Monthly Archives: December 2025
Acupuncture is considered an effective complementary therapy for major depressive disorder (MDD), yet current findings remain inconsistent, and its overall quality is uncertain. Therefore, this systematic review summarizes the existing evidence on acupuncture for MDD, providing an overview of the current research, identifying gaps and limitations in the literature, and offering guidance for future research.
A Chinese team of researchers systematically searched eight electronic databases (PubMed, EMBASE, CDSR, CENTRAL, CNKI, Wanfang, VIP, and SinoMed) and seven guideline repositories (Trip, AHRQ, NICE, NZGG, GIN, CMACPG, and NHMRC) from inception to November 15, 2024, for RCTs, systematic reviews, and clinical practice guidelines on acupuncture for major depressive disorder. Eligibility criteria were defined according to the PICOS framework. Two reviewers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and AMSTAR-2 for systematic reviews (SRs). Key evidence and recommendations were synthesized and presented in tables and figures.
A total of 374 studies were identified, including 330 RCTs, 35 SRs, and 9 clinical guidelines. Among these studies, 307 (93.03%) were published in Chinese and 23 (6.97%) in English. The RCTs generally involved small sample sizes (50 to 100 participants). The primary intervention was acupuncture combined with antidepressant medication (50%), while 79.39% of studies used antidepressants as the main control. Nearly all studies (97.88%) used changes in depression severity as the primary outcome, although the risk of bias was unclear in 80.3% of cases.
Of the SRs, 97.14% reported positive findings favoring acupuncture’s potential benefits, but 74.29% were rated as very low in methodological quality, lacking thorough bias assessments. Among the two acupuncture-specific guidelines and seven broader guidelines, recommendations for acupuncture in managing MDD varied considerably.
The authors concluded that the evidence from RCTs, SRs, and clinical guidelines suggests that acupuncture may reduce depressive symptom severity and provide additional benefits for patients with comorbid anxiety, sleep disturbances, or somatic symptoms, particularly when used as an adjunctive therapy. However, these findings are mainly based on small-scale trials with methodological limitations, and most guidelines recommend acupuncture only as a third-line complementary option. Further large, high-quality RCTs are needed to strengthen the evidence base and inform future guideline development.
For the following reasons, the conclusions are, in my opinion, wrong:
- Almost all RCTs came from China (we have discussed the untrustworthiness of these trials many times previously, e.g. here or here).
- Almost all studies were methodologically flawed.
Therefore, I suggest a more accurate conclusion based on the available data:
The evidence from RCTs, SRs, and clinical guidelines is unreliable due to the poor quality of the available data. Until reliable evidence is available, acupuncture is not a recommendable therapy for MDD, a life-threatening condition.
The literature of homeopathy is littered with papers that are weirdly hilarious. A recent example of this genre is an article by Indian authors published in the ‘INTERNATIONAL JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE’ entitled Homeopathy in chronic disease management: a critical review of the evidence. Here is its abstract:
Homeopathy remains one of the most widely practiced complementary and alternative medicine (CAM) modalities worldwide, particularly among individuals with chronic non-communicable diseases (NCDs) who seek safe, holistic, and personalized therapeutic options. Despite its global popularity, controversy continues regarding its mechanisms of action and clinical effectiveness. This review critically evaluates the current evidence on the role of homeopathy in chronic disease management. A comprehensive review of randomized controlled trials (RCTs), systematic reviews, and meta-analyses published between 2000 and 2025 was conducted. Studies were included if they examined homeopathic interventions in chronic conditions such as asthma, arthritis, type 2 diabetes mellitus, depression, chronic pain, and fibromyalgia. Data were synthesized thematically to assess efficacy, mechanistic plausibility, methodological quality, and safety outcomes. Mechanistic hypotheses suggest that hormesis, nanoparticle-mediated signaling, immune modulation, and neuropsychological or psychosocial mechanisms may contribute to the therapeutic effects of homeopathy. Meta-analytic evidence demonstrates modest but statistically significant improvements in subjective measures such as pain, fatigue, and quality of life across several chronic diseases, with standardized mean differences ranging from 0.18 to 0.25. However, objective clinical outcomes, including spirometry and HbA1c, rarely show consistent benefit. Methodological challenges, including small sample sizes, heterogeneous interventions, limited follow-up durations, and a high risk of bias, continue to constrain the reliability of existing findings. Importantly, homeopathy exhibits a favorable safety profile, with no serious adverse events reported across chronic disease studies. Current evidence indicates that homeopathy may provide modest adjunctive benefits for symptom relief and improved patient satisfaction among individuals with chronic illnesses, although its specific therapeutic mechanisms remain uncertain. Integration of homeopathy into evidence-based, patient-centered chronic disease management frameworks may enhance holistic care. Future research should emphasize large-scale, multicenter randomized trials with standardized outcome measures and mechanistic endpoints to better define clinical relevance and biological plausibility.
The lead author of this paper earns his living in the Department of Materia Medica, NatoreHomeo Medical College, Natore, Bangladesh. Thus, we might be surprised by the critical tone of this paper. However, having a closer look at it, we soon find that, under a thin veneer of critical assessment, the paper is a prime attempt of white-washing the established evidence. Let me explain; the authors claim that:
- “Mechanistic hypotheses suggest that hormesis, nanoparticle-mediated signaling, immune modulation, and neuropsychological or psychosocial mechanisms may contribute to the therapeutic effects of homeopathy.” Do the authors really suggest that all of these vague theories are true? Why not decide which one constitutes the actual mode of action? Why not tell the truth and state clearly that none of them are remotely plausible, none would explain how homeopathy works, and none is accepted by anyone outside the cult of homeopathy?
- ” Meta-analytic evidence demonstrates modest but statistically significant improvements in subjective measures such as pain, fatigue, and quality of life across several chronic diseases, with standardized mean differences ranging from 0.18 to 0.25. ” Do the authors not see that the meta-analyses demonstrating such outcomes are invariably done by overtly biased homeopath? Do they really not know that independent scientists are unable to confirm such findings?
- “Homeopathy exhibits a favorable safety profile…” Are the authors not aware that using homeopathy (or any other ineffective therapy) to treat serious conditions at best prolongs the suffering of patients and at worst hastens their death?
- “Homeopathy may provide modest adjunctive benefits for symptom relief…” Do the authors know that this statement is firstly untrue and secondly contradicts Hahnemann’s teaching (he called doctors who employed homeopathy as an add-on therapy “traitors” and insisted that homeopathy was not a symptomatic treatment but a causal cure of disease)?
Understanding that this is what homeopaths call a ‘CRITICAL’ review might be helpful: it explains, I think, why they they feel that true critical assessments are nothing but brutal and cynical destructions of their beautiful fantasies.
It has been reported that, under the ardent anti-vax Health Secretary Robert F. Kennedy Jr., the Centers for Disease Control and Prevention has named Lousiana Surgeon General Ralph Abraham as its new principal deputy director. His track record speaks fro itself: Under Abraham’s leadership, the Louisiana health department waited months to inform residents about a deadly whooping cough (pertussis) outbreak. Earlier this year, Abraham told a Louisiana news outlet that he doesn’t recommend COVID-19 vaccines because, as he put it: “I prefer natural immunity.” In February, Abraham ordered the health department to stop promoting mass vaccinations, including flu shots, and barred staff from running seasonal vaccine campaigns. Abraham also is a big fan of using the anti-malarial drug hydroxychloroquine and the de-worming drug ivermectin to treat COVID-19, despite studies finding both ineffective against the viral infection. In 2021, Abraham was the seventh-highest prescriber of ivermectin out of 12,000 practicing physicians in his state. This fits with his record of troubling prescriptions. In 2013, he was one of the top opioid prescribers.
Furthermore, Abraham believes the Affordable Care Act should be repealed and opposes the expansion of Medicaid. On the topic of COVID-19, Abraham has said that masking, lockdowns and vaccination requirements “were practically ineffective.” He said that the adverse effects of COVID vaccines were “suppressed”, that “we don’t know” whether recipients of COVID vaccines can safely donate blood, and suggested that COVID vaccines may be linked to miscarriages. Abraham issued a directive in February 2025 instructing Louisiana state workers to end long-standing mass vaccination clinics and stop promoting seasonal vaccines.
Of course, Abraham’s views are well-aligned with Kennedy’s. Abraham has even spoken out against adding fluoride to water, like the health secretary. Kennedy is diligently working to reshape the CDC to fit his anti-vaccine views, conspiracy theories, and unproven ideas. This was made very clear recently, when Kennedy directed the CDC to rewrite one of its webpages to falsely link vaccines to autism.
As soon as the appointment had been announced, experts started protesting against it. “Dr. Abraham is unqualified,” said Thomas Farley, who served as health commissioner in both New York City and Philadelphia. Dr. Nirav Shah, an epidemiologist who served on the CDC under the Biden administration, criticized the appointment on X. “Dr. Abraham has been on the wrong side of several important public health issues over the past decade,” Shah wrote. “His track record, which includes undermining confidence in vaccines and minimizing the risk of outbreaks, disqualifies him from steering an agency charged with protecting all Americans.”
Spinal epidural hematoma is a rare but potentially devastating condition that can result in permanent neurologic deficits if not diagnosed promptly. This case report presents a 48-year-old female patient with a medical history of systemic lupus erythematosus, renal transplantation, and hypertension who developed spinal epidural hematoma (SEH) after chiropractic manipulation, leading to acute quadriplegia. She came to the emergency department with progressively worsening midline back pain that had started 2 days earlier. The patient reported undergoing chiropractic manipulation at a private clinic for neck pain, after which she developed back pain that gradually worsened. The cause of the patients problems turned out to be a spinal epidural hematoma.
The objective of this report is to highlight the potential for spinal epidural hematoma development in patients with comorbidities or underlying risk factors, such as systemic autoimmune disease, hypertension, or organ transplantation, after chiropractic manipulation and to emphasize the importance of early recognition to prevent serious neurologic sequelae.
The authors concluded that SEH is a rare but serious condition that must be considered as a potential complication of chiropractic manipulation, particularly in patients with comorbidities that increase bleeding risk.
Such cases are rare, we hope (as there is no monitoring, we cannot be sure), but not unheard of. Similar cases have been described before, e.g.:
Spinal epidural hematoma (SEH) occurring after chiropractic spinal manipulation therapy (CSMT) is a rare clinical phenomenon. Our case is unique because the patient had an undiagnosed cervical spinal arteriovenous malformation (AVM) discovered on pathological analysis of the evacuated hematoma. Although the spinal manipulation likely contributed to the rupture of the AVM, there was no radiographic evidence of the use of excessive force, which was seen in another reported case. As such, patients with a known AVM who have not undergone surgical intervention should be cautioned against symptomatic treatment with CSMT, even if performed properly. Regardless of etiology, SEH is a surgical emergency and its favorable neurological recovery correlates inversely with time to surgical evacuation.
Spinal epidural hematoma is a rare but potentially devastating complication of spinal manipulation therapy. This is a case report of a healthy pregnant female who presented to the emergency department with a cervical epidural hematoma resulting from chiropractic spinal manipulation therapy that responded to conservative treatment rather than the more common route of surgical management.
Objective: We report on the case of a patient with spinal epidural hematoma (SEH) after spinal manipulative therapy and review features of reported cases of a similar nature. Clinical features: The patient was undergoing Coumadin anticoagulant therapy for atrial fibrillation and presented to the chiropractor complaining of a stiff neck. After cervical manipulation, he developed paresthesia in both feet, progressing to motor deficits in all 4 extremities. He required a laminectomy and evacuation of a clot indenting the spinal cord. Results: Review of the literature revealed 7 reported cases of SEH after manipulation; 5 patients underwent cervical manipulation and 1 patient received Coumadin therapy. Conclusion: Practitioners of spinal manipulative therapy should be aware of SEH as a possible complication of manipulation in patients at risk and should exercise caution in the care of patients undergoing anticoagulant therapy.
Introduction: Spinal epidural hematoma is a rare complication after chiropractic manipulation. In the literature, only three cases have been reported, which all necessitated surgical treatment. Case report: A 27-year-old woman was treated with cervical chiropractic manipulation (C5/6) and facet joint infiltration. 10 minutes later the patient presented signs of intracranial pressure with nausea, vertigo, headache and vomiting. The magnetic resonance imaging of the spine demonstrated an epidural hematoma extending from the cervical to the sacral spine. As the patient had no sensible or motor deficits and recovered quickly, surgical treatment was not necessary. A few days later the patient had a complete persisting remission of symptoms. Conclusion: If neurological deficits occur after chiropractic manipulation, a spinal epidural hematoma should be considered to provide adequate therapy without delay. The current case report shows an unusual expansion of the hematoma which has not described so far after chiropractic manipulation. But, in contrast to the three cases reported before, a surgical intervention was not necessary.
Conclusion?
Well, I suppose you know mine: As chiropractic spinal manipulations are of uncertain (to put it mildly!) effectiveness, even rare but serious risks weigh heavily and make the risk/benefit balance tilt into the negative. In practical terms, this obviously means this: avoid chiros where you can!
It is a long time ago; I guess some 25 years. I had received an invitation by the German Green Party to give a lecture in Hannover on so-called alternative medicine (SCAM). As I wanted to re-visit Hannover (I had lived there for 2 happy years), I accepted. Little had I foreseen that the Greens were fans of homeopathy. Thus, they were irritated by me stating that homeopathy was far from evidence-based and could even quite dangerous under certain circumstances. Needless to say, that I never again received an invitation from the Greens!
Ever since, the German Greens have stuck to their conviction that homeopathy is the best thing since sliced bread. But, as I have stated countless times: the evidence will always prevail. No matter how strong the belief, in healthcare, science is stronger; it might take a long time, but the evidence will win the argument.
As it turns out, I was not far off! Here is the news that was recently reported in the ‘Bild Zeitung’ (my translation):
After years of wrangling, everything suddenly happened very quickly: at the Green Party conference in Hanover, delegates cleared up a highly controversial issue. In future, statutory health insurance funds will no longer pay for homeopathic treatments. A turning point for the environmental and eco-friendly party!
This was preceded by a brief, factual discussion late on Friday evening. Many Greens had previously been almost ashamed that the issue was even up for discussion – the debate had been so heated and the fronts so entrenched. In addition, the general consensus was that it was time to ‘look ahead’ – a renewed debate about globules, Bach flowers and mother tinctures seemed long outdated to many.
Now, Berlin pharmacist Cedrik Schamberger (Tempelhof-Schöneberg district association) has prevailed. “The solidarity community should not pay for therapies whose effectiveness beyond the placebo effect has not been scientifically proven,” stated the motion initiated by Schamberger. Furthermore, reimbursement by health insurance companies suggests that homeopathic remedies are effective; this “misleading of patients” must be stopped. Schamberger: “A policy based on superstition is neither fair nor sustainable.”
Not everyone was willing to accept this. Homeopathic services would cost health insurance companies “only” 22 million euros per year (as of 2021), argued former Bundestag member and current federal treasurer Manuela Rottmann (53). She called for a discussion of the “real” problems instead.
The majority of party conference participants saw things differently. The fact that homeopathy is paid for, but contraceptives are not, is a “real” problem, another delegate called out in the hall.
The current decision could only backfire on one person: Cem Özdemir (59), who wants to become Minister President of Baden-Württemberg. The state is home to several large companies that specialize in homeopathy. However, the Swabian has so far done well to distance himself from his party’s course (combustion engines out, migration policy) – so he would just have to continue as before.
No, I do not think that it was my lecture of ~25 years ago that did the trick. As already mentioned, I am convinced that, in healthcare, evidence will prevail.
BETTER LATE THAN NEVER!
