter when the video makes its appearance there. We know nothing at this point about Didier Raoult’s past, or about his Marseille Institute. Neither the enmity felt towards him by the Parisian intelligentsia represented by Agnes Buzyn and her husband, nor the fact that his institute has just lost its INSERM and CNRS accreditations, nor the stance adopted by him a month earlier explaining that coronavirus would never escape from China and that it was ridiculous to get worked up about it because “the world has gone mad, something or other happens and three Chinese die and that brings about a world-scale alert”.

Some of us, practitioners and first responders, knew well the toxicity of chloroquine, that it was to be handled with care, and that was about all we said on Twitter. It was already too much. The next day in a 20 minute interview Didier Raoult brushed away his detractors. “Malicious gossip, I don’t give a damn about it. When a medication has been shown to work on 100 people while all the world is busy having a nervous breakdown, and there’s some idiots who say there’s no certainty that it works, I’m not interested! It would honestly be medical misconduct not to use chloroquine to treat Chinese coronavirus”. And he drives the point home. “People who have lived in Africa like me took chloroquine every day. Everybody who went to hot countries took it throughout their time there, and for two months after they came home. Billions of people have taken this medication. And it costs nothing: ten centimes per pill. It is a medication which is extremely reliable and it’s the cheapest imaginable. So this is super amazing news. Everybody who learns about these benefits should fall upon it.” This is no longer a mistake, this is grave medical misconduct. Nobody who knows about therapeutics would use such words so lightly.

Cardiologists, resuscitation specialists, emergency doctors, GPs, public-health specialists, we are all alarmed. Our first warnings are vehement and rational, reaffirming the toxicity of chloroquine in cardiology, and the majority of us insisting on the senseless and significant risk which Didier Raoult is running. Because it is familiar, prescribed for long stays in Africa in packages of 100 tablets, chloroquine is lying around in many medicine cabinets. To declare as a fact that we should “fall upon it” in this agonising pandemic context is to encourage unrestrained self medication, and to endanger life. Incoherent, dangerous, this announcement disturbs us deeply. Incredulous, not for a moment do we imagine just what Didier Raoult will unleash, nor that the nightmare had already begun.

 

I am sure that most of us have wondered how we might be able to boost our immune defence in order to minimise the risk of catching the corona-virus. Many have asked, what role does nutrition play? There is, of course, a substantial amount of research on this topic, but are there any clinical trials at all? And if  such studies have been published, how rigorous are they?

Here is a brand-new paper that might answer these questions.

In this review, the authors aimed to evaluate evidence from clinical trials that studied nutrition-based interventions for viral diseases (with special emphasis on respiratory infections). Studies were considered eligible if they were controlled trials in humans, measuring immunological parameters, on viral and respiratory infections. Clinical trials on vitamins, minerals, nutraceuticals and probiotics were included.

A total 43 studies met the inclusion criteria:

  • vitamins: 13;
  • minerals: 8;
  • nutraceuticals: 18
  • probiotics: 4

Among vitamins, A and D showed a potential benefit, especially in deficient populations. Among trace elements, selenium and zinc have also shown favourable immune-modulatory effects in viral respiratory infections. Several nutraceuticals and probiotics may also have some role in enhancing immune functions. Micronutrients may be beneficial in nutritionally depleted elderly population.

There were 15 studies with a high score for methodological quality. Here is what their results showed:

  1. No significant difference in incidence of winter-time upper respiratory tract infection in children with high versus low dose vitamin D.
  2. Significantly less acute respiratory infections in elderly individuals with vitamin D versus placebo.
  3. Higher TGFbeta plasma level in response to influenza vaccination but no improved antibody response in elderly, vitamin D-deficient individuals with vitamin D versus placebo.
  4. No effect on lower respiratory tract infections; however, a protective effect was noted on upper respiratory tract infections in elderly individuals with vitamin E versus placebo.
  5. Neither daily multivitamin + mineral supplementation at physiological dose nor 200 mg of vitamin E showed a favourable effect on incidence and severity of acute respiratory tract infections in well-nourished, non- institutionalized elderly individuals.
  6. Better improvement in the clinical status, respiratory rate and oxygen saturation in children suffering from pneumonia with zinc sulphate versus placebo.
  7. Selenium-yeast increased Tctx-antibody-dependent cellular cytotoxicity cell counts in blood before flu vaccination + dose-dependent increase in T cell proliferation, IL-8 and IL-10 secretion after in vivo flu challenge in healthy volunteers.
  8. Frequency and duration of acute respiratory infections during the first two months was unaffected in healthy elderly with ginseng versus placebo.
  9. Broccoli sprout homogenate favourably affected immunological variables in healthy volunteers.
  10. The incidence of illness was not reduced, however significantly fewer symptoms were reported and the proliferation index of gd-T cells in culture was almost five times higher after 10 weeks of cranberry polyphenol supplements versus placebo.
  11. Higher antibody titres against all 3 strains contained in the seasonal influenza virus vaccine than the placebo in healthy elderly individuals with a sea-weed extract versus placebo.
  12. Non-inferiority was demonstrated for Echinacea compared to oseltamivir in early treatment of clinically diagnosed and virologically confirmed influenza virus infections.
  13. Significant reduction of cold duration and severity in air travellers with elderberry supplement versus placebo.
  14. Increased NK cell activity with probiotics versus placebo in tube-fed elderly patients.
  15. Titres against the influenza B strain increased significantly more with probiotics compared to placebo in healthy elderly individuals.

The authors concluded that nutrition principles based on these data could be useful in possible prevention and management of COVID-19.

Given the current concern of millions of people, this is a most useful review, in my view. The paper also has a table recommending the following nutrients from food or as dietary supplements as possibly effective:

  • Vitamin A
  • Vitamin D
  • Zinc
  • Selenium
  • Copper
  • Garlic
  • Fish
  • Cranberry
  • Broccoli sprouts
  • Probiotics

I am not sure that the evidence is sufficiently strong for such explicit advice, but I am quite certain that the recommendations are nevertheless more suitable than Trump’s little ramblings on disinfectant.

Referring to possible treatments for corona-virus infections during a press-conference, Trump said the following:

“So supposing we hit the body with a tremendous—whether it’s ultraviolet or just a very powerful light—and I think you said that hasn’t been checked because of the testing…And then I said, supposing you brought the light inside the body, which you can do either through the skin or some other way.”

We already suspected that Trump has a thing about UV light.

We also knew that Trump has links to the SCAM scene. And his recent outburst sounds as though the president has come across a particular SCAM called ‘Ultraviolet Blood Irradiation’.

“Ultraviolet Blood Irradiation” (UBI), also called “ BioPhotonic Therapy”, is a treatment that was popular with German naturopaths a few decades ago. It seems to experience a revival and is bound to boom, now that Trump has claimed that UV light in the body might be effective against the corona-virus.

I have conducted in-vitro experiments with this method in the mid 1980s (sorry, I cannot find the publication and am not even sure we ever published the results). They failed to show any meaningful effects on blood rheology which was my main research interest at the time. I thus know how the method works:

  1. You draw a small (10-30 ml) venous blood sample.
  2. You anticoagulate it.
  3. You place it in a special chamber.
  4. You radiate it for a prescribed time with UV light.
  5. You inject the blood back into the patient.

There are semi-automated devices that are commercially available and render the process fairly easy. It seems that UBI has become popular in the US SCAM scene. One advocate of UBI informs us that:

This proven therapy has 70 years of history, helping those who still suffer after exploring other medicines.  Step into the world of over 140 published medical studies where BioPhotonic Therapy has shown amazing success rates.

  • No major side effects
  • Treats over 40 diseases  
  • Low cost 
  • Helps those in need

The same advocate also lists several viral infections for which UBI is, in his opinion, effective:

  • Hepatitis
  • HIV
  • Influenza
  • Herpes simplex/zoster
  • Mononucleosis
  • Mumps
  • Measles Infections
  • Viral Pneumonia
  • Polio

A more modern version of the same method has recently received CE marking to commercially sell its UVLrx 1500 multi-wavelength, intravenous light therapy system in the European Union. The UVLrx 1500 System offers the first intravenous, concurrent delivery of ultraviolet-A (UVA) and multiple visible light wavelengths. Using the company’s patent pending Dry Light Adapter™ and a standard I.V. catheter, the UVLrx 1500 eliminates the need for removal of blood from the body.

UVLrx’s CE marking covers the following indications:

  • Reduction of pain
  • Reduction of pathogens in the blood
  • Reduction of inflammation
  • Immune system modulation
  • Improved ATP synthesis
  • Improved wound healing
  • Improved blood oxygen transport
  • Improved circulation

Needless to say, I think, that there is no good evidence for any of these claims. Yes, there are quite a few papers on UBI and related methods. But most of them are in-vitro studies, while robust clinical trials are missing completely (if someone knows otherwise, I’d be pleased to correct this statement). Needless to say also that UBI is an invasive treatment where lots of things might go badly wrong.

So why is Trump promoting this UV therapy idea?

Search me!

The UK university at Teesside has announced its plan to offer a chiropractic degree. The course will be hosted by its School of Health and Life Sciences and the Department of Allied Health Professions. The designated course leader, Daniel Moore, explains:

“The benefit for us when we developed this curriculum from a blank canvas was not only exciting, but it granted an opportunity for us to do things in a slightly different way.  The placement model is something I feel we may see more of in the future because the benefit it gives students is significant from a confidence point of view, and provides interaction with both the profession and patients from the first semester.  We also could create our modules from scratch giving us the ability to build context into historically quite fixed modular content whilst staying mapped to the education standards.  We also give all students iPads from the start of their degree which will allow us to collaborate and communicate in a really unique and beneficial way throughout the course.”

“I have always been interested in knowledge transfer, and how as individuals we learn and how we develop ourselves.  Part of my draw to being a chiropractor was my wanting to help people become the best version of themselves.  So it isn’t a great leap to the higher educational world where my goal now is similar, facilitating and leading people towards being the best chiropractor they can be.  They can then move into the profession and make a positive impact themselves.  I feel I can make a positive difference to the profession here, and that is important to me.”

“My goal in my mind is clear.  To create chiropractors that are safe, competent and confident, to go into practice and add value to the chiropractic profession.  I also hope I can create students that are excited to graduate and practice chiropractic, I feel we have a lot to offer as chiropractors and students should be excited about that opportunity.”

“I am from the North East of England, so have an affinity to this region.  I am passionate about chiropractic and think my history, since being a student shows my willingness to represent that.  I was a student member of the NMSK faculty of the College of Medicine as well as being on WIOC Student Council for 4 years.  I then moved into practice where I took on delivery of CPD events for the RCC, qualified as an FA Medical Tutor, I was also involved in writing initial material for the RCC’s online Quality Standards offering, and have been involved in multiple British Masters Athletics Medical Team events with a great group of people over the years.  I am a dad, to two wonderful boys and a husband to Elaine (also a chiropractor and BCA member).  I keep myself fit, and race Cross Country Mountain Bikes and Cyclocross to a national level and plan on competing at the World Masters Championships this August all things being well. Now I lead the chiropractic course at Teesside and I am planning my PhD, I couldn’t be more excited about the opportunities that lay ahead.”

Allow me to add a few points and ask a few questions:

  1. Mr Moore wants to ‘create chiropractors that are safe, competent and confident’. How about creating therapists who are effective in curing or alleviating disease or symptoms? Has he perhaps realised that, in chiropractic, this is not possible? Do his peers at Teesside know that chiropractic does not generate more good than harm?
  2. I am fascinated to learn that Mr Moore is now planning to do his PhD. Should a higher degree not have been a precondition to becoming a course leader in academia?
  3. As far as I can see, Mr Moore has never published a single paper in the peer-reviewed literature. Should a track record in research not have been a precondition to becoming a course leader in academia?
  4. Does the University of Teesside know that even the most proper (and I fear the course does not even appear to be proper) teaching of nonsense must result in nonsense?
  5. Have they taken leave of their senses at Teesside university?

This study by Australian pharmacists, assessed the quality and relevance of community pharmacists’ information gathering (questioning), counselling and product selection when interacting with customers requesting a s0-called alternative medicine (SCAM) product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for ‘pharmacy only’ (S2) and ‘pharmacist only’ (S3) medicines.

A covert simulated patient (SP) was used to investigate the response of pharmacists to a request for a natural product for stress. The SP documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature.

Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product.

The authors concluded that the pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending SCAMs.

This paper offers a host of interesting information. For instance, it reveals that almost all pharmacists recommended at least one product for sale, about half of them recommended more than one. Considering that the evidence for most of the products in question is weak (to say the least), this seems concerning.

The second most recommended product, the ‘Bach Rescue Remedy‘, is perhaps a good case in point. There is no evidence that it has any effect on stress or any other condition. As the product contains no active ingredient, it is also implausible to assume it might work beyond placebo. Yet, many pharmacists are happy not only to sell it to the unsuspecting public, but even to recommend it to a customer who seeks out their advice.

I find this quite intolerable.

The paper thus confirms the point I have made repeatedly on this blog and elsewhere: community pharmacists seem to behave like commercially motivated shopkeepers, yet they are healthcare professionals who have to abide by an ethical code. When confronted with this overt conflict of interest, their vast majority seem to opt for violating their professional ethics in favour of profit.

I fail to understand why, despite these facts being well-known for so long, the professional organisations of pharmacists are doing do very little to rectify this appalling situation.

While many of us are wondering what SCAM will be promoted next for the corona pandemic, the editor of the infamous JCAM thought it wise to publish this note along with an article advertising the wonders of Ayurvedic medicine and yoga for the corona-virus entitled: ‘Public Health Approach of Ayurveda and Yoga for COVID-19 Prophylaxis‘.

Here are John Weeks’ remarks:

National governments are deeply divided over whether traditional, complementary and integrative practices have value for human beings relative to COVID-19. We witness a double standard. Medical doctors explore off-label uses of pharmaceutical agents that may have some suggestive research while evidence that indicates potential utility of natural products, practices and practitioners is often dismissed. In this Invited Commentary, a long-time JACM Editorial Board member Bhushan Patwardhan, PhD, from the AYUSH Center of Excellence, Center for Complementary and Integrative Health at the Savitribai Phule Pune University, India and colleagues from multiple institutions make a case for the potential roles of Ayurvedic medicine and Yoga as supportive measures in self-care and treatment. Patwardhan is a warrior for enhancing scientific standards in traditional medicine in India. Patwardhan was recently appointed by the Ministry of AYUSH, Government of India, as Chairman of an 18 member expert group known as “Interdisciplinary AYUSH Research and Development Taskforce” for initiating, coordinating and monitoring efforts against COVID-19. He was last seen here in an invited commentary entitled “Contesting Predators: Cleaning Up Trash in Science” (JACM, October 2019). We are pleased to have this opportunity to share the recommended approaches, the science, and the historic references as part of the global effort to leave no stone unturned in best preparing our populations to withstand COVID-19 and future viral threats. – John Weeks, Editor-in-Chief, JACM

His remarks are, I think, worthy of four very brief comments:

  1. As far as I can see, national governments and their advisors struggle to make sense of the rapidly changing situation. In all the confusion, they are, however, very clear about one thing: traditional, complementary and integrative practices have no real value for human beings relative to COVID-19.
  2. The double standards Weeks bemoans do not exist. There are dozens of studies currently on their way testing virtually any therapeutic option that shows even the smallest shimmer of hope. Testing implausible options only because some quacks feel neglected would be the last thing the world needs in the present situation.
  3. Weeks claims that ‘evidence that indicates potential utility of natural products, practices and practitioners is often dismissed’. What evidence? The article published alongside his remarks is free of what anyone with a thinking brain might call ‘evidence’. If there is evidence, Weeks or anyone else should approach the experts responsible for conducting the current trials; I am sure that they would listen and be only too happy to consider any reasonable option.
  4. The Indian Ministry of AYUSH has indeed been promoting all sorts of quackery for the corona-virus. This behaviour is likely to cause many fatalities in India. It should be squarely condemned and not promoted as Weeks seem to think.

I have known for a long time that homeopathy can be dangerous, not least through the neglect of effective treatments for seriously ill patients. But I did not know that it can cause a bone fracture – until yesterday, that is.

Yes, you have understood me correctly! Here is the first case-report of a homeopathy-induced bone fracture:

My sister in law has two charming elderly ladies as neighbours. They are now in their 90ies and have, over the years, become very frail. She therefore has taken to looking after them where she can. Since the two sisters rarely leave their home these days, they have developed a new hobby: ordering things they find attractive through the post; it seems to be their greatest pleasure and has frequently led to complications that could easily fill a book of short stories.

Recently, an advertisement caught they eyes. It proclaimed in no uncertain terms that, even at their advanced age, they could re-gain some strength and energy through a specific homeopathic remedy (Boiron, I suspect, but I cannot be sure). This, of course, sounded far too good to not give it a try, and the two sisters promptly ordered what seemed to the the answer to their prayers.

The little package arrived yesterday, and the excitement must have been palpable. The more impatient of the two sisters insisted to try the wonder drug straight away. With her hands shaking in anticipation, she opened the tiny vial of globuli. Overwhelmed by trepidation, she spilled the entire content of globuli on the floor.

‘That’s bad but not disastrous’, she thought. Trying to pick them up, she stepped on some of them. As our frail hero weighs not even 50kg, the globuli acted like the ball-bearings or a pair of roller-skates. Her feet flew off, she lost her balance and landed abruptly and painfully on her side under the kitchen table covered by a table lamp and a chair.

The second sister rushed to help but proved to be too frail to get the patient back on her feet. This is when my sister in law was phoned and, ignoring the current lock-down, arrived with her husband to the rescue. What they saw was a scene of utter devastation: Globuli everywhere, their elderly neighbour moaning on the floor covered with various items she has tried to hold on to when attempting to prevent the fall. Together they managed to get the patient back up, but soon realised that she was badly injured. An ambulance was called and in the local hospital an X-ray confirmed the diagnosis: rib fracture.

I am glad to say, the old lady – my best wishes to her and her sister! – is now back home and recovering well. Little does she know that she is about to enter the history books of medicine as the first ever documented case of ‘homeopathy-induced rib fracture’.

Yes, you read this correctly: 2/3 of the German population revealed themselves to be stupid – at least this is what a survey sponsored by the German Association of Homeopathic Doctors seems to imply.

Hard to believe?

Well, read the press-release for yourself [and if you are not reading German, let me fill you in below]:

Fast zwei Drittel der Bevölkerung in Deutschland würde den Einsatz homöopathischer Arzneimittel zur Behandlung von Covid-19-Erkrankungen befürworten.

Das ist eines von mehreren Ergebnissen einer repräsentativen Umfrage des Instituts für Politik- und Sozialforschung forsa, durchgeführt im Auftrag des Deutschen Zentralvereins homöopathischer Ärzte.

Angst vor Covid-19. Interesse an homöopathischen Methoden.

Befragt wurden insgesamt 1009 Bundesbürger, unter anderem zum Grad ihrer Besorgnis vor einer Erkrankung an Covid-19, ihrem Interesse an Vorsorgemaßnahmen gegen eine Corona-Infektion zusätzlich zu besonderer Hygiene, ihrer Einstellung zu einer Behandlung von Covid-19 mit homöopathischen Arzneimitteln, sowie zur Befürwortung oder Ablehnung staatlicher finanzieller Förderung von Forschungsprojekten zu homöopathischen Vorsorge- und Behandlungsmethoden von Covid-19-Erkrankungen.

61% ziehen homöopathische Behandlung mindestens ernsthaft in Betracht

Mehr als die Hälfte aller Befragten hat bereits Erfahrung mit einer homöopathischen Behandlung bei früheren Erkrankungen gemacht. Noch mehr, nämlich fast zwei Drittel aller Befragten, würden unter der Voraussetzung, dass es in der Vergangenheit schon positive Erfahrungen mit diesem Mittel gab, im Fall einer Erkrankung an Covid-19 eine homöopathische Behandlung für sich selbst oder ihnen nahestehenden Personen auf jeden Fall (26 %) oder eher (34 %) befürworten

Homöopathie soll auch Gelder für Forschungsprojekte erhalten

Auch hinsichtlich der weiteren Erforschung von Methoden zur Vorbeugung gegen eine Infektion mit dem Corona-Virus und der Behandlung von Covid-19 fänden es viele Bürger (42 %) in Deutschland gut oder sehr gut- in der Altersgruppe über 45 Jahren sogar rund oder mehr als die Hälfte – dass staatliche Gelder nicht nur in Forschungsprojekte der konventionellen Medizin gesteckt werden, sondern dass auch Projekte der homöopathischen Medizin gezielt gefördert werden.

Here is the gist of the press-release for non-German speakers:

The German Association of Homeopathic Doctors paid an otherwise respectable agency to run a poll for them; not just any poll, but one that is robust enough to be representative of the entire German population (sample size of 1009!). The questions asked were about homeopathy in the present health crisis. The results show that:

  • 61% would seriously consider using homeopathy,
  • more than 50% have had positive experience with homeopathy during previous episodes of illness,
  • more than 2/3 would consider homeopathy for a corona-virus infection, provided that there has been positive experience with this approach in the past,
  • 42% of Germans would find it good or very good, if public funds would also be dedicated to research in homeopathy.

What does that tell us?

It tells us that the Germans are not that stupid after all: they would only consider homeopathy for a corona-virus infection, if there has been positive experience with this approach in the past. As such positive evidence is absent, they would not consider homeopathy!

The poll also tells us that surveys can be spun to generate the most idiotic findings provided the questions that are being asked are phrased in a sufficiently leading way. It moreover tells us that the German Association of Homeopathic Doctors seem to believe that Germans are stupid and do not realise that this survey is a despicable stunt for boosting their failing business. Finally, it tells us that the German Association of Homeopathic Doctors are behaving grossly unethical to promote homeopathy during this pandemic. There is not a jot of evidence that homeopathy might be effective and a lot of evidence to show that promoting useless treatments is dangerous.

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