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

Monthly Archives: July 2023

I don’t usually find reading medical papers scary. An article in the prestigious journal ‘Nature’ is the exception. Here is its abstract:

Long COVID is the patient-coined term for the disease entity whereby persistent symptoms ensue in a significant proportion of those who have had COVID-19, whether asymptomatic, mild or severe. Estimated numbers vary but the assumption is that, of all those who had COVID-19 globally, at least 10% have long COVID. The disease burden spans from mild symptoms to profound disability, the scale making this a huge, new health-care challenge. Long COVID will likely be stratified into several more or less discrete entities with potentially distinct pathogenic pathways. The evolving symptom list is extensive, multi-organ, multisystem and relapsing–remitting, including fatigue, breathlessness, neurocognitive effects and dysautonomia. A range of radiological abnormalities in the olfactory bulb, brain, heart, lung and other sites have been observed in individuals with long COVID. Some body sites indicate the presence of microclots; these and other blood markers of hypercoagulation implicate a likely role of endothelial activation and clotting abnormalities. Diverse auto-antibody (AAB) specificities have been found, as yet without a clear consensus or correlation with symptom clusters. There is support for a role of persistent SARS-CoV-2 reservoirs and/or an effect of Epstein–Barr virus reactivation, and evidence from immune subset changes for broad immune perturbation. Thus, the current picture is one of convergence towards a map of an immunopathogenic aetiology of long COVID, though as yet with insufficient data for a mechanistic synthesis or to fully inform therapeutic pathways.

The paper ends with this gloomy statement: “The oncoming burden of long COVID faced by patients, health-care providers, governments and economies is so large as to be unfathomable, which is possibly why minimal high-level planning is currently allocated to it. If 10% of acute infections lead to persistent symptoms, it could be predicted that ~400 million individuals globally are in need of support for long COVID. The biggest unknowns remain the joined-up scheme of its pathogenesis and thus the best candidate therapeutics to be trialled in randomized controlled trials, along with a better understanding of the kinetics of recovery and the factors influencing this. Some countries have invested in first-round funding for the pilot investigations. From the above, far more will be needed.”

In the context of this blog, we must, of course, ask: HAS SO-CALLED ALTERNATIVE MEDICINE (SCAM) SOMETHING TO OFFER?

I’m afraid that the short answer to this question is No!

However, one does not need to be a clairvoyant to predict that lots of therapeutic claims followed by plenty of methodologically weak (to put it politely) research will emerge from SCAM. Already some time ago, this homeopath indicated, that SCAM providers should see COVID as an opportunity: For homeopathy, shunned during its 200 years of existence by conventional medicine, this outbreak is a key opportunity to show potentially the contribution it can make in treating COVID-19 patients. 

We should not hold our breath to see the emergence of convincing evidence, but we must be prepared to warn the public from getting exploited by charlatans.

The U.S. Department of Health and Human Services alleges that Jason James of the James Healthcare & Associates clinic in Iowa, USA — along with his wife, Deanna James, the clinic’s co-owner and office manager — filed dozens of claims with Medicare for a disposable acupuncture device, which is not covered by Medicare, as if it were a surgically implanted device for which Medicare can be billed. According to the lawsuit, more than 180 such claims were filed. Beginning in 2016, the lawsuit alleges, the clinic began offering an electro-acupuncture device referred to as a “P-Stim.” When used as designed, the P-Stim device is affixed behind a patient’s ear using an adhesive. The device delivers intermittent electrical pulses through a single-use, battery-powered attachment for several days until the battery runs out and the device is thrown away.

Because Medicare does not reimburse medical providers for the use of such devices, DHHS alleges that some doctors and clinics have billed Medicare for the P-Stim device using a code number that only applies to a surgically implanted neurostimulator. The use of an actual neurostimulator is reimbursed by Medicare at approximately $6,000 per claim, while P-Stim devices were purchased by the Keokuk clinic for just $667, DHHS alleges. The department alleges James knew his billings were fraudulent as the P-Stim device is “nowhere close to even resembling genuine implantable neurostimulators” and does not require surgery.

The lawsuit alleges that on June 15, 2016, when Jason James was contemplating the use of P-Stim devices at the Keokuk clinic, he sent a text message to P-Stim sales representative Mark Kaiser, asking, “Is there a limit on how many Neurostims can be done on one day? Don’t wanna do so many that gives Medicare a red flag on first day. Thanks.” After realizing the “large profit windfall” that could result from the billing practice, DHHS’s lawsuit alleges, James “told Mark Kaiser not to mention the Medicare reimbursement rate to his nurse practitioner or staff – only his office manager and biller needed that information.” James then pressured clinic employees to heavily market the P-Stim devices to patients, even if those patients were not agreeable or, after trying it, were reluctant to continue the treatment, the lawsuit claims.

In October 2016, the clinic’s supplier of P-Stim devices sent the clinic an email stating the company had “no position on what the proper coding might be for this device if billed to a third-party payer” such as an insurer or Medicare, according to the lawsuit. The company advised the clinic to “consult a certified biller/coder and/or attorney to ensure compliance.” According to the lawsuit, James then sent Kaiser a text message asking, “Should we be concerned?”

DHHS alleges the clinic’s initial reimbursement claims were submitted to Medicare through a nurse practitioner and were denied for payment due to the lack of a trained physician’s involvement. In response, the clinic hired Dr. Robert Schneider, an Iowa-licensed physician, to work at the clinic for the sole purpose of enabling James Healthcare & Associates to bill Medicare for the P-Stim devices, the lawsuit claims. James then informed Kaiser he had a goal of billing Medicare for 20 devices per month, which would generate roughly $125,573 of monthly income, the lawsuit alleges. The lawsuit also alleges Dr. Schneider rarely saw clinic patients in person, consulting with them instead through Facebook Live.

In April 2017, Medicare allegedly initiated a review of the clinic’s medical records, triggering additional communications between James and Kaiser. At one point, James allegedly wrote to Kaiser and said he had figured out why Medicare was auditing the clinic. “Anything over $7,500 is automatically audited for my area,” he wrote, according to the lawsuit. “We are now charging $7,450 to remove the audit.”

The clinic ultimately submitted 188 false claims to Medicare seeking reimbursement for the P-Stim devices, DHHS alleges, with Medicare paying out $4,100 and $6,300 per claim, for a total loss of $1,028,800. DHHS is suing the clinic under the federal False Claims Act and is seeking trebled damages of more than $3 million, plus a civil penalty of up to $4.2 million.

An attorney for the clinic, Michael Khouri, said Wednesday he believe the federal government’s lawsuit was filed in error because a settlement in the case had already been reached. However, the assistant U.S. attorney handling the case said no settlement in the case had been finalized and the lawsuit was not filed in error.

Previous legal cases

In 2015, the Iowa Board of Chiropractic charged Jason James with knowingly making fraudulent or untrue representations in connection with his practice, engaging in conduct that was harmful or detrimental to the public, and making untruthful statements in advertising. The board alleged James told patients they would be able to stop taking diabetes medication through the use of a diet and nutrition program, and that he had claimed to be providing extensive laboratory tests when not all of the tests for which he billed were ever conducted. The board also claimed James referred patients to a medical professional who was not licensed to practice in Iowa. The case was resolved with a settlement agreement in which James agreed to pay a $500 penalty and complete 10 hours of education in marketing and ethics.

In 2019, Schneider sued the clinic for failing to comply with the terms of his employment agreement. Court exhibits indicate the agreement stipulated that Schneider was to work no more than two days per month and would collect $2,000 for each day worked, plus $250 per month for consulting, plus “$250 per device over six per calendar month.” In March 2020, a jury ruled in favor of the clinic and found that it had not breached its employment agreement with Schneider.

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Before some chiropractors now claim that such cases represent just a few rotten apples in a big basket of essentially honest chiropractors, let me remind them of a few previous posts:

To put it bluntly: chiropractic was founded by a crook on a bunch of lies and unethical behavior, so it is hardly surprising that today the profession has a problem with ethics and honesty.

In the UK – this post is mainly for UK readers – journalists and opinion leaders are currently falling over themselves reporting about a major breakthrough: an Alzheimer’s drug has been shown to slow the disease by around 36%. “After 20 years with no new Alzheimer’s disease drugs in the UK, we now have two potential new drugs in 12 just months,” wrote Dr Richard Oakley, associate director at the Alzheimer’s Society. And the Daily Mail headlined: “New drug which claims to slow mental decline caused by Alzheimer’s by 36% could spell ‘the beginning of the end’ for the degenerative brain disease”.

That’s excellent news!

Many people will have made a sigh of relief!

So, why does it make me angry?

Once we listen to the news more closely we learn that:

  • the drug only works for patients who are diagnosed early;
  • for an early diagnosis, we need a PET scan;
  • the UK hardly has any PET scanners, in fact, we have the lowest number among developed countries;
  • these scanners are very expensive;
  • the costs for the new drug are as yet unknown but will also be high.

Collectively these facts mean that we have a major advance in healthcare that could help many patients. At the same time, we all know that this is mere theory and that the practice will be very different.

Why?

  • Because the NHS has been run down and is on its knees.
  • Because our government will again say that they have invested xy millions into this area.
  • The statement might be true or not, but in any case, the funds will be far too little.
  • The UK has become a country where some patients suffering from severe toothache currently resort to pulling out their own teeth at home with pairs of pliers.
  • In the foreseeable future, the NHS will not be allocated the money to invest in sufficient numbers of PET scans (not to mention the funds to buy the new and expensive drug).

In other words, the UK celebrates yet another medical advance raising many people’s expectations, while everyone in the know is well aware of the fact that the UK public will not benefit from it.

Does that not make you angry too?

It been reported that the German HEILPRAKTIKER, Holger G. has been sentenced to serve a total of 4 years and three months behind bars. He made himself a pair of glasses out of aluminum foil and appeared at the start of his trial wearing a Corona protective mask. The accusations against him were fierce: He was accused of having issued false Corona vaccination certificates en masse in Munich and of having given medication to patients. A woman, who had contracted Corona and had been treated by Holger G. with vitamin solutions, had died last year.

According to the verdict, Holger G. had violated the German Medicines Act. The court announced he was also convicted of 96 counts of dangerous bodily harm and 102 counts of unauthorized trading in prescription drugs. In addition, the court ordered the HEILPRAKTIKER to be placed in a rehab facility.

The 71-year-old MAN had issued Corona vaccination cards since April 2021, without actually vaccinating the people concerned. For the forged vaccination cards, he charged several tens of thousands of Euros. In addition, the former HEILPRAKTIKER illegally sold prescription drugs. The judgment is so severe because Holger G. has form. He also ordered to bear the costs of the proceedings.

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I have long criticized the German HEILPRAKTIKER. In my recent book on the subject, I make the following points:

– Today, no one can provide reliable data on the number of HEILPRAKTIKER in Germany.
– The training of HEILPRAKTIKER is woefully inadequate.
– The far-reaching rights of the HEILPRAKTIKER are out of proportion to their overt lack of competence.
– This disproportion poses a serious danger to patients.
– This danger is further increased by the fact that there is no effective control of the activity of the HEILPRAKTIKER does not take place.
– Existing laws are almost never applied to the HEILPRAKTIKER.
– Most HEILPRAKTIKER mislead the public unhindered with untenable therapeutic claims.
– The federal government seems to put off over and over again any serious discussion of the HEILPRAKTIKER.

Cases like the one above show that it is high time for reform – or, should that prove impossible, the discontinuation of this utterly obsolete and highly dangerous profession.

“We are hugely concerned about the welfare of doctors and healthcare workers with long COVID”. These are the first words of a comprehensive survey of UK doctors with post-acute COVID health complications. It reveals that these doctors experience symptoms such as:

  • fatigue,
  • headaches,
  • muscular pain,
  • nerve damage,
  • joint pain,
  • respiratory problems.

Around 60% of doctors said that post-acute COVID ill health has affected their ability to carry out day-to-day activities on a regular basis. 18% reported that they were now unable to work due to their post-acute COVID ill-health, and only 31% said they were working full-time, compared with more than half before the onset of their illness.

The report demands financial support for doctors and healthcare staff with post-acute COVID, post-acute COVID to be recognized as an occupational disease in healthcare workers, with a definition that covers all of the debilitating disease’s symptoms and for improved access to physical and mental health services to aid comprehensive assessment, appropriate investigations and treatment. The report also calls for greater workplace protection for healthcare staff risking their lives for others and better support for post-acute COVID sufferers to return to work safely if they can, including a flexible approach to the use of workplace adjustments.

In November 2021, an online survey investigating the emotional states of depression, anxiety, stress, compassion satisfaction, and compassion fatigue was administered to 78 Italian healthcare workers (HCWs). Between 5 and 20% of the cohort showed the effects of the adverse psychological impact of the pandemic and more than half of them experienced medium levels of compassion fatigue as well as a medium level of compassion satisfaction. The results also show that those with fewer years of clinical practice might be at greater risk of burnout, anxiety, and stress symptoms and might develop a lower level of compassion satisfaction. Moreover, the factors that potentially contribute to poor mental health, compassion fatigue, and compassion satisfaction seem to differ between residents and specialist physicians.

A cross-sectional study was conducted from September 2021 to April 2022 and targeted all physicians working at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to elicit self-reported data regarding depression and anxiety, respectively. In addition, sociodemographic and job-related data were collected. A total of 438 physicians responded, of which 200 (45.7%) reported symptoms of depression and 190 (43.4%) of anxiety. Being aged 25-30 years, female, resident, and reporting a reduction in work quality were factors significantly associated with both anxiety and depression. Female gender (AOR = 3.570; 95% CI = 2.283-5.582; P < 0.001), working an average 9-11 hours/day (AOR = 2.130; 95% CI = 1.009-4.495; P < 0.047), and self-perceived reduction in work quality (AOR = 3.139; 95% CI = 2.047-4.813; P < 0.001) were significant independent predictors of anxiety. Female gender (AOR = 2.929; 95% CI = 1.845-4.649; P < 0.001) and self-perceived reduction in work quality (AOR = 3.141; 95% CI = 2.053-4.804; P < 0.001) were significant independent predictors of depression.

An observational, multicenter cross-sectional study was conducted at eight tertiary care centers in India. The consenting participants were HCWs between 12 and 52 weeks post-discharge after COVID-19 infection. The mean age of the 679 eligible participants was 31.49 ± 9.54 years. The overall prevalence of COVID sequelae was 30.34%, with fatigue (11.5%) being the most common followed by insomnia (8.5%), difficulty in breathing during activity (6%), and pain in joints (5%). The odds of having any sequelae were significantly higher among participants who had moderate to severe COVID-19 (OR 6.51; 95% CI 3.46-12.23) and lower among males (OR 0.55; 95% CI 0.39-0.76). Besides these, other predictors for having sequelae were age (≥45 years), presence of any comorbidity (especially hypertension and asthma), category of HCW (non-doctors vs doctors), and hospitalization due to COVID-19.

Such data are scary. Not only will we have a tsunami of long-Covid patients from the general public, and not only do we currently lack effective causal treatments for the condition, but also is the number of HCWs who are supposed to deal with all this drastically reduced.

Most if not all countries are going to be affected by these issues. But the UK public might suffer the most, I fear. The reasons are obvious if you read a previous post of mine: in the UK, we have significantly fewer doctors, nurses, hospital beds, and funding (as well as politicians who care and would be able to do something about the problem) than in other comparable countries. To me, this looks like the emergence of a perfect storm.

 

 

An impressive article by John Mac Ghlionn caught my attention. Allow me to quote a few passages from it:

The U.S. House of Representatives and the U.S. Senate recently reintroduced legislation to increase access to Medicare-covered services provided by chiropractors. Last year, the US chiropractic market size was worth $13.13 Billion. By the end of the decade, it will be worth over $18 billion. Each year, a whopping 35 million Americans seek chiropractic care.

But why? It’s a questionable science full of questionable characters.

Last year, a Georgia woman was left paralyzed and unable to speak after receiving a neck adjustment from a chiropractor. She’s not the first person to have had her life utterly ruined by a chiropractor, and chances are she won’t be the last. Many patients who visit chiropractors suffer severe side effects; some lose their lives

As Dr. Steven Novella has noted, what used to be fraud is now known as holistic medicine. Dr. Edzard Ernst, a retired British-German physician and researcher, has expertly demonstrated the many ways in which chiropractic treatments are rooted not in science, but in mystical concepts…

Spinal adjustments, also known as “subluxations,” are also common. A dangerous practice that has been heavily criticized, spinal manipulations are associated with a number of adverse effects, including the risk of stroke. As Dr. Ernst has noted, the cost-effectiveness of this particular treatment “has not been demonstrated beyond reasonable doubt.”

Not content with spinal and neck manipulations, some chiropractors offer to treat other conditions — like diabetes, for example. They are not trained to treat diabetes. Other chiropractors appear to take joy in torturing infants. In August of 2018, a chiropractor made headlines for all the wrong reasons when a video emerged showing him hanging a two-week-old newborn upside down by the ankles

Finally, as I alluded to earlier, the chiropractic community is full of fraudsters. In 2019, in the US, 15 chiropractors were charged in an insurance fraud and illegal kickback operation. More recently, in February of this year, a New York federal judge sentenced Patrick Khaziran to 30 months in prison after he pleaded guilty to being part of a widespread scheme that defrauded the NBA out of at least $5 million. In recent times, the chiropractic community has come under scrutiny for abusive care and illegal billing practices. When it comes to instances of healthcare fraud, chiropractic medicine is unrivaled.

None of this should come as a surprise. After all, the entire chiropractic community was constructed on a foundation of lies. As the aforementioned Dr. Ernst told me, we should be skeptical of what chiropractors are offering, largely because the whole practice was founded “by a deluded charlatan, who insisted that all human diseases are due to subluxations of the spine. Today, we know that chiropractic subluxations are mere figments of Palmer’s imagination. Yet, the chiropractic profession is unable to separate itself from the myth. It is easy to see why: without it, they would at best become poorly trained physiotherapists without any raison d’etre.”

… Dr. William T. Jarvis famously referred to chiropractic as “the most significant nonscientific health-care delivery system in the United States.” Comparing the chiropractic community to a cult, Dr. Jarvis wondered, somewhat incredulously, why chiropractors are licensed to practice in all 50 US states. The entire profession, he warned, “should be viewed as a societal problem, not simply as a competitor of regular health-care.”

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In my view, this is an impressive article, not least because it is refreshingly devoid of the phenomenon known as ‘false balance, e.g. a chiropractor being invited to add his self-interested views at the end of the paper claiming, for instance, “we have years of experience and cause far less harm than real doctors”.

This systematic review evaluated all available randomized controlled trials (RCTs) investigating the clinical effects of hydrotherapy according to Kneipp which is characterized by cold water applications. All RCTs on therapy and prevention with Kneipp hydrotherapy were included. Study participants were patients and healthy volunteers of all age groups. MEDLINE (via PubMed), Scopus, Central, CAMbase, and opengrey.eu were systematically searched through April 2021 without language restrictions and updated by searching PubMed until April 6th 2023. The risk of bias was assessed using the Cochrane tool version 1.

Twenty RCTs (N=4247) were included. Due to the high heterogeneity of the RCTs, no meta-analysis was performed. The risk of bias was rated as unclear in most of the domains. Of 132 comparisons, 46 showed significant positive effects in favor of hydrotherapy on chronic venous insufficiency, menopausal symptoms, fever, cognition, emotional function, and sickness absenteeism. However, 81 comparisons showed no differences between groups, and 5 were in favor of the respective control group. Only half of the studies reported safety issues.

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The authors concluded that although RCTs on Kneipp hydrotherapy seem to show positive effects in some conditions and outcomes, it remains difficult to ascertain treatment effects due to the high risk of bias and heterogeneity of most of the considered studies. Further high-quality RCTs on Kneipp hydrotherapy are urgently warranted.

This is certainly the best review of the subject so far. It makes it very clear that the evidence for Kneipp hydrotherapy is weak, mostly because of the many flaws in the primary studies. One needs to add, I think, that 20 RCTs are an absurdly small amount considering that many indications this type of therapy is advocated for – many enthusiasts even consider it a panacea.

It follows, I fear, that Kneipp hydrotherapy is almost entirely not evidence-based. This should be bad news for the numerous institutions and Spa towns (mostly in Germany) that live on employing this treatment and telling patients that it is effective. They usually claim that experience shows this to be true. But this was the mantra of medicine ~100 years ago. Since then, we have learned that experience is a very poor guide that regularly leads us up the garden path.

Kneippians will counter that clinical trials are difficult to conduct and expensive to finance. Both arguments are of course true but, considering that an entire industry lives on telling patients something that essentially amounts to a lie (i.e. the claim that it works), it surely is obligatory to overcome these obstacles.

 

This review assessed the role of homoeopathy in the therapeutic management of substance use disorders (SUD) through a systematic web-based literature search. A comprehensive search was conducted online and manually to identify homoeopathic research studies published between 1993 and 2022 on SUD in international databases and the Central Council of Research in Homoeopathy library. Relevant studies were categorised and assessed in terms of study designs, number of participants, evidence grades and clinical outcome parameters. A total of 21 full-text studies were screened and evaluated. Risk of bias (RoB) was assessed for all studies and model validity was appraised for the included RCTs’.

10 studies were included:

  • 3 Randomised Controlled Trials,
  • 3 Observational studies,
  • 1 Pilot study,
  • 1 observational comparative study,
  • 1 retrospective cohort study,
  • 1 case series.

Three studies have a level of evidence of 1b with an ‘A’ grade of recommendation, which consists of the RCTs only. The most commonly prescribed medicines identified were:

  • Arsenic album,
  • Nux vomica,
  • Lycopodium,
  • Pulsatilla,
  • Sulphur,
  • Staphysagria,
  • Belladonna,
  • Ipecac,
  • Chamomilla,
  • Rhustox,
  • Phosphorus,
  • Lachesis.

A high risk of bias was elicited in most of the observational studies accentuating the need for more robust methodological studies.
The authors concluded that the majority of the studies have a small number of recruitments. Pragmatic studies with larger sample sizes and validated outcome measures may be designed further to validate the
promising role of homoeopathic medicines in SUDs and generate quality evidence.

The paper is surprising! Most of the studies are not RCTs and thus cannot come even near suggesting a causal effect of homeopathy. The three RCTs are the following:

  • Manchanda RK, Janardanan Nair KR, Varanasi R, Oberai P, Bhuvaneswari R, Bhalerao R, et al. A randomised comparative trial in the management of alcohol dependence: Individualised homoeopathy versus standard allopathic treatment. Indian J Res Homoeopathy; 2016.
  • Adler UC, Acorinte AC, Calzavara FO, et al. Double-blind evaluation of homeopathy on cocaine craving: A randomised controlled pilot study. J Integr Med. 2018; 16(3):178-184.
  • Grover A, Bhushan B, Goel R. Double-blind placebo-controlled trial of homoeopathic medicines in the
    management of withdrawal symptoms in opium addicts and its alkaloid derivatives dependents. Indian J Res Homoeopathy. 2009;3:41-4.

All of these 3 studies were assessed by the review authors as having major flaws. Only one is available on Medline:

Background: Brazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment.

Objective: This study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting.

Design, setting, participants, and interventions: A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group).

Main outcome measures: The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups.

Results: The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients’ appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41).

Conclusions: A psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.

This study can hardly be said to show convincing evidence for homeopathy.

This paper is all the more surprising if we consider the affiliations of the authors:

  • Clinical Research Unit (H), Aizawl under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, India.
  • All India Institute of Ayurveda, New Delhi, India.
  • Department of Materia Medica, Madhav Homoeopathic Medical College and Hospital, Madhav Hills,
    Opposite Banas River, Abu Road, Rajasthan, India.

It is time, I think, that Indian officials and researchers learn some critical thinking and formulate the conclusions of reviews based on the evidence they produced. This would be a start:

Our review has not generated convincing evidence to suggest that homeopathy is effective in treating SUDs.

Cervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). This study evaluated the association between CSM and CeAD among US adults.“As soon as the chiropractor manipulated my neck, everything went black”

Through analysis of health claims data, the researchers employed a case-control study with matched controls, a case-control design in which controls were diagnosed with ischemic stroke, and a case-crossover design in which recent exposures were compared to exposures in the same case that occurred 6-7 months earlier. The researchers evaluated the association between CeAD and the 3-level exposure, CSM versus office visit for medical evaluation and management (E&M) versus neither, with E&M set as the referent group.

2337 VAD cases and 2916 CAD cases were identified. Compared to population controls, VAD cases were 0.17 (95% CI 0.09 to 0.32) times as likely to have received CSM in the previous week as compared to E&M. In other words, E&M was about 5 times more likely than CSM in the previous week in cases, relative to controls. CSM was 2.53 (95% CI 1.71 to 3.68) times as likely as E&M in the previous week among individuals with VAD than among individuals experiencing a stroke without CeAD. In the case-crossover study, CSM was 0.38 (95% CI 0.15 to 0.91) times as likely as E&M in the week before a VAD, relative to 6 months earlier. In other words, E&M was approximately 3 times more likely than CSM in the previous week in cases, relative to controls. Results for the 14-day and 30-day timeframes were similar to those at one week.

The authors concluded that, among privately insured US adults, the overall risk of CeAD is very low. Prior receipt of CSM was more likely than E&M among VAD patients as compared to stroke patients. However, for CAD patients as compared to stroke patients, as well as for both VAD and CAD patients in comparison with population controls and in case-crossover analysis, prior receipt of E&M was more likely than CSM.

What seems fairly clear from this and a previous similar analysis by the same authors is, I think, this: retrospective studies of this type can unfortunately not provide us with much reliable information about the risks of spinal manipulation. The reasons for this are manyfold, e.g.: less than exact classifications in patients’ records, or the fact that multiple types of spinal manipulations exist of which only some might be dangerous.

Guest post by Ken McLeod

Readers will have no trouble recalling that crank ‘naturopath’ Barbara O’Neill has graced these pages several times. She is subject to a Permanent Prohibition Order by the New South Wales Health Care Complaints Commission. It goes like this:

“The Commission is satisfied that Mrs O’Neill poses a risk to the health and safety of members of the public and therefore makes the following prohibition order:

“Mrs O’Neill is permanently prohibited from providing any health services, as defined in s4 Of the Health Care Complaints Act 1993, whether in a paid or voluntary capacity.’ 1

Evidently Ms O’Neill has scrambled her chakras or muddled her meridians because she continues to forget the Order. For example;

O’Neill did a video interview concerning the Prohibition Order and that has been posted online at YouTube.2 The video was posted ‘1 year ago,’ has had 323,000 views and had 1,598 comments. She goes into great detail what she regards as the appalling treatment at the hands of the HCCC.

In the video she admits that she has continued to travel the world spreading her lies and misrepresentations. Some of the lies are that she is a naturopath, and was a nurse, and ‘I used to work in the Operating Theatre as a psychiatric nurse….’

In the video at 53:20 in the video she refers to an aboriginal man ‘Dan’ who works at her Misty Mountain Lifestyle Retreat, (note the present tense), who is in his 50s was obese and recently had a heart attack, ‘was on a lot of medications,’ ‘was a bit scared of coming off medications,’ ‘I said Dan, I think it’s time to stop your blood pressure medications, you’re going too low, you’re a 100 over 60,’ ‘three days later his blood pressure was 100 over 75,….’ 3

Call me a cynic, but that strikes me as rather dangerous advice, worthy of an investigation by the HCCC. Meanwhile, there is no sign of ‘Dan ‘ in Misty Mountain’s ‘About page.’ Dan’s brother Dave appears, but no Dan.4 Could it be that O’Neill’s advice led to some incapacity? Tips are welcome.

Meanwhile, readers could learn much more about Barbara O’Neill at Wikipedia.5

 

This article first appeared in the June issue of the Australian Skeptic Magazine,6 reprinted with kind permission.

REFERENCES

1 https://www.hccc.nsw.gov.au/decisions-orders/public-statements-and-warnings/public-statement-and-statement-of-decision-in-relation-to-in-relation-to-mrs-barbara-o-neill

2 https://www.youtube.com/watch?v=tsbK5TLdAPo

3 This was dangerous and reckless advice. The full transcript is here

4 https://www.mmh.com.au/our-story

5 https://en.wikipedia.org/wiki/Barbara_O%27Neill

6 https://www.skeptics.com.au/magazine/

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