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

Monthly Archives: September 2021

We have covered urine therapy several times already (see for instance here, and here). Essentially it is ineffective but harmless …

except…

CTV reported that a mother in Canada has temporarily lost her right to unsupervised parenting over allegations she made her young son drink his own urine as part of a controversial so-called alternative medicine (SCAM). Specifically, she had fed the eight-year-old boy smoothies made with his own urine.

Apparently, the mother began pursuing a fringe “natural and holistic” lifestyle about three years ago. “It has created significant distrust by the (father) as to the respondent’s judgment in ensuring that the child is safe in her care, which came to a head when the allegation that she was imposing urine therapy on the child arose,” the judge wrote.

The mom’s interest in alternative medicine previously resulted in her seeking unsupported remedies such as homeopathy to treat her breast cancer – all of which failed, ultimately leaving her with no choice but to undergo surgery. Eventually, that inclination also brought her to urine therapy, described in the decision as “a centuries-old practice of drinking one’s own urine and massaging it into one’s skin.”

The mother admitted in court that she started drinking her own urine last January, and even that she appeared on an obscure podcast called “Healing Powers of Urine Therapy,” but denied forcing her son to take part in the practice. The father recounted an after-school incident in which the child approached him looking confused and guilty and said, “I have a secret, you have to promise me not to tell mom. Mom made me pee in a jar, then she put the pee into my fruit smoothie.” The boy later repeated the allegations during an appointment alone with their family doctor. The child said he “didn’t want to do it, told his mom he didn’t want to but she encouraged him to.”

There were also concerns raised about the mother’s fasting, which the father said went on for days on end and left her physically incapable of caring for their son. The judge wasn’t convinced that foregoing food left the mom unable to parent, but ultimately said she agreed with the father’s assessment that, while his former partner loves their son, her “judgment and health are questionable at this time.” The judge ruled that the mother can have parenting time from Sunday mornings to Wednesday evenings, but only with supervision from a professional or a third party agreed upon by both parents.

_________________

The case shows that, once a gullible consumer falls under the influence of the SCAM cult and goes ‘off the rails’, there are no limits. This woman started by treating her cancer with homeopathy and, even though this was not successful, she continued to slide down the slippery SCAM slope until, finally, she experimented with urine therapy on her own son. This indicates to me that we might have to add another risk to the many dangers of homeopathy: it can serve as a gateway drug for all sorts of other SCAMs.

Diabetic polyneuropathy is a prevalent, potentially disabling condition. Evidence-based treatments include specific anticonvulsants and antidepressants for pain management. All current guidelines advise a personalized approach with a low-dose start that is tailored to the maximum response having the least side effects or adverse events. Homeopathy has not been shown to be effective, but it is nevertheless promoted by many homeopaths as an effective therapy.

This study assessed the efficacy of individualized homeopathic medicines in the management of diabetic polyneuropathy. A multi-centric double-blind, placebo-controlled, randomized clinical trial was conducted by the Indian Central Council for Research in Homoeopathy at six centers with a sample size of 84. Based on earlier observational studies and repertorial anamnesis of DDSP symptoms 15 homeopathic medicines were shortlisted and validated scales were used for evaluating the outcomes post-intervention. The primary outcome measure was a change in Neuropathy Total Symptom Score-6 (NTSS-6) from baseline to 12 months. Secondary outcomes included changes in peripheral nerve conduction study (NCS), World Health Organization Quality of Life BREF (WHOQOL-BREF) and Diabetic Neuropathy Examination (DNE) score at 12 months.

Data of 68 enrolled cases were considered for data analysis. A statistically significant difference (p<0.014) was found in NTSS-6 post-intervention in the Verum group. A positive trend was noted for the Verum group as per the graph plotted for DNE score and assessment done for NCS. No significant difference was found between the groups for WHOQOL-Bref. Out of 15 pre-identified homeopathic medicines, 11 medicines were prescribed in potencies in ascending order from 6C to 1M.

The authors refrain from drawing conclusions about the efficacy of their homeopathic treatment (which is more than a little odd, as their stated aim was to assess the efficacy of individualized homeopathic medicines in the management of diabetic polyneuropathy). So, please allow me to do it for them:

The findings of this study confirm that homeopathy is a useless treatment.

The General Chiropractic Council (GCC) regulates chiropractors in the UK, Isle of Man, and Gibraltar to ensure the safety of patients undergoing chiropractic treatment. The GCC sets the standards of chiropractic practice and professional conduct that all chiropractors must meet.

By providing a lengthy ruling in the case of the late John Lawler and his chiropractor, Arlene Scholten, the GCC has recently established new standards for chiropractors working in the UK, Isle of Man, and Gibraltar (see also today’s article in The Daily Mail). If I interpret the GCC’s ruling correctly, a UK chiropractor is henceforth allowed to do all of the following things without fearing to get reprimanded, as long as he or she produces evidence that the deeds were done not with malicious intentions but in a state of confusion and panic:

  • Treat a patient with treatments that are contraindicated.
  • Fail to obtain informed consent.
  • Pose as a real doctor without informing the patient that the practitioner is just a chiropractor who has never been near a medical school.
  • Cause the death of a patient by treatment to the neck.
  • Administer first aid in a way that makes matters worse.
  • Tell lies to the ambulance men who consequently failed to employ a method of transport that would save the patient’s life.
  • Keep inaccurate patient records that conceal what treatments were administered.

In previous years, the job of a chiropractor had turned out to be demanding, difficult, and stressful. This was due not least to the GCC’s professional standards which UK chiropractors were obliged to observe. The code of the GCC stated prominently that “our overall purpose is to protect the public.

All this is now a thing of the past.

The new ruling changed everything. Now, UK chiropractors can relax and can happily pursue their true devotion, namely to keep their bank manager happy, while not worrying too much about the welfare and health of their patients.

In the name of all UK chiropractors, I herewith express my thanks to the GCC for unashamedly protecting first and foremost the interests of their members, while tacitly discarding medical ethics and evidently not protecting the public.

MAKE CHIROPRACTIC GREAT AGAIN!

On 19-30 April 2021 & 1-2 September, 2021 the Professional Conduct Committee of the General Chiropractic Council considered the case of Arleen Scholten, the chiropractor who treated John Lawler, the patient who died after her treatment. Details of the case can be found in the following posts:

The Committee considered there had been breaches of the Code, those breaches occurred as a result of Mrs. Scholten’s state of mind at the time and not as a result of a deliberate intention on her part to be inaccurate or misleading. In light of those circumstances, the Committee considered other members of the profession and fully informed members of the public would not consider her failings to be morally reprehensible or deplorable, but rather would consider them regrettable but understandable in the exceptional, albeit tragic, circumstances of this case. The Committee, therefore, agreed with the GCC’s expert witness Mr Brown and did not think Mrs Scholten’s conduct fell far short of the standard required of a registered chiropractor. The Committee was not satisfied, therefore, that her behaviour amounted to unacceptable professional conduct. Accordingly, the Committee found the allegation of UPC not to be well-founded.

How can this be right?

To remind us of the case, here is what I wrote about it previously:

The tragic case of John Lawler who died after being treated by a chiropractor has been discussed on this blog before. Naturally, it generated much discussion which, however, left many questions unanswered. Today, I am able to answer some of them.

  • Mr Lawler died because of a tear and dislocation of the C4/C5 intervertebral disc caused by considerable external force.
  • The pathologist’s report also shows that the deceased’s ligaments holding the vertebrae of the upper spine in place were ossified.
  • This is a common abnormality in elderly patients and limits the range of movement of the neck.
  • There was no adequately informed consent by Mr Lawler.
  • Mr Lawler seemed to have been under the impression that the chiropractor, who used the ‘Dr’ title, was a medical doctor.
  • There is no reason to assume that the treatment of Mr Lawler’s neck would be effective for his pain located in his leg.
  • The chiropractor used an ‘activator’ which applies only little and well-controlled force. However, she also employed a ‘drop table’ which applies a larger and not well-controlled force.

I have the permission to publish the submissions made to the coroner by the barrister representing the family of Mr Lawler. The barrister’s evidence shows that:

a. The treating chiropractor owed a duty of care to the Deceased, her patient;
b. That duty was breached in that:
i. After the Deceased reported loss of sensation and paralysis in his arms, the only safe and appropriate response was to:
1. Leave him in situ;
2. Await the arrival of the paramedic;
3. Provide an accurate history to the ambulance controller and attending paramedic;
ii. The treating chiropractor, in fact:
1. Manhandled the Deceased from the treatment bed into a sitting position on a chair;
2. Tipped his head backwards and gave “mouth to mouth” breaths;
3. Provided an inaccurate and misleading history to the paramedic and ambulance controller, causing the paramedic to treat the incident as “medical” not “traumatic” and to transport the Deceased downstairs to the ambulance without stabilising his neck.
c. The risk of death was a reasonably foreseeable consequence of the breach;
d. In the absence of the breach:
iii. The paramedic would have stabilised the neck, in situ, and transported the Deceased on a scoop stretcher;
iv. The deceased would have survived.
e. Having regard to the risk of death involved, the misconduct was grossly negligent so as to be condemned as the serious crime of manslaughter. The decision to intervene as she did, went beyond a very serious mistake or very serious error of judgment having regard to the fact that:
i. She held herself out as a provider of (quasi) medical treatment;
ii. She styled herself as “doctor”, (when she was not entitled to do so);
iii. She intervened without any understanding of the injury she had caused nor any training in how to intervene safely.
___________________________________

The chiropractor, Mrs. Scholten, had been accused by the GCC of unacceptable professional conduct. The exact text of the GCC reads as follows :

1. Between 31 July 2017 and 11 August 2017, you provided chiropractic care and
treatment to Patient A at Chiropractic 1st, 68 The Mount, North Yorkshire, YO24 1AR,
(‘the Clinic’).
2. On 11 August 2017 you provided treatment to Patient A which included:
a. a drop technique applied to the thoracic spine;
b. the use of an Activator applied to the thoracic spine;
c. the use of an Activator applied to the cervical spine.
3. Following the drop technique, Patient A indicated he was in discomfort and had lost sensation in his arms and you inappropriately continued treatment.
4. During the course of a subsequent 999 telephone call:
a. you told the call handler that Patient A had laid on the adjusting table and you had used the Activator on his midback;
b. you told the call handler that when you were using the Activator on Patient A’s midback he had said his hands had gone numb;
c. you told the call handler that as Patient A was elderly you had never used any manual adjustment on Patient A;
d. you omitted to tell the call handler that you had used a drop technique on Patient A;
e. you omitted to tell the call handler that Patient A had first expressed discomfort following the drop technique;
f. you omitted to tell the call handler that you had treated Patient A’s cervical spine.
5. When paramedics arrived at the Clinic:
a. you told them words to the effect that you had manipulated Patient A’s midback with the use of an Activator;
b. you told them words to the effect that Patient A had first complained of discomfort when you had been using the Activator on his midback;
c. you omitted to tell the paramedics you had used a drop technique on Patient A;
d. you omitted to tell the paramedics that Patient A had first expressed discomfort following the drop technique;
e. you omitted to tell the paramedics that you had treated Patient A’s cervical spine;
f. you demonstrated the force applied by an Activator on one of the paramedic’s arms.
6. In Patient A’s records for 11 August 2017:
a. you recorded that you had used the Activator on Patient A’s thoracic spine at T2/3 level;
b. you recorded that Patient A had directly said his arms felt numb;
c. you omitted to record that you had used a drop technique on Patient A;
d. you omitted to record that you had treated Patient A’s cervical spine.
7. Your comments and omissions as set out above at 4 and/or 5, and/or as recorded at 6 above, were;
a. inaccurate;
b. misleading;
c. dishonest in that you intended to mislead as to the precise details of the treatment you had provided Patient A

Mr Goldring, on behalf of Mrs Scholten, indicated that the following facts were admitted: Particulars 1, 2(a), 4(a), 4(b), 4(c), 4(d), 5(a), 5(b), 5(c), 5(f), 6(a), 6(b), 6(c) and 7(a) and (b), insofar as they related to the aforementioned admitted facts. The Chair therefore announced that those matters were found proved. Later in the proceedings Mr Goldring indicated that 7(a) and 7(b) were not in fact admitted in respect of 4(c) and 6(b), since it was Mrs Scholten’s case that she had not used any manual adjustment on Patient A, (Particular 4(c)) and the record that Patient A had directly said his arms felt numb was accurate, (Particular 6(b)). Accordingly, the Chair formally announced that position.

END OF QUOTES

I am totally baffled by this ruling.

  • What about the fact that the chiropractor’s treatment was not even indicated?
  • What about the fact that no informed consent was obtained?
  • What about the fear that the chiropractor moved her patient after the injury had happened and made an attempt of ‘mouth to mouth’ resuscitation which seems to have aggravated the injury?
  • What about the fact that she misled the paramedics which then caused them not to stabilise Mr. Lawlwer’s neck?

Is the GCC truly saying that, as long as a chiropractor panics, all these mistakes can be excused? I am at a complete loss trying to understand the GCC ruling and very much hope that someone can explain it to me.

 

Homeopaths believe that their remedies work for every condition imaginable and that naturally includes irritable bowel syndrome (IBS). But what does the evidence show?

The aim of this pilot study was to evaluate the efficacy of individualized homeopathic treatment in patients with IBS. The study was carried out at the National Homeopathic Hospital of the Secretary of Health, Mexico City, Mexico and included 41 patients: 3 men and 38 women, mean age 54 ± 14.89 years, diagnosed with IBS as defined by the Rome IV Diagnostic criteria. Single individualized homeopathics were prescribed for each patient, taking into account all presenting symptoms, clinical history, and personality via repertorization using RADAR Homeopathic Software. The homeopathic remedies were used at the fifty-millesimal (LM) potency per the Mexican Homeopathic Pharmacopoeia starting with 0/1 and increasing every month (0/2, 0/3, 0/6). Severity scales were applied at the beginning of treatment and every month for 4 months of treatment. The evaluation was based on comparing symptom severity scales during treatment.

The results demonstrated that 100% of patients showed some improvement and 63% showed major improvement or were cured. The study showed a significant decrease in the severity of symptom scores 3 months after the treatment, with the pain score showing a decrease already one month after treatment.

The authors state that the results highlight the importance of individualized medicine regimens using LM potency, although the early decrease in pain observed could also be due to the fact that Lycopodium clavatum and Nux vomica were the main homeopathic medicine prescribed, and these medicines contain many types of alkaloids, which have shown significant analgesic effects on pain caused by physical and chemical stimulation.

The authors concluded that this pilot study suggests that individualized homeopathic treatment using LM potencies benefits patients with IBS.

Where to begin?

Let me mention just a few rather obvious points:

  1. A pilot study is not for evaluating the efficacy, but for testing the feasibility of a definitive trial.
  2. The study has no control group, therefore the outcome cannot be attributed to the treatment but is most likely due to a mixture of placebo effects, regression towards the mean, and natural history of IBS.
  3. The conclusions are not warranted.
  4. The paper was published in the infamous Altern Ther Health Med.

Just to make sure that nobody is fooled into believing that homeopathy might nonetheless be effective for IBS. Here is what the Cochrane review on this subject tells us: no firm conclusions regarding the effectiveness and safety of homeopathy for the treatment of IBS can be drawn. Further high quality, adequately powered RCTs are required to assess the efficacy and safety of clinical and individualised homeopathy for IBS compared to placebo or usual care.

In my view, even the conclusion of the Cochrane review is odd and slightly misleading. The correct conclusion would have been something more to the point:

THE CURRENT TRIAL EVIDENCE FAILS TO INDICATE THAT HOMEOPATHY IS AN EFFECTIVE TREATMENT FOR IBS.

The authors of this review start their paper with the following statement:

Acupuncture has demonstrated effectiveness for symptom management among breast cancer survivors.

This, I think, begs the following question: if they already know that, why do they conduct a systematic review of the subject?

The answer becomes clear as we read thier article: they want to add another paper to the literature that shows they are correct in their assumption.

So, they do the searches and found 26 trials (2055 patients), of which 20 (1709 patients) could be included in the meta-analysis. Unsurprisingly, their results show that acupuncture was more effective than control groups in improving pain intensity [standardized mean difference (SMD) = -0.60, 95% confidence intervals (CI) -1.06 to -0.15], fatigue [SMD = -0.62, 95% CI -1.03 to -0.20], and hot flash severity [SMD = -0.52, 95% CI -0.82 to -0.22].  Compared with waitlist control and usual care groups, the acupuncture groups showed significant reductions in pain intensity, fatigue, depression, hot flash severity, and neuropathy. No serious adverse events were reported related to acupuncture intervention. Mild adverse events (i.e., bruising, pain, swelling, skin infection, hematoma, headache, menstrual bleeding) were reported in 11 studies.

The authors concluded that this systematic review and meta-analysis suggest that acupuncture significantly reduces multiple treatment-related symptoms compared with the usual care or waitlist control group among breast cancer survivors. The safety of acupuncture was inadequately reported in the included studies. Based on the available data, acupuncture seems to be generally a safe treatment with some mild adverse events. These findings provide evidence-based recommendations for incorporating acupuncture into clinical breast cancer symptom management. Due to the high risk of bias and blinding issues in some RCTs, more rigorous trials are needed to confirm the efficacy of acupuncture in reducing multiple treatment-related symptoms among breast cancer survivors.

Yes, I agree: this is an uncritical white-wash of the evidence. So, why do I bother to discuss this paper? After all, the acupuncture literature is littered with such nonsense.

Well, to my surprise, the results did contain a little gem after all.

A subgroup analysis of the data indicated that acupuncture showed no significant effects on any of the treatment-related symptoms compared with the sham acupuncture groups.

In other words, this paper confirms what has been discussed repeatedly on this blog (see for instance here, here, and here):

Acupuncture seems to be a placebo therapy!

Acupuncture is usually promoted as a safe therapy. This may be good marketing but, sadly, it is not the truth. About 10% of all patients experience mild to moderate adverse effects such as pain or bleeding. In addition, there are well-documented complications, for instance:

However, there have been few reports of deaths due to pneumothorax after acupuncture treatment, especially focused on electroacupuncture.

Japanese authors recently reported an autopsy case of a man in his 60s who went into cardiopulmonary arrest and died immediately after receiving electroacupuncture. Postmortem computed tomography (PMCT) showed bilateral pneumothoraces, as well as the presence of numerous gold threads embedded subcutaneously. An autopsy revealed two ecchymoses in the right thoracic cavity and a pinhole injury on the lower lobe of the right lung, suggesting that the needles had penetrated the lung. There were marked emphysematous changes in the lung, suggesting that rupture of bullae might also have contributed to bilateral pneumothoraces and fatal outcomes. The acupuncture needles may have been drawn deeper into the body than at the time of insertion due to electrical pulses and muscle contraction, indicating the need for careful determination of treatment indications and technical safety measures, such as fail-safe mechanisms.

This is the first case report of fatal bilateral pneumothoraces after electroacupuncture reported in the English literature. This case sheds light on the safety of electroacupuncture and the need for special care when administering it to patients with pulmonary disease who may be at a higher risk of pneumothorax. This is also the first report of three-dimensional reconstructed PMCT images showing the whole-body distribution of embedded gold acupuncture threads, which is unusual.

One-sided pneumothoraxes are common events after acupuncture. Several hundred cases have been published and the vast majority of such incidents remain unpublished or even unnoticed. These events are not normally life-threatening. If ‘only’ one lung is punctured, the patient may experience breathing difficulties, but in many cases these are temporary and the patient soon recovers.

Yet a bilateral pneumothorax is an entirely different affair. If both lungs malfunction, the patient’s chances of survival are slim unless he/she is close to an intensive care unit.

You might think that it needs an especially ungifted acupuncturist to manage to puncture both lungs simultaneously. I might agree, but we need to consider that acupuncture needles are often inserted in a symmetrical fashion into the patient’s body. This means that, if the therapist puts a needle at one point of the thorax that is close to a lung, he is not unlikely to do the same on the other side.

And how does one prevent such disasters?

Easy:

  • train acupuncturists properly,
  • avoid needles on the upper thorax,
  • or refuse acupuncture altogether.

 

 

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