alternative medicine
I published this article 20 years ago! Yet, it is, I think, still relevant today. For the purpose of this blog, I have altered it marginally (mainly by using the acromym SCAM):
Whatever SCAM is, it is not an alternative to conventional medicine. Nevertheless, one might still ask why so many people pay for ‘unproven’ SCAM when they can have scientifically backed medicine at no extra expense. Chandola et al suggest that 44% who use CM hope for a cure, 30% fear adverse effects of mainstream drugs, and 27% are dissatisfied with conventional care. In a much larger survey conducted in the USA, Astin found that dissatisfaction with orthodox medicine was prevalent but did not predict use of SCAM. SCAM users tended to be better educated and to subscribe to a more ‘holistic’ philosophy of healthcare. Interestingly, they reported poorer health status than non-users. Moreover, SCAM attracts patients because it offers more personal autonomy or control and is less impersonal or high-tech than mainstream medicine. Finally patients, particularly those with chronic conditions, may simply try SCAM so as to leave no stone unturned.
‘Scientifically backed’ medicine may not be quite as helpful as one tends to assume at least not in the eyes of the patient. A survey of 1420 (mostly musculoskeletal) pain sufferers suggested that SCAMs were perceived as more successful than mainstream drugs. In fact, orthodox therapies such as parenteral injections and oral medications ranked only 8th and 11th, respectively. Perhaps more disturbingly, patients seem to experience the therapeutic encounter with SCAM practitioners as more satisfying, empathetic and informative than that with their general practitioners. While many physicians (rightly or wrongly) continue to see SCAM as a nuisance, maybe we should think again: SCAM’s popularity amounts to a biting criticism of mainstream medicine that ought to be taken seriously.
How are clinicians to reconcile the public demand for SCAM with the new zeal for evidence-based medicine? The apparently easy answer is to pursue a strategy of evidence-based SCAM. This is precisely what my department is doing. There are now about 2000 clinical trials in this diverse area. But clinical trials are often full of contradictions and seldom clarify clinical questions adequately. A US study, for instance, has contributed to increasing doubts about whether chiropractic is helpful for acute uncomplicated low back pain in a clinically relevant way. What we really need for informing clinicians’ decisions are systematic reviews incorporating the totality of the available data. For the past 5 years this has been the focus of my department’s work, and we have published a considerable number of such papers. The notion that SCAM is totally devoid of evidence is a cliché which, like many clichés, is not entirely true.
Undoubtedly, vast areas of uncertainty do remain. The more difficult question is, therefore, how should clinicians deal with their patients’ desire for SCAM in the absence of evidence? Embarrassingly few convincing answers are on offer. Physicians have become experts in dealing with uncertainty in many aspects of their work. A dose of common sense will usually go quite far. At the very least, doctors should know what type of treatments their patients are trying. Taking a detailed history should nowadays include asking specifically about use of SCAM. In order not to alienate patients, one should resist the temptation to be dismissive. If there are good reasons to warn of a certain form of SCAM, these are best offered in an objective manner. To give evidence-based advice, clinicians obviously have to be informed about the facts, and impartial information is hard to find. One ray of light in this relative darkness is the Cochrane Collaboration, which now has a ‘field’ working on SCAM. The number of systematic reviews available from the Cochrane database is growing rapidly.
Once a patient is using SCAM (with or against the doctor’s advice), it makes sense to monitor the effects. This increases the safety of the patient and contributes to the physician’s knowledge of and experience with SCAM. There is also a good argument for establishing working relationships with a selection of local SCAM therapists who have a good track record and adequate training. At present, communication between doctors and therapists is often poor or even non-existent. Surely this cannot be to the benefit of the patient.
For SCAM, the best chance of survival in a harsh climate of evidence-based medicine and increasing rationing of resources is to come up with the goods and demonstrate what treatments are effective, safe and cost-effective for which condition. For physicians, the best way of reconciling the ‘two worlds’ is to inform themselves adequately and guide their patients through the ‘SCAM maze’ with a generous helping of good common sense. For patients, last but not least, the best approach is to be cautious and remember that, if it sounds too good to be true, it probably is.
END OF QUOTE
Twenty years, and little has changed:
- There still are vast areas of uncertainty.
- Imparcial information about SCAM is still scarce.
- Patient demand for SCAM is still considerable.
- The implied criticism of conventional medicine is still not taken seriously.
- The communication between doctors and SCAM practitioners is still lamentable.
- Most doctors still do not include questions about SCAM in their medical history taking.
- Arguably, SCAM has become even less evidence-based.
- Most doctors remain blissfully uninformed about SCAM.
- Most of the claims made for SCAM are too good to be true.
- …
- …
- …
- etc.
I think you get the gist.
The current Cochrane review of clinical trials testing the effectiveness of manipulation/mobilisation for neck pain concluded as follows:
Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.
Such a critical assessment must be tough for chiropractors who gain a substantial part of their income from treating such patients. What is the solution? Simple, convene a panel of chiros and issue recommendations that are more prone to stimulate their cash flow!
Exactly that seems to have just happened.
The purpose of the researchers was to develop best-practice recommendations for chiropractic management of adults with neck pain.
A steering committee of experts in chiropractic practice, education, and research drafted a set of recommendations based on the most current relevant clinical practice guidelines. Additional supportive literature was identified through targeted searches conducted by a health sciences librarian. A national panel of chiropractors representing expertise in practice, research, and teaching rated the recommendations using a modified Delphi process. The consensus process was conducted from August to November 2018. Fifty-six panelists rated the 50 statements and concepts and reached consensus on all statements within 3 rounds.
The statements and concepts covered aspects of the clinical encounter, ranging from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral for patients presenting with neck pain.
The authors concluded that these best-practice recommendations for chiropractic management of adults with neck pain are based on the best available scientific evidence. For uncomplicated neck pain, including neck pain with headache or radicular symptoms, chiropractic manipulation and multimodal care are recommended.
Let’s be clear what this amounts to: a panel of highly selected chiropractors (sponsored by a chiropractic organisation) has reached a consensus (and published it in a chiropractic) which allows them to continue to treat patients with neck pain.
Isn’t that just great?
Now let’s think ahead – what next?
I suggest the following:
- A panel of homeopaths recommending homeopathy.
- A panel of faith healers recommending faith healing.
- A panel of crystal healers recommending crystal healing.
- A panel of colon therapists recommending colonic irrigation.
- A panel of supplement manufacturers recommending to buy supplements.
- …
- …
- …
I am sure you get the gist.
At the heart of this story is Joseph Mercola, a dietary supplement entrepreneur and osteopath.
His website states that:
EVERYONE can benefit from Dr Mercola’s unparalleled knowledge. For expertise in alternative healthcare and high quality supplemental medicine, it’s hard to beat visionary Dr Joseph Mercola. The Chicago-based health wizard has his own website, Mercola.com (‘Take Control of Your Health’), but you can find so many of his health support products right here at Evolution Organics. Our customers swear by them. They love the diversity of the range, and that the products are priced affordably, meaning that everyone can benefit from Dr Mercola’s vast experience and unmatched know-how. And it’s not just men, women and children who can feel better ‘the Dr Mercola way’ – his brand includes health support products for pets, too.
However, an article in the Washington Post tells a different story; allow me to quote a few excerpts:
The Northern Virginia-based National Vaccine Information Center lists Mercola.com as a partner on its homepage and links to the website, where readers can learn about and purchase Mercola’s merchandise. Last month, Mercola wrote on his website that measles “continues to be a Trojan Horse for increasing vaccine mandates.” A page that was recently removed said that “vitamin C supplementation is a viable option for measles prevention.” Elsewhere on the site, a page about vitamin D includes the headline, “Avoid Flu Shots With the One Vitamin that Will Stop Flu in Its Tracks.”
Mercola … has also given at least $4 million to several groups that echo the anti-vaccine message… Mercola … offers “simple, inexpensive and safe alternatives to the conventional medical system, which is contributing to the premature death of millions and is causing needless pain and suffering in great part because multinational corporations want to increase their revenues.” … Supplements containing those vitamins are among Mercola’s “top products,” his website says… Earlier this month, Samoan anti-vaccine activist Edwin Tamasese, who touted vitamins as an alternative to vaccination, was arrested for allegedly claiming on social media that measles vaccinations would result in mass deaths…
The National Vaccine Information Center was founded in 1982 by Barbara Loe Fisher, who has said that her son was injured by a vaccine. The group claimed credit this year for helping to defeat legislation in a dozen states that would have made it harder for parents to opt out of vaccinating their children. At the beginning of last year’s flu season, Fisher and Mercola appeared in a YouTube video urging people to be skeptical about flu shots. Mercola claimed that vaccines have been associated with “deaths and permanent neurological complications,” and he said vitamin D supplements were among “far more effective, less expensive and less risky alternatives.” … Fisher said in an interview that Mercola has asked for nothing in exchange for his donations and that the National Vaccine Information Center does not sell or advertise Mercola’s products on its site. “I do not take funding for a quid pro quo,” she said. “When [Mercola] called me, he said, ‘I admire your work. I’d like to help you.’ ” The center’s homepage, which the group says was visited more than 1.2 million times last year, displays Mercola.com’s logo. An affiliated website run by Fisher’s group refers numerous times to Mercola.com as one of the most popular health and wellness websites…
In recent years, the center has been at the forefront of a movement that has led some parents to forgo or delay immunizing their children against vaccine-preventable diseases such as measles… The Northern Virginia-based National Vaccine Information Center lists Mercola.com as a partner on its homepage and links to the website, where readers can learn about and purchase Mercola’s merchandise…Asked if his companies benefit from his donations to the anti-vaccine group, Mercola said in an email that “being an adversary to powerful industries is not a positive for a business like mine.” …
The FDA has taken no enforcement action against Mercola over his vaccine claims. The agency said in a statement that it has no role in approving dietary supplements or in evaluating claims about them — unless those products are purported to treat, diagnose, prevent or cure diseases and are reported to the agency as unapproved drugs. Agency officials did not answer questions about Mercola’s claims regarding vitamins C and D…
The resurgent movement found a handful of wealthy patrons, including hedge fund manager and philanthropist Bernard Selz and his wife, Lisa. The Selzes gave $200,000 to a legal fund for Wakefield in 2012, and they went on to give more than $3 million to anti-vaccine groups, including one that held forums this year in Brooklyn, the epicenter of the measles outbreak…
The $2.98 million Mercola has given to Fisher’s group since 2009 came from the Natural Health Research Foundation, a private foundation that is entirely funded by his business and that he leads as president, tax records show. The foundation has also given more than $3.3 million to the Organic Consumers Association, a health and environmental advocacy group, tax records show. On its website, the organization advertises Mercola’s products and reposts some of his content about vaccines and other topics, as well as articles by prominent anti-vaccine activist Robert F. Kennedy Jr. …
While Fisher emphasized that she does not promote any retailers’ products, she told potential sponsors of an anti-vaccine conference her group held in 2009 that the event could help them gain “access to both national and international markets” and “increase sales and visibility,” promotional material shows. Mercola attended the conference and received an “NVIC visionary award.” Mercola did not respond to questions about whether he was a sponsor. He donated $20,000 that year to the National Vaccine Information Center through his foundation. Without elaborating, Fisher said the money “was not an earmarked donation.” The following year, Fisher’s group and Mercola.com launched a website that tracks vaccine-related legislation in every state. The site provides activists with detailed information, including how to sign up for public comment to support or oppose legislation in their state, where to park to attend a public hearing and what color T-shirt to wear to rallies.
In 2011, Mercola co-sponsored a 15-second video ad on a Jumbotron in Times Square. The ad featured an image of a woman holding a baby with the message “Vaccines: Know the Risks.” Logos of both the National Vaccine Information Center and Mercola.com were prominently displayed…
In addition to the large contributions from Mercola, Fisher’s group has received financial support from Focus for Health. That foundation, funded by wealthy New Jersey businessman Barry Segal, gave Fisher’s group more than $400,000 from 2011 to 2017, according to tax records.
In September of this year, as flu season approached, Mercola and the National Vaccine Information Center co-sponsored their 10th annual “vaccine awareness week.” Mercola offered to match all donations made to the center that week up to $100,000, according to a video posted to his YouTube channel. In a video posted the following day, Fisher described her group’s recent successes in state legislatures across the country. Those states include Colorado, Minnesota, Oregon and Texas, Fisher said. “I look forward to another 30 years of working with you,” she told Mercola.
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On this blog, I have repeatedly warned that many so-called alternative medicine (SCAM) practitioners recommend against vaccinations. Specifically implicated are:
- Physicians practising integrative medicine
- Doctors of anthroposophical medicine
- Naturopaths
- Homeopaths
- Chiropractors
We knew about the ‘ideology’ and the misinformation pushing SCAM-related anti-vaccination sentiments. The article in the Washington Post is a stark reminder of the financial interests behind all this. As a result, SCAM-use is associated with low vaccination-uptake (as we have discussed ad nauseam – see for instance here, here, here and here). Anyone who needs more information will find it by searching this blog. Anyone claiming that this is all my exaggeration might look at papers which have nothing to do with me (there are plenty more for those who are willing to conduct a Medline search):
- Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homeopathic physicians towards vaccination. Vaccine. 2001;19:4859–4864. doi: 10.1016/S0264-410X(01)00180-3. [PubMed]
- Halper J, Berger LR. Naturopaths and childhood immunizations: Heterodoxy among the unorthodox. Pediatrics. 1981;68:407–410. [PubMed]
- Colley F, Haas M. Attitudes on immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics. 1994;17:584–590. [PubMed]
This post is dedicated to all who claim that I never discuss anything positive about so-called alternative medicine (SCAM).
Autogenic training is a therapy developed in the 1920s by the German psychiatrist Johannes Heinrich Schultz (1884 – 1970). It is an auto-hypnotic relaxation technique popular in Germany but less so other countries. (The lack of international appreciation of autogenic training might be related to Schultz’ well-documented Nazi past. In 1935, he published an essay which supported compulsory sterilization of men to eliminate hereditary illnesses. Later he was appointed deputy director of the Göring Institute in Berlin. Through this institute, he had an active role in the extermination of mentally handicapped individuals in the framework of the ‘Aktion T4’, the Nazi’s infamous euthanasia programme.)
Autogenic training consists of mental exercises using instructions directed at different parts of the body to control bodily perceptions, such as ‘my right foot feels warm’ or ‘my left arm feels heavy’. Patients tend to report an intense sense of relaxation during and after autogenic training. Autogenic training is taught in a series of lessons by a qualified instructor.
Autogenic training should be practised regularly and does not require further supervision. It is thus an inexpensive therapy. The technique is claimed to help for a range of (mostly stress-related) conditions. However, the evidence from clinical trials is scarce and, not least due to methodological problems, less than convincing.
This systematic review was conducted to evaluate the effectiveness of autogenic training on stress responses. A total 11 studies were included in a meta-analysis. They showed that autogenic training decreased anxiety and depression, and increased the high frequency of heart rate variability as well as a reduction of anxiety score by 1.37 points (n=85, SMD=-1.37: 95% CI -2.07 to -0.67), in the studies on short-term intervention targeting healthy adults.For depression, a reduction was noted of the symptom score by 0.29 point (n=327, SMD=-0.29: 95% CI -0.50 to -0.07) in the studies on long term intervention targeting the patient group.
The authors concluded that autogenic training is effective for adults’ stress management, and nurses will be able to effectively perform autogenic training programs for workers’ stress relief at the workplace.
I cannot access the full article because it was published in Korean. Nevertheless, I feel that the conclusions are probably correct.
Why?
Because I know (most of) the primary studies and three of the RCTs are my own.
(Yet, some of my critics continue to claim that I never conducted any positive studies of SCAM)
If you had thought that HRH Prince Charles, soon to be King, would calm down regarding his royal bee under his alternative bonnet, you evidently were mistaken. In June 2019, he became the patron of the ‘Faculty of Homeopathy‘ the professional organisation of UK doctor homeopaths. And a few days ago, it has been announced that he now has also become the patron of the ‘College of Medicine and Integrated Health’ (CMIH). The College chair, Michael Dixon, was quoted stating: ‘This is a great honour and will support us as an organisation committed to taking medicine beyond drugs and procedures. This generous royal endorsement will enable us to be ever more ambitious in our mission to achieve a more compassionate and sustainable health service.”
I find it hard to be surprised by Charles’ latest move. After all, the CHIM is the direct successor of Charles’ ‘Foundation for Integrated Health‘ (FIH). When this bizarre organisation had to close in 2010 amid claims of fraud, money laundering and misuse of charity status (its chief executive later went to prison!), Dixon quickly organised the creation of the CMIH. Even though he was clearly involved, Charles was probably wise to keep his distance after the scandal. But now, almost a decade later, the dust has settled and he feels he can again patronise (= become a patron).
Dixon who was the medical director of the FIH did not go to prison; why should he? He had done nothing wrong! On the contrary, he collected another gong and even aspired to become the president of the ‘Royal College of General Practitioners‘. He failed, but his honours and appointments are still second to none:
- LVO (2015)
- OBE (2001)
- Visiting Professor University College of London
- Visiting Professor Westminster University
- Honorary Senior Fellow, HSMC Birmingham University
- Honorary Senior Lecturer Peninsula Medical School, Exeter
- Medical Advisor to the Prince of Wales
Don’t I just admire my ex-friend Michael?!
And so should you!!!
Just read the abstract of his study of spiritual healing. If you are not impressed by this work of beauty, there must be something wrong with you.
This study was designed to examine the effects of a healer seeing chronically ill patients in a large semirural practice. The 57 patients were allocated alternately either to receive ten weekly healing sessions or to become waiting-list controls. Two weeks after completion of ‘healing’ 22 (81%) of the 27 study patients thought their symptoms had improved and 15 of these thought they had improved substantially. Study patients scored better than controls on both measures of symptoms (P < 0.05, P < 0.01), on anxiety and depression ratings (P < 0.01, P < 0.05) and on general function measured by the Nottingham Health Profile (P < 0.01). Treatment differences were still evident three months later for one of the measures of symptom change (P < 0.05) and for both anxiety and depression ratings (P < 0.01, P < 0.05). The percentages of natural killer cells (CD16, CD56) did not change greatly in either group. These results suggest that healing may be an effective adjunct for the treatment of chronically ill patients presenting in general practice. They do not distinguish between any specific effects of spiritual healing and non-specific effects such as relaxation; for further investigation, randomized controlled trials will be needed.
Sorry, I digress – this should be about Charles, not Michael.
Now that he is patron of both the FoH and the CMIH, what might be next? As he has already tried his own brand of herbal remedies, I suggest the next launches a brand of homeopathics. What about
‘HRH – Hopeless Royal Homeopathy‘?
Not good?
‘HRH – Hopeless Royal’s Homeopathy’
No?
Well, suggest something better then!
There are no representative studies using a probability sample examining whether US physicians recommend so-called alternative medicines (SCAMs) to their patients. This article fills a void in the current literature for robust data on recommendations for SCAMs by office-based physicians in the US.
Descriptive statistics and multivariable regression analyses of physician-level data were from the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII), a nationally representative survey of office-based physicians. Weighted response rate among eligible physicians sampled for the 2012 NAMCS PII was 59.7%.
Recommendations by physicians to their patients were recorded for any SCAM, and the following individual SCAMs: massage therapy, herbs/nonvitamin supplements, chiropractic/osteopathic manipulation, yoga, acupuncture, and mind–body therapies.
Massage therapy was the most commonly recommended SCAM (30.4%), followed by chiropractic/osteopathic manipulation (27.1%), herbs/nonvitamin supplements (26.5%), yoga (25.6%), and acupuncture (22.4%). The most commonly recommended SCAMs by general/family practice physicians were chiropractic/osteopathic manipulation (54.0%) and massage therapy (52.6%). Of all U.S. physicians, 53.1% recommended at least one SCAM to patients during the previous 12 months. Multivariable analyses found physician’s sex, race, specialty, and U.S. region to be significant predictors of SCAMrecommendations. Female physicians were more likely than male physicians to recommend massage therapy, herbs/nonvitamin supplements, yoga, acupuncture, and mind–body therapies to patients. Psychiatrists, OB/GYNs, and paediatricians were all less likely to recommend chiropractic/osteopathic manipulation than general and family practitioners.
The authors concluded that, overall, more than half of office-based physicians recommended at least one SCAM to their patients. Female physicians recommended every individual SCAM at a higher rate than male physicians except for chiropractic and osteopathic manipulation. These findings may enable consumers, physicians, and medical schools to better understand potential differences in use of SCAMs with patients.
Yes, I know!
Who cares what type of SCAMs US physicians recommended to their patients 7 years ago?
And who knows what the true figures would have looked like, if the ~40% who did not respond would have been included?
Such surveys usually tell us little of relevance. What is worse, they are misused for exploiting the ‘appeal to authority’ fallacy which hold that, if physicians recommend SCAMs, they must be fine. That this is a fallacy becomes obvious, if we remind ourselves that US physicians also are the main cause for the current opioid crisis in the US (if physicians recommend opioids, they must be fine???).
More importantly, I think, this survey also suggests the following:
- 73% of US physicians do NOT recommend chiropractic/osteopathic manipulations.
- 73% of them do NOT recommend herbal medicine.
- 74% of them do NOT recommend yoga.
- 77% of them do NOT recommend acupuncture.
I wonder why!
According to WebMed, the shark cartilage (tough elastic tissue that provides support, much as bone does) used for medicine comes primarily from sharks caught in the Pacific Ocean. Several types of extracts are made from shark cartilage including squalamine lactate, AE-941, and U-995.
Shark cartilage is most famously used for cancer. Shark cartilage is also used for osteoarthritis, plaque psoriasis, age-related vision loss, wound healing, damage to the retina of the eye due to diabetes, and inflammation of the intestine (enteritis).
A more realistic picture is pained by this abstract:
The promotion of crude shark cartilage extracts as a cure for cancer has contributed to at least two significant negative outcomes: a dramatic decline in shark populations and a diversion of patients from effective cancer treatments. An alleged lack of cancer in sharks constitutes a key justification for its use. Herein, both malignant and benign neoplasms of sharks and their relatives are described, including previously unreported cases from the Registry of Tumors in Lower Animals, and two sharks with two cancers each. Additional justifications for using shark cartilage are illogical extensions of the finding of antiangiogenic and anti-invasive substances in cartilage. Scientific evidence to date supports neither the efficacy of crude cartilage extracts nor the ability of effective components to reach and eradicate cancer cells. The fact that people think shark cartilage consumption can cure cancer illustrates the serious potential impacts of pseudoscience. Although components of shark cartilage may work as a cancer retardant, crude extracts are ineffective. Efficiencies of technology (e.g., fish harvesting), the power of mass media to reach the lay public, and the susceptibility of the public to pseudoscience amplifies the negative impacts of shark cartilage use. To facilitate the use of reason as the basis of public and private decision-making, the evidence-based mechanisms of evaluation used daily by the scientific community should be added to the training of media and governmental professionals. Increased use of logical, collaborative discussion will be necessary to ensure a sustainable future for man and the biosphere.
To be clear: there is no good evidence that the supplements commercially available currently are effective for any condition.
Now, there is more news on this topic:
The objective of this study was to analyse labelling practices and compliance with regulatory standards for shark cartilage supplements sold in the United States. The product labels of 29 commercial shark cartilage supplements were assessed for compliance with U.S. regulations. Claims, including nutrient content, prohibited disease, and nutritional support statements, were examined for compliance and substantiation.
Overall, 48% of the samples had at least one instance of non-compliance with labelling regulations. The most common labelling violations observed were:
- missing a domestic address/phone number,
- non-compliant nutrient content claim,
- missing/incomplete disclaimer,
- missing statement of identity,
- prohibited disease claims,
- incomplete “Supplement Facts” label.
The use of prohibited disease claims and nutritional support statements without the required disclaimer is concerning from a public health standpoint because consumers may delay seeking professional treatment for a disease.
The authors concluded that the results of this study indicate a need for improved labelling compliance among shark cartilage supplements.
In summary, it seems that shark cartilage supplements are bad for all concerned:
- Patients who rely on them might hasten their death.
- Sharks are becoming an endangered species.
- Consumers are being mislead and misinformed.
There is just one party smiling: the supplement manufacturers who make a healthy profit destroying the health of gullible consumers and patients.
Carl Sagan was a giant in critical thinking and has inspired many, including myself. His book THE DEMON HAUTED WORLD is a classic. In it, he published his ‘BALONEY DETECTION KIT’. As it relates to SCAM and so much more that troubles us today, I today take the liberty of citing it here.
- Wherever possible there must be independent confirmation of the “facts.”
- Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
- Arguments from authority carry little weight — “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.
- Spin more than one hypothesis. If there’s something to be explained, think of all the different ways in which it could be explained. Then think of tests by which you might systematically disprove each of the alternatives. What survives, the hypothesis that resists disproof in this Darwinian selection among “multiple working hypotheses,” has a much better chance of being the right answer than if you had simply run with the first idea that caught your fancy.
- Try not to get overly attached to a hypothesis just because it’s yours. It’s only a way station in the pursuit of knowledge. Ask yourself why you like the idea. Compare it fairly with the alternatives. See if you can find reasons for rejecting it. If you don’t, others will.
- Quantify. If whatever it is you’re explaining has some measure, some numerical quantity attached to it, you’ll be much better able to discriminate among competing hypotheses. What is vague and qualitative is open to many explanations. Of course there are truths to be sought in the many qualitative issues we are obliged to confront, but finding them is more challenging.
- If there’s a chain of argument, every link in the chain must work (including the premise) — not just most of them.
- Occam’s Razor. This convenient rule-of-thumb urges us when faced with two hypotheses that explain the data equally well to choose the simpler.
- Always ask whether the hypothesis can be, at least in principle, falsified. Propositions that are untestable, unfalsifiable are not worth much. Consider the grand idea that our Universe and everything in it is just an elementary particle — an electron, say — in a much bigger Cosmos. But if we can never acquire information from outside our Universe, is not the idea incapable of disproof? You must be able to check assertions out. Inveterate skeptics must be given the chance to follow your reasoning, to duplicate your experiments and see if they get the same result.
As I said, this is a good book; I warmly recommend it to you.
I have to admit, I only read the DAILY MAIL, if I have to (and certainly not today). This is probably why I missed this article announcing the 1st traditional Chinese medicine to be licensed in the UK.
The plant Sigesbeckia, which has an unpleasant smell, is renowned for its ability to treat aches and pains – including those caused by arthritis. It is the active ingredient in Phynova Joint and Muscle Relief Tablets, which have just been licensed by drug safety watchdog the Medicines and Healthcare Products Regulatory Agency.
The directive also made it more difficult for medicines to get a licence as it demanded they had to have been in use for 30 years, of which at least 15 years had to be in the EU. Some Western herbal medicines have managed to gain licences in a process costing thousands of pounds to verify their ingredients. But the Phynova tablets are the first traditional Chinese medicine to be approved.
Robert Miller, chief executive of Oxford-based Phynova, said he was ‘extremely proud’, adding: ‘This has come from years of working with our Chinese colleagues. ‘Britain can now benefit from having access to high quality, regulated Chinese medicines.’ He also said that the company is planning to apply for a licence for a second traditional Chinese medicine, a cold and flu remedy.
Dr Chris Etheridge, a medical herbalist and adviser to Potter’s Herbals, celebrated the ‘good news’, adding that Sigesbeckia, which is not commonly used in the West, ‘offers an alternative to those who prefer not to take non-steroidal anti-inflammatory drugs for muscle and joint pain’.
But Michael McIntyre, chairman of the European Herbal and Traditional Medicine Practitioners Association, warned that the new product demonstrates the difficulties the EU rules created for supplying herbal products safely to the public. He said it is ‘almost impossible to satisfy the licensing conditions’. He added that some people have therefore turned to the internet to buy unlicensed products, but this means they have ‘no idea whether they are safe or effective’.
How exciting!
Exciting enough to do a quick search for the evidence. Are there any clinical trials to show or suggest that this herbal remedy does anything other than filling the bank account of the manufacturer? Sadly, the answer seems to be NO! At least, I could not find a single such study (if anyone knows more, I’d be pleased to stand corrected).
Frustrated I looked at the website of the manufacturer. Here I found this:
Exclusively containing Sigesbeckia extract, Phynova Joint and Muscle Relief Tablets is a traditional herbal medicinal product used for the relief of backache, rheumatic, joint and muscle pain as well as minor sports injuries. Sigesbeckia has been used for thousands of years around the world to relieve painful joints and muscles.
Benefits
– Relief from joint & muscle pain
– Gentle on the stomach
– No known side effects
– No known drug indications or contraindications
– Can be taken with or without food
And this:
What can Sigesbeckia be used to treat?
Traditionally used for arthritic pain, rheumatic pain, back pain and sciatica. Today, Sigesbeckia can be used for;
Backache
Back pain can occur through a sprain or strain, spasms, nerve compression, herniated discs and other problems in your lower, middle and upper back.
Poor posture, lifting and stretching, sudden movements placing strain on your lower back and sports injuries, are amongst the main culprits for causing back pain.
Minor sports injuries
Minor sports injuries can be caused by an accident such as a fall or blow, not warming up properly before exercise, pushing yourself too hard and not using the appropriate equipment or perhaps poor technique.
Rheumatic and muscular pain
Common causes of rheumatic and muscle pain can be due to; tension and stress, lack of minerals, certain medication, dehydration, sprains and strains, sleep deficiency, too much physical activity and sometimes other underlying health conditions and diseases.
General aches and pains in muscles and joints
Overexertion due to a new exercise routine or from a sprain or strain can cause general aches and pains in muscles and joints. But so too can modern day busy life. The impact on our bodies can trigger aches and pains in your muscles and joints and lower your resistance to illness and disease.
The Benefit of Sigesbeckia extract
One of the benefits of Sigesbeckia extract, as used in approved licensed products, is that it has no known side effects or interactions with other medications according to the Summary of Product Characteristics (SmPC). Always check that the product you purchase is an approved Traditional Herbal Medicine Product in the UK.
In summary: Look after your joints and muscles with Sigesbeckia
Our bodies are all different, and our approach and tolerances will vary. Used for over a thousand years and known for its anti-inflammatory and mobility benefits alongside being used for joint and muscle pain; Sigesbeckia is a herbal medicine that works best when used over time.
Looking for a traditional remedy for joint and muscle relief? Why not try Sigesbeckia?
But again no sign of a clinical trial to back up this plethora of therapeutic claims. How can this be? The answer lies in the directive mentioned in the Mail article. To obtain a licence that enables the manufacturer to make therapeutic claims, a herbal remedy merely needs to demonstrate that it has been in use for 30 years, of which at least 15 years had to be in the EU.
I think I understand the intention of the directive. But I would nevertheless have thought that, 4 years after obtaining a license, the manufacturer could have conducted a study to test whether the product works. In my view this should be a moral and ethical, if not legal obligation. The ‘test of time’ is woefully insufficient and unreliable and no basis for generating progress or securing the best interests of patients.
Considering the total lack of efficacy and safety data, do you agree that the above comment by Michael McIntyre are ironic to the extreme? And do you agree that manufacturers who manage to obtain such a license should be obliged to deliver a proof of efficacy within a reasonable period of time?
Many patients with chronic pain (CP) are prescribed opioids, a situation which has led to the much-discussed opioid crisis. Integrative medicine (IM), which combines pharmacological and so-called alternative medicine (SCAM), has been proposed as a solution. Yet, the role of SCAM therapies in reducing opioid use remains unclear.
This systematic review explored the effectiveness of the IM approach or any of the SCAM therapies to reduce or cease opioid use in CP patients. Electronic searches yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, seven were retrospective studies, four studies were prospective observational, three were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM/SCAM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioral therapy, and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design.
The authors concluded that there is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including SCAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/SCAM therapies for CP.
I am unimpressed by this review.
And here is why:
- Because of their design, most of the included studies do not allow any conclusions about cause and effect.
- The 8 RCTs that would allow such conclusions are mostly of poor quality.
- Some of the 8 RCTs are not even what the review authors claim to be. Here is just one example:
Background: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
Purpose: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
Methods: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.
Results: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).
Conclusions: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.
This study is evidently NOT an RCT!
Most of the 8 RCTs investigate whether SCAM is useful for weaning opioid-dependent patients off their drug. To equate this with the question whether IM/SCAM can reduce or cease opioid use in CP patients is, I think, wrong. The way to reduce opioid use in CP patients is to prescribe less opioids. And for prescribing less opioids, we need no SCAM but we need to remember what we learned in medical school: opioids are not for routine treatment of CP!
So, why do the authors of this review try to mislead us?
Could it have something to do with some of their affiliations and the bias that goes with it?
- Canadian College of Naturopathic Medicine, North York, Ontario, Canada.
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
- Pacific College of Oriental Medicine, San Diego, California, USA.
What do you think?