alternative medicine
Nonspecific neck pain is extremely common, often disabling, and very costly for us all. If we believe those who earn their money with them, effective treatments for the condition abound. One of these therapies is osteopathy. But does osteopathic manipulation/mobilisation really work?
The objective of a recent review (the link I originally put in here does not work, I will supply a new one as soon as the article becomes available on Medline) was to find out. Specifically, the authors wanted to assess the effectiveness of osteopathic manipulative treatment (OMT) in the management of chronic nonspecific neck pain regarding pain, functional status, and adverse events.
Electronic literature searches unrestricted by language were performed in March 2014. A manual search of reference lists and personal communication with experts identified additional studies. Only randomized clinical trials (RCTs) were included, and studies of specific neck pain or single treatment techniques were excluded. Primary outcomes were pain and functional status, and secondary outcome was adverse events.
Studies were independently reviewed using a standardized data extraction form. Mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated for primary outcomes. GRADE was used to assess quality of the evidence.
Of 299 identified articles, 18 were evaluated and 15 excluded. The three included RCTs had low risk of bias. The results show that moderate-quality evidence suggested OMT had a significant and clinically relevant effect on pain relief (MD: -13.04, 95% CI: -20.64 to -5.44) in chronic nonspecific neck pain, and moderate-quality evidence suggested a non-significant difference in favour of OMT for functional status (SMD: -0.38, 95% CI: -0.88 to -0.11). No serious adverse events were reported.
The authors concluded that, based on the three included studies, the review suggested clinically relevant effects of OMT for reducing pain in patients with chronic nonspecific neck pain. Given the small sample sizes, different comparison groups, and lack of long-term measurements in the few available studies, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
Yet again I am taken aback by several things simultaneously:
- the extreme paucity of RCTs, particularly considering that neck pain is one of the main indication for osteopaths,
- the rather uncritical text by the authors,
- the nonsensical conclusions.
Let me offer my own conclusions which are, I hope, a little more realistic:
GIVEN THE PAUCITY OF THE RCTs AND THEIR SMALL SAMPLE SIZES, IT IS NOT POSSIBLE TO CLAIM THAT OMT FOR NONSPECIFIC NECK PAIN IS AN EVIDENCE-BASED APPROACH
Dear Professor Robinson,
please forgive me for writing to you in a matter that, you might think, is really none of my business. I have been following the news and discussions about the BLACKMORE CHAIR at your university. Having been a professor of complementary medicine at Exeter for ~20 years and having published more papers on this subject than anyone else on the planet, I am naturally interested and would like to express some concerns, if you allow me to.
With my background, I would probably be the last person to argue that a research chair in alternative medicine is not a good and much-needed thing. However, accepting an endowment from a commercially interested source is, as you are well aware, a highly problematic matter.
I am confident that you intend to keep the sponsor at arm’s length and plan to appoint a true scientist to this post who will not engage in the promotional activities which the alternative medicine scene might be expecting. And I am equally sure that the money will be put to good use resulting in good and fully independent science.
But, even if all of this is the case, there are important problems to consider. By accepting Blackmore’s money, you have, perhaps inadvertently, given credit to a commercially driven business empire. As you probably know, Blackmores have a reputation of being ‘a bit on the cavalier side’ when it comes to rules and regulations. This is evidenced, for instance, by the number of complaints that have been upheld against them by the Australian authorities.
For these reasons, the creation of the new chair is not just a step towards generating research, it could (and almost inevitably will) be seen as a boost for quackery. It is foremost this aspect which might endanger the reputation of your university, I am afraid.
My own experience over the last two decades has taught me to be cautious and sceptical regarding the motives of many involved in the multi-billion alternative medicine business. I have recently published my memoir entitled ‘A SCIENTIST IN WONDERLAND. SEARCHING FOR TRUTH AND FINDING TROUBLE’; it might be a helpful read for you and the new professor.
I hope you take my remarks as they were meant: constructive advice from someone who had to learn it all the hard way. If I can be of further assistance, please do not hesitate to ask me.
Sincerely
Edzard Ernst
Prince Charles’ meddling beyond his constitutional role is yet again in the press today. I was sent the 2nd batch of ‘spider memos’ yesterday, studied them and commented as follows:
The letters demonstrate yet again that Prince Charles relentlessly meddles in UK health politics and thus disrespects his constitutional role. His arguments in favour of CAM, and in particular homeopathy, show a devastating lack of knowledge and understanding; they are ill-informed, invalid and embarrassingly naïve – but at the same time they are remarkably persistent. Charles tries to give the impression that he is motivated by passion and compassion, but in health care such drivers need solid evidence and expertise. Charles has neither which is not just regrettable, it is arrogant on his part and potentially harmful for public health.
If you get the feeling that I have little patience with Charles’ meddling, you may be right. I have little doubt that it was his interfering that led to the closure of my research unit at Exeter. In my book, A SCIENTIST IN WONDERLAND, I provide the full details of what happened. Here I would just like to reproduce the incredible ‘spider memo’ in question.
It was not actually authored by Charles but by Sir Michael Peat, his 1st private secretary. On 22 September 2005, Peat wrote on Clarence House note-paper to the Vice Chancellor of Exeter University wrongly accusing me of a serious breach of confidentiality:
I am writing both as The Prince of Wales’ Private Secretary and as Acting Chairman of His Royal Highness’ Foundation for Integrated Health.
There has been a breach of confidence by Professor Edzard Ernst in respect of a draft report on the efficacy of certain complementary therapies sent to him by Mr. Christopher Smallwood. The report was commissioned by The Prince of Wales.
Mr. Smallwood sent Professor Ernst an early and, at that stage, incomplete draft of the report for comment. The accompanying e-mail requested and stressed the need for confidentiality. Professor Ernst implicitly agreed to comment on the report on this basis but then, as you probably saw, gave his views about the report to the national press. I attach a copy of a letter from the Editor of the Lancet published by The Times which summarises the issues well. I also attach a copy of the e-mail sent to Professor Ernst by Mr. Smallwood.
I apologise for troubling you, but I felt that you should have this matter drawn to your attention.
What followed was embarrassing and shameful: my uni started a 13 month investigation, eventually I was pronounced innocent but my unit was closed down. Unbelievably, Clarence house denied that Charles even knew about this amazing attempt to meddle in academic affairs. As I say, you need to read my memoir to understand this story fully.
Not much is known about the interactions of real doctors (by this I mean people who have been to medical school) and chiropractors who like to call themselves ‘doctors’ or ‘DCs’ but have never been to medical school. Therefore this recent article is of particular interest, in my view.
The purpose of this paper was to identify characteristics of Canadian chiropractors (DCs) associated with the number of patients referred by medical doctors (MDs). For this purpose, secondary data analyses were performed on the 2011 cross-sectional survey of the Canadian Chiropractic Resources Databank survey which included 81 questions about the practice of DCs. Of the 6533 mailed questionnaires, 2529 (38.7%) were returned and 489 did not meet our inclusion criteria. In total, the analysed sample included 2040 respondents.
The results show that, on average, DCs reported receiving 15.6 (SD 31.3) patient referrals from MDs per year. Nearly one-third of the respondents did not receive any. The type of clinic (multidisciplinary with MD), the province of practice (Atlantic provinces), the number of treatments provided per week, the number of practicing hours, rehabilitation and sports injuries as the main sector of activity, prescription of exercises, use of heat packs and ultrasound, and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking own radiographs, being the client of a chiropractic management service, and considering maintenance/wellness care as a main sector of activity were associated with fewer MD referrals.
The authors concluded that Canadian DCs who interacted with other health care workers and who focus their practice on musculoskeletal conditions reported more referrals from MDs.
One could criticise this survey for a number of reasons, for instance:
- the response rate was low,
- the sample was small,
- the data are now 4 years old and might be obsolete.
Despite these flaws, the paper does seem to reveal some relevant things. What I find especially interesting is that:
- the level of referrals from doctors to chiropractors seems exceedingly low,
- dubious chiropractic activities such as maintenance therapy or treatment of non-spinal conditions led to even less referrals.
To me, that implies that Canadian doctors are, on the one hand, willing to co-operate with chiropractors. On the other hand, they remain cautious about the high level of quackery in this profession.
All this means really is that Canadian doctors are responsible and aim to adhere to evidence-based practice…in contrast to many chiropractors, I hasten to add.
Lots of alternative therapies are advocated for migraine. Few of them are supported by good evidence. An exception could be the herbal remedy FEVERFEW.
This review is an update of a previously published review in the Cochrane Database of Systematic Reviews on ‘Feverfew for preventing migraine’. Feverfew (Tanacetum parthenium L.) extract is a herbal remedy, which has been used for preventing attacks of migraine. Our aim was to systematically review the evidence from double-blind, randomised, clinical trials (RCTs) assessing the clinical efficacy and safety of feverfew monopreparations versus placebo for preventing migraine.
For this updated version of the review we searched CENTRAL, MEDLINE, EMBASE and AMED to January 2015. We contacted manufacturers of feverfew and checked the bibliographies of identified articles for further trials.
We included randomised, placebo-controlled, double-blind trials assessing the efficacy of feverfew monopreparations for preventing migraine in migraine sufferers of any age. We included trials using clinical outcome measures, while we excluded trials focusing exclusively on physiological parameters. There were no restrictions regarding the language of publication.
We systematically extracted data on patients, interventions, methods, outcome measures, results and adverse events. We assessed risk of bias using the Cochrane ‘Risk of bias’ tool and evaluated methodological quality using the Oxford Quality Scale developed by Jadad and colleagues. Two review authors independently selected studies, assessed methodological quality and extracted data. We resolved disagreements concerning evaluation of individual trials through discussion.
We identified one new study for this update, resulting in a total of 6 trials (561 patients) meeting the inclusion criteria. Five of the 6 trials reported on the main outcome measure which was migraine frequency. Although 5 of the trials were generally of good methodological quality, all studies were either of unclear or high risk of bias with regards to sample size. Pooled analysis of the results was not possible due to the lack of common outcome measures and heterogeneity between studies in terms of participants, interventions and designs. The most recent trial added to this update was rigorous and larger (n = 218) than previous studies. It used a stable feverfew extract at a dose determined by a previous dose-finding trial. It reported that feverfew reduced migraine frequency by 1.9 attacks from 4.8 to 2.9 and placebo by 1.3 from to 4.8 to 3.5 per month. This difference in effect between feverfew and placebo was thus 0.6 attacks per month. For the secondary outcome measures such as intensity and duration of migraine attacks, incidence and severity of nausea and vomiting, and global assessment no statistically significant differences between feverfew and placebo were reported.
The results of previous trials were not convincing: three trials reporting positive effects of feverfew were all of small sample size (17 to 60 participants), while two rigorous trials (n = 50, 147) did not find significant differences between feverfew and placebo.
Only mild and transient adverse events of feverfew, most commonly gastrointestinal complaints and mouth ulcers, were reported in the included trials.
We concluded that, since the last version of this review, one larger rigorous study has been included, reporting a difference in effect between feverfew and placebo of 0.6 attacks per month. This adds some positive evidence to the mixed and inconclusive findings of the previous review. However, this constitutes low quality evidence, which needs to be confirmed in larger rigorous trials with stable feverfew extracts and clearly defined migraine populations before firm conclusions can be drawn. It appears from the data reviewed that feverfew is not associated with any major safety concerns.
So, good or bad news for migraine sufferers? I suppose it depends on whether you are an optimist or a pessimist. I would say that, considering the mostly bad news about alternative medicine for migraine, it is relative good news: patients who want to try something ‘natural’ could do so, particularly in view of the lack of serious risks.
The principal aim of this survey was to map centres across Europe that provide public health services and operating within the national health system in integrative oncology.
Information was received from 123 (52.1 %) of the 236 centres contacted. Forty-seven out of 99 responding centres meeting inclusion criteria (47.5 %) provided integrative oncology treatments, 24 from Italy and 23 from other European countries. The number of patients seen per year was on average 301.2 ± 337. Among the centres providing these kinds of therapies, 33 (70.2 %) use fixed protocols and 35 (74.5 %) use systems for the evaluation of results. Thirty-two centres (68.1 %) were research-active.
The alternative therapies most frequently provided were acupuncture 26 (55.3 %), homeopathy 19 (40.4 %), herbal medicine 18 (38.3 %) and traditional Chinese medicine 17 (36.2 %); anthroposophic medicine 10 (21.3 %); homotoxicology 6 (12.8 %); and other therapies 30 (63.8 %).
Treatments were mainly directed to reduce adverse reactions to chemo-radiotherapy (23.9 %), in particular nausea and vomiting (13.4 %) and leucopenia (5 %). The alternative treatments were also used to reduce pain and fatigue (10.9 %), to reduce side effects of iatrogenic menopause (8.8 %) and to improve anxiety and depression (5.9 %), gastrointestinal disorders (5 %), sleep disturbances and neuropathy (3.8 %).
The authors concluded that mapping of the centres across Europe is an essential step in the process of creating a European network of centres, experts and professionals constantly engaged in the field of integrative oncology, in order to increase, share and disseminate the knowledge in this field and provide evidence-based practice.
DISSEMINATE KNOWLEDGE?
EVIDENCE-BASED PRACTICE?
WHAT KNOWLEDGE?
WHAT EVIDENCE-BASED PRACTICE?
Where is the evidence that homeopathy or homotoxicology or Chinese medicine are effective for any of the conditions listed above? The answer, of course, is that it does not exist.
I fear the results of this survey show foremost one thing: ‘integrative oncology’ is little else but a smokescreen behind which quacks submit desperate patients to bogus treatments.
If I tell you that I just read a book by a homeopath writing about homeopathy, would you doubt my sanity? But I did, and I read it in one session with great interest. The book is (in German) by Natalie Grams (perhaps I should mention that I had never heard of her before Springer sent me her book), a German doctor; it is entitled HOMOEOPATHIE NEU GEDACHT (Homeopathy newly considered). I liked it a lot.
The author discusses in some detail why basically everything homeopaths believe in is erroneous. You might think: so what, we all knew that. True, we did, but she then she concludes that homeopathy has still some value as some sort of psychotherapy. The remedy is effective because the consultation with a homeopath gives it a ‘meaning’ which is tailor-made for each patient. Now you will think: that this is hardly original, others have considered this before. And you are, of course, correct again.
So why did this book fascinate me? Mostly because, in a few passages, Natalie Grams tells her very personal story how she matured from an enthusiast to rationalist. This could be reminiscent of my own life, but it isn’t (and by no means do I agree with everything doctor Grams writes). I found myself in a homeopathic hospital directly after medical school, became a homeopath (of sorts), later I learnt to think critically and researched homeopathy. As a scientist, when the evidence was squarely negative, I said so loud and clear (I published the whole story with all the relevant details here).
Natalie Grams studied medicine and seemed to have become disenchanted with the lack of humanity in mainstream medicine (as a clinician, I often felt this too but always concluded that the solution was not to turn away from medicine but to re-introduce more humanity into it). Doctor Grams then experienced serious health problems which were cured/alleviated by homeopathy. This made her look into the subject a little closer. She decided to do the necessary courses, uncritically adopted most of what she was told by die-hard homeopaths and eventually fulfilled her dream: she opened her own private practice as a homeopath. In other words, she dropped out of real medicine and into homeopathy, while I, in a way, did the reverse.
Doctor Grams’ practice seemed to have been successful; many of her patients, even some with serious conditions, got better. All she had been told about homeopathy seemed to get confirmed in her clinical routine. Homeopaths, like most clinicians, remember their success stories and tend to forget their failures. If this happens over and over during an entire life-time, the last doubts a budding homeopath may have once had dissolve into thin air. The result is a clinician who is utterly convinced that like cures like and high dilutions are powerful medicines because water has a memory.
Up to this point, Dr Grams career is a textbook example of a homeopath who would bet on the life of her children that homeopathy is correct and science is wrong. The world is full of them, and I have personally met many. They are usually kind, empathetic and dedicated clinicians. But they are also totally impervious to reason. They have their experience and NOBODY is allowed to question it. If you do, you are no longer their friend.
This is where the typical story of homeopaths ends… and they happily lied ever after (to themselves, their patients and everyone else). Not so in the case of Natalie Grams!
When she was still an enthusiast, she decided to write a book. It was going to be a book that showed how good homeopathy was and how bad its critics were. To do this responsibly, she read a lot of the original literature. What she found shocked her. When reading her account, I could repeatedly feel the agony she must have felt through her discoveries. Eventually, she had no choice but to agree with most of the arguments of homeopathy’s critics and disagreed with practically all of the arguments of her fellow homeopaths.
I predict that Natalie’s painful ‘journey’ has not yet come to an end; she now argues that the 200 year old assumptions of homeopathy are all obsolete and homeopathy is certainly not an effective drug therapy. However, it may turn out to be a valuable ‘talking therapy’, she believes.
I hate to say it, but I am fairly certain that she will have to go through further agony and find that her discovery is not truly workable. It might have some theoretical value but, for a whole number of reasons, it will not function in real life heath care.
My hope is that Natalie will find her way back to what she calls ‘normal medicine’ (there is, of course, the danger that she does the opposite and wanders off into even more esoteric grounds). We need doctors like her who have empathy, compassion and understanding for their patients. These are qualities many homeopaths who I have met have in abundance – but these are qualities that belong not into the realm of quackery, they belong into real medicine.
The Royal Australian College of General Practitioners (RACGP) just issued an important statement on homeopathy which, in several ways, goes beyond previous announcements on this subject. I take the liberty of reproducing it here in full:
The RACGP supports the use of evidence-based medicine, in which current research information is used as the basis for clinical decision-making. In light of strong evidence to confirm that homeopathy has no effect beyond that of placebo as a treatment for various clinical conditions, the position of the RACGP is:
1. Medical practitioners should not practice homeopathy, refer patients to homeopathic practitioners, or recommend homeopathic products to their patients.
2. Pharmacists should not sell, recommend, or support the use of homeopathic products.
3. Homeopathic alternatives should not be used in place of conventional immunisation.
4. Private health insurers should not supply rebates for or otherwise support homeopathic services or products.
Background
The contention that homeopathy is an effective treatment is not supported by evidence from systematic literature reviews. The National Health and Medical Research Council (NHMRC) analysed the scientific evidence for the effectiveness of homeopathy in treating a range of clinical conditions and released a position statement [1] in March 2015. The NHMRC’s review concluded homeopathy does not produce health benefits over and above that of placebo, or equivalent to that of another treatment.[2] Crucially, the report states that there are “no health conditions for which there is reliable evidence that homeopathy is effective” as a treatment.
While not covered in the NHMRC’s review, it is also the case that homeopathic alternatives to conventional vaccination do not prevent communicable diseases or increase protective antibodies to disease. The National Centre for Immunisation Research and Surveillance has advised that there are no studies of sufficient quality to demonstrate the safety or effectiveness of ‘homeopathic vaccines’ for protection against disease.[3] Indeed, there is no plausible biological mechanism of action by which these products could prevent infection.[4]
Harms associated with homeopathy
Homeopathic products are sometimes considered harmless as they are generally administered at a high dilution. Some may not even contain a single molecule of the original source material. However, there are a number of risks associated with the use of homeopathy.
Delaying or avoiding conventional medical care
When the use of homeopathy causes a person to delay or avoid consultation with a registered medical practitioner or reject conventional medical approaches, serious and sometimes fatal consequences can occur. As evidenced by recent Australian court findings, spurious claims made by homeopathic practitioners[5] and retailers[6] can mislead individuals about the effectiveness of conventional medicine. When homeopathic vaccines are used as an alternative to conventional immunisation, both the individual and the community are left exposed to preventable diseases.
Problems associated with unregulated products
Although homeopathic products manufactured in Australia are regulated as medicines under the Therapeutic Goods Act 1989, products sold on international websites may not meet Australian quality and safety standards. These products may be of particular concern when materials from problematic sources are employed in the preparation (e.g., pathogenic organs or tissues; causative agents such as bacteria, fungi, parasites, ova, yeast, and virus particles; disease products; excretions or secretions; heavy metals and toxins such as aconitum, kerosene and thallium). Impurities of source material and contamination associated with poor manufacturing processes also present threats to the quality and safety of these products.[7]
Direct adverse effects
Various direct harms associated with the use of homeopathic products have been noted in the literature, including allergic reaction, drug interactions, and complications related to the ingestion of toxic substances.[8]
The importance of patient-centred practice
The RACGP supports the concept of patient-centred practice, in which the values, preferences, and personal healthcare philosophy of the patient are respected and individuals play an important role in their own healthcare. An estimated six per cent of Australians use homeopathy over the course of a year.[9] It is important that these patients feel comfortable in discussing their use of complementary and alternative medicines with all members of their treatment team.
It is good practice for medical practitioners to initiate conversations with patients about their use of or intention to use homeopathy, and assist patients to think critically about the efficacy and safety of homeopathy so that they may make informed healthcare decisions.
Private health insurance and homeopathy
Many private health insurers provide ancillary (extras) cover that subsidises homeopathic treatment, and the individual’s costs in taking out this cover are subsidised under the Australian Government’s private health insurance rebate. The RACGP is concerned that health insurance premiums continue to rise as funds disburse significant sums for the use of homeopathy and other natural therapies lacking rigorous evidentiary support. In the 2013–14 financial year, health insurers paid out $164 million in benefits for natural therapies, up by almost 60 per cent from 2010–11.[10]
The RACGP also notes that offering subsidies for the use of homeopathy sends a confusing message to consumers. Listing homeopathic treatments alongside evidence-based modalities in a list of member benefits lends legitimacy to a practice that is not supported by scientific data.
References
1. National Health and Medical Research Council. NHMRC Statement: Statement on Homeopathy. Canberra: NHMRC; 2015.
2. National Health and Medical Research Council. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: NHMRC; 2015.
3. National Centre for Immunisation Research and Surveillance. Homeopathy and vaccination [fact sheet].2014 [cited 2015 April]. Available from http://www.ncirs.edu.au/immunisation/factsheets/homeopathyvaccination-
fact-sheet.pdf
4. Commonwealth Department of Health and Ageing. Myths and realities: Responding to arguments against vaccination. A guide for providers. Canberra: DoHA; 2013.
5. Coronial inquest into the death of Penelope Dingle. State Coroner of Western Australia, 2010.
6. Australian Competition and Consumer Commission v Homeopathy Plus! Pty Ltd. FCA, 2014.
7. World Health Organization. Safety issues in the preparation of homeopathic medicines. Geneva: WHO; 2009.
8. Posadzki P, Alotaibi A, Ernst E. Adverse effects of homeopathy: a systematic review of published case reports and case series. International Journal of Clinical Practice 2012 Dec;66(12): 1178–88.
9. Xue CCL, Zhang AL, Lin V, Da Costa C, Story DF. Complementary and alternative medicine use in Australia: a national population-based survey. Journal of Alternative and Complementary Medicine 2007; 13(16):643–50.
10. Private Health Insurance Administration Council. Operations of the Private Health Insurers Annual Report 2013–14. Canberra: PHIAC; 2014.
I think this is a very good statement:
- it is based on the best evidence currently available,
- it is concise and to the point,
- it covers all the necessary ground,
- it provides valuable and practical recommendations.
Perhaps I should mention that it came as a complete surprise to me, and I was not involved in any way.
Finally, I would like to express my hope that this statement will be adopted in Australia and send a powerful signal to organisations across the world to issue similar recommendations for the benefit of vulnerable patients who still fall victim to bogus claims by homeopaths every day.
On 26/5/2015, I received the email reproduced below. I thought it was interesting, looked up its author (“Shawn is a philosopher and writer educated at York University in Toronto, and the author of two books. He’s also worked with Aboriginal youth in the Northwest Territories of Canada”) and decided to respond by writing a blog-post rather than by answering Alli directly.
Hello Dr. Ernst, this is Shawn Alli from Canada, a blogger and philosopher. I recently finished a critical article on James Randi’s legacy. It gets into everything from ideological science, manipulation, ESP, faith healing, acupuncture and homeopathy.
Let me know what you think about it:
http://www.shawnalli.com/james-randi-disingenuous-legacy.html
It’s quite long so save it for a rainy day.
So far, the reply from skeptical organizations range from: “I couldn’t read further than the first few paragraphs because I disagree with the claims…” to one word replies: “Petty.”
It’s always nice to know how open-minded skeptical organizations are.
Hopefully you can add a bit more.
Sincerely,
Shawn
Yes, indeed, I can but try to add a bit more!
However, Alli’s actual article is far too long to analyse it here in full. I therefore selected just the bit that I feel most competent commenting on and which is closest to my heart. Below, I re-produce this section of Alli’s article in full. I add my comments at the end (in bold) by inserting numbered responses which refer to the numbers (in round brackets [the square ones refer to Alli’s references]) inserted throughout Alli’s text. Here we go:
Homeopathy & Acupuncture:
A significant part of Randi’s legacy is his war against homeopathy. This is where Randi shines even above mainstream scientists such as Dawkins or Tyson.
Most of his talks ridicule homeopathy as nonsense that doesn’t deserve the distinction of being called a treatment. This is due to the fact that the current scientific method is unable to account for the results of homeopathy (1). In reality, the current scientific method can’t account for the placebo effect as well (2).
But then again, that presents an internal problem as well. The homeopathic community is divided by those who believe it’s a placebo effect and those that believe it’s more than that, advocating the theory of water memory, which mainstream scientists ridicule and vilify (3).
I don’t know what camp is correct (4), but I do know that the homeopathic community shouldn’t follow the lead of mainstream scientists and downplay the placebo effect as, it’s just a placebo (5).
Remember, the placebo effect is downplayed because the current scientific method is unable to account for the phenomenon (3, 5). It’s a wondrous and real effect, regardless of the ridicule and vilification (6) that’s attached to it.
While homeopathy isn’t suitable as a treatment for severe or acute medical conditions, it’s an acceptable treatment for minor, moderate or chronic ones (7). Personally, I’ve never tried homeopathic treatments. But I would never tell individuals not to consider it. To each their own, as long as it’s within universal ethics (8).
A homeopathic community in Greece attempts to conduct an experiment demonstrating a biological effect using homeopathic medicine and win Randi’s million dollar challenge. George Vithoulkas and his team spend years creating the protocol of the study, only to be told by Randi to redo it from scratch. [29] (9) I recommend readers take a look at:
Randi’s war against homeopathy is an ideological one (10). He’ll never change his mind despite positive results in and out of the lab (11). This is the epitome of dogmatic ideological thinking (12).
The same is true for acupuncture (13). In his NECSS 2012 talk Randi says:
Harvard Medical School is now offering an advanced course for physicians in acupuncture, which has been tested endlessly for centuries and it does not work in any way. And believe me, I know what I’m talking about. [30]
Acupuncture is somewhat of a grey area for mainstream scientists and the current scientific method. One ideological theory states that acupuncture operates on principles of non-physical energy in the human body and relieving pressure on specific meridians. The current scientific method is unable to account for non-physical human energy and meridians.
A mainstream scientific theory of acupuncture is one of neurophysiology, whereby acupuncture works by affecting the release of neurotransmitters. I don’t know which theory is correct; but I do know that those who do try acupuncture usually feel better (14).
In regards to the peer-reviewed literature, I believe (15) that there’s a publication bias against acupuncture being seen as a viable treatment for minor, moderate or chronic conditions. A few peer-reviewed articles support the use of acupuncture for various conditions:
Eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of symptoms in patients suffering from chronic radiation-induced xerostomia. [31]
It is concluded that this study showed highly positive effects on pain and function through the collaborative treatment of acupuncture and motion style in aLBP [acute lower back pain] patients. [32]
Given the limited efficacy of antidepressant treatment…the present study provides evidence in supporting the viewpoint that acupuncture is an effective and safe alternative treatment for depressive disorders, and could be considered an alternative option especially for patients with MDD [major depressive disorder] and PSD [post-stroke depression], although evidence for its effects in augmenting antidepressant agents remains controversial. [33]
In conclusion: We find that acupuncture significantly relieves hot flashes and sleep disturbances in women treated for breast cancer. The effect was seen in the therapy period and at least 12 weeks after acupuncture treatment ceased. The effect was not correlated with increased levels of plasma estradiol. The current study showed no side effects of acupuncture. These results indicate that acupuncture can be used as an effective treatment of menopausal discomfort. [34]
In conclusion, the present study demonstrates, in rats, that EA [electroacupuncture] significantly attenuates bone cancer induced hyperalgesia, which, at least in part, is mediated by EA suppression of IL-1…expression. [35]
In animal model of focal cerebral ischemia, BBA [Baihui (GV20)-based Scalp acupuncture] could improve IV [infarct volume] and NFS [neurological function score]. Although some factors such as study quality and possible publication bias may undermine the validity of positive findings, BBA may have potential neuroprotective role in experimental stroke. [36]
In conclusion, this randomized sham-controlled study suggests that electroacupuncture at acupoints including Zusanli, Sanyinjiao, Hegu, and Zhigou is more effective than no acupuncture and sham acupuncture in stimulating early return of bowel function and reducing postoperative analgesic requirements after laparoscopic colorectal surgery. Electroacupuncture is also more effective than no acupuncture in reducing the duration of hospital stay. [37]
In conclusion, we found acupuncture to be superior to both no acupuncture control and sham acupuncture for the treatment of chronic pain…Our results from individual patient data meta-analyses of nearly 18000 randomized patients in high-quality RCTs [randomized controlled trials] provide the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain. [38]
While Randi and many other mainstream scientists will argue (16) that the above claims are the result of ideological science and cherry picking, in reality, they’re the result of good science going up against dogmatic (17) and profit-driven (17) ideological (17) science.
Yes, the alternative medicine industry is now a billion dollar industry. But the global pharmaceutical medical industry is worth hundreds of trillions of dollars. And without its patients (who need to be in a constant state of ill health), it can’t survive (18).
Individuals who have minor, moderate, or chronic medical conditions don’t want to be part of the hostile debate between alternative medicine vs. pharmaceutical medical science (19). They just want to get better and move on with their life. The constant war that mainstream scientists wage against alternative medicine is only hurting the people they’re supposed to be helping (20).
Yes, the ideologies (21) are incompatible. Yes, there are no accepted scientific theories for such treatments. Yes, it defies what mainstream scientists currently “know” about the human body (22).
It would be impressive if a peace treaty can exist between both sides, where both don’t agree, but respect each other enough to put aside their pride and help patients to regain their health (23).
END OF ALLI’S TEXT
And here are my numbered comments:
(1) This is not how I understand Randi’s position. Randi makes a powerful point about the fact that the assumptions of homeopathy are not plausible, which is entirely correct – so much so that even some leading homeopaths admit that this is true.
(2) This is definitely not correct; the placebo effect has been studied in much detail, and we can certainly ‘account’ for it.
(3) In my 40 years of researching homeopathy and talking to homeopaths, I have not met any homeopaths who “believe it’s a placebo effect”.
(4) There is no ‘placebo camp’ amongst homeopaths; so this is not a basis for an argument; it’s a fallacy.
(5) They very definitely are mainstream scientists, like F Benedetti, who research the placebo effect and they certainly do not ‘downplay’ it. (What many people fail to understand is that, in placebo-controlled trials, one aims at controlling the placebo effect; to a research-naïve person, this may indeed LOOK LIKE downplaying it. But this impression is wrong and reflects merely a lack of understanding.)
(6) No serious scientist attaches ‘ridicule and vilification’ to it.
(7) Who says so? I know only homeopaths who hold this opinion; and it is not evidence-based.
(8) Ethics demand that patients require the best available treatment; homeopathy does not fall into this category.
(9) At one stage (more than 10 years ago), I was involved in the design of this test. My recollection of it is not in line with the report that is linked here.
(10) So far, we have seen no evidence for this statement.
(11) Which ones? No examples are provided.
(12) Yet another statement without evidence – potentially libellous.
(13) Conclusion before any evidence; sign for a closed mind?
(14) This outcome could be entirely unrelated to acupuncture, as anyone who has a minimum of health care knowledge should know.
(15) We are not concerned with beliefs, we concerned with facts here, aren’t we ?
(16) But did they argue this? Where is the evidence to support this statement?
(17) Non-evidence-based accusations.
(18) Classic fallacy.
(19) The debate is not between alt med and ‘pharmaceutical science’, it is between those who insist on treatments which demonstrably generate more good than harm, and those who want alt med regardless of any such considerations.
(20) Warning consumers of treatments which fail to fulfil the above criterion is, in my view, an ethical duty which can save much money and many lives.
(21) Yes, alt med is clearly ideology-driven; by contrast conventional medicine is not (if it were, Alli would have explained what ideology it is precisely). Conventional medicine changes all the time, sometimes even faster than we can cope with, and is mainly orientated on evidence which is not an ideology. Alt med hardly changes or progresses at all; for the most part, its ideology is that of a cult celebrating anti-science and obsolete traditions.
(22) Overt contradiction to what Alli just stated about acupuncture.
(23) To me, this seems rather nonsensical and a hindrance to progress.
In summary, I feel that Alli argues his corner very poorly. He makes statements without supporting evidence, issues lots of opinion without providing the facts (occasionally even hiding them), falls victim of logical fallacies, and demonstrates an embarrassing lack of knowledge and common sense. Most crucially, the text seems bar of any critical analysis; to me, it seems like a bonanza of unreason.
To save Alli the embarrassment of arguing that I am biased or don’t know what I am talking about, I’d like to declare the following: I am not paid by ‘Big Pharma’ or anyone else, I am not aware of having any other conflicts of interest, I have probably published more research on alt med (some of it with positive conclusions !!!) than anyone else on the planet, my research was funded mostly by organisations/donors who were in favour of alt med, and I have no reason whatsoever to defend Randi (I only met him personally once). My main motivation for responding to Alli’s invitation to comment on his bizarre article is that I have fun exposing ‘alt med nonsense’ and believe it is a task worth doing.
Time for some fun!
In alternative medicine, there often seems to be an uneasy uncertainty about research methodology. This is, of course, regrettable, as it can (and often does) lead to misunderstandings. I feel that I have some responsibility to educate research-naïve practitioners. I hope this little dictionary of research terminology turns out to be a valuable contribution in this respect.
Abstract: a concise summary of what you wanted to do skilfully hiding what you managed to do.
Acute: an exceptionally good-looking nurse.
Adverse reaction: a side effect of a therapy that I do not practise.
Anecdotal evidence: the type of evidence that charlatans prefer.
Audit: misspelled name of German car manufacturer.
Avogadro’s number: telephone number of an Italian friend.
Basic research: investigations which are too simplistic to bother with.
Best evidence synthesis: a review of those cases where my therapy worked extraordinarily well.
Bias: prejudice against my therapy held by opponents.
Bioavailability: number of health food shops in the region.
Bogus: a term Simon Singh tried to highjack, but chiropractors sued and thus got the right use it for characterising their trade.
Chiropractic manipulation: a method of discretely adjusting data so that they yield positive results.
Confidence interval: the time between reading a paper and realising that it is rubbish.
Confounder: founder of a firm selling bogus treatments.
Conflict of interest: bribery by ‘Big Pharma’.
Data manipulation: main aim of chiropractic.
Declaration of Helsinki: a statement by the Finnish Society for Homeopathy in favour of treating Ebola with homeopathy.
Dose response: weird concept of pharmacologists which has been disproven by homeopathy.
Controlled clinical trial: a study where I am in control of the data and can prettify them, if necessary.
Critical appraisal: an assessment of my work by people fellow charlatans.
Doctor: title mostly used by chiropractors and naturopaths.
EBM: eminence-based medicine.
Error: a thing done by my opponents.
Ethics: misspelled name of an English county North of London.
Evidence: the stuff one can select from Medline when one needs a positive result in a hurry.
Evidence-based medicine: the health care based on the above.
Exclusion criteria: term used to characterise material that is not to my liking and must therefore be omitted.
Exploratory analysis: valuable approach of re-analysing negative results until a positive finding pops up.
Focus group: useful method for obtaining any desired outcome.
Forest plot: a piece of land with lots of trees.
Funnel plot: an intrigue initiated by Prof Funnel to discredit homeopathy.
Good clinical practice: the stuff I do in my clinical routine.
Grey literature: print-outs of articles from a faulty printer.
Hawthorne effect: the effects of Crataegus on cardiovascular function.
Hierarchy of evidence: a pyramid with my opinion on top.
Homeopathic delusion: method of manufacturing a homeopathic remedy.
Informed consent: agreement of patients to pay my fee.
Intention to treat analysis: a method of calculating data in such a way that they demonstrate what I intended to show.
Logic: my way of thinking.
Mean: attitude of chiropractors to anyone suggesting their manipulations are not a panacea.
Metastasis: lack of progress with a meta-analysis.
Numbers needed to treat: amount of patients I require to make a good living.
Odds ratio: number of lunatics in my professional organisation divided by the number of people who seem normal.
Observational study: results from a few patients who did exceptionally well on my therapy.
Pathogenesis: a rock group who have fallen ill.
Peer review: assessment of my work by several very close friends of mine.
Pharmacodynamics: the way ‘Big Pharma’ is trying to supress my findings.
Pilot study: a trial that went so terribly wrong that it became unpublishable – but, in the end, we still got it in an alt med journal.
Placebo-effect: a most useful phenomenon that makes patients who receive my therapy feel better.
Pragmatic trial: a study that is designed to generate the result I want
Silicon Valley: region in US where most stupid fraudsters are said to come from.
Standard deviation: a term describing the fact that deviation from the study protocol is normal.
Statistics: a range of methods which are applied to the data until they eventually yield a significant finding.
Survey: popular method of interviewing a few happy customers in order to promote my practice.
Systematic review: a review of all the positive results I could find.
Like it? If so, why don’t you suggest a few more entries into my dictionary via the comment section below?
