alternative medicine
Lumbar spinal stenosis (LSS) is a common reason for spine surgery. Several non-surgical LSS treatment options are also available, but their effectiveness remains unproven. The objective of this study was to explore the comparative clinical effectiveness of three non-surgical interventions for patients with LSS:
- medical care,
- group exercise,
- individualised exercise plus manual therapy.
All interventions were delivered during 6 weeks with follow-up at 2 months and 6 months at an outpatient research clinic. Patients older than 60 years with LSS were recruited from the general public. Eligibility required anatomical evidence of central canal and/or lateral recess stenosis (magnetic resonance imaging/computed tomography) and clinical symptoms associated with LSS (neurogenic claudication; less symptoms with flexion). Analysis was intention to treat.
Medical care consisted of medications and/or epidural injections provided by a physiatrist. Group exercise classes were supervised by fitness instructors. Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists. The primary outcomes were between-group differences at 2 months in self-reported symptoms and physical function measured by the Swiss Spinal Stenosis questionnaire (score range, 12-55) and a measure of walking capacity using the self-paced walking test (meters walked for 0 to 30 minutes).
A total of 259 participants were allocated to medical care (n = 88), group exercise (n = 84), or manual therapy/individualized exercise (n = 87). Adjusted between-group analyses at 2 months showed manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise. Manual therapy/individualized exercise had a greater proportion of responders (≥30% improvement) in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). At 6 months, there were no between-group differences in mean outcome scores or responder rates.
The authors concluded that a combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.
In many ways, this is a fairly rigorous study; in one important way, however, it is odd. One can easily see why one group received the usual standard care (except perhaps for the fact that standard medical care should also include exercise). I also understand why one group attended group exercise. Yet, I fail to see the logic in the third intervention, individualised exercise plus manual therapy.
Individualised exercise is likely to be superior to group exercise. If the researchers wanted to test this hypothesis, they should not have added the manual therapy. If they wanted to find out whether manual therapy is better that the other two treatments, they should not have added individualised exercise. As it stands, they cannot claim that either manual therapy or individualised exercise are effective (yet, I am sure that the chiropractic fraternity will claim that this study shows their treatment to be indicated for LSS [three of the authors are chiropractors and the 1st author seems to have a commercial interest in the matter!]).
Manual therapy procedures used in this trial included:
- lumbar distraction mobilization,
- hip joint mobilization,
- side posture lumbar/sacroiliac joint mobilization,
- and neural mobilization.
Is there any good reason to assume that these interventions work for LSS? I doubt it!
And this is what makes the new study odd, in my view. Assuming I am correct in speculating that individualised exercise is better than group exercise, the trial would have yielded a similarly positive result, if the researchers had offered, instead of the manual therapy, a packet of cigarettes, a cup of tea, a chocolate bar, or swinging a dead cat. In other words, if someone had wanted to make a useless therapy appear to be effective, they could not have chosen a better trial design.
And why do I find such studies objectionable?
Mainly because they deliberately mislead many of us. In the present case, many non-critical observers might conclude that manual therapy is effective for LSS. Yet, the truth could well be that it is useless or even harmful (assuming that the effect size of individualised exercise is large, adding a harmful therapy would still render the combination effective). To put it bluntly, such trials
- could harm patients,
- might waste money,
- and hinder progress.
Benign prostate hypertrophy (BPH) affects many men aged 50 and older. It is caused by an enlargement of the prostate resulting in difficulties to urinate and to fully empty the bladder. There are several conventional treatment options, including life-style changes that are effective. In addition, a myriad of alternative therapies are being promoted, most of which are of doubtful effectiveness. Recently, a homeopathy-promoter, Dr Jens Behnke, triumphantly tweeted a trial of homeopathy for BPH allegedly proving that homeopathy does work after all. There is no conceivable reason why homeopathic remedies should have any effect on this (or any other) condition. Therefore, I decided to have a closer look at this paper.
The objective of this 5-centre, three-armed, open, randomised study was to evaluate the effectiveness of Homoeopathic Constitutional remedy (HC) and Homoeopathic Constitutional + Organ remedy (HCOM) in comparison to Placebo (PL) in patients suffering from BPH using International Prostate Symptom Score (IPSS), ultrasonographic changes in prostate volume, post-void residual urine, uroflowmetry and in WHO Quality of Life (QOL)-BREF. Patients were randomised into three groups in 2:2:1 ratio and were followed up for 6 months. The statistical analysis was done with modified intention-to-treat principle (mITT).
Of 461 patients screened, 254 patients were enrolled in the study and 241 patients were analysed as per mITT. The mean changes in IPSS and QOL due to urinary symptoms from baseline to end of study showed a positive trend in all the three groups. However, in the HC group, the changes were more prominent as compared to the other two groups. There was no difference between HC and HCOM groups and they were equally effective in terms of managing lower urinary tract symptoms due to BPH. With regard to secondary outcome, there was no difference between the groups. The psychological, social and environmental domains of WHOQOL-BREF have shown positive trend, but there was no statistically significant difference in intervention groups.
The authors concluded that statistical significance was found in the IPSS in all the three groups but only in HC and not in any of the objective parameters.
The paper is so badly written that I struggle to make sense of it. However, the above graph seems clear enough. The changes are perhaps statistically significant (which I find odd and cannot quite understand) but they are certainly not clinically relevant. Most likely, they are due to the fact that this study was not blind, meaning that patients and investigators were aware of the group allocations. This suggests to me that this study
- is dubious in more than one way,
- tests a hypothesis that lacks plausibility,
- yields a result that is clinically irrelevant.
In other words, it does not amount to anything remotely resembling a proof of homeopathy’s efficacy.
I came across an embarrassingly poor and uncritical article that essentially seemed to promote a London-based clinic specialised in giving vitamins intravenously. Its website shows the full range of options on offer and it even lists the eye-watering prices they command. Reading this information, my amazement became considerable and I decided to share some of it with you.
Possibly the most remarkable of all the treatments on offer is this one (the following are quotes from the clinic’s website):
Stemcellation injections or placenta lucchini (sheep placenta) treatments are delivered intravenously (via IV), although intramuscular (IM) administration is also possible. Stem cells are reported to possess regenerative biological properties.
We offer two types of Stemcellation injections: a non-vegetarian option and a vegetarian-friendly option. Please enquire for further details.
Alongside placenta lucchini, Stemcellation injections at Vitamin Injections London contain a range of other potent active ingredients, including: physiologically active carbohydrate, nucleic acid, epithelial growth factor, amino acids, hydrolysed collagen, concentrated bioprotein and stem cells.
Please visit our Vitamin 101 section to learn more about the ingredients in Stemcellation sheep placenta injections.
Renowned for their powerful regenerating properties, Stemcellation injections can stimulate collagen production as well as:
- Remedy cosmetic problems such as wrinkles, discolouration, pigmentation, eye bags and uneven skin tone;
- Can be undertaken by those who are interested in maintaining their physical activity levels;
- Can be undertaken alongside other IV/IM injections.
Vitamin Injections London is headed by skilled IV/IM Medical Aesthetician and Skin Specialist Bianca Estelle. Our skilled IV/IM practitioners will conduct a full review of your medical history and advise you regarding your suitability for Stemcellation injections.
END OF QUOTES
The only Medline-listed paper I was able to locate on the subject of placenta lucchini injections was from 1962 and did not substantiate any of the above claims. In my view, all of this begs many questions; here are just seven that spring into my mind:
- Is there any evidence at all that any of the intravenous injections/infusions offered at this clinic are effective for any condition other than acute vitamin deficiencies (which are, of course, extremely rare these days)?
- Would the staff be adequately trained to diagnose such cases?
- How do they justify the price tags for their treatments?
- What is a ‘medical aesthetician’ and a ‘skin specialist’?
- Is it at all legal for ‘medical aestheticians’ and ‘skin specialists’ (apparently without medical qualifications) to give intravenous injections and infusions?
- How many customers have suffered severe allergic reactions after placenta lucchini (or other) treatments?
- Is the clinic equipped and its staff adequately trained to deal with medical emergencies?
These are not rhetorical questions; I genuinely do not know the answers. Therefore, I would be obliged, if you could answer them for me, in case you know them.
My last post was rather depressive, and I certainly do not want my readers to be under the weather when they go into 2019. For this last post of 2018, I have therefore selected 20 events which gave me hope that perhaps we – those who prefer rationality to nonsense – are making progress.
- It has been reported that New Brunswick judge ruled this week that Canadian naturopaths — pseudoscience purveyors who promote a variety of “alternative medicines” like homeopathy, herbs, detoxes, and acupuncture — cannot legally call themselves “medically trained.”
- The Spanish Ministries of Health and Sciences announced their ‘Health Protection Plan against Pseudotherapies’.
- The medical school of Vienna axed their courses in homeopathy.
- A most comprehensive review of homeopathy concluded that the effects of homeopathy do not differ from those of placebo.
- The UK Pharmaceutical Society has stated that it does not endorse homeopathy and that pharmacists must advise patients considering a homeopathic product about their lack of efficacy beyond that of a placebo.
- A top medical journal has retracted a dodgy meta-analysis of acupuncture.
- A prominent BMJ columnist wrote : Many people seek to make money from those who don’t understand science. Doctors should call out bollocksology when they see it.
- Pharmacare and Bioglan received a ‘Stonky’ for its over-the-counter Melatonin Homeopathic Sleep Formula.
- The Governing Body of Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG) approved changes that mean NHS funded homeopathy will only be available in exceptional circumstances in the area.
- Health ministers of all German counties have decided that they will start reforming the profession of the Heilpraktiker, the German non-medically trained alternative practitioners.
- The NHS chief, Simon Stevens was quoted saying: There is no robust evidence to support homeopathy which is at best a placebo and a misuse of scarce NHS funds.
- A systematic review concluded that there is no evidence in the literature of an effect of chiropractic treatment in the scope of primary prevention or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.
- A Cochrane review did not show any benefit of homeopathic medicinal products compared to placebo on recurrence of acute respiratory tract infections or cure rates in children.
- The French minister of health stated that ‘the French are very attached [to homeopathy]; it’s probably a placebo effect. If it can prevent the use of toxic medicine, I think that we all win. I does not hurt.
- The Australian Acupuncture and Chinese Medicine Association retracted false accusation against me about their assumption that I had undeclared conflicts of interest.
- The ‘Daily Telegraph‘ published the following statement after misquoting me: Emeritus Professor Edzard Ernst, Britain’s first professor of complementary medicine at Exeter University said that doctors should make it clear to patients that they could not be taking herbal remedies alongside drugs. Prof Ernst said there was no good evidence that they work and that doctors were ‘contributing to disinformation’ by turning a blind eye to the practice.
- A comprehensive overview of the therapeutic options for chronic low back pain showed that chiropractic is not any better than over-the-counter painkillers or exercise, and that patients need to take precautions when seeking out a chiropractor.
Hold on, you promised 20, but these are just 17!!!, I hear my attentive readers mutter.
Correct! I tried to find 20 to match my last post; and I only found 17. This might be a reflection that, in the realm of SCAM, the bad still outweighs the good news (by much more that 20:17, I fear).
Yet, this should not depress us. On the contrary, let’s see it as a challenge to get on with out work of fighting for good evidence, ethical standards, rationality and critical thinking.
In this spirit, I wish you all a very good, healthy and productive year 2019.
You probably know what yoga is. But what is FODMAP? It stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, more commonly known as carbohydrates. In essence, FODMAPs are carbohydrates found in a wide range of foods including onions, garlic, mushrooms, apples, lentils, rye and milk. These sugars are poorly absorbed, pass through the small intestine and enter the colon . There they are fermented by bacteria a process that produces gas which stretches the sensitive bowel causing bloating, wind and sometimes even pain. This can also cause water to move into and out of the colon, causing diarrhoea, constipation or a combination of both. Irritable bowel syndrome (IBS) makes people more susceptible to such problems.
During a low FODMAP diet these carbohydrates are eliminated usually for six to eight weeks. Subsequently, small amounts of FODMAP foods are gradually re-introduced to find a level of symptom-free tolerance. The question is, does the low FODMAP diet work?
This study examined the effect of a yoga-based intervention vs a low FODMAP diet on patients with irritable bowel syndrome. Fifty-nine patients with IBS undertook a randomised controlled trial involving yoga or a low FODMAP diet for 12 weeks. Patients in the yoga group received two sessions weekly, while patients in the low FODMAP group received a total of three sessions of nutritional counselling. The primary outcome was a change in gastrointestinal symptoms (IBS-SSS). Secondary outcomes explored changes in quality of life (IBS-QOL), health (SF-36), perceived stress (CPSS, PSQ), body awareness (BAQ), body responsiveness (BRS) and safety of the interventions. Outcomes were examined in weeks 12 and 24 by assessors “blinded” to patients’ group allocation.
No statistically significant difference was found between the intervention groups, with regard to IBS-SSS score, at either 12 or 24 weeks. Within-group comparisons showed statistically significant effects for yoga and low FODMAP diet at both 12 and 24 weeks. Comparable within-group effects occurred for the other outcomes. One patient in each intervention group experienced serious adverse events and another, also in each group, experienced nonserious adverse events.
The authors concluded that patients with irritable bowel syndrome might benefit from yoga and a low-FODMAP diet, as both groups showed a reduction in gastrointestinal symptoms. More research on the underlying mechanisms of both interventions is warranted, as well as exploration of potential benefits from their combined use.
Technically, this study is an equivalence study comparing two interventions. Such trials only make sense, if one of the two treatments have been proven to be effective. This is, however, not the case. Moreover, equivalence studies require much larger sample sizes than the 59 patients included here.
What follows is that this trial is pure pseudoscience and the positive conclusion of this study is not warranted. The authors have, in my view, demonstrated a remarkable level of ignorance regarding clinical research. None of this is all that unusual in the realm of alternative medicine; sadly, it seems more the rule than the exception.
What might make this lack of research know-how more noteworthy is something else: starting in January 2019, one of the lead authors of this piece of pseudo-research (Prof. Dr. med. Jost Langhorst) will be the director of the new Stiftungslehrstuhl “Integrative Medizin” am Klinikum Bamberg (clinic and chair of integrative medicine in Bamberg, Germany).
This does not bode well, does it?
What is osteopathy?
That’s a straightforward question; and it’s one that I am being asked regularly. Embarrassingly, I am not sure I know the optimal answer. A dictionary definition states that osteopathy is ‘a system of medical practice based on a theory that diseases are due chiefly to loss of structural integrity which can be restored by manipulation of the parts supplemented by therapeutic measures (such as use of drugs or surgery).‘ And in my most recent book, I defined it as ‘a manual therapy involving manipulation of the spine and other joints as well as mobilization of soft tissues‘. However, I am aware of the fact that these definitions are not optimal. Therefore, I was pleased to find a short article entitled ‘What is osteopathy?’; it was published on the website of the London-based UNIVERSITY COLLEGE OF OSTEOPATHY (UCO).
The UCU has a proud history of ~100 years and a mission stating that they want to continually provide the highest quality education and research for all and the very best care, for each patient, on every occasion. Surely, they must know what osteopathy is.
Here is how they define it:
Osteopathy is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well.
At the UCO, we believe that osteopathy has the potential to help people change their lives – not only by searching for ways to manage disease, but also by helping patients to discover ways to enhance and maintain their own health and wellbeing.
A core principle of osteopathy is that wellbeing is dependent on how each person is able to function and adapt to changes in physical capability and their environment. Osteopaths are often described as treating the individual rather than the condition: when treating a patient they consider the symptom or injury alongside other biological, physiological and social factors which may be contributing to it.
Osteopaths work to ensure the best possible care for their patients, aiding their recovery and supporting them to help manage their conditions through a range of approaches, including physical manipulation of the musculoskeletal system and education and advice on exercise, diet and lifestyle.
END OF QUOTE
Let’s analyse this text bit by bit:
- … a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. Sorry, but this sounds like a platitude to me. It could apply to any quackery on the planet: Homeopathy is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. Faith healing is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. Chiropractic is a person-centred manual therapy that aims to enable patients to respond and adapt to changing circumstances and to live well. etc., etc.
- … we believe that osteopathy has the potential to help people change their lives – not only by searching for ways to manage disease, but also by helping patients to discover ways to enhance and maintain their own health and wellbeing. Of course, they believe that. Homeopaths, faith healers, chiropractors believe the same about their bogus treatments. But medicine should have more to offer than mere belief.
- … wellbeing is dependent on how each person is able to function and adapt to changes in physical capability and their environment. Yes, perhaps. But this statement is too broad to amount to more than a platitude.
- Osteopaths are often described as treating the individual rather than the condition: when treating a patient they consider the symptom or injury alongside other biological, physiological and social factors which may be contributing to it. Really? I thought that all great clinicians can be described as treating the individual rather than the condition: when treating a patient they consider the symptom or injury alongside other biological, physiological and social factors which may be contributing to it. (‘The good physician treats the disease; the great physician treats the patient who has the disease.’ [William Osler], ‘Reductionism is a dirty word, and a kind of ‘holistier than thou’ self-righteousness has become fashionable.’ [Richard Dawkins])
- Osteopaths work to ensure the best possible care for their patients, aiding their recovery and supporting them to help manage their conditions through a range of approaches… What is this supposed to mean? Do non-osteopaths work to ensure the worst possible care for their patients, obstructing their recovery and preventing them to help manage their conditions through a range of approaches? In my view, this sentence is just plain stupid.
What have we learnt from this excursion?
Mainly two things, I think:
- Osteopaths and even the UCO seems unable to provide a decent definition of osteopathy. The reason for this odd phenomenon might be that it is not easy to define nonsense.
- Osteopaths, like other SCAM-practitioners, may not be all that good at logical thinking, but – by Jove! – they are excellent at touting fallacies.
In Traditional Chinese Medicine (TCM), the deer antler, the young, non-ossifying, and pilose antler on the head of deer, is known as Lu Rong. It is a prized and highly sought after commodity and thus an ideal X-mas present for TCM-fans. Deer antler has been used for hundreds of years for health and longevity and is considered a yang tonic. The most expensive deer antler is harvested in Alaska; prices range from $100 to $ 500 per 100 gram.
TCM knows three main treasures – deer antler velvet (Lu Rong), Ginseng (Ren Shen), and carex meyeriana grass (Wu La Cao). Among them deer velvet antler is the most precious. It is used for curing all deficiency syndromes, especially deficiency of the kidney, weak constitution, premature aging, deficiency of qi, blood, and semen. Reportedly, deer antlers contain 25 kinds of amino acids and a variety of vitamins that can improve the body’s immune system and promote hematopoietic function. In his “Compendium of Materia Medica”, Li Shizhen stated that deer antler is for reinforcing kidney to strengthen yang, promoting essence production, enriching blood, supplementing marrow, and invigorating bone.
Does deer antler work? TCM-practitioners seem to have little doubt. They claim it can:
- enhance immunity,
- increase body resistance to disease
- delay aging,
- sharpen the brain,
- and strengthen memory,
- treat infertility,
- cure deficient cold,
- treat postpartum weakness,
- cure metrorrhagia,
- treat metrostaxis,
- treat paediatric liver and kidney deficiency,
- remedy slow growth,
- help with delayed walking of children,
- help with delayed eruption of teeth, delayed closure of the anterior fontanelle, soft bone condition, and more.
And what about any evidence for all this extraordinary claims and assumptions?
A 2013 review concluded that deer antler base has emerged as a good source of traditional medicine. However, further investigations are needed to explore individual bioactive compounds responsible for these in vitro and in vivo pharmacological effects and its mechanism of actions. Further safety assessments and clinical trials in humans need to be performed before it can be integrated into medicinal practices. The present review has provided preliminary information for further studies and commercial exploitations of deer antler base.
In plain language: there is no evidence that deer antler has any health effects whatsoever.
If you are nevertheless interested, you can very easily buy deer antler as a supplement.
But PLEASE, don’t let Rudolph hear about it; he empathises with his relatives who detest being harvested for useless TCM.
Need a last minute X-mas present?
I might have just the right thing for you: Healing Courses Online.
They are run by true professionals who clearly know what they are doing: The founders of The Online Bio Energy Healing Training Course are John Donohoe and Patricia Hesnan, both of whom have been working in the alternative complementary healing area for over 25 years. Our healing centre clinic has been involved in teaching, development and trainings since it was first established in 1990, and we continue to promote and hold our regular live training courses.
Healing Courses Online is registered with the CMA (Complementary Medical Association), which is internationally recognized as the leading organization in professional, ethical complementary medicine by professional practitioners, therapists, and the public in general. Having completed this course, you can apply for membership of the CMA which offers a number of benefits including supplying professional accreditation. The CAM industry does not have a single regulatory body at present. With this in mind here at Oisin Centre Limited and Healing Courses Online we provide certification and training of the highest standards and expect our students to adhere to all statutory regulations, standards and codes of ethics regarding professional practice as therapists. You can feel safe in the knowledge that we are an experienced and trusted provider of Energy Healing training courses.
AND HERE ARE THE DETAILS AND PRICE-TAGS OF 4 COURSES:
A diploma course in energy healing. It includes 58 professional video lessons, 8 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages. When you have completed the course you receive a Certified Diploma in Energy Healing. Once you have the knowledge and understand how to apply this energy healing therapy you can help yourself and others to activate the body’s own natural process of self-healing.
€97.00 – Was €375.00
A diploma course in sound healing. It includes 37 professional video lessons, 18 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages. When you have completed the course, you receive a Certified Diploma in Sound Healing. Learn the secrets to sound healing with Tibetan singing bowls, Chinese gong, Tuning forks, the Human Voice, plus energy healing clearing for chakras plus much more.
€69.00 – Was €275.00
A diploma course in animal energy healing. It includes 30 practical video lessons and 5 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages. When you have completed the course, you receive a Certified Diploma in Animal Healing. This is an ideal course to learn how you can help your pet or any animal so they may be healthy, happy and content.
€59.00 – Was €225.00
SELF HEALING / SELF HELP ONLINE COURSE includes 24 professional video lessons, plus 20 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages and certification of completion. You can view a video with simple Qi-Gong exercises filmed at picturesque Galway Bay in Ireland. The aim of using singing bowls, crystal bowls, tuning forks, healing music, or the human voice as a self healing modality is to help restore the body to its normal.
€19.99 – Was €199.00
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IN CASE YOU WONDER WHAT YOU CAN DO ONCE YOU HAVE PASSED ONE OF THOSE COURSES, THE COURSE DIRECTORS GIVE IT TO YOU STRAIGHT:
Energy healing can be used as a standalone therapy or in conjunction with many other modalities including counselling, psychotherapy, hypnosis, acupuncture, massage, reflexology, and many more.
As soon as you have completed the course plus a short 10 question test, you will be granted your diploma, which you can download and print. (Your diploma is also automatically sent to your email account.)
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On this blog and elsewhere, my critics regularly complain that I do not have any qualifications in alternative medicine. Therefore, I am tempted to enrol (as a generous and high-value X-mas present to myself) – even though I am still uncertain which of the 4 courses might be best for me (and, of course, I cannot be sure to pass the ’10 question test’!).
How about you?
Will you join me?
A few weeks ago, I was interviewed by a journalist who wanted to publish the result in a magazine. He now informed me that his editor decided against it, and the interview thus remained unpublished. I have the journalist’s permission to publish it here. The journalist who, in my view, was well-prepared (much better than most), prefers to remain unnamed.
Q: How would you describe yourself?
A: I am a researcher of alternative medicine.
Q: Not a critic of alternative medicine?
A: Primarily, I am a researcher; after all, I have published more Medline-listed research papers on the subject than anyone else on the planet.
Q: You are retired since a few years; why do you carry on working?
A: Mainly because I see a need for a critical voice amongst all the false and often dangerous claims made by proponents of alternative medicine. But also because I enjoy what I am doing. Since I retired, I can focus on the activities I like. There is nobody to tell me what to do and what not to do; the latter happened far too often when I was still head of my research unit.
Q: Fine, but I still do not quite understand what drives you. Who is motivating you to criticise alternative medicine?
A: Nobody. Some people claim I am paid for my current activities. This is not true. My blog actually costs me money. My books never return enough royalties to break even, considering the time they take to write. And for most of my lectures I don’t charge a penny.
Q: There are people who find this hard to believe.
A: I know. This just shows how money-orientated they are. Do they want me to publish my tax returns?
Q: Sorry, but I still don’t understand your motivation.
A: I guess what motivates me is a sense of responsibility, a somewhat naïve determination to do something good as a physician. I am one of the only – perhaps even THE only – scientist who has researched alternative medicine extensively and who is not a promoter of bogus therapies but voices criticism about them. There are several other prominent and excellent critics of alternative medicine, of course, but they all come ‘from the outside’. I come from the inside of the alternative medicine business. This probably gives me a special understanding of this field. In any case, I feel the responsibility to counter-balance all the nonsense that is being published on a daily basis.
Q: What’s your ultimate aim?
A: I want to create progress through educating people to think more critically.
Q: Which alternative medicine do you hate most?
A: I do not hate any of them. In fact, I still have more sympathy for them than might be apparent. For my blog, for instance, I constantly search for new research papers that are rigorous and show a positive result. The trouble is, there are so very few of those articles. But when I find one, I am delighted to report about it. No, I do not hate or despise any alternative medicine; I am in favour of good science, and I get irritated by poor research. And yes, I do dislike false claims that potentially harm consumers. And yes, I do dislike it when chiropractors or other charlatans defraud consumers by taking their money for endless series of useless interventions.
Q: I noticed you go on about the risks of alternative medicine. But surely, they are small compared to the risks of conventional healthcare, aren’t they?
A: That’s a big topic. To make it simple: alternative medicine is usually portrayed as risk-free. The truth, however, is that there are numerous risks of direct and indirect harm; the latter is usually much more important than the former. Crucially, the risk-free image is incongruent with reality. I want to redress this incongruence. And as to conventional medicine: sure, it can be much more harmful. But one always has to see this in relation to the proven benefit. Chemotherapy, for instance, can kill a cancer patient, but more likely it saves her life. Homeopathic remedies cannot kill you, but employed as an alternative to an effective cancer treatment, homeopathy will certainly kill you.
Q: Homeopathy seems to be your particular hobby horse.
A: Perhaps. This is because it exemplifies alternative medicine in several ways, and because I started my alternative ‘career’ in a homeopathic hospital, all those years ago.
Q: In what way is homeopathy exemplary?
A: Its axioms are implausible, like those of many other alternative modalities. The clinical evidence fails to support the claims, like with so many alternative therapies. And it is seemingly safe, yet can do a lot of harm, like so many other treatments.
Q: You have no qualification in homeopathy, is that right?
A: No, I have no such qualifications. And I never said so. When I want to tease homeopaths a little, I state that I am a trained homeopath; and that is entirely correct.
Q: In several countries, homeopathy has taken spectacular hits recently. Is that your doing?
A: No, I don’t think so. But I do hope that my work has inspired the many dedicated activists who are currently protesting against the reimbursement of homeopathy by the public purse in the UK, Germany, France, Spain, etc.
Q: You often refer to medical ethics; why is that?
A: Because, in the final analysis, many of the questions we already discussed are really ethical issues. And in alternative medicine, few people have so far given the ethical dimensions any consideration. I think ethics are central to alternative medicine, so much so that I co-authored an entire book on this topic this year.
Q: Any plans for the future?
A: Plenty.
Q: Can you tell me more?
A: I will publish another book in 2019 with Springer. It will be a critical evaluation of precisely 150 different alternative modalities. I am thinking of writing yet another book, but have not yet found a literary agent who wants to take me on. I have been offered a new professorship at a private University in Vienna, and am hesitant whether to accept or not. I have been invited to give a few lectures in 2019 and hope to receive more invitations. Last not least, I work almost every day on my blog.
Q: More than enough for a retiree, it seems. Thank you for your time.
A: My pleasure.
Most chiropractors claim that their manipulations prevent illness, not just spinal but also non-spinal conditions. But is there any sound evidence for that assumption? A team of chiropractic researchers wanted to find out. Specifically, the objective of their systematic review was to investigate if there is any evidence that spinal manipulations/chiropractic care can be used in primary prevention (PP) and/or early secondary prevention in diseases other than musculoskeletal conditions.
Of the 13.099 titles scrutinized by the authors, 13 articles were included. These were
- 8 clinical studies,
- 5 population studies.
These studies dealt with various issues such as
- diastolic blood pressure,
- blood test immunological markers,
- and mortality.
Only two clinical studies could be used for data synthesis. None showed any effect of spinal manipulation/chiropractic treatment.
The authors’ conclusions were straight forward: we found no evidence in the literature of an effect of chiropractic treatment in the scope of PP or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.
Many chiropractors have adopted the ‘dental model’ in their practice, proposing to prevent all sorts of conditions through treatment of spinal subluxations before symptoms arise. Some call this approach ‘maintenance care’ and liken it to the need for servicing a car. They tell their patients that regular consultations will prevent problems in the future. It seems obvious that this can be a nice little earner. In 2009, I reviewed the evidence on chiropractic maintenance treatment. Here is the abstract:
Most chiropractors advise patients to have regular maintenance treatments with spinal manipulation, even in the absence of any symptoms or diseases. This article evaluates the evidence for or against this approach. No compelling evidence was found to indicate that chiropractic maintenance therapy effectively prevents symptoms or diseases. As spinal manipulation has repeatedly been associated with considerable harm, the risk benefit balance of chiropractic maintenance care is not demonstrably positive. Therefore there are no good reasons to recommend it.
The new review confirms that this approach is useful only for filling the pockets of chiropractors.
The inevitable question arises: WHEN WILL CHIROPRACTORS STOP MISLEADING THE PUBLIC FOR THEIR PERSONAL GAIN?
