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

Monthly Archives: December 2021

Aromatherapy, the use of essential oils for medicinal purposes, exists in several guises. One of them is inhalation aromatherapy which is a complementary therapy used in different clinical settings. But is there any sound evidence about its effectiveness?

The aim of this review was to assess the effectiveness of inhalational aromatherapy in the care of hospitalized pediatric patients.

A systematic review of clinical trials and quasi-experimental studies was conducted, based on PRISMA recommendations, searching Medline, Web of ScienceScopus, SciELO, LILACS, CINAHLScience Direct, EBSCO, and updated databases. The Down and Black 2020, RoB 2020 CLARITY, and ROBINS-I 2020 scales were used through the Distiller SR software to verify the studies’ internal validity and risk of bias.

From 446 articles identified, 9 fulfilled the inclusion criteria. Seven were randomized controlled trials (RCTs), one pilot RCT, and one non-randomized quasi-experimental trial.

Different outcomes were analyzed, with pain being the most frequently measured variable. None of the 6 studies that evaluated pain showed significant effects with inhalation aromatherapy. Additionally, non-significant effects were found regarding nausea, vomiting, and behavioral/emotional variables.

The authors concluded that the findings are still inconclusive, and more evidence is required from future studies with high methodological quality, blinding, and adequate sample sizes.

Inconclusive?

Really?

Call me a skeptic, but I think the findings show quite clearly that there is no sound evidence to suggest that inhalation aromatherapy might be effective for kids.

Protection against electromagnetic fields has been a topic before (see here and here). In so-called alternative medicine (SCAM) entrepreneurs have been quick to sell all sorts of ‘protective’ gadgets to the often all too gullible public. The devices are based on two main assumptions:

  1. EMF causes ill health.
  2. The device prevents this from happening.

Neither of them is correct, and the harm done by the claim is substantial. It can be measured in £ or $, because these gadgets are, of course, not cheap. Now a new type of harm is in the spotlight.

It has been reported that the Dutch authority for nuclear safety and radiation protection (ANVS) found several of these devices claimed to protect against 5G networks gave off harmful ionising radiation. It urged people not to use the products, which could cause harm in the long term.

The World Health Organization assures us that 5G mobile networks are safe, and not fundamentally different from existing 3G and 4G signals. They emit non-ionizing radio waves that do not damage DNA. But the marketers of these devices claim otherwise and many consumers believe them. This explains why there have been attacks on transmitters by people who believe 5G is harmful. The Guardian reported that, last year, 15 EU member states called on the European Commission to address a spate of conspiracy theories that had led to arson attacks against telecommunications masts.

The products identified included:

  • “Energy Armor” sleeping mask,
  • “Energy Armor” bracelet,
  • “Energy Armor” necklace,
  • Magnetix Wellness, a device for children.

Despite clear evidence that EMF protection is an expensive scam, Kim Jobst, Visiting Professor of Healthcare and Integrated Medicine Oxford Brooks University UK and former editor of the notorious JACM, stated the following about such a gadget: “Emerging evidence from early clinical, cellular and molecular studies of the effects of QLink on cardiovascular, immune and central nervous systems is startling.”

In May 2020, the UK’s Trading Standards sought to halt sales of a £339 USB stick that claimed to offer “protection” from 5G. “Anti-radiation stickers” have also been sold on Amazon. On this blog, we have discussed EMF devices that cost well over £4000.

This study assessed the effectiveness of Oscillococcinum in the protection from upper respiratory tract infections (URTIs) in patients with COPD who had been vaccinated against influenza infection over the 2018-2019 winter season.

A total of 106 patients were randomized into two groups:

  • group V received influenza vaccination only
  • group OV received influenza vaccination plus Oscillococcinum® (one oral dose per week from inclusion in the study until the end of follow-up, with a maximum of 6 months follow-up over the winter season).

The primary endpoint was the incidence rate of URTIs (number of URTIs/1000 patient-treatment exposure days) during follow-up compared between the two groups.

There was no significant difference in any of the demographic characteristics, baseline COPD, or clinical data between the two treatment groups (OV and V). The URTI incidence rate was significantly higher in group V than in group OV (2.9 versus 1.2 episodes/1000 treatment days, difference OV-V = -1.7; p=0.0312). There was a significant delay in occurrence of an URTI episode in the OV group versus the V group (mean ± standard error: 48.7 ± 3.0 versus 67.0 ± 2.8 days, respectively; p=0.0158). Limitations to this study include its small population size and the self-recording by patients of the number and duration of URTIs and exacerbations.

The authors concluded that the use of Oscillococcinum in patients with COPD led to a significant decrease in incidence and a delay in the appearance of URTI symptoms during the influenza-exposure period. The results of this study confirm the impact of this homeopathic medication on URTIs in patients with COPD.

Primary endpoint, comparison of the number of upper respiratory tract infections in the two treatment groups during follow-up

This prospective, randomized, single-center study was funded by Laboratoires Boiron, was conducted in the Pneumology Department of Charles Nicolle Hospital, Tunis, and was written up by a commercial firm specializing in writing for the pharmaceutical industry. The latter point may explain why it reads well and elegantly glosses over the many flaws of the trial.

If I did not know better, I might suspect that the study was designed to deceive us (Boiron would, of course, never do this!): The primary endpoint was the incidence rate of URTIs (number of URTIs/1000 patient-treatment exposure days) in the two groups during the follow-up period. This rate is calculated as the number of episodes of URTIs per 1000 days of follow-up/treatment exposure. The rates were then compared between the OV and V groups. The following symptoms were considered indicative of an URTI: fever, shivering, runny or blocked nose, sneezing, muscular aches/pain, sore throat, watery eyes, headaches, nausea/vomiting, diarrhoea, fatigue and loss of appetite.

This means that there was no verification whatsoever of the primary endpoint. In itself, this flaw would perhaps not be so bad. But put it together with the fact that patients were not blinded (there were no placebos!), it certainly is fatal.

In essence, the study shows that patients who perceive to receive treatment will also perceive to have fewer URTIs.

SURPRISE, SURPRISE! 

A remarkable case of a German doctor homeopath from the Lake Constance district in Germany has been reported. The public prosecutor’s office in Constance is currently investigating the physician on suspicion of causing bodily harm.

Several hundred people seem to have received an ineffective Corona vaccination from her. According to a spokesperson from the office of the Lake Constance district, 430 people who had been vaccinated against the Coronavirus in the doctor’s practice in Markdorf have now received mail from the public health department.

The recipients of the letter were instructed to take an antibody test to clarify their vaccination status. The officials are also interested in their testimonies on the circumstances of the vaccination. It is suspected that the doctor added “something homeopathic” to the injections which presumably were saline solutions.

One of the victims has now filed an official complaint. At the request of the Constance public prosecutor’s office, a judge of the district court issued a search warrant for the medical practice concerned, whereupon officers of the Ravensburg police headquarters seized evidence.

The case had come to the attention of the authorities after no antibodies against the coronavirus could be detected initially in three patients despite them having received first and second vaccinations and no plausible medical reasons for this lack of response could be found.

__________________

It is true that some homeopaths reject vaccinations and believe that homeopathic vaccinations are an effective alternative. It is also clear to anyone who has followed the discussions on this blog that some homeopaths are severely deluded and might therefore try this method on patients, even though there is not a jot of evidence that it works. The fact that this is done dishonestly and without the informed consent of the patient is nevertheless astonishing. Even more surprising, I find, is the notion that such a crime should be committed by a doctor who must know better.

 

This systematic review summarized the evidence of the effects of dance/movement therapy (DMT) on mental health outcomes and quality of life in breast cancer patients.

Ninety-four articles were found. Only empirical interventional studies (N = 6) were selected for the review:

  • randomised controlled trials (RCT) (n = 5)
  • non-RCT (n = 1).

Data from 6 studies including 385 participants who had been diagnosed with breast cancer, were of an average age of 55.7 years, and had participated in DMT programmes for 3–24 weeks were analysed.

In each study, the main outcomes that were measured were

  • quality of life,
  • physical activity,
  • stress,
  • emotional and social well-being.

Different questionnaires were used for the evaluation of outcomes. The mental health of the participants who received DMT intervention improved: they reported a better quality of life and decreased stress, symptoms, and fatigue.

The authors concluded that DMT could be successfully used as a complimentary therapy in addition to standard cancer treatment for improving the quality of life and mental health of women who have been diagnosed with breast cancer. More research is needed to evaluate the complexity of the impact of complimentary therapies. It is possible that DMT could be more effective if used with other therapies.

The American Dance Therapy Association defines DMT as a multidimensional approach that integrates body awareness, creative expression, and the psychotherapeutic use of movement to promote the emotional, social, cognitive, and physical integration of the individual to improve health and well-being. The European Association of Dance Movement Therapy adds “spiritual integration” to this list. The types of dance used in the primary studies varied (from traditional Greek to belly dancing), and for none was there more than one study. No study of eurythmy (the anthroposophical dance therapy) was included.

I do not find it hard to imagine that DMT helps some cancer patients. Yet, I find the rigor of both the review and the primary studies somewhat wanting. The review authors, for instance, claimed that they followed the PRISMA guidelines; this is, however, not the case. The primary studies tested DMT mostly against no therapy at all which means that no attempts were made to control for non-specific effects.

I think the most obvious conclusion is that, during their supportive care, cancer patients can benefit from

  • attention,
  • empathy
  • movement,
  • self-expression,
  • social interaction,
  • etc.

This, however, is not the same as claiming that DMT is the best option for them.

The Corona Committee (Corona Ausschuss) was founded in Berlin in July 2020 by the lawyers Viviane Fischer, Antonia Fischer, Dr. Reiner Füllmich, and Dr. Justus Hoffmann. Its aim is to provide a “factual analysis” of the coronavirus events and the consequences of the measures taken against them. In live sessions lasting several hours, the committee hears experts from all COVID-affected fields.

In an interview, Dr. Fuellmich said: “The decision to set up a Corona Inquiry Committee came about in the first telephone conversation Viviane Fischer and I ever had. After I had spoken out in the USA via various videos since April 2020 about the fact that the principle ‘audiatur et altera pars’ (hear the other side as well) had been blatantly violated here on the part of the government, I had come back to Germany from the USA because I felt that this was now my place and that I had to stand up here to ensure that our democracy and our constitutional state did not go completely to the dogs. I wanted to organize a symposium on the legal issues surrounding Corona, but I didn’t know any critical lawyers in Germany. I called my old friend Dr. Wolfgang Wodarg, whom I knew from the Justice Working Group at Transparency International, and he then referred me to Viviane Fischer.”

The ‘Speerspitze‘, an “anonymous collective of contrarians, Corona deniers, Nazi witches and conspiracy heretics” considers the work of the Corona Committee to be “one of the most important pillars of the fight against the madness to which we have been subjected for the last year and a half and [has] great respect for all the activists, actors, and interviewees of the Committee who publicly denounce with their name and face what is happening.” Numerous further websites have joined in the promotion of the Corona Committee.

However, if you look at the information that the Corona Committee is disseminating, and if you are able to think critically, you are likely to come to very different conclusions:

– There is the expert who warns that the unvaccinated could soon be picked up and put into concentration camps. There is the threat of a “manhunt”, and loving parents might then have to hide their children under the boards of the floor at home to prevent them from being sprayed to death.

– There is the man who claims that Israel’s government is currently carrying out a holocaust on its own population (“You can see that by how many people are dying from the vaccinations”). A guest declares that there are “something like living octopuses” in the vaccine against Corona.

Anyone who takes a look at the many tediously long videos will quickly realize that every Corona denier, vaccination opponent, conspiracy theorist, mask opponent, and lateral thinker, no matter how paranoid, have their say here and spreads their pipe dreams under the guise of evidence-based information with the nodding approval of the lawyers present. Opposition is never raised and there is no trace of ‘audiatur et altera pars’; everyone agrees: worldwide, all governments are hell-bound at smashing everything there is to govern.

For those who are still not fed up, the website of the Corona Committee offers written answers to 31 very specific questions. Here is just one.

QUESTION: IS THE COVID-19 DISEASE SEVERE AND WIDESPREAD?

ANSWER: No, most people have no or only mild flu symptoms. Children and adolescents are extremely rarely affected. Post-mortem examinations by a Hamburg forensic pathologist on over 100 elderly people who died with a positive corona test revealed at least one other serious cause of death in all cases. Other published figures are mostly based on non-transparent attributions and assumptions without excluding other causes. Often, no attention was even paid to other pathogens or previous medication.

Factual analyses?

Afraid not!

For a long time, I have been wondering where the penetratingly vociferous opposition to COVID vaccinations in Germany might come from. After studying the dangerous nonsense that the Corona Committee has been spreading for many months, I wonder a little less.

(texts in German were translated by me)

Conversion therapy has been banned last week in Canada. These therapies – also known as sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure – rely on the assumption that sexual orientation can be changed, an idea long discredited by major medical associations in the US, the UK, France, and elsewhere. The new law makes “providing, promoting, or advertising conversion therapy” a criminal offense. It will also be an offense to profit from the provision of conversion therapy. In addition, the bill states a person cannot remove a “child from Canada with the intention that the child undergo conversion therapy outside Canada.” Prime Minister Justin Trudeau hailed the law’s Royal Assent: “It’s official: Our government’s legislation banning the despicable and degrading practice of conversion therapy has received Royal Assent — meaning it is now law.”

Conversion therapy is the attempt to change an individual’s sexual or gender identity by psychological, medical, or surgical interventions. Often, informed consent is insufficient or lacking. In conventional medicine, numerous treatments have been tried for this purpose, some of them dangerous and all of them ineffective. In alternative medicine, approaches that have been advocated include:

  • Homeopathy (see below),
  • Hypnotherapy,
  • Spiritual healing,
  • Prayer,
  • Eye Movement Desensitization,
  • Rebirthing,
  • and others.
Survey data imply that conversion therapy is still disturbingly popular, often leads to undesirable outcomes, and is most frequently practiced by:
  • Faith-based organizations or leaders
  • Licensed healthcare professionals
  • Unlicensed healthcare professionals

As previously reported, the German ‘Association of Catholic Doctors’ claimed that homeopathic remedies can cure homosexuality. Specifically, they advised that ‘…the working group ‘HOMEOPATHY’ of the Association notes homeopathic therapy options for homosexual tendencies…repertories contain special rubrics pointing to characteristic signs of homosexual behavior, including sexual peculiarities such as anal intercourse. And a homeopathic remedy called ‘Dr. Reckeweg R20 Glandular Drops for Women’ was claimed to treat “lesbian tendencies.” The product is “derived and potentised from fetal tissues.”

Several countries are now in the process of banning conversion therapy. France has already banned it and so has Germany. The UK government intends to introduce a legislative ban on the practice of conversion therapy. The consultation on how to best do this is open until 4 February 2022.

It has been reported that, after a majority of Canadian chiropractors attending a meeting of their regulator voted to oppose a COVID-19 vaccine mandate, B.C.’s health minister told a representative he was starting to doubt the wisdom of self-regulation.

On Dec. 1, the College of Chiropractors of B.C. (BCCA) held its AGM and registrants voted in favour of a non-binding resolution calling for the regulator to “take a stand” against an expected vaccine mandate for health professionals. Subsequently, Health Minister Adrian Dix then “expressed his extreme displeasure” about the remarks of some chiropractors.

“Minister Dix indicated it was an embarrassment that a health profession would in such resounding numbers … support such unfounded and false claims while people are dying from COVID-19,” said the BCCA’s executive director Angie Knott. In bold and underlined text, she added, “He also stated that it made him question the validity of self-regulation.”

During the meeting in question, 78% of those chiropractors in attendance had voted in favour of the motion. Chiropractors are not trained in treating or preventing infectious disease and are prohibited from offering advice on vaccinations in B.C.

This is not the first time health ministry officials have expressed concerns about the ability of chiropractors to adequately regulate themselves.

In my view, this story is a poignant reminder of something I have been saying often:

Even the proper regulation of quackery will merely result in quackery!

 

Lian gong (LG), also called Lian Gong Shi Ba Fa, is a form of so-called alternative medicine (SCAM) from China.  More specifically, it is a set of stretching, breathing exercises, and self-massaging techniques aimed at preventing and relieving stress as well as acute pains around the neck, shoulders, back, hips, legs, joints, and connective tissues.  Even though it is relatively new, it is based on old Chinese stretching, breathing, and warm-up exercises dating back more than 1,000 years, including the Eight Silk Brocade (八段錦).  Lian gong has spread rapidly from China to other countries, especially to Japan and Brazil.

Lian Gong was developed by Dr. Zhuang Yuan Ming (1919- ), a traditional Chinese medical doctor, who started conducting a series of clinical trials around 1974 in a Shanghai hospital on patients suffering from a variety of stress-related conditions. Lian Gong is now being promoted as “massage in motion”.

One of the few controlled clinical studies of Liam gong aimed to evaluate the effects of LG on the impact of dizziness on the quality of life and fear of falling in primary health care patients. It was designed as a randomized clinical trial with 36 patients with dizziness not caused by central changes. The participants were randomly assigned to 3 groups:

  • the Liam gong (LG) group ( n = 11),
  • the vestibular rehabilitation (VR) group ( n = 11),
  • the control group ( n = 14).

The treatments were carried out over a period of 12 weeks.

Lian gong reduced the influence of dizziness on the quality of life in physical (1.8 points, 95% confidence interval [CI]: 0.2-3.4), functional (4.0 points, 95% CI: 2.1-5.9), and emotional domains of quality of life (4.4 points, 95% CI: 1.7-7.2), with no differences, compared with VR.

The authors concluded that Lian gong was shown to be an effective balance rehabilitation strategy to reduce the impact of dizziness on quality of life, with similar results to those of VR.

Unfortunately, this study has many flaws – not least its minute sample size. Therefore, the conclusions seem more than a little over-optimistic. I would not be all that surprised to learn that these exercises can have beneficial effects for a range of conditions. What seems doubtful in my view, however, is whether it is superior to more conventional exercise therapies.

This review investigated whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain.

The authors searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with:

  • mindfulness,
  • hypnosis,
  • yoga,
  • guided imagery,
  • progressive muscle relaxation.

The primary outcome was pain intensity.

A total of 40 primary studies involving 3569 participants were found. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I2 = 86.3%, p < 0.001). After excluding four “outlier” studies in sensitivity analyses, the effect size remained significant but became weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality.

The authors concluded that mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.

These conclusions are broadly correct. I can confirm this because I recently summarized the evidence in a book and arrived at very similar conclusions. If I had to criticize the review, it would be for not including all mind-body therapies for which there is evidence from clinical trials. In my book, I was able to include the following additional treatments:

  • Autogenic training
  • Music therapy
  • Qigong
  • Tai chi

The effects of these treatments are about the same regardless of which one we use. This might lead us to suspect that they work not via specific but via non-specific effects, e.g. placebo.

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