MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

alternative medicine

Yesterday, Harriet’s many friends received the sad news of her unexpected death on 11 January. Harriet was not just a good and loyal friend, she was a tirelessly working, determined, and effective skeptic. Her work focussed on so-called alternative medicine (SCAM), and thus the two of us were on the same wavelength.

Harriet’s husband, Kirk, posted this short note about her death on social media:

I know Harriet’s work was followed and admired by many of you. It is with great sadness that I must tell you my beloved wife passed away quietly and unexpectedly in her sleep last night. At this moment, she would probably simply ask you to have a kind thought for her, be kind to each other and continue to support her belief in the truth.

I feel that, without intending to, Kirk described Harriet’s character very well. She was a quiet and kind person. Yet she inspired many, and her influence was considerable. Harriet Hall had been the founding member of skeptic organizations, author of books and countless articles, recipient of awards, author of many brilliant lectures, and much more.

Harriet and I have met in person only 2 or 3 times. But we did keep in contact and exchanged many emails. Most generously, she published reviews of most of my books and was often immeasurably supportive of my work.

Harriet Hall will be remembered by skeptics around the world for her quiet enthusiasm, her kindness, and her honesty. I will always remember her for coining an absolutely perfect term for the pseudo-research that plagues the field of SCAM:

TOOTH FAIRY SCIENCE

I lost a friend; the world lost a great skeptic.

We will all miss you, Harriet!

It is hardly surprising that I receive plenty of complaints about the things I publish. After all, so-called alternative medicine (SCAM) is dominated by emotions and not by rationality. When I was still in post at Exeter, my peers received complaints about me all the time. Now that I write articles for several newspapers and journals (not to mention this blog), the flow of complaints to the editors is continuing nicely. Consequently, I am in a good position to offer a beginner’s guide to complaining to everyone who is fed up with me and my work.

Foremost, such a complaint must have a clear structure. Here is one that I advise considering:

  1. Introduction
  2. Self-aggrandizement
  3. Your objection
  4. Ad hominem
  5. Generalizations
  6. Threats

Allow me to take you through these headings one by one.

Introduction

The recipient of your complaint (e.g. a newspaper editor) needs to know why you are addressing him or her. This means you ought to clearly state your aim at the outset. Something like “I am writing to you to complain about an article recently published in your paper” would probably suffice. But you probably find it hard to be concise – and who could blame you: you are fuming with anger and overflowing with emotion.

I am sure the recipient of your complaint will understand that you have to use a few colorful sentences to introduce the subject properly. If you feel like elaborating that you have been a reader of the paper since 1972, or that you slept badly last night, or that your last dinner was indigestible, or why you are opposed to COVID vaccinations – by all means, please go ahead. The editor will be delighted to receive a little background and can thus empathize with your concerns.

Self-aggrandizement

Despite these efforts, there is always the danger that the editor reading your complaint does not take you seriously. This must be avoided at all costs. Therefore, you must make sure he/she understands how important you truly are. As your complaint is healthcare-related, it is helpful to stress your unique standing in this area. Do not worry if you have not studied medicine, are not a scientist, or understand buggar all about anything. The least you must do is to state that you have years of experience in health. Such phraseology is non-commital – after all, you probably have been ill once or twice – and it makes it clear that you know what you are talking about.

Your objection

Now it is time to state what you actually object to and why. This might not be as easy as it sounds. Most people who complain about my work are unable to pinpoint what exactly it is that they don’t like. They never dispute a concrete fact or finding I presented but they disagree with my stance in general terms. Therefore, they cannot define a precise error or misinterpretation in my text. In such cases, it might be best to claim that you have read several or all of my articles and you are scandalized by my general attitude, ignorance, or malice. You might add that my articles systematically defame SCAMs that:

  • have clearly stood the test of time,
  • are used by millions,
  • are holistic,
  • have cured your goldfish, etc.

Do never include any actual data in your complaint. This can only expose you to criticism; and that’s the last thing you want to achieve.

Ad hominem

The less specific material you complain about, the more important it is to display true conviction by going on a personal attack. I can highly recommend the ad hominem principle for this purpose. Go for it!

In a previous post, I listed some ideas that might help you here. You could claim that:

  • I am not qualified
  • I only speak tosh
  • I do not understand science
  • I never did any ‘real’ research
  • Exeter Uni fired me
  • I have been caught red-handed (not quite sure at what)
  • I am on BIG PHARMA’s payroll
  • I faked my research papers

Feel free to come up with your own ideas; use your imagination. I am sure the editor who reads your inspired lines will thank you for it.

Generalizations

Now that you have thoroughly dealt with me (Prof Ernst) as a person, you need to generalize in order to lend more relevance and impact to your complaint. You could point out, for example, that not just I but all scientists or skeptics are corrupt, ignorant, etc. Or you might explain that, in any case, science is over-rated and cannot be trusted. Such enlightened remarks are important because they put things into perspective and show that you are well-informed.

Threats

To end your letter, it is advisable to ensure that the editor who is trying to make sense of your complaint cannot dismiss it easily. For this purpose, I find it helpful to add a few actual threats. The editor needs to know that he would disregard your concerns at his own peril.

For instance, you could state that, if this paper/journal in question should dare to ever again publish a single line of Ernst’s writings, you will never again buy this publication. If you want to sound alarmingly dangerous, add that you will tell all your friends to do likewise. And if you wish to scare the hell out of the poor editor, tell him/her that you will file a report with the ombudsman.

______________________________

 GOOD LUCK

 

The objective of this cross-sectional survey was to evaluate the beliefs about and attitudes toward cancer prevention of people professing vaccination skepticism or conspiracy theories. Data were collected mainly from a well-known Spanish forum and other platforms, including Reddit (English), 4Chan (English), HispaChan (Spanish), and a Spanish-language website for cancer prevention (mejorsincancer.org) from January to March 2022.

Among 1494 responders, 209 were unvaccinated against covid-19, 112 preferred so-called alternative rather than conventional medicine, and 62 reported flat earth or reptilian beliefs. Cancer beliefs were assessed using the Cancer Awareness Measure (CAM) and Cancer Awareness Measure Mythical Causes Scale (CAM-MYCS), both validated tools.

Awareness of the actual causes of cancer was greater (median CAM score 63.6%) than that of mythical causes (41.7%). The most endorsed mythical causes of cancer were:

  • eating food containing additives or sweeteners,
  • feeling stressed,
  • eating genetically modified food.

Awareness of the actual and mythical causes of cancer among the unvaccinated, alternative medicine, and conspiracy groups was lower than among their counterparts. A median of 54.5% of the actual causes was accurately identified among each of the unvaccinated, alternative medicine, and conspiracy groups, and a median of 63.6% was identified in each of the three corresponding counterparts (P=0.13, 0.04, and 0.003, respectively). For mythical causes, medians of 25.0%, 16.7%, and 16.7% were accurately identified in the unvaccinated, alternative medicine, and conspiracy groups, respectively; a median of 41.7% was identified in each of the three corresponding counterparts (P<0.001 in adjusted models for all comparisons).

In total, 673 (45.0%) participants agreed with the statement “It seems like everything causes cancer.” No significant differences were observed among the unvaccinated (44.0%), conspiracist (41.9%), or alternative medicine groups (35.7%), compared with their counterparts (45.2%, 45.7%, and 45.8%, respectively).

The authors’ conclusions were as follows: we evaluated the patterns of beliefs about cancer among people who believed in conspiracies, rejected the covid-19 vaccine, or preferred alternative medicine. We observed that the participants who belonged to these groups were more likely to endorse mythical causes of cancer than were their counterparts but were less likely to endorse the actual causes of cancer. Almost half of the participants, whether
conspiracists or not, agreed with the statement “It seems like everything causes cancer,” which highlights the difficulty that society encounters in differentiating actual causes of cancer from mythical causes owing to mass (veridical or not) information. This suggests a direct connection between digital misinformation and consequent potential erroneous health decisions, which may represent a further preventable fraction of cancer. Cultivating oriented medical education and scientific literacy, improving online ranking algorithms, building trust, and using effective health communication and social marketing campaigns may be possible ways to tackle this complex public health threat.

This is yet another study showing that so-called alternative medicine (SCAM) usage is linked to misinformation and conspiratorial thinking in other areas. We have discussed similar findings all too often. They are hardly surprising, in my view. As I have repeatedly been trying to point out:

The best way to prevent harm must therefore be to educate the public responsibly (which, of course, is one of the main aims of this blog.

I have tried!

Honestly!

But at present, it is simply not possible to escape the revelations and accusations by Harry Windsor.

So, eventually, I gave in and had a look at the therapy he often refers to. He claims that he is deeply traumatized by what he had to go through and, to help him survive the ordeal, Harry has been reported to use EMDR.

Eye Movement Desensitization and Reprocessing (EMDR) is a fringe psychotherapy that was developed to alleviate the distress associated with traumatic memories. It is supposed to facilitate the accessing and processing of traumatic memories and other adverse life experiences with a view of bringing these to an adaptive resolution. The claim is that, after successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.

During EMDR therapy the patient must attend to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist-directed lateral eye movements are commonly used as external stimulus but a variety of other stimuli including hand-tapping and audio stimulation can also be employed.

Francine Shapiro, the psychologist who invented EMDR claims to have serendipitously discovered this technique by experiencing spontaneous saccadic eye movements in response to disturbing thoughts during a walk in the woods. Yet, as GM Rosen explains, this explanation is difficult to accept because normal saccadic eye movements appear to be physiologically undetectable and are typically triggered by external stimuli.

Shapiro hypothesizes that EMDR therapy facilitates the access to the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are alleged to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.

EMDR therapy uses a three-pronged protocol:

  • (1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
  • (2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
  • (3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.

The question I ask myself is, of course: Does EMDR work?

The evidence is mixed and generally flimsy. A systematic review showed that “limitations to the current evidence exist, and much current evidence relies on small sample sizes and provides limited follow-up data”.

What might be particularly interesting in relation to Harry Windsor is that EMDR techniques have been associated with memory-undermining effects and may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.

Personally, I think that Harry’s outbursts lend support to the hypothesis that EMDR is not effective. In the interest of the royal family, we should perhaps see whether so-called alternative medicine (SCAM) does offer an effective treatment against navel gazing?

It has been reported that a German consumer association, the ‘Verbraucherzentrale NRW’, has first cautioned the manufacturer MEDICE Arzneimittel Pütter GmbH & Co. and then sued them for misleading advertising statements. The advertisement in question gave the wrong impression that their homeopathic remedy MEDITONSIN would:

  1. for certain generate a health improvement,
  2. have no side effects,
  3. be superior to “chemical-synthetic drugs”.

The study used by the manufacturer in support of such claims was not convincing according to the Regional Court of Dortmund. The results of a “large-scale study with more than 1,000 patients” presented a pie chart indicating that 90% of the patients were satisfied or very satisfied with the effect of Meditonsin. However, this was only based on a “pharmacy-based observational study” with little scientific validity, as pointed out by the consumer association. Despite the lack of evidence, the manufacturer claimed that their study “once again impressively confirms the good efficacy and tolerability of Meditonsin® Drops”. The Regional Court of Dortmund disagreed with the manufacturer and agreed with the reasoning of the consumer association.

“It is not permitted to advertise with statements that give the false impression that a successful treatment can be expected with certainty, as suggested by the advertising for Meditonsin Drops,” emphasizes Gesa Schölgens, head of “Faktencheck Gesundheitswerbung,” a joint project of the consumer centers of North Rhine-Westphalia and Rhineland-Palatinate. According to German law, this is prohibited. In addition, the Regional Court of Dortmund considered consumers to be misled by the advertising because the false impression was created that no harmful side effects are to be expected when Meditonsin Drops are taken. The package insert of the drug lists several side effects, according to which there could even be an initial worsening of symptoms after taking the drug.

The claim of advantages of the “natural remedy” represented by the manufacturer in comparison with “chemical-synthetic medicaments, which merely suppress the symptoms”, was also deemed to be inadmissible. Such comparative advertising is inadmissible.

__________________________________

This ruling is, I think, interesting in several ways. The marketing claims of so-called alternative medicine (SCAM) products seem all too often not within the limits of the laws. One can therefore hope that this case might inspire many more legal cases against the inadmissible advertising of SCAMs.

 

You, the readers of this blog, have spoken!

The WORST PAPER OF 2022 competition has concluded with a fairly clear winner.

To fill in those new to all this: over the last year, I selected articles that struck me as being of particularly poor quality. I then published them with my comments on this blog. In this way, we ended up with 10 papers, and you had the chance to nominate the one that, in your view, stood out as the worst. Votes came in via comments to my last post about the competition and via emails directly to me. A simple count identified the winner.

It is PAUL VARNAS, DC, a graduate of the National College of Chiropractic, US. He is the author of several books and has taught nutrition at the National University of Health Sciences. His award-winning paper is entitled “What is the goal of science? ‘Scientific’ has been co-opted, but science is on the side of chiropractic“. In my view, it is a worthy winner of the award (the runner-up was entry No 10). Here are a few memorable quotes directly from Paul’s article:

  • Most of what chiropractors do in natural health care is scientific; it just has not been proven in a laboratory at the level we would like.
  • In many ways we are more scientific than traditional medicine because we keep an open mind and study our observations.
  • Traditional medicine fails to be scientific because it ignores clinical observations out of hand.
  • When you think about it, in natural health care we are much better at utilizing the scientific process than traditional medicine.

But I am surely doing Paul an injustice. To appreciate his article, please read his article in full.

I am especially pleased that this award goes to a chiropractor who informs us about the value of science and research. The two research questions that undoubtedly need answering more urgently than any other in the realm of chiropractic relate to the therapeutic effectiveness and risks of chiropractic. I just had a quick look in Medline and found an almost complete absence of research from 2022 into these two issues. This, I believe, makes the award for the WORST PAPER OF 2022 all the more meaningful.

 

PS

Yesterday, I wrote to Paul informing him about the good news (as yet, no reply). Once he provides me with a postal address, I will send him a copy of my recent book on chiropractic as his well-earned prize. I have also invited him to contribute a guest post to this blog. Watch this space!

This meta-analysis of randomized clinical trials (RCTs) was aimed at evaluating the effects of massage therapy in the treatment of postoperative pain.

Three databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95% confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I2. Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry.

The analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, -1.32; 95% CI, −2.01 to −0.63; p = 0.0002; I2 = 98.67%). A similarly positive effect was found for both short (immediate assessment) and long terms (assessment performed 4 to 6 weeks after the MT). Neither the duration per session nor the dose had a significant impact on the effect of MT, and there was no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery.

The authors concluded that MT may be effective for postoperative pain relief. We also found a high level of heterogeneity among existing studies, most of which were compromised in the methodological quality. Thus, more high-quality RCTs with a low risk of bias, longer follow-up, and a sufficient sample size are needed to demonstrate the true usefulness of MT.

The authors discuss that publication bias might be possible due to the exclusion of all studies not published in English. Additionally, the included RCTs were extremely heterogeneous. None of the included studies was double-blind (which is, of course, not easy to do for MT). There was evidence of publication bias in the included data. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias.

Patients who have just had an operation and are in pain are usually thankful for the attention provided by carers. It might thus not matter whether it is provided by a massage or other therapist. The question is: does it matter? For the patient, it probably doesn’t; However, for making progress, it does, in my view.

In the end, we have to realize that, with clinical trials of certain treatments, scientific rigor can reach its limits. It is not possible to conduct double-blind, placebo-controlled studies of MT. Thus we can only conclude that, for some indications, massage seems to be helpful (and almost free of adverse effects).

This is also the conclusion that has been drawn long ago in some countries. In Germany, for instance, where I trained and practiced in my younger years, Swedish massage therapy has always been an accepted, conventional form of treatment (while exotic or alternative versions of massage therapy had no place in routine care). And in Vienna where I was chair of rehab medicine I employed about 8 massage therapists in my department.

Every now and then, I like to look at what our good friend and SCAM entrepreneur Gwyneth Paltrow is offering via her extraordinary ripoff called GOOP. When I recently browsed through her goodies, I find lots of items that made me blush (common decency does not permit me to go into details here). But I also found something that I am sure many of us might need after the over-indulgence of recent weeks:Preview Changes (opens in a new tab)

“The Martini” Emotional Detox Bath Soak

The product is described as follows:

This body-and-spirit-centering bath soak, infused with Himalayan pink salt, helps take the edge off during turbulent times (or after a crazy day). Called “The Martini” after the traditional name for the last take of the day in filmmaking,  the soak is made with pharmaceutical-grade Epsom salts, chia-seed oil, passionflower, valerian root, myrrh, Australian sandalwood, and wild-crafted frankincense.

Here at goop we believe in making every choice count, which is why we’ve always been outspoken about the toxic ingredients used in personal-care and beauty products (all are effectively unregulated in this country). We’re also passionate about the idea that beauty comes from the inside out. So we use clinically proven and best-in-class ingredients at active levels to create skin care, skin-boosting ingestibles, and body essentials that are luxurious, deliver high-performance results, and enliven the senses with exquisite textures and beautiful scents. We don’t rest until we think our products are perfect—safe enough and powerful enough for noticeable results. (All our products are formulated without parabens, petroleum, phthalates, SLS, SLES, PEGs, TEA, DEA, silicones, or artificial dyes or fragrances. And our formulas are not tested on animals.) We hope you love them as much as we do.

Yes, there is a whole world out there of which a retired chap like myself knows as good as nothing. And it has its very own terminology: 

  • emotional detox
  • body-and-spirit-centering
  • pharmaceutical-grade Epsom salts
  • wild-crafted
  • clinically proven and best-in-class ingredients
  • skin-boosting ingestibles
  • body essentials
  • high-performance results

By now, I am sure, you are dying to learn what the Emotional Detox Bath Soak contains:

Sodium Chloride, Magnesium Sulfate, Passiflora Incarnata Extract, Valeriana Officinalis Root Extract, Salvia Hispanica Seed Oil, Helianthus Annuus (Sunflower) Seed Oil, Rosmarinus Officinalis (Rosemary), Leaf Extract, Maltodextrin, Boswellia Carterii Oil, Commiphora Myrrha Oil, Fusanus Spicatus Wood Oil, Cyperus Scariosus (Nagarmotha) Oil, Vetiveria Zizanoides Root Oil, Simmondsia Chinensis (Jojoba) Seed Oil, Tocopherol.

Clinically proven, you ask?

Well, perhaps not in the sense that sad, retired academics tend to understand the term, but you have to realize, this is a different world where words have different meanings, the meaning entretreneurs want them to have. What is proven though is this: at $40 a tiny jar, the detox bath will eliminate some cash from your pocket – after all, that’s what detox is all about, isn’t it?

This pilot study tested the feasibility of using US Food and Drug Administration (FDA)–recommended endpoints to evaluate the efficacy of acupuncture in the treatment of IBS. It was designed as a multicenter randomized clinical trial, conducted in 4 tertiary hospitals in China from July 1, 2020, to March 31, 2021, and 14-week data collection was completed in March 2021. Individuals with a diagnosis of IBS with diarrhea (IBS-D) were randomized to 1 of 3 groups:

  1. acupuncture groups 1 (using specific acupoints [SA])
  2. acupuncture group 2 (using nonspecific acupoints [NSA])
  3. sham acupuncture group (non-acupoints [NA])

Patients in all groups received twelve 30-minute sessions over 4 consecutive weeks at 3 sessions per week, ideally every other day.

The primary outcome was the response rate at week 4, which was defined as the proportion of patients whose worst abdominal pain score (score range, 0-10, with 0 indicating no pain and 10 indicating unbearable severe pain) decreased by at least 30% and the number of type 6 or 7 stool days decreased by 50% or greater.

Ninety patients (54 male [60.0%]; mean [SD] age, 34.5 [11.3] years) were enrolled, with 30 patients in each group. There were substantial improvements in the primary outcomes for all groups

  • response rates in the SA group = 46.7% [95% CI, 28.8%-65.4%]
  • response rate in the NSA group = 46.7% [95% CI, 28.8%-65.4%]
  • response rate in the NA group = 26.7% [95% CI, 13.0%-46.2%]

The difference between the groups was not statistically significant (P = .18). The response rates of adequate relief at week 4 were 64.3% (95% CI, 44.1%-80.7%) in the SA group, 62.1% (95% CI, 42.4%-78.7%) in the NSA group, and 55.2% (95% CI, 36.0%-73.0%) in the NA group (P = .76). Adverse events were reported in 2 patients (6.7%) in the SA group and 3 patients (10%) in NSA or NA group.

The authors concluded that acupuncture in both the SA and NSA groups showed clinically meaningful improvement in IBS-D symptoms, although there were no significant differences among the 3 groups. These findings suggest that acupuncture is feasible and safe; a larger, sufficiently powered trial is needed to accurately assess efficacy.

WHAT A LOAD OF TOSH!

Here are some of the most obvious issues I have with this new study:

  • A pilot study is not about reporting effectiveness/efficacy but about testing the feasibility of a study.
  • That acupuncture is feasible has been known for ~2000 years.
  • The conclusion that acupuncture is safe is not warranted on the basis of the data; for that we would need a much larger investigation.
  • The authors seem to have used our sham needle without acknowledging it.
  • The authors are affiliated with the International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, yet they state that they have no conflicts of interest.
  • The results are clearly negative, yet the authors seem to attempt to draw a positive conclusion.

The main question that occurs to me is this: how low has the JAMA sunk to publish such junk?

The year 2022 has drawn to a close, and it is time to vote on the ‘WORST PAPER OF 2022 COMPETITION’. As a prize, I am offering the winner (that is the lead author of the winning paper) one of my books that best fits his/her subject. I am sure this will overjoy him or her. Here are to 10 candidates that we discussed in 2022:

I am pleased to see that the 10 entries cover a wide range of so-called alternative medicines (SCAMs). This has not been achieved by design but by coincidence; it suggests that I do not have a particular grudge against any specific SCAM but was led by the quality of the paper. Similarly, the papers were published in a wide range of different journals, and this implies that I am not out to defame a particular journal (such as ‘Homeopathy’, for instance, that fired me from its ed board). And lastly, the list also shows that I am not abusing this little exercise to defame a particular researcher; in fact, I think I do not know any of the individuals in person.

The 10 entries are clearly numbered. If you want to (re-)read them, please click on the links and the original post should appear. There you find the links to the original articles. Once you have decided which is in your view the worst paper, please cast your vote either by posting a comment here or by sending me an email via the contact option on top of this post.

I will wait for three days and then announce the lucky winner. Subsequently, I will contact the winner and ask for his/her postal address; if he/she gives it to me, I will post a book to him/her with my congratulations.

I hope I can count on you to vote.

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