Monthly Archives: November 2020
Many people have pointed out that the US election was disappointing because, after Trump’s four years in office, people must have realised that he is a vile and dangerous president. Yet, a very large proportion of Americans voted for him. Some commentators even speak of a cult-like movement supporting Trump.
Many people have also pointed out that some forms of so-called alternative medicine (SCAM) are irrational and even harmful. Yet, a sizable proportion of the population continue to use them. Some experts even speak of a cult-like movement supporting SCAM.
Why do so many people make irrational choices?
Are they all stupid?
I don’t think so!
The way I see it, a key here must be critical thinking. Critical thinking means making decisions and judgements based on (often confusing) evidence. According to the ‘National Council for Excellence in Critical Thinking’ it is the intellectually disciplined process of actively and skilfully conceptualizing, applying, analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.
Critical thinking is not something one is born with; but most people can learn this skill. In one study, researchers measured the relationship between student’s religion, gender, and propensity for fantasy thinking with the change in belief for paranormal and pseudoscientific subjects following a science and critical thinking course. Following the course, overall beliefs in paranormal and pseudo-scientific subcategories were lower by 6.8–28.9%.
Though easily confused with intelligence, critical thinking has little to do with it. Critical thinking is a collection of cognitive skills that allow us to rationalise. Critical thinkers are flexible thinkers who require evidence to support their beliefs and recognize fallacious attempts to mislead them. Critical thinking is the skill of minimising cognitive biases.
If I am correct, those people who voted for Trump in the US (or similar politicians, such as Boris Johnson in the UK) and those consumers who spend their money on bogus SCAMs both are deficient in their ability to think critically. This does not mean that they are the same individuals. I merely suggest they have one characteristic in common.
It is crucial, I think, to realise that critical thinking can be improved with education. In the final analysis, disappointing results of any election in which (far too many) people voted for a dishonest, corrupt politician, and the disappointingly high usage of bogus SCAMs have, I believe, their roots in poor education. This means that, if we want to reduce the risk of the Trump disaster repeating itself, we need to invest effectively and generously in better educating our children (and adults). And if we want to minimise the risk of consumers wasting their money or damaging their health with bogus SCAMs, we need to make sure the public has a sufficient understanding of logic, reason, evidence and science.
Reflexology (originally called ‘zone therapy’ by its inventor) is a manual technique where pressure is applied to the sole of the patient’s foot. Reflexology is said to have its roots in ancient cultures. Its current popularity goes back to the US doctor William Fitzgerald (1872-1942) who did some research in the early 1900s and thought to have discovered that the human body is divided into 10 zones each of which is represented on the sole of the foot. Reflexologists thus drew maps of the sole of the foot where all the body’s organs are depicted. Numerous such maps have been published and, embarrassingly, they do not all agree with each other as to the location of our organs on the sole of our feet. By massaging specific zones which are assumed to be connected to specific organs, reflexologists believe to positively influence the function of these organs.
So, does reflexology do more good than harm?
The aim of this review was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality.
Twenty-six studies could be included. The meta-analyses showed that foot reflexology intervention significantly improved adult depression, anxiety, and sleep quality. Metaregression revealed that an increase in total foot reflexology time and duration can significantly improve sleep quality.
The authors concluded that foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.
Finally a so-called alternative medicine (SCAM) that is backed by soild evidence!
Or perhaps not?
Here are a few concerns that lead me to doubt these conclusions:
- Most of the primary studies were of poor methodological quality.
- Most studies failed to mention adverse effects.
- Very few studies controlled for placebo effects.
- There was evidence of publication bias (negative studies tended to remain unpublished).
- Studies published in languages other than English were not considered.
- The authors fail to point out that a foot massage is, of course, agreeable (and thus may relieve a range of symptoms), but reflexology with all its weird assumptions is less than plausible.
- Many of the studies located by the authors were excluded for reasons that are less than clear.
The last point seems particularly puzzling. Our own trial, for instance, was excluded because, according to the review authors, it did not include relevant outcomes. However, our method secion makes it clear that the primary focus for this study was the subscores for anxiety and depression, which comprise four and seven items, respectively. As it happens, our study was negative.
Also cuirous is the fact that the authors did not mention our own 2011 systematic review of reflexology:
Reflexology is a popular form of complementary and alternative medicine (CAM). The aim of this update is to critically evaluate the evidence for or against the effectiveness of reflexology in patients with any type of medical condition. Six electronic databases were searched to identify all relevant randomised clinical trials (RCTs). Their methodological quality was assessed independently by the two reviewers using the Jadad score. Overall, 23 studies met all inclusion criteria. They related to a wide range of medical conditions. The methodological quality of the RCTs was often poor. Nine high quality RCTs generated negative findings; and five generated positive findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia yet important caveats remain. It is concluded that the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.
I wonder why!
As the world is waiting for the drawn-out process of vote-counting in the US to end, and as Trump has already declared himself to be the winner, it is easy to get emotional about the harm the current POTUS has done (and might do in future) to his country and the world. One comment I read this morning:
Christians have feared the arrival of the Anti-Christ for 2 000 years. And as soon as he appears, they vote for him.
I have to admit that I find it amazing that close to 50% of the US citizens, after observing Trump in action, are not wiser than to vote for him – amazing and frightening!
Yet, we must remain rational.
He might still be voted out!
To remind myself why I, as a scientist, find Donald Trump so deeply objectionable, I have collected a few of his quotes on science. I hope you see my point:
- Not only are wind farms disgusting looking, but even worse they are bad for people’s health
- Remember, new “environment friendly” lightbulbs can cause cancer. Be careful– the idiots who came up with this stuff don’t care.
- Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!
- The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive.
- So, supposing we hit the body with a tremendous — whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body, which you can do either through the skin or in some other way, and I think you said you’re going to test that too. It sounds interesting…
- And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that. So, that, you’re going to have to use medical doctors with. But it sounds — it sounds interesting to me.
- People are surprised that I understand it [science]. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for President.
- Some say that and some say differently [global warming]. I mean, you have scientists on both sides of it. My uncle was a great professor at MIT for many years. Dr. John Trump. And I didn’t talk to him about this particular subject, but I have a natural instinct for science, and I will say that you have scientists on both sides of the picture.
- And when you’re talking about an atmosphere, oceans are very small. And it blows over and it sails over.
- I’m speaking with myself, number one, because I have a very good brain and I’ve said a lot of things.
- What do I know about it? All I know is what’s on the internet
To this picture, we evidently have to add
NO UNDERSTANDING OF OR RESPECT FOR SCIENCE.
If you think that the papers published on SCAM for humans are bad, you should have a look at those in the veterinary sector. Take for instance this article from the AHVMA (American Holistic Veterinary Medical Association) Journal:
Evidence demonstrates that acupuncture and herbal medicine are useful and effective for the treatment of seizures. In the perspective of Traditional Chinese Veterinary Medicine (TCVM), seizures in dogs and cats can be classified into 6 patterns:
- Obstruction by WindPhlegm,
- Internal Profusion of Phlegm-Fire,
- Stagnation of Blood,
- Liver Blood Deficiency,
- Liver/Kidney Yin Deficiency,
- Yin Deficiency with Blood Deficiency.
This article focuses on how to differentiate and treat these patterns using herbal medicine and acupuncture. An overview of clinical trials is provided, and case examples are also included.
The authors from the ‘Equine Acupuncture Center/University of Florida, USA, concluded that the combination of TCVM and Western medicine (WM) can be an effective therapeutic approach to control seizures and epilepsy. WM is effective for initial control of severe seizures and in identification of the cause of the disease. TCVM can be effectively used for the treatment of milder cases and to help control seizures in those patients that fail to respond to WM.
Having done some research into acupuncture for animals myself, I was particularly interested in this aspect of the paper – interested and disappointed, I have to admit. The sad truth is that, despite the opimistic conclusions of the authors, there is no sound evidence. As no good evidence has emerged since, our own systematic review of 2006 (which was not cited by the authors of the above article) still holds true:
Acupuncture is a popular complementary treatment option in human medicine. Increasingly, owners also seek acupuncture for their animals. The aim of the systematic review reported here was to summarize and assess the clinical evidence for or against the effectiveness of acupuncture in veterinary medicine. Systematic searches were conducted on Medline, Embase, Amed, Cinahl, Japana Centra Revuo Medicina and Chikusan Bunken Kensaku. Hand-searches included conference proceedings, bibliographies, and contact with experts and veterinary acupuncture associations. There were no restrictions regarding the language of publication. All controlled clinical trials testing acupuncture in any condition of domestic animals were included. Studies using laboratory animals were excluded. Titles and abstracts of identified articles were read, and hard copies were obtained. Inclusion and exclusion of studies, data extraction, and validation were performed independently by two reviewers. Methodologic quality was evaluated by means of the Jadad score. Fourteen randomized controlled trials and 17 nonrandomized controlled trials met our criteria and were, therefore, included. The methodologic quality of these trials was variable but, on average, was low. For cutaneous pain and diarrhea, encouraging evidence exists that warrants further investigation in rigorous trials. Single studies reported some positive intergroup differences for spinal cord injury, Cushing’s syndrome, lung function, hepatitis, and rumen acidosis. These trials require independent replication. On the basis of the findings of this systematic review, there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals. Some encouraging data do exist that warrant further investigation in independent rigorous trials.
The AHVMA-article becomes wholly farcical, once we see the heading the AHVMA-journal has given it:
The AHVMA-journal is the official publication of the American Holistic Veterinary Medical Association, according to their own statement, is the mindful leader elevating the veterinary professional through innovation, education, and advocacy of integrative medicine.
One stated objective of the AHVMA is to advance and educate in the science and art of holistic veterinary medicine. If their new ‘scientific review’ is anything to go by, they seem to have a most bizarre view about science. The question that occurred to me while reading the paper was this: are they not promoting animal abuse, a term defined as any use or treatment of animals that seems unnecessarily cruel, regardless of whether the act is against the law?
I know of one patient who turned to the Gerson Therapy having been told that she was suffering from terminal cancer and would not survive another course of chemotherapy. Happily, seven years later she is alive and well. So therefore it is vital that, rather than dismissing such experiences, we should further investigate the beneficial nature of these treatments.
HRH The Prince of Wales (2004)
I was reminded of this embarrassing (because displaying profound ignorance) quote when I looked at the website of the ‘GERSON SUPPORT GROUP UK‘ where it is prominently cited. Under the heading ‘SCIENCE & CLINICAL RATIONAL’ the site offers a long article about the Gerson therapy (GT). Allow me to show you a few quotes from it:
Dr Max Gerson’s therapy is based on the belief that insufficient nutrients within the cells and an accumulation of toxins in the tissues lead to a breakdown in healthy cellular function which, if left unchecked, can trigger cancer.
That is interesting, I find, because the statement clearly admits that the GT is not an evidence-based therapy but a belief-based treatment.
The therapy that he developed uses a restrictive, plant-based diet and specific supplements to boost healthy cellular function; and various detoxification procedures, including coffee enemas, to eliminate waste products.
The claims hidden in this sentence remain unproven. There is no evidence that cellular fuction is boosted, nor that the procedures eliminate toxins.
… we only need to look at communities across the globe which exist in a pre-industrialised state to see that, whilst they might be more likely to die from pneumonia or tuberculosis, rates of degenerative illness are a fraction of those in the ‘developed‘ world. The age-adjusted death rate from breast cancer is less than 2 per 100,000 of the population in Thailand, Sri Lanka and El Salvador and around 33 per 100,000 in the UK, US, The Netherlands and numerous other affluent, Western countries.
Correlation is not causation! Pre-industrial societies also watch less TV, eat less ice-cream, read less fashion magazines, etc., etc. Are these habits also the cause of cancer?
… migrant studies show that within two generations the cancer rates of migrants increase rapidly towards Western rates, again underlining the assertion that cancer is caused primarily by diet and lifestyle rather than ‘faulty’ genes.
In no way is this an argument for eating raw vegetable and taking your coffee via the rectum.
In the German scientific golden age of the 1920s and 30s…
Golden age for what, for fascists?
Gerson had used a restricted diet to cure himself of migraines. He then helped another patient to reverse tuberculosis, and many others to reverse a variety of degenerative illnesses, all by similar means. He later developed his therapy to the point where he was able to help individuals reverse cancer.
In this case, Max Gerson was ignorant of the fact that experience and evidence are two fundamentally different things.
Max Gerson developed his therapy in an iterative way, starting with a restrictive plant-based diet, adding vitamins, minerals and enzymes to encourage the oxygenation of the cells and then introducing the coffee enemas to aid detoxification of waste products. What is fascinating is that science has subsequently explained the mechanism of action behind some of his theories. (See Biochemical Basis to the Therapy).
Science has not explained the mechanism of action, not least because the action has never been verified. There are no robust clinical trials of Gerson’s therapy. Evidently, 100 years were not enough to conduct any – or perhaps the proponents know only too well that they would not generate the results they hoped?
Equally interesting is that in 2012 Dr Thomas Seyfried published the results of many years research in Cancer as a Metabolic Disease.
Really? On Medline, I find only two cancer-related papers for Seyfried T. 2012:
Thus, nearly a century after their original proposition that the fundamental cause of cancer was faulty cellular metabolism, it seems that doctors Otto Warburg and Max Gerson might be vindicated.
No, to ‘vindicate’ a therapeutic suggestion one needs several rigorous clinical trials. And for the GT, they remain absent.
So, what does the GT amount to?
- proponents had ~100 years to produce evidence;
- they failed to do so;
- thus the therapy is at best unproven;
- it is also biologically implausible;
- moreover, it is expensive;
- crucially it is not free of serious adverse effects;
- it is promoted only by those who seem to make money from it.
The only controlled clinical trial of a Gerson-like therapy that I know of is this one (rarely cited by Gerson fans):
Conventional medicine has had little to offer patients with inoperable pancreatic adenocarcinoma; thus, many patients seek alternative treatments. The National Cancer Institute, in 1998, sponsored a randomized, phase III, controlled trial of proteolytic enzyme therapy versus chemotherapy. Because most eligible patients refused random assignment, the trial was changed in 2001 to a controlled, observational study.
All patients were seen by one of the investigators at Columbia University, and patients who received enzyme therapy were seen by the participating alternative practitioner. Of 55 patients who had inoperable pancreatic cancer, 23 elected gemcitabine-based chemotherapy, and 32 elected enzyme treatment, which included pancreatic enzymes, nutritional supplements, detoxification, and an organic diet. Primary and secondary outcomes were overall survival and quality of life, respectively.
At enrollment, the treatment groups had no statistically significant differences in patient characteristics, pathology, quality of life, or clinically meaningful laboratory values. Kaplan-Meier analysis found a 9.7-month difference in median survival between the chemotherapy group (median survival, 14 months) and enzyme treatment groups (median survival, 4.3 months) and found an adjusted-mortality hazard ratio of the enzyme group compared with the chemotherapy group of 6.96 (P < .001). At 1 year, 56% of chemotherapy-group patients were alive, and 16% of enzyme-therapy patients were alive. The quality of life ratings were better in the chemotherapy group than in the enzyme-treated group (P < .01).
Among patients who have pancreatic cancer, those who chose gemcitabine-based chemotherapy survived more than three times as long (14.0 v 4.3 months) and had better quality of life than those who chose proteolytic enzyme treatment.
Considering all this, I believe, it would be hard to name a cancer quackery that is less credible than the GT.