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

Monthly Archives: November 2021

In a recently published study, the willingness to be vaccinated of parents of underage children and persons without underage children was examined. The study was based on a random sample (telephone survey, n = 2014, survey between 12.11.2020 and 10.12.2020).
The results revealed that parents consistently show a lower propensity to vaccinate with a COVID-19 vaccine than respondents without minor children (54.1% vs. 71.1%). Fathers showed a more pronounced own willingness to vaccinate than mothers. Furthermore, men were more willing than women to have their own child vaccinated with a COVID-19 vaccine.
The overall sample also showed that a rejection of so-called alternative medicine (SCAM) was associated with a significantly higher willingness to be vaccinated. There was also a significant correlation between the attitude towards homeopathy and one’s own willingness to be vaccinated. If homeopathy was supported, the willingness to vaccinate was lower. This correlation between the attitude towards homeopathy and willingness to vaccinate was also evident in the sub-sample of parents. Among the parents, it was again the women who significantly more often had a positive attitude towards homeopathy than men, who more often do not think anything of it.

This new evidence ties in neatly with many of my previous posts on the subject of SCAM and vaccination, for instance:

Collectively, this evidence tells us that:

  • the effect has been shown in many different ways,
  • it can therefore be assumed to be real,
  • it is not confined to COVID vaccinations,
  • it is not confined to one particular branch of SCAM,
  • it even affects MDs (who surely should know better) dabbling in SCAM,
  • it has a long history,
  • it is prevalent in many, if not most countries,
  • it does real harm.

So, the next time someone tells you that SCAM and SCAM practitioners have a positive influence on public health, tell them to think again.

 

I have said it often before, and I will say it again:

Homeopathy and other ineffective so-called alternative medicines (SCAMs) are dangerous mostly because they might replace effective treatments.

The tragic death of an Austrian boy is a stark reminder of this fact. Even though this happened a decade ago, I only just came across this case. It was, to the best of my knowledge, never published in English. Allow me, therefore, to summarize it here:

In 2011, a judge sentenced a couple from East Tyrol to a one-year suspended sentence. Their son, who suffered from a rare congenital immune system disorder (SCID*), had been treated only with homeopathy until he died. The doctor who treated the boy in this way received the same sentence.** The verdicts took into account that the parents and the family doctor did not act out of sheer ignorance, but had been informed about the nature of the disease and its consequences.

The parents told the court that they had previously had extremely negative experiences with conventional medicine when their first two children, who suffered from the same condition, had died. When their third child fell ill, the parents took him to a clinic where a bone marrow transplant was to be carried out, which, according to an expert witness, would have had a 95 % chance of curing the boy. Because the parents were put off by the sight of other children in the hospital, they took their son home again and withheld all further conventional treatments or appropriate examinations. Instead, they instructed their family doctor to cure the boy with homeopathy. The doctor refrained from administering antibiotics when the illness worsened due to an infection and failed to admit the boy to a hospital when he became severely ill.

The child then died of sepsis. The autopsy revealed that he was malnourished and one of his ear canals as well as his lungs were necrotic with inflammation.

______________________

It is hard not to be repulsed and nauseated by such stories. They show how dangerously unreasonable some homeopaths and their followers are. And they remind us that even a seemingly harmless SCAM will cost lives in the hands of such fanatics.

 

* Severe combined immunodeficiency (SCID) is a group of rare disorders caused by mutations in different genes involved in the development and function of infection-fighting immune cells. Infants with SCID appear healthy at birth but are highly susceptible to severe infections. The condition is fatal, usually within the first year or two of life, unless infants receive immune-restoring treatments, such as transplants of blood-forming stem cells, gene therapy, or enzyme therapy.

**Personally, I find the sentence for the doctor far too lenient. One could argue that the parents had been punished by the loss of their child and thus deserve merci, but the doctor?

This post has no direct relation to so-called alternative medicine (SCAM), except that many fans of SCAM and most anti-vaxxers claim that COVID-19 is ‘just a flu’ and therefore should not be taken all that seriously. A little bit of this or that SCAM is surely enough for protecting us, they claim. To all who are of this opinion, I recommend reading this new BMJ paper very carefully.

This analysis aimed at estimating the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic. A time-series analysis was undertaken with the data from 37 upper-middle and high-income countries or regions with reliable and complete mortality data. The annual all-cause mortality data from the Human Mortality Database for 2005-20 were used, harmonized, and disaggregated by age and sex.

The reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table.

A reduction in life expectancy in men and women was observed in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. No evidence was found of a change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in

  • Russia (men: −2.33, 95% confidence interval −2.50 to −2.17; women: −2.14, −2.25 to −2.03),
  • the United States (men: −2.27, −2.39 to −2.15; women: −1.61, −1.70 to −1.51),
  • Bulgaria (men: −1.96, −2.11 to −1.81; women: −1.37, −1.74 to −1.01),
  • Lithuania (men: −1.83, −2.07 to −1.59; women: −1.21, −1.36 to −1.05),
  • Chile (men: −1.64, −1.97 to −1.32; women: −0.88, −1.28 to −0.50),
  • Spain (men: −1.35, −1.53 to −1.18; women: −1.13, −1.37 to −0.90).

Years of life lost in 2020 were higher than expected in all countries except Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea. In the remaining 31 countries, more than 222 million years of life were lost in 2020, which is 28.1 million (95% confidence interval 26.8m to 29.5m) years of life lost more than expected (17.3 million (16.8m to 17.8m) in men and 10.8 million (10.4m to 11.3m) in women). The highest excess years of life lost per 100 000 population were observed in

  • Bulgaria (men: 7260, 95% confidence interval 6820 to 7710; women: 3730, 2740 to 4730),
  • Russia (men: 7020, 6550 to 7480; women: 4760, 4530 to 4990),
  • Lithuania (men: 5430, 4750 to 6070; women: 2640, 2310 to 2980),
  • the US (men: 4350, 4170 to 4530; women: 2430, 2320 to 2550),
  • Poland (men: 3830, 3540 to 4120; women: 1830, 1630 to 2040),
  • Hungary (men: 2770, 2490 to 3040; women: 1920, 1590 to 2240).

The excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the US where the excess years of life lost was >2000 per 100 000.

The authors concluded that more than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women. Excess years of life lost associated with the covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015.

_______________________

I hope (yet, sadly, I am not sure) that this will silence all those who like to claim:

it’s just a flu!

Remember the 10:23 Campaign? It was an awareness and protest campaign against homoeopathy organised by the Merseyside Skeptics Society, a non-profit organisation, to oppose the sale of homoeopathic products in the UK. It consisted of volunteers publicly taking overdoses of homeopathic remedies. With their actions, they wanted to demonstrate that homeopathic remedies are devoid of active ingredients and physiological effects. Suicide by homeopathy, they showed us, was impossible.

But they were mistaken – it is possible after all!

A few days ago, it was reported that an Italian doctor has died of a COVID-19 infection. This is tragic, no doubt, but in itself, it is not all that newsworthy in the context of this blog. What makes it remarkable is the fact that the doctor was a convinced homeopath who had refused to get vaccinated and was adamant that homeopathy would protect him.

Domenico Giannola, a doctor homeopath from Cinisi, died of complications due to Covid-19 at Palermo’s Cervello hospital. Dr. Giannola had not been vaccinated and after he got infected with COVID-19, he had tried to treat himself with homeopathic remedies.

Domenico Giannola was a well-known advocate of anthroposophical and homeopathic medicine. In a Youtube video from last year, he described his ‘methods of treatment. As he had a preexisting heart condition, he was a high-risk patient.

After he fell ill, he had been in home isolation for several days and was followed by the special continuity care unit (Usca) of the Palermo hospital. He had always insisted that he had no intention of becoming infected and would treat himself at home with lactoferrin and homeopathic remedies. Lactoferrin is one of the components of the immune system of the body; it has antimicrobial activity against bacteria and fungi.

As his condition worsened, Domenico Giannola was eventually transported to the emergency room of the Cervello hospital in Palermo by a 118 ambulance. He died an hour after his arrival at the hospital.

_________________________

I find such reports tragic beyond words. At the same time, they are deeply worrying. A question that one needs to ask is this: if some homeopaths do this to themselves, what are they capable of inflicting on their patients?

 

If you are not American, you will ask: Who the Dickens is Aaron Rodgers? I too had to look it up. He is an American football star. And it seems that US football fans are worried about him and his rather brainless idea of homeopathic vaccination.

Yesterday it was confirmed that the ‘Green Bay Packers’ quarterback, Aaron Rodgers, had tested positive for Covid and will thus have to miss at least 10 days of crucial games. Only the unvaccinated players are forced to miss a mandatory 10 games following a positive test — while vaccinated players can return at any point, as long as they provide two negative tests 24 hours apart and are not experiencing symptoms.

Everyone had assumed that Rodgers was vaccinated – after all, he had confirmed it when asked about his vaccination status by a reporter prior to the start of the season. Presumably, he thought so himself when he affirmed, with a straight face, that he was immunized.

But now it has been revealed that Aaron Rodgers was given a homeopathic vaccination for COVID from his personal doctor. When the NFL reviewed his treatment, they did not deem it suitable to appropriately label him as “vaccinated.”

Per NFL.com:

Rodgers received homeopathic treatment from his personal doctor to raise his antibody levels and asked the NFL to review his status. The league pointed Rodgers to the NFL-NFLPA protocols, which do not account for such an exemption for players. So, Rodgers remained subject to a variety of restrictions, including daily testing, mask-wearing and high-risk close contact protocol that would force him to isolate for five days based on interaction with a positive individual, even if he tested negative.

Now, as an unvaccinated player, Aaron Rodgers will have to sit out the next 10 days, at least. That means he won’t play for the Packers this Sunday against the Kansas City Chiefs. The soonest he can return to the team is Saturday, November 13, one day before the Packers’ week 10 matchup with the Seattle Seahawks.

I don’t suppose that Aaron Rodgers is an avid reader of my blog. Pity! Because, if he had followed our discussions, he would have known what to think of homeopathy in general and of homeopathic vaccination in particular:

Some people seem to insist on finding out the hard way about homeopathy. Personally, I hope Aaron Rodgers recovers fully from both his COVID infection and his homeopathic fantasies. Oh, I almost forgot: I also want to thank him for his sacrifice; it hopefully leads to a better understanding in the US of the fact that homeopathy is a placebo treatment.

PS

This is what the man himself had to say:

Image

Well-conducted systematic reviews (SRs) should in principle provide the most reliable evidence on the effectiveness of acupuncture. However, limitations on the methodological rigour of SRs may impact the trustworthiness of their conclusions. This cross-sectional study was aimed at evaluating the methodological quality of recent SRs of acupuncture.

The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE were searched for SRs focusing on manual acupuncture or electro-acupuncture published during January 2018 and March 2020. Eligible SRs needed to contain at least one meta-analysis and be published in the English language. Two independent reviewers extracted the bibliographical characteristics of the included SRs with a pre-designed questionnaire and appraised the methodological quality of the reviews with the validated AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2). The associations between bibliographical characteristics and methodological quality ratings were explored using Kruskal-Wallis rank tests and Spearman’s rank correlation coefficients.

A total of 106 SRs were appraised. The results were as follows:

  • one (0.9%) SR was of high methodological quality,
  • no review (0%) was of moderate quality,
  • six (5.7%) were of low quality,
  • 99 (93.4%) were of critically low quality.

Only ten (9.4%) provided an a priori protocol, only four (3.8%) conducted a comprehensive literature search, only five (4.7%) provided a list of excluded studies, and only six (5.7%) performed a meta-analysis appropriately. Cochrane SRs, updated SRs, and SRs that did not search non-English databases had relatively higher overall quality. The vast majority (87.7%) of the 106 reviews included in this analysis originated from Asia. Conflicts of interest of the review authors were declared in only 2 of the 106 reviews.

The authors concluded that the methodological quality of SRs on acupuncture is unsatisfactory. Future reviewers should improve critical methodological aspects of publishing protocols, performing comprehensive search, providing a list of excluded studies with justifications for exclusion, and conducting appropriate meta-analyses. These recommendations can be implemented via enhancing the technical competency of reviewers in SR methodology through established education approaches as well as quality gatekeeping by journal editors and reviewers. Finally, for evidence users, skills in SR critical appraisal remain to be essential as relevant evidence may not be available in pre-appraised formats.

On this blog, I have often complained about the lack of critical input and the poor quality of systematic reviews of so-called alternative medicine (SCAM), particularly of acupuncture, and especially of Chinese reviews, and even more especially Chinese reviews of (mostly) Chinese studies. This new paper is a valuable confirmation of this fast-growing deficit.

One does not need to be a prophet to predict that this pollution of the literature with complete rubbish will have detrimental effects. Because poor reviews almost always draw an over-optimistic picture of the value of acupuncture, this phenomenon must seriously mislead the public. The end result will be that the public believes acupuncture to be effective.

I cannot help thinking that this is, in fact, the intended aim of the authors of such poor, false-positive reviews. Moreover, a glance at the subject areas of the reviews in the list below gives the impression that China is heavily promoting the idea that acupuncture is a panacea. Yet there is good evidence to show that acupuncture is little more than placebo therapy.

In my last post, I have reported that I am an author of many of the frequently-cited systematic acupuncture reviews. You might thus assume that I am a significant part of this pollution by rubbish reviews. This would, however, be an entirely wrong conclusion. The above analysis covers a period when my unit had already been closed, and I am thus not responsible for a single of the papers included in the above analysis.

List of included systematic reviews

ID Included systematic reviews
1 Acupuncture for primary insomnia: An updated systematic review of randomized controlled trials
2 Efficacy and safety of acupuncture for essential hypertension: A meta-analysis
3 Acupuncture for the treatment of sudden sensorineural hearing loss: A systematic review and meta-analysis: Acupuncture for SSNHL
4 Effectiveness of Acupuncturing at the Sphenopalatine Ganglion Acupoint Alone for Treatment of Allergic Rhinitis: A Systematic Review and Meta-Analysis
5 Acupuncture and clomiphene citrate for anovulatory infertility: a systematic review and meta-analysis
6 Acupuncture for primary trigeminal neuralgia: A systematic review and PRISMA-compliant meta-analysis
7 Acupuncture as an adjunctive treatment for angina due to coronary artery disease: A meta-analysis
8 Conventional treatments plus acupuncture for asthma in adults and adolescent: A systematic review and meta-analysis
9 Optimizing acupuncture treatment for dry eye syndrome: A systematic review
10 Acupuncture using pattern-identification for the treatment of insomnia disorder: a systematic review and meta-analysis of randomized controlled trials
11 Efficacy and Safety of Auricular Acupuncture for Cognitive Impairment and Dementia: A Systematic Review
12 Acupuncture for cognitive impairment in vascular dementia, alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis
13 Effectiveness of pharmacopuncture for cervical spondylosis: A systematic review and meta-analysis
14 Acupuncture combined with swallowing training for poststroke dysphagia: a meta-analysis of randomised controlled trials
15 Scalp acupuncture treatment for children’s autism spectrum disorders: A systematic review and meta-analysis
16 Acupuncture for Post-stroke Shoulder-Hand Syndrome: A systematic review and meta-analysis
17 Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome
18 Acupuncture for hip osteoarthritis
19 Clinical Benefits of Acupuncture for the Reduction of Hormone Therapy-Related Side Effects in Breast Cancer Patients: A Systematic Review
20 Combination therapy of scalp electro-acupuncture and medication for the treatment of Parkinson’s disease: A systematic review and meta-analysis
21 Acupuncture for migraine: A systematic review and meta-analysis
22 Acupuncture to Promote Recovery of Disorder of Consciousness after Traumatic Brain Injury: A Systematic Review and Meta-Analysis
23 Acupuncture Compared with Intramuscular Injection of Neostigmine for Postpartum Urinary Retention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
24 Acupuncture for the relief of hot flashes in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials and observational studies
25 Effectiveness and Safety of Acupuncture for Perimenopausal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
26 Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis
27 Electroacupuncture as an adjunctive therapy for motor dysfunction in acute stroke survivors: A systematic review and meta-analyses
28 Acupuncture for Acute Pancreatitis: A Systematic Review and Meta-analysis
29 Acupuncture for chronic fatigue syndrome: a systematic review and meta-analysis
30 Compare the efficacy of acupuncture with drugs in the treatment of Bell’s palsy: A systematic review and meta-analysis of RCTs
31 The effectiveness and safety of acupuncture for the treatment of myasthenia gravis: a systematic review and meta-analysis of randomized controlled trials
32 Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials
33 The effectiveness of acupuncture therapy in patients with post-stroke depression: An updated meta-analysis of randomized controlled trials
34 Fire needling for herpes zoster: A systematic review and meta-analysis of randomized clinical trials
35 Comparison between the Effects of Acupuncture Relative to Other Controls on Irritable Bowel Syndrome: A Meta-Analysis
36 Manual Acupuncture for Optic Atrophy: A Systematic Review and Meta-Analysis
37 Effect of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis: A systematic review and meta-analysis
38 The Effect of Acupuncture in Breast Cancer-Related Lymphoedema (BCRL): A Systematic Review and Meta-Analysis
39 The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis
40 The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review
41 The effectiveness of acupuncture in the management of persistent regional myofascial head and neck pain: A systematic review and meta-analysis
42 Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis
43 The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis
44 Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis
45 Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis
46 The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis
47 Comparing verum and sham acupuncture in fibromyalgia syndrome: a systematic review and meta-analysis
48 Acupuncture for symptomatic gastroparesis
49 The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis
50 Acupuncture Versus Sham-acupuncture: A Meta-analysis on Evidence for Non-immediate Effects of Acupuncture in Musculoskeletal Disorders
51 Acupuncture Treatment for Post-Stroke Dysphagia: An Update Meta-Analysis of Randomized Controlled Trials
52 Effectiveness of Acupuncture Used for the Management of Postpartum Depression: A Systematic Review and Meta-Analysis
53 Clinical effects and safety of electroacupuncture for the treatment of post-stroke depression: a systematic review and meta-analysis of randomised controlled trials
54 Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis
55 Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis
56 Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis
57 Warm needle acupuncture in primary osteoporosis management: a systematic review and meta-analysis
58 Acupuncture for overactive bladder in adults: a systematic review and meta-analysis
59 Traditional acupuncture for menopausal hot flashes: A systematic review and meta-analysis of randomized controlled trials
60 The effectiveness of acupuncture for osteoporosis: A systematic review and meta-analysis
61 Long-term effects of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: Systematic review and single-Arm meta-Analyses
62 Does acupuncture the day of embryo transfer affect the clinical pregnancy rate? Systematic review and meta-analysis
63 Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials
64 Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis
65 Is Acupuncture Effective for Improving Insulin Resistance? A Systematic Review and Meta-analysis
66 Efficacy of acupuncture in the management of post-apoplectic aphasia: A systematic review and meta-analysis of randomized controlled trials
67 Acupuncture for lumbar disc herniation: a systematic review and meta-analysis
68 Traditional Chinese acupuncture and postpartum depression: A systematic review and meta-analysis
69 Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis
70 Acupuncture Therapy for Functional Effects and Quality of Life in COPD Patients: A Systematic Review and Meta-Analysis
71 Electroacupuncture for Reflex Sympathetic Dystrophy after Stroke: A Meta-Analysis
72 The Effect of Patient Characteristics on Acupuncture Treatment Outcomes
73 The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis
74 Role of acupuncture in the treatment of insulin resistance: A systematic review and meta-analysis
75 Appropriateness of sham or placebo acupuncture for randomized controlled trials of acupuncture for nonspecific low back pain: A systematic review and meta-analysis
76 Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials
77 The effects of acupuncture on pregnancy outcomes of in vitro fertilization: A systematic review and meta-analysis
78 Acupuncture for migraine without aura: a systematic review and meta-analysis
79 Acupuncture for acute stroke
80 Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
81 Acupuncture for hypertension
82 The effect of acupuncture on Bell’s palsy: An overall and cumulative meta-analysis of randomized controlled trials
83 Effects of acupuncture on cancer-related fatigue: a meta-analysis
84 Acupuncture for adults with overactive bladder
85 Electroacupuncture for Postoperative Urinary Retention: A Systematic Review and Meta-Analysis
86 Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive Care
87 Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis
88 The effect of acupuncture on the quality of life in patients with migraine: A systematic review and meta-analysis
89 Cognitive improvement effects of electro-acupuncture for the treatment of MCI compared with Western medications: A systematic review and Meta-analysis 11 Medical and Health Sciences 1103 Clinical Sciences
90 Oriental herbal medicine and moxibustion for polycystic ovary syndrome: A meta-analysis
91 The Effect of Acupuncture and Moxibustion on Heart Function in Heart Failure Patients: A Systematic Review and Meta-Analysis
92 Acupuncture therapy for the treatment of stable angina pectoris: An updated meta-analysis of randomized controlled trials
93 Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis
94 Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis: A meta-analysis
95 Acupuncture Treatment for Chronic Pelvic Pain in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
96 The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis
97 Acupuncture for postherpetic neuralgia systematic review and meta-analysis
98 Acupoint selection for the treatment of dry eye: A systematic review and meta-analysis of randomized controlled trials
99 Warm-needle moxibustion for spasticity after stroke: A systematic review of randomized controlled trials
100 Acupuncture for menstrual migraine: a systematic review
101 The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis
102 Acupuncture and weight loss in Asians: A PRISMA-compliant systematic review and meta-analysis
103 Effects of Acupuncture on Breast Cancer-Related lymphoedema: A Systematic Review and Meta-Analysis
104 Acupuncture for infertile women without undergoing assisted reproductive techniques (ART): A systematic review and meta-analysis
105 Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer
106 Acupuncture for stable angina pectoris: A systematic review and meta-analysis

It was only when I came across this recent paper that I realized that, apparently, I am THE WORLD CHAMPION in acupuncture reviews. The aim of this paper was to analyze the 100 most-cited systematic reviews or meta-analyses in the field of acupuncture research.

The Web of Science Core Collection was used to retrieve lists of 100 most-cited systematic reviews or meta-analyses in the field of acupuncture research. Two authors screened literature, extracted data, and analyzed the results.

The citation number of the 100 most-cited systematic reviews or meta-analyses varied from 65 to 577; they were published between 1989 and 2018. Fourteen authors published more than 1 study as the corresponding author and 10 authors published more than 1 study as the first author.

In terms of the corresponding authors, Edzard Ernst and Linde Klaus published the most systematic reviews/meta-analyses (n = 7). The USA published most of the systematic reviews or meta-analyses (n = 24), followed by England (n = 23) and China (n = 14). Most institutions with more than 1 study were from England (4/13). The institutions with the largest numbers of most-cited systematic reviews or meta-analyses were the Technical University of Munich in Germany, the University of Maryland School of Medicine in the USA (n = 8), the Universities of Exeter and Plymouth in England (n = 6), and the University of Exeter in England (n = 6). The journal with the largest number of most-cited systematic reviews or meta-analyses was the Cochrane Database of Systematic Reviews (n = 20), followed by Pain (n = 6). The majority of the 100 most-cited reviews are on pain or pain-related conditions. Only 4 of them focus on safety issues, and all of these are by my team.

The authors concluded that the 100 most-cited systematic reviews or meta-analyses in the acupuncture research field are mostly from high impact factor journals and developed countries. It will help researchers follow research hot spots, broaden their research scope, expand their academic horizons, and explore new research ideas, thereby improving the quality of acupuncture research.

The authors show that, both in the list of corresponding as well as first authors, I am in place number one! Not only that, they furthermore reveal that my department is also in place number 1 (as Universities of Exeter and Plymouth in England (n = 6), and the University of Exeter in England (n = 6) both refer to my unit [in the 19 years it existed the Exeter medical school changed affiliation twice]). This is remarkable, particularly because acupuncture was only one of several research foci of my team (the other 3 being herbal medicine, homeopathy, and spinal manipulation), and my department was closed almost 10 years ago.

When I write about acupuncture these days (mostly on this blog), I often get the impression that the true believers in this therapy don’t especially like what I have to say. I, therefore, fear that the concept of me being the WORLD CHAMPION of acupuncture reviews might cause some degree of displeasure to them.

What can I say?

Sorry guys!

The non-specific effects constitute part of the overall effect of acupuncture. It is unclear whether responders and non-responders of acupuncture experience non-specific effects differently. This analysis aimed to compare their experiences in a nested qualitative study embedded in an acupuncture trial on functional dyspepsia.

Purposive sampling was used to capture the experience of responders (n=15) and non-responders (n=15) to acupuncture via individual in-depth interviews. Design and analysis followed a framework analysis approach, with reference to an existing model on acupuncture non-specific effects. Themes emerging outside of this model were purposefully explored.

The findings suggest that responders had a more trusting relationship with the acupuncturist in response to their expression of empathy. In turn, they were more actively engaged in lifestyle modifications and dietary advice offered by acupuncturists. Non-responders were not satisfied with the level of reassurance regarding acupuncture safety. They were also expecting more peer support from fellow participants, regarded that as an empowerment process for initiating and sustaining lifestyle changes.

The authors concluded that our results highlighted key differences in acupuncture non-specific effect components experienced by responders and non-responders. Positive non-specific effects contributing to overall benefits could be enhanced by emphasizing on empathy expression from acupuncturists, trust-building, offering appropriate explanations on safety, and organizing patient support groups. Further research on the relative importance of each component is warranted.

I doubt that this tiny study lends itself to drawing any firm conclusions. However, what they seem to imply and what the authors (proponents of acupuncture) ignore totally is the following: acupuncture responders are those people who respond to the context of the treatment situation. Thus their positive result is not due to the specific effects of acupuncture itself but to non-specific effects. In other words, acupuncture operates predominantly or entirely via non-specific effects. Or, to put it bluntly: this analysis confirms what we have discussed many times before (see for instance here, here, and here), namely that

acupuncture is a placebo therapy.

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