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

Monthly Archives: January 2021

Professor Andreas Michalsen is the clinical director of the department of naturopathy in a Berlin hospital. He seems most keen to represent the scientific side of so-called alternative medicine in Germany. He has published several (fairly uncritical) books on SCAM and numerous papers in the medical literature. I had a look at those papers and hope you agree that Michalsen should join the other extraordinary experts in THE ALTERNATIVE MEDICINE HALL OF FAME:

My Medline search on 10/1/2021 for ‘Michalsen A, clinical trial’, generated 69 hits. Below I list the key conclusions of the 47 SCAM studies that were published in English by Andreas Michalsen et al:

  1. In this explorative pilot trial, an increase of HRV (more parasympathetic dominance and overall higher HRV) after ten weeks of yoga in school in comparison to regular school sports was demonstrated, showing an improved self-regulation of the autonomic nervous system. (pilot)
  2.  Results showed a contrast between the high agreement of the consented final diagnosis and disagreement on certain diagnostic details.
  3. A single session of leech therapy is more effective over the short term in lowering the intensity of pain over the short term and in improving physical function and quality of life over the intermediate term.
  4. Short term fasting during chemotherapy is well tolerated and appears to improve QOL and fatigue during chemotherapy. Larger studies should prove the effect of STF as an adjunct to chemotherapy. (pilot)
  5. Administering verum (a complex homeopathic drug) resulted in a statistically significantly greater improvement of the Cough Assessment Score than the placebo. The tolerability was good and not inferior to that of the placebo.
  6. Ayurvedic treatment is beneficial in reducing knee OA symptoms.
  7. We did not find any clinically relevant differences between groups in this controlled clinical pilot trial of 8 wk of intermittent fasting in healthy volunteers.
  8. We found positive effects for both groups, which however were more pronounced in the Ayurvedic group. The conversational and counseling techniques in the Ayurvedic group offered more opportunities for problem description by patients as well as patient-centered practice and resource-oriented recommendations by the physician.
  9. Results of this study suggest that prolonged fasting is feasible and might have beneficial clinical effects. (pilot)
  10. This clinical trial indicates comparable efficacy of the herbal combination and antibiotic, although non-inferiority was not proved. However, the results and lessons learned are important for the planning of future trials.
  11. Thus, cycles of a 5-day fasting-mimiking diet are safe, feasible, and effective in reducing markers/risk factors for aging and age-related diseases.
  12. Ayurvedic external treatment is effective for pain-relief in chronic low back pain in the short term.
  13. Focused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain.
  14. This randomized trial found no effects of yoga on health-related quality of life in patients with colorectal cancer. Given the high attrition rate and low intervention adherence, no definite conclusions can be drawn from this trial.
  15. The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain.
  16.  In conclusion, meditation may support chronic pain patients in pain reduction and pain coping. 
  17. The herbal preparation of myrrh, chamomile extract and coffee charcoal is well tolerated and shows a good safety profile. We found first evidence for a potential efficacy non-inferior to the gold standard therapy mesalazine, which merits further study of its clinical usefulness in maintenance therapy of patients with ulcerative colitis.
  18. Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.
  19. In this preliminary trial, yoga appears to be an effective treatment in chronic neck pain with possible additional effects on psychological well-being and QOL.  (pilot)
  20. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain.
  21. The data indicate that during needle insertion high dose acupuncture stimulation leads to a higher increase of sympathetic nerve activity than low dose stimulation independent of personality. After needle insertion subjects who tend to augment incoming stimuli might show a lack of psychological relaxation when receiving high dose stimulation.
  22. In patients with METS, phlebotomy, with consecutive reduction of body iron stores, lowered BP and resulted in improvements in markers of cardiovascular risk and glycemic control.
  23. The present study gives preliminary evidence that healing clay jojoba oil facial masks can be effective treatment for lesioned skin and mild acne vulgaris.
  24. In a laboratory setting, an electroacupuncture procedure was as effective as a single dose of an orally administered opiate in reducing experimentally induced ischaemic pain.
  25. In the presence of modern treatments, complementary prescription of comprehensive lifestyle modification has no impact on coronary artery calcium progression but sustainable benefit for blood pressure, heart rate and the need of anti-ischemic medication is demonstrated. 
  26. A single course of leech therapy was effective in relieving pain in the short-term and improved disability in intermediate-term. Leeches might be considered as an additional option in the therapeutic approach to lateral epicondylitis.
  27. Gua sha has beneficial short-term effects on pain and functional status in patients with chronic neck pain.
  28. Alterations in short-chain fatty acids were found in terms of significant changes to increased acetate levels in the fasting group.
  29. In this first study on the efficacy of cantharidin blisters, a clinically relevant pain-relieving short-term effect on lumbar spinal stenosis was observed.
  30. We conclude that cupping therapy may be effective in relieving the pain and other symptoms related to CTS.
  31.  A single course of leech therapy is effective in relieving pain, improving disability and QoL for at least 2 months.
  32. The high effect sizes indicate that repeated rhythmic embrocation with Solum Oil may improve mood, pain perception (sensory PPS), and the ability to cope with pain (affective PPS) in patients with chronic low back pain.
  33. The data indicate, that verum acupuncture and sham acupuncture might have a beneficial influence on the autonomic nervous system in migraineurs with a reduction of the LF power of HRV related to the clinical effect. This might be due to a reduction of sympathetic nerve activity. VA and SA induce different effects on the high-frequency component of HRV, which seem, however, not to be relevant for the clinical outcome in migraine.
  34. Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia. Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.
  35. These results are consistent with possible short-term benefits of a comprehensive lifestyle modification program on some aspects of quality-of-life and emotional well-being, but no effects were discernable 12 months after completion of therapy.
  36. In the presence of modern treatments, comprehensive lifestyle modification provides no additional benefits on progression of atherosclerosis but improves autonomic function, angina, and QOL with concomitant reduced need of medication. These responses are more pronounced in GNB3*825T allele carriers.
  37. Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal flora and sIgA levels in patients with RA and FM.
  38. Women suffering from mental distress participating in a 3-month Iyengar yoga class show significant improvements on measures of stress and psychological outcomes.
  39. Adoption of a Mediterranean diet by patients with medically treated CAD has no effect on markers of inflammation and metabolic risk factors.
  40. A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.
  41. Mind-body therapy may improve quality of life in patients with UC in remission, while no effects of therapy on clinical or physiological parameters were found, which may at least in part be related to selective patient recruitment.
  42. Leech therapy helps relieve symptoms in patients with osteoarthritis of the knee.
  43. A home-based hydrotherapeutic thermal treatment program improves quality of life, heart-failure-related symptoms and heart rate response to exercise in patients with mild chronic heart failure. The results of this investigation suggest a beneficial adaptive response to repeated brief cold stimuli in addition to enhanced peripheral perfusion due to thermal hydrotherapy in patients with chronic heart failure.
  44. This open pilot study demonstrates that along with a decrease in sleep arousals a 1-week fasting period promotes the quality of sleep and daytime performance in non-obese subjects.
  45. Periarticular application of 4 leeches led to rapid relief of pain with sustained improvement after 4 weeks in the absence of major complications.
  46. Short-term fasting in inpatients with pain and stress syndromes is safe and well tolerated, concomitant mineral supplements have no additive benefit.
  47. The results suggest that the cardiovascular response during whole-body infrared-A irradiation is accompanied by significant changes in autonomic cardiac regulation: A significant decrease of low-frequency power corresponding to depressed vagal activity results in an increase of Iow/high-frequency ratio. During serial hyperthermias the acute response is diminished suggesting an adaption of the autonomic response to hyperthermia.

This list is impressive in several ways: very few SCAM researchers managed to publish 47 Medline-listed clinical studies, and nobody I know has ever conducted clinical trials of so many different SCAMs in so many different medical conditions. They include:

  • Acupuncture
  • Alexander technique
  • Ayrurvedic medicine
  • Blood letting
  • Cupping
  • Diet
  • Embrocation
  • Fasting
  • Gua cha
  • Herbal medicine
  • Homeopathy
  • Hydrotherapy
  • Hyperthermia
  • Meditation
  • Mind/body therapies
  • Leeching
  • Life style modification
  • Yoga

While this is astounding, another fact is even more baffling: with just 2 or 3 exceptions, all these studies yield postive results. Whatever Michalsen touches turns to gold! And if it doesn’t, he spins the findings such that the conclusions are at least partly positive; see for instance No 14, 33, 36, 40 or 41 in the above list.

WELCOME TO THE ALTERNATIVE MEDICINE HALL OF FAME PROFESSOR MICHALSEN!

Turmeric is certainly a plant with fascinating properties; we have therefore discussed it before. Reseach into turmeric continues to be active, and I will continue to report about new studies.

This study was aimed at estimating the effect of turmeric supplementation on quality of life (QoL) and haematological parameters in breast cancer patients who were on Paclitaxel chemotherapy. In this case series with 60 participants, QoL was assessed using a standard questionnaire and haematological parameters were recorded from the patients’ hospital records.

Turmeric supplementation for 21 days resulted in clinically relevant and statistically significant improvement in global health status, symptom scores (fatigue, nausea, vomiting, pain, appetite loss, insomnia), and haematological parameters.

The authors concluded that turmeric supplementation improved QoL, brought about symptom palliation and increased hematological parameters in breast cancer patients.

Really?

The way the conclusions are phrased, they clearly imply that turmeric caused the observed outcomes. How certain can we be that this is true?

On a scale of 0 -10, I would say 0.

Why?

Because there are important other determinants of the outcomes:

  • placebo,
  • concommittant treatments,
  • natural history,
  • etc., etc.

Why does this matter?

  • Because such unwarranted conclusions mislead patients, healthcare professionals and carers.
  • Because such bad science gives a bad name to clinical research.
  • Because this type of nonsense might deter meaningful research into a promising subject.
  • Because no ‘scientific’ journal should be permitted to publish such nonsense.
  • Because it is unethical of ‘scientists’ to make false claims.

But maybe the Indian authors are just a few well-meaning and naive practitioners who merely were doing their unexperienced best? Sadly not! The authors of this paper give the following affiliations:

  • Clinical Pharmacology, Pfizer Healthcare Private Limited, Chennai, Tamil Nadu, India.
  • Department of Radiation Oncology, Faculty of Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
  • Process Development, HCL Technologies, Chennai, Tamil Nadu, India.
  • Department of Pharmacognosy, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.

Yes, they really should know better!

So-called alternative medicine (SCAM) is, as we all know, an umbrella term. Under this umbrella, we find hundreds of different modalities that have little in common with each other. Here I often focus on:

  • homeopathy,
  • chiropractic,
  • acupuncture,
  • herbal medicine.

There are uncounted others, and in my recent book, I published critical evaluations 150 of them. But for the moment, let’s keep to the 4 SCAMs listed above.

What strikes me regularly is that many SCAM enthusiasts do seem to appreciate my critical assessments of SCAM; for instance:

  • When I point out that the assumptions of homeopathy fly in the face of science, most SCAM enthusiasts agree.
  • When I point out that chiropractic spinal manipulations might not be safe, most SCAM enthusiasts agree.
  • When I point out that acupuncture is not a panacea, most SCAM enthusiasts agree.
  • When I point out that herbal remedies can interact with prescribed drugs, most SCAM enthusiasts agree.

Most but not all!

  • Those who find my criticism of homeopathy unfair are the homeopaths and their proponents.
  • Those who find my criticism of chiropractic unfair are the chiropractors and their proponents.
  • Those who find my criticism of acupuncture unfair are the acupuncturists and their proponents.
  • Those who find my criticism of herbal medicine unfair are the herbalists and their proponents.

Hardly ever does a herbalist defend homeopathy’s weird assumptions; rarely does an acupuncturist tell me that I am too harsh with the chiropractors; never have I heard a chiropractor complain that my criticism of acupuncture is unjustified.

Entirely obvious?

Perhaps!

But I find it nevertheless curious, because my critical stance is always the same. I do not change it for this or that form of SCAM (I would also not change it for conventional medicine, but I leave it to those who have more specific expertise to do the criticising). I have no axe to grind against any particular SCAM. All I do is point out flaws in their logic, limitations in their studies, gaps in the evidence. All I do is provide my honest interpretation of the evidence.

It really seems to me that everyone appreciates my honesty, until I start being honest with them.

And this is why I find it curious. Homeopaths, chiropractors, acupuncturists, herbalists and all the other types of SCAM practitioners like to be seen on the side of science, evidence, critical thinking and progress. This, I suppose, is good for the (self) image; it might even help the delusion that they are all evidence-based. But as soon as someone applies science, evidence, critical thinking and progress to their very own little niche within SCAM, they stop liking it and start aggressing the critic.

I suppose this is entirely obvious as well?

Perhaps!

But it also exposes the double standard that is so deeply ingrained in SCAM.

We live in truly grim times! Let me therefore try to cheer you up a little. Here is a story that might make you smile.

In 1981, I moved back from London to Munich. While still in London, I had written an article on garlic for a German medical journal. It was published just as we arrived in our new home. Here is it’s English abstract:

Garlic has had a firm place in folk medicine since ancient times. More recent results are summarized here which show that extracts of the plant have an antimicrobial action, they are capable of lowering blood cholesterol and of reducing secondary vascular changes. They raise fibrinolytic activity and inhibit thrombocyte aggregation. Therefore the plant contains highly active therapeutic principles which appear to be particularly suitable for prophylaxis of arteriosclerosis.

Yes, you are quite right, this paper is nothing to write home about. So, why do I consider it ‘most consequential‘? Here is what happened:

My wife and I had barely arrived in our new home, when a man phoned (he had gone to a lot of trouble to find my number) and said: “I know you are the leading expert on garlic; I urgently need to talk to you”. Never correct a man’s mistake, if it’s in your favour, I thought, and we made an appointment for a meeting at the Munich train station hotel.

When I met him a few days later, he ordered me a coffee (which later I had to pay for) and explained that he had worked his whole life (he was about 50, I guessed) for the pharmaceutical industry and had now decided that this was enough. He thus planned to set up his own pharmaceutical company. He already had a photocopy machine in his basement, he proudly told me, and a wife who was willing to work as hard as he was. Specifically, his plan was to launch a garlic pill, and for that he needed my advice. I told him what he wanted to know, and we parted after about two hours promising to stay in contact.

The man’s name was Kuno Lichtwer.

During the weeks that followed, he often phoned me to pick my brain. One day, he told me that he had everything in place: he had found a supplier of the materials, a manufacturer to produce the pills and even registered a name for it:

KWAI

Then he popped the question that was foremost on his mind: ‘What do you think, Dr Ernst, should I risk it and go ahead with this or not?’. I had started to like that man; he was going to lose all his savings on a crazy idea, I felt. So, I told him: ‘If I were you, I would not do it. There are already plenty of garlic pills on the market. You are risking to lose everything.’ Then there was a long pause; eventually, he thanked me for my honest advice and hung up.

Weeks later he phoned again to tell me that he had truly appreciated my brutally direct advice, thought long and hard about it, but went ahead with his plan anyway. Would I now accept the position of ‘medical advisor’ to Lichwer Pharma? I was surprised, but accepted this new post. Thereafter, I advised him the best I could. We even conducted and published the very first clinical trial with his product. It was a rather flimsy study (we had no funds at all), but did suggest a positive result.

Each time Mr Lichtwer called me, he was elated; things were not just going well, they were booming! He was evidently hugely gifted in promoting KWAI. Then he invited me several times to come to Berlin where Lichtwer Pharma was based for business meetings. Proudly, he showed me that meanwhile his firm had moved out of his basement into a proper building. The next I knew was that he had a dozen employees. Lichtwer seemed unstoppable. This went on for 2 or 3 years, if I remember correctly.

During all this time, we had never talked about money, and my work for him had always been unpaid – that is, until one day just before Christmas he phoned and explained that he had moved his firm to yet a bigger building and hired yet more staff. He also realised that I deserved some renumeration for my advice; therefore, he had put a cheque in the post. When I told my wife about it, we both celebrated in anticipation of the substantial windfall. Two days later, his letter arrived. He very kindly thanked me for years of work and included a cheque of 500 DM (about 150 DM per year of work). A few months later, his firm had grown so big that a full time medical and research director was badly needed. He informed me that he had found a highly experienced expert and invited me to meet the new man, Prof Schulz.

No, I did not feel hard done by! On the contrary, I was happy that my prediction had been grossly wrong and that my friend Kuno was doing so well. In addition, I was also relieved, because my research at the University did not give me nearly enough time to look adequately after the now substantial firm of Lichtwer Pharma.

Thereafter, Lichtwer’s garlic pill went from strength to strength. Several larger studies confirmed our initial results that garlic positively influenced blood lipids (in 2000, our systematic review concluded: The available data suggest that garlic is superior to placebo in reducing total cholesterol levels. However, the size of the effect is modest, and the robustness of the effect is debatable. The use of garlic for hypercholesterolemia is therefore of questionable value). One day, I read somewhere that KWAI had become the most consumed pill in Germany (even beating Aspirin). Then Lichtwer Pharma went international and added several further herbal products to its portfolio. In 1991, Lichtwer Pharma was estimated to be worth 100 Million DM. Several years later, the firm had almost 400 employees and a yearly turnover of 353 Million DM.

To his credit, Kuno Lichtwer never entirely forgot me. When I had moved to the UK, he even came to Exeter, was entertained by my University, and made a donation of £100 000 towards a ‘Lichtwer Research Fellowship’ for my department. I am not sure whether Kuno Lichtwer is still alive. If he is, he would probably agree that, had I offered him 10 000 DM of my savings during our 1st meeting in 1981 (he did hint at that possibility), he would have gladly made me a partner in his enterprise.

But, as they say: money is not everything.

And a good story to tell is also not bad.

Dr Jennifer Jacobs is a homeopaths from the US. She is a family physician and a clinical assistant professor in epidemiology at the University of Washington School of Public Health and Community Medicine. She received her MD degree from Wayne State University and a Masters in Public Health from the University of Washington.

Jennifer is foremost famous for the homeopathic childhood diarhoea studies, but does that justify her joining THE ALTERNATIVE MEDICINE HALL OF FAME with its 15 current members who managed the impossible feast of never publishing a negative conclusion about their pet SCAM:

A Medline search generated 25 papers of hers on homeopathy. Here are the key findings of the … that report original data on the effectiveness of homeopathy (clinical trials or reviews):

  1. If and when conventional medicine runs out of options for treating epidemic diseases, homeopathy could be seen as an attractive alternative, but only if there is viable experimental evidence of its success.
  2. The homeopathic syrup appeared to be effective in reducing the severity of cold symptoms in the first day after beginning treatment.
  3. the medicines prescribed in individualised homeopathy may have small, specific, treatment effects.
  4. Homeopathic ear drops may be effective in reducing the use of antibiotics in children with AOM managed with a delayed antibiotic approach.
  5. This study suggests that homeopathic ear drops were moderately effective in treating otalgia in children with AOM and may be most effective in the early period after a diagnosis of AOM. Pediatricians and other primary health care providers should consider homeopathic ear drops a useful adjunct to standard therapy.
  6. The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children. Further study is needed to develop affordable and effective methods of using homeopathy to reduce the global burden of childhood diarrhea.
  7. This pilot study provides no evidence to support a therapeutic effect of individually selected homeopathic remedies in children with ADHD. A therapeutic effect of the homeopathic encounter is suggested and warrants further evaluation.
  8. Small sample size precludes definitive answers, but results from this preliminary trial suggest that homeopathy may be of value in the treatment of menopausal symptoms and improving quality of life, especially in those women not on tamoxifen.
  9. The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness.
  10. These results suggest that a positive treatment effect of homeopathy when compared with placebo in acute otitis media cannot be excluded and that a larger study is justified.
  11. These results are consistent with the finding from the previous study that individualized homeopathic treatment decreases the duration of diarrhea and number of stools in children with acute childhood diarrhea.
  12. The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration.

Next to Claudia Witt, Jennifer might be the researcher who has published the most clinical trials of homeopathy with positive conclusions (don’t be jealous Michael Frass, you might be in third place!). Attentive readers have probably noticed, she also published a negative trial with a negative conclusion (No 6) and a negative trial with a not so negative conclusion (No 7). The negative study almost cost her the place in the HALL OF FAME. But let’s be generous, and let’s consider the TRUSTWORTHINESS INDEX which, in her case, is still well and safely in the untrustworthy region. Therefore, I hope we all agree: Jenifer does deserve a place in THE ALTERNATIVE MEDICINE HALL OF FAME.

WELCOME JENNIFER!

The UK Professional Standards Authority has just made this announcement:

The Professional Standards Authority has suspended the accreditation of the Society of Homeopaths (SoH) following its failure to meet Conditions set by the Authority during 2020. The suspension is effective from today.

Under the Accredited Registers programme, organisations can apply for accreditation of registers they hold of unregulated healthcare practitioners and must meet Standards set by the Authority. The SoH was first accredited in 2014. In February 2020 accreditation was renewed, subject to a Condition that included making its position statements clear that registrants must not practise CEASE, practise or advertise adjunctive therapies, or provide advice on vaccination.

Accreditation of registers is renewed annually, however where there are serious concerns, we conduct an in-year review. We undertook an in-year review of the SoH during the summer of 2020, after concerns were raised in relation to the appointment of a key official. As set out in the outcome of our in-year review three further Conditions were issued, the first two of which were due in October 2020. In December 2020, a Panel met to consider whether these had been met.

We found the Conditions were not met and that the SoH did not fully meet a number of our Standards. In view of the recurrent nature of the concerns, and that several Conditions had already been imposed on the SoH since February 2020, we decided to suspend accreditation.

The suspension will be reviewed after 12 months. To be lifted the SoH will need to demonstrate that it prioritises public protection over professional interests in its handling of complaints and governance processes. If the SoH can demonstrate that this is achieved through fulfilment of the Conditions and Standards earlier than 12 months then we will consider lifting the suspension sooner.

END OF QUOTE

For background information, the following posts might be helpful:

The UK Society of Homeopaths, a hub of anti-vaccination activists? (edzardernst.com)

The decision by the PSA to grant reaccreditation to the Society of Homeopaths is being challenged (edzardernst.com)

The Society of Homeopaths have a Code of Ethics, but seem to ignore it. I wonder why! (edzardernst.com)

Seven things you might want to know about ‘CEASE’ therapy (as practised by homeopaths and naturopaths) (edzardernst.com)

The UK ‘Society of Homeopath’ is an anti-vaxx hub that endangers public health (in my humble opinion) (edzardernst.com)

Hesperidin is a flavonoid found in citrus fruits, especially orange and grapefruit. It is said to have antioxidant and anti-inflammatory effects. Research into hesperidin began in the 1940s but only recently interest turned buoyant, and all sorts of benefits have been suggested. Here are just three recent clinical studies:

  1. This study investigated the effects of chronic intake of an orange extract (2S-hesperidin) or placebo on non-oxidative/glycolytic and oxidative metabolism markers and performance markers in amateur cyclists. A double-blind, randomized, placebo-controlled trial was carried out between late September and December 2018. Forty amateur cyclists were randomized into two groups: one taking 500 mg/day 2S-hesperidin and the other taking 500 mg/day placebo (microcellulose) for eight weeks. All participants completed the study. An incremental test was used to evaluate performance, and a step test was used to measure oxygen consumption, carbon dioxide, efficiency and oxidation of carbohydrates and fat by indirect calorimetry. The anaerobic power (non-oxidative) was determined using Wingate tests (30 s). After eight weeks supplementation, there was an increase in the incremental test in estimated functional threshold power (FTP) (3.2%; p ≤ 0.05) and maximum power (2.7%; p ≤ 0.05) with 2S-hesperdin compared to placebo. In the step test, there was a decrease in VO2 (L/min) (-8.3%; p ≤ 0.01) and VO2R (mL/kg/min) (-8.9%; p ≤ 0.01) at VT2 in placebo. However, there were no differences between groups. In the Wingate test, there was a significant increase (p ≤ 0.05) in peak and relative power in both groups, but without differences between groups. Supplementation with an orange extract (2S-hesperdin) 500 mg/day improves estimated FTP and maximum power performance in amateur cyclists.
  2. In this clinical trial with a parallel-group design, 49 patients with MetS received either 500-mg hesperidin or placebo, twice daily, for 12 weeks. Number of participants with treated MetS was considered as a primary end point. Anthropometric parameters, dietary intake, physical activity, lipid profile, glucose homeostasis parameter, tumor necrosis factor alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP) were assessed at the beginning and at the end of the study. Compared with the placebo group, hesperidin decreased fasting glucose level (- 6.07 vs. – 13.32 mg/dL, P = 0.043), triglyceride (- 8.83 vs. – 49.09 mg/dL, P = 0.049), systolic blood pressure (- 0.58 vs. – 2.68 mmHg, P = 0.048) and TNF-α (- 1.29 vs. – 4.44 pg/mL, P = 0.009). Based on the within-group analysis, hesperidin led to significant decrease in serum levels of glucose, insulin, triglyceride, total cholesterol, low density lipoprotein cholesterol, TNF-α and hs-CRP, while in control group only glucose and insulin significantly decreased. The results indicate that hesperidin supplementation can improve metabolic abnormalities and inflammatory status in patients with MetS.
  3. In this study, 64 patients were randomly allocated to receive 500 mg/day hesperidin or placebo capsules for 6 weeks. Data on systolic blood pressure (SBP), diastolic blood pressure, serum total antioxidant capacity (TAC), tumor necrosis factor alpha, interleukin 6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were collected at the baseline and at the end of the study. In the hesperidin group, SBP (122.7 ± 8.5 vs. 119.0 ± 7.4; p = .005), mean arterial blood pressure (94.2 ± 5.5 vs. 91.8 ± 5.5; p = .009), IL-6 (8.3 ± 2.1 vs. 7.4 ± 1.8; p = .001), and hs-CRP (1.9 ± 1.2 vs. 1.1 ± 0.9; p < .000) decreased whereas TAC increased (0.74 ± 0.1 vs. 0.82 ± 0.1; p < .000) in comparison to the baseline values. There was a significant difference in mean percent change of SBP, diastolic blood pressure, mean arterial blood pressure, serum TAC, and inflammatory markers (tumor necrosis factor alpha, IL-6, and hs-CRP) between hesperidin and control groups following intervention in adjusted models (p < .05). These results suggest that hesperidin may have antihypertensive and anti-inflammatory effects in type 2 diabetes.

The latest suggestion for Hesperidin is – how could be be otherwise? – that it helps against COVID-19: Hesperidin can block coronavirus from entering host cells through ACE2 receptors which can prevent the infection. Anti-viral activity of hesperidin might constitute a treatment option for COVID-19 through improving host cellular immunity against infection and its good anti-inflammatory activity may help in controlling cytokine storm. Hesperidin mixture with diosmin co-administrated with heparin protect against venous thromboembolism which may prevent disease progression. Based on that, hesperidin might be used as a meaningful prophylactic agent and a promising adjuvant treatment option against SARS-CoV-2 infection.

According to one source, Hesperidin can cause several problems:

  • abdominal pain,
  • diarrhea,
  • contact dermatitis,
  • nausea,
  • interactions with medications (including anticoagulants, blood pressure drugs, and calcium channel blockers),
  • increased risk of bleeding.

No doubt, Hesperidin is an interesting substance. Yet, I feel that much more research is needed until we can be reasonably sure that it is clinically effective for any condition, particularly COVID-19.

I was alerted to an article in which some US doctors, including the famous Andrew Weil, promote the idea that so-called alternative medicine (SCAM) has a lot to offer for people recovering from Covid-19 infections. There would be a lot to argue about their recommendations, but today I will not go into this (I find it just too predictable how SCAM proponents try to promote SCAM on the basis of flimsy evidence; perhaps I am suffering from ‘BS for Covid fatigue’?). What did, however, strike me in their paper was a definition of INTEGRATIVE MEDICINE (IM) that I had not yet come across:

Integrative medicine is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.

Ever since the term IM became fashionable, there have been dozens of definitions of the term (almost as though IM proponents were not quite sure themselves what they were promoting). And ever since I first heard about IM, I felt it was a thinly disguised attempt to smuggle unproven treatments into the routine of evidence-based medicine (EBM). In 2002, I published my 1st comment on the subject. In it, I warned that IM must not become an excuse for using every conceivable untested treatment under the banner of holism. Nineteen years on, this is exactly what has happened, and one definition of IM after the next is soaked in platitudes, falsehoods and misunderstandings.

So, let’s see how reasonable this new definition is. I will try to do this by briefly discussing each element of the two sentences.

  1. IM is healing-oriented medicine: this is a transparently daft platitude. Does anyone know a medicine that is not oriented towards healing? Healing is the process of becoming well again, especially after a cut or other injury, or of making someone well again. Healing is what medicine has always been and always be aimed at. In other words, it is not something that differentiates IM from other forms of healthcare.
  2. IM takes account of the whole person: This is the little holistic trick that IM proponents like to adopt. It implies that normal medicine or EBM is not holistic. This implication is wrong. Any good medicine is holistic, and if a sector of healthcare fails to account for the whole person, we need to reform it. (Here are the conclusions of an editorial I published in 2007 entitled ‘Holistic heath care?‘: good health care is likely to be holistic but holistic health care, as it is marketed at present, is not necessarily good. The term ‘holistic’ may even be a ‘red herring’ which misleads patients. What matters most is whether or not any given approach optimally benefits the patient. This goal is best achieved with effective and safe interventions administered humanely — regardless of what label we put on them.) Creating a branch of medicine that, like IM, pretends to have a monopoly on holism can only hinder this process.
  3. IM includes all aspects of lifestyle: really, all of them? This is nonsense! Good physicians take into account the RELEVANT lifestyles of their patients. If, for instance, my patient with intermittent claudication is a postman, his condition would affect him differently from a patient who is a secretary. But all lifestyles? No! I fear this ‘over the top’ statement merely indicates that those who have conceived it have difficulties differentiating the important from the trivial.
  4. IM emphasizes the therapeutic relationship: that’s nice! But so do all other physicians (except perhaps pathologists). As medical students, we were taught how to do it, some physicians wrote books about it (remember Balint?), and many of us ran courses on the subject. Some conventional clinicians might even feel insulted by the implication that they do not emphasize the therapeutic relationship. Again, the IM brigade take an essential element of good healthcare as their monopoly. It almost seems to be a nasty habit of theirs to highjack a core element of healthcare and declare it as their invention.
  5. IM is informed by evidence: that is brilliant, finally there emerges a real difference between IM and EBM! While proper medicine is BASED on evidence, IM is merely INFORMED by it. The difference is fundamental, because it allows IM clinicians to use any un- or disproven SCAM. The evidence for homeopathy fails to show that it is effective? Never mind, IM is not evidence-based, it is evidence-informed. IM physiciance know homeopathy is a placebo therapy (if not they would be ill-informed which would make them unethical), but they nevertheless use homeopathy (try to find an IM clinic that does not offer homeopathy!), because IM is not EBM. IM is evidence-informed!
  6. IM makes use of all appropriate therapies: and the last point takes the biscuit. Are the IM fanatics honestly suggesting that conventional doctors use inappropriate therapies? Does anyone know a branch of health care where clinicians systematically employ therapies that are not appropriate? Appropriate means suitable or right for a particular situation or occasion. Are IM practitioners the only ones who use therapies that are suitable for a particular situation? This last point really does count on anyone falling for IM not to have the slightest ability to think analytically.

This short analysis confirms yet again that IM is little more than a smokescreen behind which IM advocates try to smuggle nonsense into routine healthcare. The fact that, during the last two decades, the definition constantly changed, while no half decent definition emerged suggests that they themselves don’t quite know what it is. They like moving the goal post but seem unsure in which direction. And their latest attempt to define IM indicates to me that IM advocates might not be the brightest buttons in the drawer.

So sorry, I have been neglecting THE ALTERNATIVE MEDICINE HALL OF FAME of late. I was reminded of its existence when writing my post about Adrian White the other day. Reading the kind comments I received on it, I not only decided to make Adrian an honorary member (for his latter part of his career as an acupuncture researcher, but also to reactivate the idea of the HALL OF FAME in more general terms. And in the course of doing just this, I noticed that I somehow forgot to admit Prof Michael Frass, an omission which I regret and herewith rectify. A warm welcome to both!

In case you are unaware what THE ALTERNATIVE MEDICINE HALL OF FAME is, let me explain: it is a group of researchers who manage to go through (part of) their professional life researching their particular SCAM without ever publishing a negative conclusion about it, or who have other outstanding merits in misleading the public about so-called alternative medicine (SCAM). As of today, we thus have the following experts in the HALL:

Adrian White (acupuncturist, UK)

Michael Frass (homeopath, Austria)

Jens Behnke (research officer, Germany)

John Weeks (editor of JCAM, US)

Deepak Chopra (entrepreneur, Us)

Cheryl Hawk (US chiropractor)

David Peters (osteopathy, homeopathy, UK)

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

I must say, this is an assembly of international SCAM experts to be proud of – even if I say so myself!

The new member I am proposing to admit today is Dr Jenice Pellow. She is a lecturer in the Department of Complementary Medicine at the University of Johannisburg and already once featured on this blog. But now it seems time to admit this relatively little-known researcher into my HALL OF FAME. Dr Pellow has 11 Medline-listed papers on so-called alternative medicine (SCAM). Allow me to show you some key findings from their abstracts:

  1. Complementary and alternative medicine (CAM) offers parents various treatment options for this condition [ADHD], including dietary modifications, nutritional supplementation, herbal medicine, and homeopathy. CAM appears to be most effective when prescribed holistically and according to each individual’s characteristic symptoms.
  2. The homeopathic medicine reduced the sensitivity reaction of cat allergic adults to cat allergen, according to the SPT. Future studies are warranted to further investigate the effect of Cat saliva and Histaminum and their role as a potential therapeutic option for this condition.
  3. Findings suggest that daily use of the homeopathic complex does have an effect over a 4-wk period on physiological and cognitive arousal at bedtime as well as on sleep onset latency in PI sufferers. Further research on the use of this complex for PI is warranted before any definitive conclusions can be drawn.
  4. The homeopathic complex used in this study exhibited significant anti-inflammatory and pain-relieving qualities in children with acute viral tonsillitis. No patients reported any adverse effects. These preliminary findings are promising; however, the sample size was small and therefore a definitive conclusion cannot be reached. A larger, more inclusive research study should be undertaken to verify the findings of this study.
  5. results suggest the homeopathic complex, together with physiotherapy, can significantly improve symptoms associated with CLBP due to OA.
  6. This small study showed the potential benefits of individualized homeopathic treatment of binge eating in males, decreasing both the frequency and severity of binging episodes. 
  7. There have been numerous trials and pharmacological studies of specific herbal preparations related to the treatment of low sexual desire.
  8. Most of the evaluated medicinal plants showed evidence of efficacy in relieving menstrual pain in at least one RCT.
  9. Results indicated that most participants made use of both complementary and conventional medicines for their infant’s colic; the most commonly used complementary medicine products were homeopathic remedies, probiotics and herbal medicines.
  10. Promising evidence for the following single supplements were found [for allergic rhinitis]: apple polyphenols, tomato extract, spirulina, chlorophyll c2, honey, conjugated linoleic acid, MSM, isoquercitrin, vitamins C, D and E, as well as probiotics. Combination formulas may also be beneficial, particularly specific probiotic complexes, a mixture of vitamin D3, quercetin and Perilla frutescens, as well as the combination of vitamin D3 and L. reuteri. 
  11. Despite a reported lack of knowledge regarding complementary medicine and limited personal use, participants had an overall positive attitude towards complementary medicine. 

I admit that 11 papers in 7 years is not an overwhelming output for a University lecturer. However, please do consider the fact that all of them – particularly the ones on homeopathy which is be the particular focus of Jenice (after all, she is a homeopath) – chime a happy tune for SCAM. I therefore think that Jenice should be admitted to THE ALTERNATIVE MEDICINE HALL OF FAME and hope you agree.

Welcome to  ALTERNATIVE MEDICINE HALL OF FAME, Jenice!

As though the UK does not have plenty of organisations promoting so-called alternative medicine (SCAM)! Obviously not – because a new one is about to emerge.

In mid-January, THE COLLEGE OF MEDICINE AND INTEGRATED HEALTH (COMIH) will launch the Integrated Medicine Alliance bringing together the leaders of many complementary health organisations to provide patients, clinicians and policy makers with information on the various complementary modalities, which will be needed in a post COVID-19 world, where:

  1. patient choice is better respected,
  2. requirements for evidence of efficacy are more proportionate to the seriousness of the disease and the safety of the intervention,
  3. and where benefit versus risk are better balanced.

We already saw this in 2020 with the College advocating from the very beginning of the year that people should think about taking Vitamin D, while the National Institute for Clinical Excellence continued to say the evidence was insufficient, but the Secretary of State has now supported it being given to the vulnerable on the basis of the balance between cost, benefit and safety.

Elsewhere we learn more about the Integrated Medicine Alliance (IMA):

The IMA is a group of organisations and individuals that have been brought together for the purpose of encouraging and optimising the best use of complementary therapies alongside conventional healthcare for the benefit of all.

The idea for this group was conceived by Dr Michael Dixon in discussion with colleagues associated with the College of Medicine, and the initial meeting to convene the group was held in February 2019.

The group transitioned through a number of titles before settling on the ‘Integrated Medicine Alliance’ and began work on developing a patient leaflet and a series of information sheets on the key complementary therapies.

It was agreed that in the first instance the IMA should exist under the wing of the College of Medicine, but that in the future it may develop into a formal organisation in its own right, but inevitably maintaining a close relationship with the College of Medicine.

The IMA also offers ‘INFORMATION SHEETS’ on the following modalities:

I find those leaflets revealing. They tell us, for example that the Reiki practitioner channels universal energy through their hands to help rebalance each of the body’s energy centres, known as chakras. About homeopathy, we learn that a large corpus of evidence has accumulated which stands the most robust tests of modern science. And about naturopathy, we learn that it includes ozone therapy but is perfectly safe.

Just for the fun of it – and free of charge – let me try to place a few corrections here:

  • Reiki healers use their hands to perform what is little more than a party trick.
  • The universal energy they claim to direct does not exist.
  • The body does not have energy centres.
  • Chakras are a figment of imagination.
  • The corpus of evidence on homeopathy is by no means large.
  • The evidence is flimsy.
  • The most robust tests of modern science fail to show that homeopathy is effective beyond placebo.
  • Naturopathy is a hotchpotch of treatments most of which are neither natural nor perfectly safe.

One does wonder who writes such drivel for the COMIH, and one shudders to think what else the IMA might be up to.

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