Monthly Archives: October 2023
Conspiracy beliefs (CBs) can have substantial consequences on health behaviours by influencing both conventional and non-conventional medicine uptake. They can target powerful groups (i.e. upward CBs) or powerless groups (i.e. downward CBs). Considering their repercussions in oncology, it appears useful to understand how CBs are related to the intentions to use conventional and so-called alternative medicines (SCAM), defined as “medical products and practices that are not part of standard medical care” including practices
such as mind–body therapies, botanicals, energy healing or naturopathic medicine.
This paper includes two pre-registered online correlational studies on a general French population (Study 1 N = 248, recruited on social media Mage = 40.07, SDage = 14.78; 205 women, 41 men and 2 non-binaries; Study 2 N = 313, recruited on social media and Prolific, Mage = 28.91, SDage = 9.60; 154 women, 149 men and 10 non-binaries). the researchers investigated the links between generic and chemotherapy-related CBs and intentions to use conventional or SCAMs. Study 2 consisted of a conceptual replication of Study 1, considering the orientation of CBs.
Generic CBs and chemotherapy-related CBs appear strongly and positively correlated, negatively correlated with intentions to take conventional medicine and positively with intentions to take SCAM. The link between generic CBs and medication intention is fully mediated by chemotherapy-related CBs. When distinguished, upward CBs are a stronger predictor of chemotherapy-related CBs than downward CBs.
The authors concluded that the findings suggest that intentions to use medicine are strongly associated with CBs. This has several important implications for further research and practice, notably on the presence and effects of CBs on medication behaviours in cancer patients.
Sadly, the influence of CBs is not confined to the field of oncology but applies across all diseases and conditions. We have seen and discussed these issues in several previous posts, e.g.:
- Conspiracy Beliefs Predict Health Behavior and Well-being during the Pandemic
- Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines
- Mistrust + Misinformation —> CONSPIRACY THEORY
- Conspiracy theories and dangerous recommendations via YouTube videos
- Conspiracy theories, assumptions, opinions, evidence and scientific facts
- A conspiracy theory seems to be driving the popularity of alternative medicine
The most impressive evidence, however, is regularly being provided by some of the people who post comments on this blog. Collectively, this evidence has prompted me to postulate that SCAM itself can be seen as a consiracy theory.
It has been reported that a cancer patient died of multiple organ failure after he took a herbalist’s remedy that included mistletoe. Retired electrician Haydn Owen Jones had been receiving a third course of treatment for his multiple myeloma when he turned to a herbalist. Alongside two chemotherapy drugs and a steroid, Jones started using a remedy which included mistletoe, yarrow, lily of the valley, cat’s claw, echinacea, and corn silk. Days later he fell ill with a fever, swelling and a rash. He was treated for sepsis but never recovered as his liver function deteriorated. Coroner concluded that it was probable the mix of cancer drugs and the alternative therapy proved deadly to him.
As with all tragic cases of this nature, it is difficult or even impossible to establish what caused the death. Was the herbal remedy involved at all? If so, it could be the toxicity of one or more of its ingredients, interactions between them, interactions with prescribed drugs, or contaminations/adulterations of the remedy. If there is a lesson at all to learn from this case, it is, I think, this: be very cautious about using herbal remedies, particularly when combined with other medicines, and seek professional advice, preferably NOT from a herbalist.
This study investigated whether Tongxinluo,a traditional Chinese medicine compound that has shown promise in in vitro, animal, and small human studies for myocardial infarction, could improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The randomized, double-blind, placebo-controlled clinical trial was conducted among patients with STEMI within 24 hours of symptom onset from 124 hospitals in China. Patients were enrolled from May 2019 to December 2020; the last date of follow-up was December 15, 2021.
Patients were randomized 1:1 to receive either Tongxinluo or placebo orally for 12 months. A loading dose of 2.08 g was given after randomization, followed by the maintenance dose of 1.04 g, 3 times a day, in addition to STEMI guideline-directed treatments. The primary end point was 30-day major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial reinfarction, emergent coronary revascularization, and stroke. Follow-up for MACCEs occurred every 3 months to 1 year.
Among 3797 patients who were randomized, 3777 (Tongxinluo: 1889 and placebo: 1888; mean age, 61 years; 76.9% male) were included in the primary analysis. Thirty-day MACCEs occurred in 64 patients (3.4%) in the Tongxinluo group vs 99 patients (5.2%) in the control group. Individual components of 30-day MACCEs, including cardiac death, were also significantly lower in the Tongxinluo group than the placebo group. By 1 year, the Tongxinluo group continued to have lower rates of MACCEs and cardiac death. There were no significant differences in other secondary end points including 30-day stroke; major bleeding at 30 days and 1 year; 1-year all-cause mortality; and in-stent thrombosis. More adverse drug reactions occurred in the Tongxinluo group than the placebo group, mainly driven by gastrointestinal symptoms.
The authors concluded that in patients with STEMI, the Chinese patent medicine Tongxinluo, as an adjunctive therapy in addition to STEMI guideline-directed treatments, significantly improved both 30-day and 1-year clinical outcomes. Further research is needed to determine the mechanism of action of Tongxinluo in STEMI.
Tongxinluo is mixture of various active ingredients, including
- Paeonia lactiflora,
- cicada slough,
- woodlouse bug,
With chaotic mixtures of this type, it is impossible to name all the potentially active ingredients, list their actions, or identify the ones that are truly relevant. According to the thinking of TCM proponents, this would also be the wrong way to go about it – such mixtures work as a whole, they would insist.
Tongxinluo is by no means a mixture that has not been studied before.
A previous systematic review of 12 studies found that Tongxinluo capsule is superior to conventional treatment in improving clinical overall response rate and hemorheological indexes and is relatively safe. Due to the deficiencies of the existing studies, more high-quality studies with rigorous design are required for further verification.
A 2022 meta-analysis indicated that the mixture had beneficial effects on the prevention of cardiovascular adverse events, especially in TVR or ISR after coronary revascularization and may possibly lower the incidence of first or recurrent MI and HF within 12 months in patients with CHD, while insufficient sample size implied that these results lacked certain stability. And the effects of TXLC on cardiovascular mortality, cerebrovascular events, and unscheduled readmission for CVDs could not be confirmed due to insufficient cases. Clinical trials with large-sample sizes and extended follow-up time are of interest in the future researches.
A further meta-analysis suggested beneficial effects on reducing the adverse cardiovascular events without compromising safety for CHD patients after PCI on the 6-month course.
Finally, a systematic review of 10 studies found that the remedy is an effective and safe therapy for CHD patients after percutaneous coronary interventions.
So, should we believe the new study with its remarkable findings? On the one hand, the trial seems rigorous and is reported in much detail. On the other hand, the study (as all previous trials of this mixture) originates from China. We know how important TCM is for that country as an export item, and we know how notoriously unreliable Chinese research sadly has become. In view of this, I would like to see an independent replication of this study by an established research group outside China before I recommend Tongxinluo to anyone.
Let’s not forget:
if it sound too good to be true, it probably is!
Mistletoe, an anthroposophical medicine, is often recommended as a so-callled alternative medicine (SCAM) for cancer patients. But what type of cancer, what type of mistletoe preparation, what dosage regimen, what form of application?
The aim of this systematic analysis was to assess the concept of mistletoe treatment in published clinical studies with respect to indication, type of mistletoe preparation, treatment schedule, aim of treatment, and assessment of treatment results. The following databases were systematically searched: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL, and “Science Citation Index Expanded” (Web of Science). The researchers assessed all studies for study types, methods, endpoints and mistletoe preparations including their ways of application, host trees and dosage schedules.
The searches revealed 3296 hits. Of these, 102 publications with a total of 19.441 patients were included. The researchers included several study types investigating the application of mistletoe in different groups of participants: cancer patients with any type of cancer were included as well as studies conducted with healthy volunteers and pediatric patients. The most common types of cancer were:
- breast cancer,
- pancreatic cancer,
- colorectal cancer,
- malignant melanoma.
Randomized controlled studies, cohort studies and case reports make up most of the included studies. A huge variety was observed concerning the type and composition of mistletoe extracts (differing pharmaceutical companies and host trees), ways of applications and dosage schedules. Administration varied widely, e. g. between using mistletoe extract as sole treatment and as concomitant therapy to cancer treatment. The researchers found no relationship between the mistletoe preparation used, host tree, dosage, and cancer type.
A variety of different mistletoe preparations was used to treat cancer patients. Due to the heterogeneity of the mistletoe preparations used, no comparability between different studies or within single studies using different types of mistletoe preparations or host trees is possible. Moreover, no relationship between mistletoe preparation and type of cancer can be observed. This results in a severely limited comparability of studies with regard to the different cancer entities and mistletoe therapy in oncology in general. Analyzing the methods sections of all articles, there are no information on how the selection of the respective mistletoe preparation took place. None of the articles provided any argument which type of preparation (homeopathic, anthroposophic, standardized) or which host tree was chosen due to which selection criteria. Considering preparations from different companies, funding may have been the reason of the selection.
Dosage or dosage regimens varied strongly in the studies. Due to the heterogeneity of dosage and dosage regimens within studies and between studies of the endpoints the comparability of the different studies is severely limited. Duration of mistletoe treatment varied strongly in the studies ranging from a single dose given on one day to the application of mistletoe preparations for several years. Moreover, the duration of treatment frequently varied within the studies. Mistletoe preparations were administered by different ways of application. Most frequently, the patients received mistletoe preparations subcutaneously. The second most common way was intravenous administration of mistletoe preparations. According to the respective manufacturers, this type of application is only recommended for Lektinol® and Eurixor®. Other preparations were given as off-label intravenous applications. No dosage recommendations from the respective manufacturers were available. Only in two studies the dose schedules were mentioned: according to the classical phase I 3 + 3 dose escalation schedule or in ratio to the body surface area.
The authors concluded that despite a large number of clinical studies and reports, there is a complete lack of transparently reported, structured procedures considering all fields of mistletoe therapy. This applies to type of mistletoe extract, host tree, preparation, treatment schedules as well as indication with respect of type of cancer and the respective treatment aim. All in all, despite several decades of clinical mistletoe research, no clear concept of usage is discernible and, from an evidence-based point of view, there are serious concerns on the scientific base of this part of anthroposophical treatment.
A long time ago, I worked as a junior doctor in a hospital where we used subcutaneous misteloe injections regularly to treat cancer. I remember being utterly confused: none of my peers was able to explain to me what preparation to use and how to does it. There simply were no rules and the manufacurer’s instructions made little sense. I suspected then that mistletoe therapy was a danerous nonsense. Today, after much research has been published on mistletoe, I do no longer suspect it, I know it.
I would urge every cancer patient to stay well clear of mistletoe and those practitioners who recommend it.
Recently, I had the pleasure to give a lecture about bias in research to medical students at my former medical school in Vienna. This led to interesting discussions with the audience. They prompted me to think more than usual about ‘the biased researcher’, a phenomenon that, in my opinion, seriously plagues the field of so-called alternative medicine (SCAM). The way I see it, we can differentiate 4 overlapping categories of researchers (male or female; for simplicity, I here use only the masculine form) investigating the effectiveness of various forms of SCAM:
THE TRUE SCIENTIST
The true scientist is adequaately trained in all aspects of his work. Therefore, he knows that he research consists of testing hypotheses. He does his job without emotional or ideological baggage. All he aims at doing is answering the research question at hand in the most rigorous fashion. He is not influenced by outside pressures, does not care about the direction of his results, and merely wants to conduct the best science possible that his particular situation allows. In other words, he does what he can to minimize all sources of bias.
THE SLOPPY RESEARCHER
The sloppy researcher is either less well trained or he is less focussed and somewhat careless. He tends to cut corners, and is thus prone to make mistakes. His miskakes can introduce bias in his research which is unintentional because he has no axe to grind. In other words, the sloppy researcher is not biased but might easily produce biased results. As the sloppyness is unintentional, the resulting bias can go in either direction; the sloppy researcher might therefore generate false-positive and false-negative findings at random.
THE BIASED RESEARCHER
The biased researcher does have an axe to grind. Typically, he has a strong positive opinion about the treatment he is testing. For him, the concept of falsifying his beloved hypothesis is an abomination – he might know that this is how science out to work, but he can simply not bring himself to doing it. His mission is to confirm his prior conviction that the therapy in question is effective. This conviction is so strong that he does not feel that he is doing anything wrong. Obviously, the biased researcher would introduce bias into his research at multible levels. His bias will then compell him to hide the flaws in his research as much as he can. Consequently, his published papers will not easily disclose his bias and will therefore have the power to mislead the public.
THE DISHONEST RESEARCHER
The dishonest researcher is out to cheat. He wants to generate resuts of a certain type, usually showing that the therapy in question is effective. He is usually motivated by money and/or ambition. He may be sufficiently well trained to be able to hide his dishonesty from detection. Like the biased researcher’s papers, his fraudulent publications will not disclose his fabrications and will therefore have the power to mislead the public.
You will, of course, realize that, in my attempt to create these 4 categories, I have exaggerated and created caricatures of the real-life situations. However, I feel the the distinction between the 4 categories might be helpful to understand medical research and its pitfalls. As I pointed out in the introduction, the categories overlap. In reality, most researchers are hybrids of two or more categories. For instance, nobody can entirely be free of bias and everybody makes mistakes occasionally.
The question arises as to which type of category might dominate SCAM. I am not aware of reliable research that would answer it. However, my experience tells me that, in SCAM, we have a regrettable void of true scientists combined with an abundance of biased researchers (see, for instance, the growing list of researchers in my ALTERNATIVE MEDICINE HALL OF FAME). What is worse, the latter category is bringing SCAM research more and more into disrepute which, in turn, demotivates true scientists to consider SCAM as a serious subject.
How often have we heard that, even if so-called alternative medicine (SCAM) does not improve the more tangible health outcomes, at least it does improve the quality of life of those who use it. But is that popular assumprion correct?
The present study investigated the use of SCAM and its relationship with health-related quality of life (HRQOL) in patients with type 2 diabetes mellitus. A total of 421 patients with type 2 diabetes mellitus who met the inclusion criteria were recruited in this cross-sectional study. The researchers recorded the use of SCAM, such as:
HRQOL was assessed by EuroQOL.
A total of 161 patients (38.2%) with type 2 diabetes mellitus used some type of SCAM. The use of supplements and/or health foods was the highest among SCAM users (112 subjects, 26.6%). HRQOL was significantly lower in patients who used some SCAM (0.829 ± 0.221) than in those without any SCAM use (0.881 ± 0.189), even after adjustments for confounding factors [F(1, 414) = 2.530, p = 0.014].
The authors concluded that proper information on SCAM is needed for patients with type 2 diabetes mellitus.
We have often discussed whether SCAM use improves or reduces QoL. The evidence is mixed.
Some studies of often poor quality suggest that SCAM improves QoL, e.g.:
- Can massage improve the quality of life?
- The effect of acupuncture on myelosuppression and quality of life in women with breast cancer
- SCAM-Use and Quality of Life in Patients with Breast Cancer
- Acupuncture is said to improve the quality of life of migraineurs, but I am unconvinced
- Yoga improves quality of life, fatigue and sleep of breast cancer patients
However, other studies suggest that SCAM has no effect or even reduces QoL, e.g.:
- Mistletoe for cancer: Does it improve patients’ quality of life?
- Alternative therapies: do they really improve the quality of life of cancer patients?
- Chiropractic improves quality of life: another bogus claim?
- Homeopathy for cancer? Unsurprisingly, the evidence is not positive.
- Multidisciplinary versus chiropractic care for low back pain
- Use of alternative medicine hastens death of cancer patients
The authors of the present study contribute further evidence to the discussion:
Huo et al. evaluated HRQOL in 17,923 patients with bronchial asthma using the Behavioral Risk Factor Surveillance System, and showed that HRQOL was significantly lower in patients with than in those without the use of CAM . Opheim et al. also demonstrated that HRQOL was significantly lower in inflammatory bowel disease (IBD) patients with than in those without the use of CAM . These findings indicate that the use of some CAM is associated with lower HRQOL. Consistent with previous findings, HRQOL was significantly lower in patients with the use of some CAM than in those without any CAM in the present study.
The issue is obviously complex. Findings would depend on the type of patient and the form of SCAM as well on a multitude of other factors. Moreover, it is often unclear what was the cause and what the effect: did SCAM cause low (or high) QoL or did the latter just prompt the use of the former?
In view of this confusion, it is probably safe to merely conclude that the often-heard blanket statement that SCAM improves QoL is not nearly as certain as SCAM enthusiasts want it to be.
Here we go, enjoy!
Autogenic training (AT) is a relaxation technique that has garnered attention for its potential to reduce anxiety and improve psychological well-being. This review aimed to synthesize the findings from a diverse range of studies investigating the relationship between AT and anxiety disorder across different populations and settings.
A comprehensive review of 162 studies, including randomised controlled trials (RCTs), non-randomized controlled trials (N-RCTs), surveys, and meta-analysis, was conducted and 29 studies were selected. Participants in the studies were patients with:
- bulimia nervosa,
- coronary angioplasty,
Others were nursing students, healthy volunteers, athletes, etc.
Anxiety levels were measured before and after the AT intervention using a variety of anxiety assessment scales, including the State Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS). The formats, duration, and delivery of the interventions varied, with some studies utilising guided sessions by professionals and other self-administered practises.
The combined findings of these studies revealed consistent trends in the beneficial effects of AT on anxiety reduction. AT was found to be effective in reducing anxiety symptoms across a wide range of populations and settings. Following AT interventions, participants reported reduced anxiety, improved mood states, and improved coping mechanisms. AT was found to be superior to no treatment or a comparable intervention in a number of cases.
The authors conclused that the body of evidence supports autogenic training as a non-pharmacological approach to reducing anxiety and improving psychological well-being. Despite differences in methodology and participant profiles, the studies show that AT has a positive impact on a wide range of populations. The findings merit further investigation and highlight AT’s potential contribution to anxiety management strategies.
I was taught AT many years ago and have practised it occasionally ever since. I have also co-authored several papers of AT that showed encouraging results, e.g.:
- Autogenic training for tension type headaches: a systematic review of controlled trials. Complement Ther Med. 2006 Jun;14(2):144-50.
- Autogenic training for stress and anxiety: a systematic review. Complement Ther Med. 2000 Jun;8(2):106-10.
- Autogenic training to reduce anxiety in nursing students: randomized controlled trial. Kanji N, White A, Ernst E.J Adv Nurs. 2006 Mar;53(6):729-35.
- Autogenic training to manage symptomology in women with chest pain and normal coronary arteries. Menopause. 2009 Jan-Feb;16(1):60-5.
- Autogenic training reduces anxiety after coronary angioplasty: a randomized clinical trial. Am Heart J. 2004 Mar;147(3)
Thus, I feel that the conclusions of this review might be correct.
Several further recent papers seem to support the notion that AT is a treatment worth trying, e.g.:
- A review concluded that as an add-on intervention psychotherapy technique with beneficial outcome on psychophysiological functioning, AT represents a promising avenue towards expanding research findings of brain-body links beyond the current limits of the prevention and clinical management of number of mental disorders.
- A clinical trial showed that AT seems to improve sleep quality and could improve some dimensions of quality of life and other symptoms among people living with HIV. Further studies are needed to confirm these results.
Why then AT is not better studied and more popular? A short paragraph of my next book (to be published in about 6 months) on the inventors of so-called alternative medicines (SCAMs), including the German psychiatry professor Johannes Schulz (1884-1970), inventor of AT, might give you a clue:
Schultz supported the euthanasia program of the Nazis, i.e. the extermination of disabled and other people considered ‘unworthy of living’ during the Third Reich. He passed death sentences on “hysterical women” through his diagnoses. In 1933, Schultz began research on a guide-book on sexual education in which he focused on homosexuality and explored the topics of sterilization and euthanasia. In 1935, he published an essay about the psychological consequences of sterilization and castration among men; in it he supported compulsory sterilization of men in order to eliminate hereditary illnesses. With a diagnostic scheme developed by him in 1940, Schulz advocated the execution of mentally ill patients by stating: “I personally have to align myself with Mr. Hoche […], by recalling the ‘annihilation of life unworthy of life’ and by raising the hope that the madhouses will soon become emptied and remodelled according to this principle.” Schultz was fully aware of the consequences of his diagnostic assessment and even used the term “death sentence in the form of a diagnosis”.
I came across this evidence only years after having published my papers on AT. Would I have developed an interest in AT, if I had known about Schulz’s Nazi past? Probably not.
Robert Jütte, a German medical historian, has long been a defender of homeopathy and other forms of so-called alternative medicine (SCAM). His latest paper refers to the situation in Switzerland where the public was given the chance to vote for or against the reimbursement of several SCAMs, including homeopathy. I reported previously about this unusual situation, e.g.:
- More about homeopathy in Switzerland: “Globuli only cause unnecessary healthcare costs”
- More on the situation of homeopathy in Switzerland
- SCAM in Switzerland: paediatricians couldn’t care less
- It’s official: Switzerland is going holistically round the bend
Unsurprisingly, Prof Jütte’s views are quite different from mine. Here is the abstract of his recent paper:
Behind the principle of involving users and voters directly in decision-making about the health care system are ideas relating to empowerment. This implies a challenge to the traditional view that scientific knowledge is generally believed to be of higher value than tried and tested experience, as it is the case with CAM. The aim of this review is to show how a perspective of the history of medicine and science as well as direct democracy mechanisms such as stipulated in the Swiss constitution can be used to achieve the acceptance of CAM in a modern medical health care system. A public health care system financed by levies from the population should also reflect the widely documented desire in the population for medical pluralism (provided that therapeutical alternatives are not risky). Otherwise, the problem of social inequality arises because only people with a good financial background can afford this medicine.
I think that Jütte’s statement that “a public health care system financed by levies from the population should also reflect the widely documented desire in the population for medical pluralism provided that therapeutical alternatives are not risky. Otherwise, the problem of social inequality arises because only people with a good financial background can afford this medicine” is untenable. Here are my reasons:
- Lay people are not normally sufficiently informed to decide which treatments are effective and which are not. If we leave these decisions to the public, we will end up with all manner of nonsense diluting the effectiveness of our health services and wasting our scarce public funds.
- Jütte seems to assume that SCAMs that are not risky do no harm. He fails to consider that ineffective treatments inevitably do harm by not adequately treating symptoms and diseases. In serious conditions this will even hasten the death of patients!
- Jütte seems concerned about inequity, yet I think this concern is misplaced. Not paying from the public purse for nonsensical therapies is hardly a disadvantage. Arguably, those who cannot affort ineffective SCAMs are even likely to benefit in terms of their health.
I do realize that there might be conflicting ethical principles at play here. I am, however, convinced that the ethical concern of doing more good than harm to as many consumers as possible is best realized by implementing the principles of evidence-based medicine. Or – to put it bluntly – a healthcare system is not a supermarket where consumers can pick and chose any rubbish they fancy.
I wonder who you think is correct, Jütte or I?
This systematic review aimed to assess the impact of Tai Chi on individuals with essential hypertension and to compare the effects of Tai Chi with other therapies. The researchers conducted a systematic literature search of the Medline, Scholar, Elsevier, Wiley Online Library, Chinese Academic Journal (CNKI) and Wanfang databases from January 2003 to August 2023. Using the methods of the Cochrane Collaboration Handbook, a meta-analysis was conducted to assess the collective impact of Tai Chi exercise in controlling hypertension. The primary outcomes measured included blood pressure and nitric oxide levels.
A total of 32 RCTs were included. The participants consisted of adults with an average age of 57.1 years who had hypertension (mean ± standard deviation systolic blood pressure at 148.2 ± 12.1 mmHg and diastolic blood pressure at 89.2 ± 8.3 mmHg). Individuals who practiced Tai Chi experienced reductions in systolic blood pressure of 10.6 mmHg, diastolic blood pressure of 4.7 mmHg and an increase in nitric oxide levels.
The authors concluded that Tai Chi can be a viable lifestyle intervention for managing hypertension. Greater promotion of Tai Chi by medical professionals could extend these benefits to a larger patient population.
Tai Chi allegedly incorporates principles rooted in the Yin and Yang theory, Chinese medicine meridians and breathing techniques, and creates a unique form of exercise characterized by its inward focus, continuous flow, the balance of strength and gentleness, and alternation between fast and slow movements. What sets Tai Chi apart from other forms of excercise is the requirement for mindful guidance during practice. This aspect may, according to the authors, be the reason why Tai Chi also outperforms general aerobic exercise in managing hypertension.
I can well imagine that any form of relaxation reduces blood pressure. What I find hard to believe is that Tai Chi is better than any other relaxing SCAMs. The 32 RCTs included in this new review fail to impress me because they are all from China, and – as we have often mentioned before – studies from China are to be taken with a pinch of salt.
Yet, the subject is important enough, in my view, to merit a few rigorous trials conducted by independent researchers. Until such data are available, I think, I prefer to rely on our own systematic review which conculded that the evidence for tai chi in reducing blood pressure … is limited. Whether tai chi has benefits over exercise is still unclear. The number of trials and the total sample size are too small to draw any firm conclusions.