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

Monthly Archives: August 2021

Subluxation is … a displacement of two or more bones whose articular surfaces have lost, wholly or in part, their natural connection. (D. D. Palmer, 1910)

The definition of ‘subluxation’ as used by chiropractors differs from that in conventional medicine where it describes a partial dislocation of the bony surfaces of a joint readily visible via an X-ray. Crucially, a subluxation, as understood in conventional medicine, is not the cause of disease. Spinal subluxations, according to medical terminology, are possible only if anatomical structures are seriously disrupted.

Subluxation, as chiropractors understand the term, has been central to chiropractic from its very beginning. Despite its central role in chiropractic, its definition is far from clear and has changed significantly over time.

DD Palmer (the guy who invented chiropractic) was extremely vague about most of his ideas. Yet, he remained steadfast about his claims that 95% of all diseases were due to subluxations of the spine, that subluxations hindered the flow of the ‘innate intelligence’ which controlled the vital functions of the body. Innate intelligence or ‘inate’, he believed, operated through the nerves, and subluxated vertebra caused pinched nerves, which in turn blocked the flow of the innate and thus led to abnormal function of our organs. For Palmer and his followers, subluxation is the sole or at least the main cause of all diseases (or dis-eases, as Palmer preferred).

Almost exactly 4 years ago, I published this post:

Is chiropractic subluxation a notion of the past? SADLY NOT! 

In it, I provided evidence that – contrary to what we are often told – chiropractors remain fond of the subluxation nonsense they leant in school. This can be shown by the frequency by which chiropractors advertise on Twitter the concept of chiropractic subluxation.

Today, I had another look. The question I asked myself was: has the promotion of the obsolete subluxation concept by chiropractors subsided?

The findings did not surprise me.

Even a quick glance reveals that there is still a plethora of advertising going on that uses the subluxation myth. Many chiros use imaginative artwork to get their misleading message across. Below is a small selection.

Yes, I know, this little display is not very scientific. In fact, it is a mere impression and does not intend to be anything else. So, let’s look at some more scientific data on this subject. Here are the last 2 paragraphs from the chapter on subluxation in my recent book on chiropractic:

A 2018 survey determined how many chiropractic institutions worldwide still use the term in their curricula.[1] Forty-six chiropractic programmes (18 from US and 28 non-US) participated. The term subluxation was found in all but two US course catalogues. Remarkably, between 2011 and 2017, the use of subluxation in US courses even increased. Similarly, a survey of 7455 US students of chiropractic showed that 61% of them agreed or strongly agreed that the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes.[2]

Even though chiropractic subluxation is at the heart of chiropractic, its definition remains nebulous and its very existence seems doubtful. But doubt is not what chiropractors want. Without subluxation, spinal manipulation seems questionable – and this will be the theme of the next chapter.

[1] https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0191-1

[2] https://www.ncbi.nlm.nih.gov/pubmed/25646145

In a nutshell: chiros cannot give up the concept of subluxation because, if they did, they would be physios except with a much narrower focus.

This retrospective electronic medical record data analysis compared the characteristics and outcomes of drug-induced liver injury (DILI) caused by paracetamol and non-paracetamol medications, particularly herbal and dietary supplements. Adults admitted with DILI to the Gastroenterology and Liver Centre at the Royal Prince Alfred Hospital, Sydney (a quaternary referral liver transplantation centre), 2009-2020 were included. The 90-day transplant-free survival and the drugs implicated as causal agents in DILI were extracted from the records.

A total of 115 patients with paracetamol-related DILI and 69 with non-paracetamol DILI were admitted to our centre. The most frequently implicated non-paracetamol medications were:

  • antibiotics (19, 28%),
  • herbal and dietary supplements (15, 22%),
  • anti-tuberculosis medications (6, 9%),
  • anti-cancer medications (5, 7%).

The number of non-paracetamol DILI admissions was similar across the study period, but the proportion linked with herbal and dietary supplements increased from 2 of 11 (15%) during 2009-11 to 10 of 19 (47%) during 2018-20 (linear trend: P = 0.011). Despite higher median baseline model for end-stage liver disease (MELD) scores, 90-day transplant-free survival for patients with paracetamol-related DILI was higher than for patients with non-paracetamol DILI (86%; 95% CI, 79-93% v 71%; 95% CI, 60-82%) and herbal and dietary supplement-related cases (59%; 95% CI, 34-85%). MELD score was an independent predictor of poorer 90-day transplant-free survival in both paracetamol-related (per point increase: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.09-3.74) and non-paracetamol DILI (aHR, 1.24; 95% CI, 1.14-1.36).

The authors concluded that, in our single centre study, the proportion of cases of people hospitalised with DILI linked with herbal and dietary supplements has increased since 2009. Ninety-day transplant-free survival for patients with non-paracetamol DILI, especially those with supplement-related DILI, is poorer than for those with paracetamol-related DILI.

A co-author of the paper, specialist transplant hepatologist Dr Ken Liu, was quoted in the Guardian saying he felt compelled to conduct the study because he was noticing more patients with liver injuries from drugs not typically associated with liver harm. “I was starting to see injury in patients admitted with liver injury after using bodybuilding supplements for males or weight loss supplements in females,” he said. “I just decided I better do a study on it to see if my hunch that more of these substances were causing these injuries was true.”

Liu and his colleagues said there needed to be more rigorous regulatory oversight for supplements and other alternative and natural therapies. They also noticed almost half the patients with supplement-induced severe liver injury had non-European ethnic backgrounds. Liu said more culturally appropriate community education about the risks of supplements was needed.

Dr Ken Harvey, public health physician and president of Friends of Science in Medicine, said it was important to note that Liu’s study only examined the most severe cases of supplement-induced liver harm and that the actual rate of harm was likely much higher. “The study only examines severe cases admitted to a specialised liver unit; they cannot be extrapolated to the overall incidence of complementary medicine associated liver injury in Australia,” Harvey said.

The Royal Australian College of General Practitioners, Choice, Friends of Science in Medicine and others have called for an educational statement on the pack and promotional material of medicines making traditional claims, for example saying “This product is based on traditional beliefs and not modern scientific evidence”.

“This was opposed by industry and the TGA,” Harvey said. “But is still needed.”

Pelargonium sidoides, a traditional medicinal plant native to South Africa, is one of the ornamental geraniums that is thought to be effective in treating URTIs. The plant seems to contain a large variety of phytochemicals, including amino acids, phenolic acids, α-hydroxy-acids, vitamins, polyphenols, flavonoids, coumarins, coumarins glucosides, coumarin sulphates and nucleotides. It is mostly used to treat the symptoms of acute bronchitis, common cold and acute rhinosinusitis.

The present study aimed to assess the effectiveness of the liquid herbal drug preparation from the root extracts of Pelargonium sidoides in improving symptoms of uncomplicated upper respiratory tract infections (URTIs). One hundred sixty-four patients with URTI were randomized and given either verum containing the root extracts of Pelargonium sidoides (n = 82) or a matching placebo (n = 82) in a single-blind manner for 7 days. The median total scores of all symptoms (TSS) showed a significant decreasing trend in the group treated with the root extracts derived from Pelargonium sidoides compared to the placebo group from day 0 to day 7 (TSS significantly decreased by 0.85 points in the root extract group compared to a decrease of 0.62 points, p = 0.018). “Cough frequency” showed a significant improvement from day 0 to day 3 (p = 0.023). There was also detected a significant recovery in “sneezing” on day 3 via Brunner-Langer model, and it was detected that the extract administration given in the first 24 h onset of the symptoms had provided a significant improvement in day 0 to day 3 (difference of TSS 0.18 point, p = 0.011).

The authors concluded that Pelargonium sidoides extracts are effective in relieving the symptom burden in the duration of the disease. It may be regarded as an alternative option for the management of URTIs.

These findings are less surprising than they may seem. Already in 2008, we published the following systematic review:

Objective: To critically assess the efficacy of Pelargonium sidoides for treating acute bronchitis.

Data sources: Systematic literature searches were performed in 5 electronic databases: (Medline (1950 – July 2007), Amed (1985 – July 2007), Embase (1974 – July 2007), CINAHL (1982 – July 2007), and The Cochrane Library (Issue 3, 2007) without language restrictions. Reference lists of retrieved articles were searched, and manufacturers contacted for published and unpublished materials.

Review methods: Study selection was done according to predefined criteria. All randomized clinical trials (RCTs) testing P. sidoides extracts (mono preparations) against placebo or standard treatment in patients with acute bronchitis and assessing clinically relevant outcomes were included. Two reviewers independently selected studies, extracted and validated relevant data. Methodological quality was evaluated using the Jadad score. Meta-analysis was performed using a fixed-effect model for continuous data, reported as weighted mean difference with 95% confidence intervals.

Results: Six RCTs met the inclusion criteria, of which 4 were suitable for statistical pooling. Methodological quality of most trials was good. One study compared an extract of P. sidoides, EPs 7630, against conventional non-antibiotic treatment (acetylcysteine); the other five studies tested EPs 7630 against placebo. All RCTs reported findings suggesting the effectiveness of P. sidoides in treating acute bronchitis. Meta-analysis of the four placebo-controlled RCTs suggested that EPs 7630 significantly reduced bronchitis symptom scores in patients with acute bronchitis by day 7. No serious adverse events were reported.

Conclusion: There is encouraging evidence from currently available data that P. sidoides is effective compared to placebo for patients with acute bronchitis.

Meanwhile, P.sidoides has been associated with liver damage, a fact that might dampen our enthusiasm for this remedy.  Nevertheless, it seems to me that this plant merits further study.

I recently came across this paper by Prof. Dr. Chad E. Cook, a physical therapist, PhD, a Fellow of the American Physical Therapy Association (FAPTA), and a professor as well as director of clinical research in the Department of Orthopaedics, Department of Population Health Sciences at the Duke Clinical Research Institute at Duke University in North Carolina, USA. The paper is entitled ‘The Demonization of Manual Therapy‘.

Cook introduced the subject by stating: “In medicine, when we do not understand or when we dislike something, we demonize it. Well-known examples throughout history include the initial ridicule of antiseptic handwashing, percutaneous transluminal coronary angioplasty (i. e., balloon angioplasty), the relationships between viruses and cancer, the contribution of bacteria in the development of ulcers, and the role of heredity in the development of disease. In each example, naysayers attempted to discredit the use of each of the concepts, despite having no evidence to support their claims. The goal in each of the aforementioned topics: demonize the concept.”

Cook then discussed 8 ‘demonizations’ of manual therapy. Number 7 is entitled “Causes as Much Harm as Help“. Here is this section in full:

By definition, harms include adverse reactions (e. g., side effects of treatments), and other undesirable consequences of health care products and services. Harms can be classified as “none”, minor, moderate, serious and severe [67]. Most interventions have some harms, typically minor, which are defined as a non-life-threatening, temporary harm that may or may not require efforts to assess for a change in a patient’s condition such as monitoring [67].
There are harms associated with a manual therapy intervention, but they are generally benign (minor). Up to 20 –40 % of individuals will report adverse events after the application of manual therapy. The most common adverse events were soreness in muscles, increased pain, stiffness and tiredness [68]. There are rare occasions of several harms associated with manual therapy and these include spinal or neurological problems as well as cervical arterial strokes [9]. It is critical to emphasize how rare these events are; serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients [69].

Cook then concludes that “manual therapy has been inappropriately demonized over the last decade and has been associated with inaccurate assumptions and false speculations that many clinicians have acquired over the last decade. This paper critically analyzed eight of the most common assumptions that have belabored manual therapy and identified notable errors in seven of the eight. It is my hope that the physiotherapy community will carefully re-evaluate its stance on manual therapy and consider a more evidence-based approach for the betterment of our patients.

REFERENCES

[9] Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–338.
doi:10.1177/014107680710000716

[68] Paanalahti K, Holm LW, Nordin M et al. Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskelet Disord 2014; 15: 77. doi:10.1186/1471-2474-15-77

[69] Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap 2017; 25: 37. doi:10.1186/s12998-017-0168-5

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Here are a few things that I find odd or wrong with Cook’s text:

  • The term ‘demonizing’ seems to be a poor choice. The historical examples chosen by Cook were not cases of demonization. They were mostly instances where new discoveries did not fit into the thinking of the time and therefore took a long time to get accepted. They also show that sooner or later, sound evidence always prevails. Lastly, they suggest that speeding up this process via the concept of evidence-based medicine is a good idea.
  • Cook then introduces the principle of risk/benefit balance by entitling the cited section “Causes as Much Harm as Help“. Oddly, however, he only discusses the risks of manual therapies and omits the benefit side of the equation.
  • This omission is all the more puzzling since he quotes my paper (his reference [9]) states that “the effectiveness of spinal manipulation for most indications is less than convincing. A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.”
  • In discussing the risks, he seems to assume that all manual therapies are similar. This is clearly not true. Massage therapies have a very low risk, while this cannot be said of spinal manipulations.
  • The harms mentioned by Cook seem to be those of spinal manipulation and not those of all types of manual therapy.
  • Cook states that “up to 20 –40 % of individuals will report adverse events after the application of manual therapy.” Yet, the reference he uses in support of this statement is a clinical trial that reported an adverse effect rate of 51%.
  • Cook then states that “there are rare occasions of several harms associated with manual therapy and these include spinal or neurological problems as well as cervical arterial strokes.” In support, he quotes one of my papers. In it, I emphasize that “the incidence of such events is unknown.” Cook not only ignores this fact but states in the following sentence that “it is critical to emphasize how rare these events are…”

Cook concludes that “manual therapy has been inappropriately demonized over the last decade and has been associated with inaccurate assumptions and false speculations …” He confuses, I think, demonization with critical assessment.

Cook’s defence of manual therapy is clumsy, inaccurate, ill-conceived, misleading and often borders on the ridiculous. In the age of evidence-based medicine, therapies are not ‘demonized’ but evaluated on the basis of their effectiveness and safety. Manual therapies are too diverse to do this wholesale. They range from various massage techniques, some of which have a positive risk/benefit balance, to high-velocity, low-amplitude thrusts, for which the risks do not demonstrably outweigh the benefits.

Harry G Frankfurt published his delightful booklet ‘ON BULLSHIT‘ in 2005 (in case you don’t know it, I highly recommend you read it). Since then, the term ‘bullshit’ has become accepted terminology even in polite discourse. But what exactly is bullshit? Frankfurt explains that is something between a lie and a bluff, perhaps more like the latter than the former.

Not least due to Frankfurt’s book, there is today plenty of research on the subject of bullshit. As much of it relates to so-called alternative medicine (SCAM), allow me to present here just 5 of the most recent papers on bullshit.

No 1

Navigating social systems efficiently is critical to our species. Humans appear endowed with a cognitive system that has formed to meet the unique challenges that emerge for highly social species. Bullshitting, communication characterised by an intent to be convincing or impressive without concern for truth, is ubiquitous within human societies. Across two studies (N = 1,017), we assess participants’ ability to produce satisfying and seemingly accurate bullshit as an honest signal of their intelligence. We find that bullshit ability is associated with an individual’s intelligence and individuals capable of producing more satisfying bullshit are judged by second-hand observers to be more intelligent. We interpret these results as adding evidence for intelligence being geared towards the navigation of social systems. The ability to produce satisfying bullshit may serve to assist individuals in negotiating their social world, both as an energetically efficient strategy for impressing others and as an honest signal of intelligence.

No 2

Research into both receptivity to falling for bullshit and the propensity to produce it have recently emerged as active, independent areas of inquiry into the spread of misleading information. However, it remains unclear whether those who frequently produce bullshit are inoculated from its influence. For example, both bullshit receptivity and bullshitting frequency are negatively related to cognitive ability and aspects of analytic thinking style, suggesting that those who frequently engage in bullshitting may be more likely to fall for bullshit. However, separate research suggests that individuals who frequently engage in deception are better at detecting it, thus leading to the possibility that frequent bullshitters may be less likely to fall for bullshit. Here, we present three studies (N = 826) attempting to distinguish between these competing hypotheses, finding that frequency of persuasive bullshitting (i.e., bullshitting intended to impress or persuade others) positively predicts susceptibility to various types of misleading information and that this association is robust to individual differences in cognitive ability and analytic cognitive style.

No 3

Recent psychological research has identified important individual differences associated with receptivity to bullshit, which has greatly enhanced our understanding of the processes behind susceptibility to pseudo-profound or otherwise misleading information. However, the bulk of this research attention has focused on cognitive and dispositional factors related to bullshit (the product), while largely overlooking the influences behind bullshitting (the act). Here, we present results from four studies focusing on the construction and validation of a new, reliable scale measuring the frequency with which individuals engage in two types of bullshitting (persuasive and evasive) in everyday situations. Overall, bullshitting frequency was negatively associated with sincerity, honesty, cognitive ability, open-minded cognition, and self-regard. Additionally, the Bullshitting Frequency Scale was found to reliably measure constructs that are (1) distinct from lying and (2) significantly related to performance on overclaiming and social decision tasks. These results represent an important step forward by demonstrating the utility of the Bullshitting Frequency Scale as well as highlighting certain individual differences that may play important roles in the extent to which individuals engage in everyday bullshitting.

No 4

Although generally viewed as a common and undesirable social behaviour, very little is known about the nature of bullshitting (i.e., communicating with little to no regard for evidence or truth; Raritan Q Rev 6, 1986, 81); its consequences; and its potential communicative utility. Specifically, it is hypothesized that bullshitting may be may be relatively influential under specified conditions. Experiment 1 participants were exposed to a traditional persuasion paradigm, receiving either strong or weak arguments in either an evidence-based or bullshit frame. Experiment 2 also incorporated a manipulation of a peripheral route cue (i.e., source attractiveness). Findings demonstrate that bullshitting can be an effective means of influence when arguments are weak, yet undermine persuasive attempts when arguments are strong. Results also suggest that bullshit frames may cue peripheral route processing of persuasive information relative to evidence-based frames that appear to cue central route processing. Results are discussed in light of social perception and attitude change.

No 5

Objective: Fake news represents a particularly egregious and direct avenue by which inaccurate beliefs have been propagated via social media. We investigate the psychological profile of individuals who fall prey to fake news.

Method: We recruited 1,606 participants from Amazon’s Mechanical Turk for three online surveys.

Results: The tendency to ascribe profundity to randomly generated sentences-pseudo-profound bullshit receptivity-correlates positively with perceptions of fake news accuracy, and negatively with the ability to differentiate between fake and real news (media truth discernment). Relatedly, individuals who overclaim their level of knowledge also judge fake news to be more accurate. We also extend previous research indicating that analytic thinking correlates negatively with perceived accuracy by showing that this relationship is not moderated by the presence/absence of the headline’s source (which has no effect on accuracy), or by familiarity with the headlines (which correlates positively with perceived accuracy of fake and real news).

Conclusion: Our results suggest that belief in fake news may be driven, to some extent, by a general tendency to be overly accepting of weak claims. This tendency, which we refer to as reflexive open-mindedness, may be partly responsible for the prevalence of epistemically suspect beliefs writ large.

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Yes, bullshit seems to be an active area of research. And rightly so! There is so much of it about. Those who regularly read the comments sections of this blog will probably agree with some of the writing above. The statement that ‘bullshitting can be an effective means of influence when arguments are weak’ rang particularly true, I thought. ‘Communication characterised by an intent to be convincing or impressive without concern for truth’ might perhaps also remind us of a few notorious commentators on this blog.

In any case, I am relieved to know that research into bullshit is buoyant – there clearly is a need to better understand the phenomenon. I for one intend to use this terminology more frequently in the future.

This overview was aimed at critically appraising the best available systematic review (SR) evidence on the health
effects of Tai Chi. Nine databases (English and Chinese languages) were searched for SRs of controlled clinical trials of Tai Chi interventions published between Jan-2010 and Dec-2020 in any language. Excluded were primary studies and meta-analyses that combined Tai Chi with other interventions. To minimize overlap, effect estimates were extracted from the most recent, comprehensive, highest quality SR for each population, condition, and outcome. SR quality was appraised using AMSTAR 2 and effect estimates with GRADE.

Of the 210 included SRs, 193 only included randomized controlled trials, one only included non-randomized
studies of interventions, and 16 included both. The most common conditions were neurological (18.6%), falls/balance (14.7%), cardiovascular (14.7%), musculoskeletal (11.0%), cancer (7.1%) and diabetes mellitus (6.7%). Except for stroke, no evidence for disease prevention was found, instead, proxy-outcomes/risks factors were evaluated. 114 effect estimates were extracted from 37 SRs (2 high quality, 6 moderate, 18 low, and 11 critically low), representing 59,306 adults. Compared to active and/or inactive controls, a clinically important benefit from Tai Chi was reported for 66 effect estimates; 53 reported an equivalent or marginal benefit, and 6 had an equivalent risk of adverse events. Eight effect estimates (7.0%) were graded as high certainty evidence, 43 (37.7%) moderate, 36 (31.6%) low, and 27 (23.7%) very low. This was due to concerns with risk of bias in 92 (80.7%) effect estimates, imprecision in 43 (37.7%), inconsistency in 37 (32.5%), and publication bias in 3 (2.6%). SR quality was limited by the search strategies, language bias, inadequate consideration of clinical, methodological, and statistical heterogeneity, poor reporting standards, and/or no registered protocol.

The authors concluded that the findings suggest Tai Chi has multisystem effects with physical, psychological, and quality of life benefits for a wide range of conditions, including individuals with multiple health problems. Clinically important benefits were most consistently reported for Parkinson’s disease, falls risk, knee osteoarthritis, low back pain, cardiovascular diseases including hypertension, and stroke. Notwithstanding, for most conditions, higher quality primary studies and SRs are required.

The authors start the discussion section by stating: This critical overview comprehensively identified SRs of Tai Chi published in English, Chinese and Korean languages that evaluated the effectiveness and safety of Tai Chi for health promotion, and disease prevention and management.

I must say that I do not find the overview all that ,critical’. The authors admit that the primary studies often lacked scientific rigor. Yet they draw firm positive conclusions from the data. I think that this is wrong.

Most of the authors of this overview come from Chinese institutions dedicated to promoting TCM. Yet there is no declaration that this fact might constitute a conflict of interest.

I also miss critical comments on two important questions:

  1. Are the positive effects of Tai chi superior to conventional treatments of the respective conditions?
  2. Are the effects of Tai chi really due to the treatment per see or might they be largely caused by context effects (which, considering the nature of the therapy, might be substantial)?

 

The purpose of this qualitative research was to explore whether pilgrims visiting Lourdes, France had transcendent experiences and to examine their nature.

For this purpose, the researchers traveled to Lourdes and spoke with 67 pilgrims including assisted pilgrims, young volunteers, and medical staff. About two in five reported a transcendent experience: some felt they had communicated or had close contact with a divine presence, while others reported a powerful experience of something intangible and otherworldly.

The authors concluded that visiting Lourdes can have a powerful effect on a pilgrim and may include an “out of the ordinary” transcendent experience, involving a sense of relationship with the divine, or experiences of something otherworldly and intangible. There is a growing focus on Lourdes as a place with therapeutic benefits rather that cures: our analysis suggests that transcendent experiences can be central to this therapeutic effect. Such experiences can result in powerful emotional responses, which themselves may contribute to long term well-being. Our participants described a range of transcendent experiences, from the prosaic and mildly pleasant, to intense experiences that affected pilgrims’ lives. The place itself is crucially important, above all the Grotto, as a space where pilgrims perceive that the divine can break through into normal life, enabling closer connections with the divine, with nature and with the self.

Some people can have powerful effects when they expect something powerful. So what?

To make any sense out of this, we need a controlled experiment. I am glad to tell you that Austrian psychologists recently published a controlled study of this type. They tested the effects of tap water labeled as Lourdes water versus tap water labeled as tap water found that placebos in the context of religious beliefs and practices can change the experience of emotional salience and cognitive control which is accompanied by connectivity changes in the associated brain networks. They concluded that the findings of the present study allow us to draw preliminary conclusions about the placebo effect in the context of religious beliefs and practices. We found that this type of placebo can enhance emotional-somatic well-being, and can lead to changes in rsFC in cognitive control/emotional salience networks of the brain. Future research is warranted to replicate the results. Moreover, future research should investigate whether the observed effects generalize across different religious affiliations. The idea of “holy water” (or blessed water) is common in several religions, from Christianity, Islam, Buddhism to Sikhism.

Placebo can enhance emotional-somatic well-being. Expectation can play all sorts of tricks on us. This makes sense to me – much to the contrary to the ‘qualitative study’ suggesting that transcendental experiences can be central to this therapeutic effect experienced by believers in Lourdes.

Italian authors recently published a remarkable review entitled ‘Systemic Agro-Homeopathy: A New Approach to Agriculture‘ (OBM Integrative and Complementary Medicine 2021, volume 6, issue 3 doi:10.21926/obm.icm.2103020). Allow me to present you with their (lengthy) conclusions:

The systemic agro-homeopathic approach considers the farm as a single organism, an agroecosystem of living and non-living elements, which establishes a dense network of interactions. Its purpose is to strengthen and intensify the relationships among the organisms to create a stronger and healthier agroecosystem, involving all the organisms within the agroecosystem. To fulfill this aim, the described approach allows one to control and manage the agricultural processes through the application of highly diluted and dynamized natural substances. The latter might restore the equilibrium in the agroecosystem by stimulating the natural resistance already present in the agrarian system. The identification of the correct mineral remedy, through the biotypes and pathogenesis levels, could allow one to act on the chronic conditions of the agroecosystem (imbalance in plant primary metabolism or cellular levels), whereas, the identification of plant/animal homeopathic remedy, based on the principle of metabolic similarity, might allow the management of the acute conditions (phytopathological diseases).

Till now, the systemic agro-homeopathic approach has been adopted by some farmers in Europe, particularly in Italy, for about six years and it is increasing interest, especially among organic producers. To date, several observations have been reported by farmers (personal communications), providing positive and encouraging perspectives, but some rigorous scientific experimentation at the farm level is needed to validate such results. If statistical data from field trials were to confirm the observations made so far, the systemic agro-homeopathic approach could represent an agroecological production model with a very low energy impact. Additionally, this approach could be in line with the current European community orientation (European Green Deal), which aims to promote a type of sustainable agriculture. In this context, systemic agro-homeopathy would meet the three pillars of sustainability: (1) economic, due to the very low use of raw materials; (2) environmental, by avoiding the use of chemical substances such as fertilizers, pesticides, etc.; and (3) social, with the production of healthy, safe, and high-quality food.

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Normally, when I encounter something weird, unproven, or incredible, I react by saying something like: SHOW ME THE EVIDENCE! In this case, I think any attempts to gather evidence might be a waste of time. Some things are just too idiotic to even test them. An open mind is usually a good thing, but one still needs to take care that one’s brain does not fall out.

Health Canada is a government agency responsible for helping Canadians maintain and improve their health. It ensures that high-quality health services are accessible, and works to reduce health risks. Health Canada regulates consumer health products that are sold directly to consumers and do not require a prescription or the oversight of a health care professional. In the past, Health Canada has approved more than 8,500 homeopathic products. A recent survey by Health Canada showed that 11% of parents and guardians believe that alternative practices such as homeopathy or naturopathy can replace vaccines.

Now, Health Canada is proposing changes to the labelling and evidence requirements for homeopathic products, as part of the proposed guidance document: Labelling Requirements for Natural Health Products. These changes would require that all homeopathic products that are sold over the counter include on the front panel of their label the statement “This claim is based on traditional homeopathic references and not modern scientific evidence.” Health Canada is also consulting on the introduction of risk-based evidence standards for homeopathic products, which would align requirements with those of other natural health products. The public consultation opens June 26, 2021 and closes September 4, 2021. For more information on how to participate, visit Consultation – Proposed Amendments to the Natural Health Products Regulations.

I hope you agree with me that it might be worth participating in this public consultation with a view of preventing regulations that could open the door to quackery in Canada. So, please do have a look at the documents and make sure that Canadian consumers are adequately protected.

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