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

alternative therapist

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Shiatsu is a (mostly) manual therapy that was popularised by Japanese Tokujiro Namikoshi (1905–2000). It developed out of the Chinese massage therapy, ‘tui na’. The word shiatsu means finger pressure in Japanese; however, a range of devices is also being promoted for shiatsu. The evidence that shiatsu is effective for any condition is close to non-existent.

This study aimed to investigate the effect of Shiatsu massage on agitation in mechanically ventilated patients.

A total of 68 mechanically ventilated patients were randomly assigned to two groups. Patients in the intervention group received three 5-minute periods of Shiatsu massage with a 2-minute break between them, while patients in the control group only received a touch on the area considered for the message. Data were collected before and after the intervention using the Richmond Agitation-Sedation Scale (RASS) and then analyzed.

The results showed that the level of agitation significantly decreased in the intervention group compared to the control group (p=.001).

The authors concluded that the application of shiatsu massage seems to be effective in managing agitation in mechanically ventilated patients. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings.

It is good to see that, as far as I know for the first time, an attempt was made to control for placebo and other non-specific effects in a trial of shiatsu. However, in itself, the attempt is not convincing. What we need to know is whether the attempt was successful or not. Were the patients fully blinded and unable to tell the difference between verum and sham? From reading not just the abstract but the full paper, I do not get the impression that patients were successfully blinded. This means that the results might be entirely due to the effect of deblinding.

 

Currently, 15.2 percent of German adults have not even had their first COVID vaccination. A long-term study has recently investigated why some Germans do behave in this way.

Researchers from the University of Erfurt surveyed around 1,200 unvaccinated and 2,000 vaccinated people in Germany. Here is a summary of the findings:

  • 74% of the unvaccinated definitely do not want to be vaccinated against Corona
  • 6% are willing to get vaccinated
  • 37 percent of those who have not been vaccinated against Corona do not want to be vaccinated against anything
  • thus, about two-thirds of them are not principled vaccination refusers.

The researchers also asked the unvaccinated Germans about their reasons for deciding against vaccination:

  • 56% of the unvaccinated are afraid of vaccination
  • 64% of these people cite fear of vaccination consequences and side effects as their reason
  • 8% are even afraid of dying from the vaccination
  • 38% of the unvaccinated agree with the statement, “I am proud not to have been vaccinated against Covid-19”, while 60% of the vaccinated agree with the sentence “I am proud to be vaccinated against Covid-19.” Unvaccinated people also have much less trust in the federal government and the Robert Koch Institute than vaccinated people.
  • 86% of the unvaccinated Germans find the current debate unfair, arrogant, and moralizing.

Based on these findings, the researchers recommend that measures to combat the pandemic should focus above all on maintaining the trust of the majority of those who have been vaccinated. The researchers also advise that attention should be paid to respectful and factual communications, especially by VIPs.

Personally, I find the notion that 56% of the unvaccinated are afraid of vaccination the most interesting finding here. It means we need to communicate the safety aspect much better than we have managed so far. As there is good reason to believe that many of the unvaccinated people are proponents of so-called alternative medicine (SCAM) – see for instance here and here – a reasonable strategy should probably include making sure that SCAM practitioners inform their patients correctly and responsibly.

How can this be done?

I am not sure that I know the answer. But I know that there are psychologists who specialize in this sort of thing. It would, I think, be wise to create a multidisciplinary team to tackle the problem. Any solutions that could come out of such an exercise would come too late for the current Omicron wave. But there will be more to come, and we should be better prepared, I feel.

 

The use of the doctor title by chiropractors has long been a controversial issue. A recent statement from the UK General Chiropractic Council (GCC) is aimed at creating clarity for UK chiropractors. It is directly from the website of the GCC:

Recently, the GCC has received some queries regarding the use of ‘Doctor’ for chiropractors.

As a reminder, if the courtesy title of ‘Doctor’, or its abbreviation ‘Dr’ or ‘DC’ is used, any public-facing content must state clearly that this is not as a registered medical practitioner, but a ‘Doctor of Chiropractic’.

We urge all registrants to review their public-facing materials, on- and offline, to ensure that they fully comply with these requirements. To assist, we have published three communication-focussed toolkits on social mediaadvertising and websites, providing useful guidance and advice on how best to remain compliant to GCC and Advertising Standards Authority requirements.

Internationally, chiropractors seem keen on the doctor title. So much so, that they even claim that DD and BJ Palmer, the inventors of chiropractic, were doctors:

Chiropractic as a profession was established by Dr. D. D. Palmer in 1895 … The International Chiropractors Association (ICA) is here to serve the chiropractic community worldwide.  Established in 1926 in Davenport, Iowa, USA by Dr. B.J. Palmer, the ICA is the world’s oldest international chiropractic professional organization representing practitioners, students, chiropractic assistants, educators and lay persons globally.

In the US, it seems therefore entirely normal that chiropractors use the doctor title. In the UK, however, it is less common.

Remember the tragic case of John Lawler? He consulted a ‘Dr.’ thinking she was a medical doctor. She turned out to be a chiro and the patient paid with his life. Recently, the GCC found that the chiro was not guilty of any wrongdoing. It took me less than 10 minutes on the Internet to find plenty who do use the doctor title or allow it to be used on their website:

  •  Thanks to Dr Jasper for helping me to get rid of the terrible back pain
  • Dr. Mo is a chiropractor in Manchester and Stockport helping with back pain, sciatica, neck pain, headaches.
  • Dr Maria Madge is an experienced chiropractor working in Norfolk.
  • Dr James Shervell has 25 years’ experience to help with your pain…

So, in the spirit of goodwill and constructive criticism, may I make a suggestion to the GCC? Instead of issuing reminders like the one above, could you please invest a little time (a few hours would probably suffice), identify all of those of your members who still misuse the title, and instruct them to stop? It just might prevent tragedies like the above-mentioned Lawler case from happening again!

 

 

Please take a moment to read this short letter by the ‘LIGA MEDICORUM HOMOEOPATHICA INTERNATIONALIS’:

As you know, the World Health Organization (WHO) is predicting that civilization faces a crisis of antibiotic-resistant diseases that may soon result in as many as 10 million deaths per year while pushing as many as 24 million people into extreme poverty.

We, the undersigned, are duly licensed healthcare professionals practicing homeopathy, with the authority to diagnose and treat disease, who have reviewed the extensive research literature demonstrating the clear therapeutic value of homeopathy.  Each of us has had extensive clinical experience successfully treating hundreds of thousands of patients suffering from infectious diseases worldwide.

Homeopathy works, does not cause further antibiotic resistance, is generally devoid of side effects, is inexpensive, and is good for health of the planet.

We are calling upon the WHO to encourage the international medical community to immediately begin training in homeopathy as an adjunctive therapeutic measure to avoid this catastrophic loss of life and would like a meeting with you or your representative to discuss the grave challenge of antibiotic resistance at your earliest convenience.

Thank you for considering this urgent appeal.

________________________

I stated above that this is a letter. In fact, it is more – it is a petition directed to the Director-General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus, to immediately begin training physicians in homeopathy as an adjunctive therapeutic measure to combat the looming crisis of antibiotic-resistant diseases.

The Liga Medicorum Homoeopathica Internationalis (LMHI) represents homeopathic physicians in more than 70 countries all over the world. The purposes of the association are the development and securing of homeopathy worldwide and the creation of a link among licensed homeopaths with medical diplomas and societies and persons who are interested in homeopathy. The LMHI is exclusively devoted to non-profit activities serving philanthropic benefits.

The LMHI might ring a bell for regular readers of this blog. A few years ago, I reported that its president advocates curing cancers with homeopathy. And in 2014, I reported that a journey to Liberia of leading homeopaths was co-organized by the LMHI; its purpose was to cure Ebola patients of their disease with homeopathy.

I find all of this seriously worrying – not because I fear that the WHO will now start training physicians across the globe in homeopathy. It is worrying, I feel, because it shows how hopelessly deluded homeopaths are. The fact that clinicians so far detached from reality treat ill and vulnerable patients frightens me.

A remarkable case of a German doctor homeopath from the Lake Constance district in Germany has been reported. The public prosecutor’s office in Constance is currently investigating the physician on suspicion of causing bodily harm.

Several hundred people seem to have received an ineffective Corona vaccination from her. According to a spokesperson from the office of the Lake Constance district, 430 people who had been vaccinated against the Coronavirus in the doctor’s practice in Markdorf have now received mail from the public health department.

The recipients of the letter were instructed to take an antibody test to clarify their vaccination status. The officials are also interested in their testimonies on the circumstances of the vaccination. It is suspected that the doctor added “something homeopathic” to the injections which presumably were saline solutions.

One of the victims has now filed an official complaint. At the request of the Constance public prosecutor’s office, a judge of the district court issued a search warrant for the medical practice concerned, whereupon officers of the Ravensburg police headquarters seized evidence.

The case had come to the attention of the authorities after no antibodies against the coronavirus could be detected initially in three patients despite them having received first and second vaccinations and no plausible medical reasons for this lack of response could be found.

__________________

It is true that some homeopaths reject vaccinations and believe that homeopathic vaccinations are an effective alternative. It is also clear to anyone who has followed the discussions on this blog that some homeopaths are severely deluded and might therefore try this method on patients, even though there is not a jot of evidence that it works. The fact that this is done dishonestly and without the informed consent of the patient is nevertheless astonishing. Even more surprising, I find, is the notion that such a crime should be committed by a doctor who must know better.

 

It has been reported that, after a majority of Canadian chiropractors attending a meeting of their regulator voted to oppose a COVID-19 vaccine mandate, B.C.’s health minister told a representative he was starting to doubt the wisdom of self-regulation.

On Dec. 1, the College of Chiropractors of B.C. (BCCA) held its AGM and registrants voted in favour of a non-binding resolution calling for the regulator to “take a stand” against an expected vaccine mandate for health professionals. Subsequently, Health Minister Adrian Dix then “expressed his extreme displeasure” about the remarks of some chiropractors.

“Minister Dix indicated it was an embarrassment that a health profession would in such resounding numbers … support such unfounded and false claims while people are dying from COVID-19,” said the BCCA’s executive director Angie Knott. In bold and underlined text, she added, “He also stated that it made him question the validity of self-regulation.”

During the meeting in question, 78% of those chiropractors in attendance had voted in favour of the motion. Chiropractors are not trained in treating or preventing infectious disease and are prohibited from offering advice on vaccinations in B.C.

This is not the first time health ministry officials have expressed concerns about the ability of chiropractors to adequately regulate themselves.

In my view, this story is a poignant reminder of something I have been saying often:

Even the proper regulation of quackery will merely result in quackery!

 

The following press release was published by the AMA on 16/11/2021. I consider it sufficiently relevant to re-publish it here in full and, as it is entirely self-explanatory, without further comment:

At its Special Meeting today, the American Medical Association (AMA) House of Delegates approved a resolution stating that only licensed physicians should determine whether a person should receive a medical exemption from vaccines.

The policy comes in the wake of tens of thousands of people seeking exemptions to state and municipal COVID mandates, contending they have medical reasons for remaining unvaccinated. The new policy states that only licensed physicians should have the medical authority and the power to grant these exemptions.

“Vaccine hesitancy has played an unfortunate role in extending the COVID-19 public emergency. Failing to get vaccinated has resulted in tragic and unnecessary deaths. To protect everyone, we must be sure that a trained, licensed physician is making the judgment on whether a person actually warrants an exemption,” said Willie Underwood III, M.D., M.Sc., M.P.H., a member of the AMA Board of Trustees.

The definition of “medical authority” varies from state to state, with some states allowing alternative practitioners, such as naturopathic providers, to approve vaccine exemptions. Surveys have shown that naturopathic providers and other alternative medicine providers (such as homeopaths and chiropractors) are less likely to recommend vaccines—or even recommend against vaccines—despite scientific evidence of safety and efficacy.

“State policymakers need to limit the definition to physicians who have the training necessary to recognize a medical condition that prevents a patient from receiving a vaccine,” Dr. Underwood said. “We shouldn’t jeopardize public health by listening to unlicensed and untrained providers.”

The AMA already has policy opposing nonmedical (religious, philosophic, or personal belief) exemptions from immunizations, since such exemptions endanger the health of the unvaccinated individual and the health of the community at large. The AMA supports the immunization recommendations of the Advisory Committee on Immunization Practices for all individuals without medical contraindications. It also supports legislation eliminating nonmedical immunization exemptions and encourages state medical associations to seek removal of nonmedical exemptions in states requiring mandatory immunizations.

“One of the unfortunate side effects of the COVID-19 pandemic and misinformation around it is the questioning of vaccine efficacy even though vaccines have nearly wiped out diseases that once plagued us. Physicians must make the argument clearly and loudly based on the science: Vaccines save lives,” Underwood said.

Long-COVID syndrome is a condition that will affect a large proportion of those who survived a COVID-19 infection. According to a recent meta-analysis, it is associated predominantly with poor quality of life, persistent symptoms including fatigue, dyspnea, anosmia, sleep disturbances, and mental health problems.

At present, we are still struggling to understand the exact causes and mechanisms of this condition. Therefore, its optimal treatment is as yet uncertain. Governments around the world have therefore made sizable research funds available to make progress in this area, and research in this area is frantically active.

Regardless of the evidence, practitioners and entrepreneurs of so-called alternative medicine (SCAM) are gearing up to jump on this bandwagon by declaring that their offerings are a solution to this growing problem. Indeed, many of them have already done so. Here are just three sites that I found today which are promoting homeopathy for long COVID:

One hardly needs to mention that homeopathy is not supported by sound evidence in the management of long-Covid (or any other condition for that matter). Neither does one need to stress that homeopaths are just one example, and virtually all other SCAM providers are promoting their services in the absence of evidence.

A recent review of the literature stated this:

Patients with long COVID commonly refer to taking ‘the stack’ or ‘the supplement stack’, which includes high-dose vitamin C and D, niacin (nicotinic acid), quercetin, zinc, selenium, and sometimes also magnesium. Further research is needed to confirm or refute the impact of supplements in long COVID. Examples of noteworthy interactions with supplements include: niacin causing an increased risk of bleeding events when combined with selective serotonin reuptake inhibitors or non-steroidal anti-inflammatory drugs, increased risk of rhabdomyolysis together with statins, and quercetin causing inhibition and induction of various human cytochrome P450 enzymes.

Why then are SCAM providers promoting SCAM for long-COVID?

This is a daft question if there ever was one.

It seems obvious they do it because:

  • they are believers who don’t care about evidence,
  • they are in it for the money,
  • or both.

Some time ago, this homeopath already indicated, that SCAM providers should see COVID as an opportunity: For homeopathy, shunned during its 200 years of existence by conventional medicine, this outbreak is a key opportunity to show potentially the contribution it can make in treating COVID-19 patients. We should perhaps not hold our breath to see the emergence of convincing evidence, but we should be prepared to warn the public of getting exploited by charlatans who disregard both ethics and evidence.

The German paper DIE ZEIT reported about the dire state of the pandemic in Upper Bavaria. In the district of Rosenheim (close to where I grew up), only about 58% of the population are fully vaccinated, far less than the German average.

Why?

The article blames a broad distrust in conventional medicine, the media, and politics. And a pronounced tendency to look for alternatives. Nowhere in Bavaria are there as many Heilpraktiker as in Upper Bavaria. Heilpraktikers are not medical practitioners, they focus on so-called alternative medicine (SCAM) and do not have to prove that they can effectively treat patients, even if that is what the name suggests. “That seems to be a cultural factor in the region. They are already pretty much in their own soup here,” says the director of the local hospital, Jens Deerberg-Wittram. There is much skepticism towards everything that comes from above and a pronounced interest in SCAM in the region, he says.

The gradient runs from north to south through Bavaria. With Heilpraktiker as well as with vaccination. The higher the density of Heilpraktiker, the lower the uptake of immunizations. This is just as true for Corona as for vaccination in general. For measles, the figure for fully vaccinated children in 2019 was 92.3 % in Germany, but in Rosenheim, it was only 83.3 %. “These are all ingredients for the big Corona cake,” says Deerberg-Wittram.

In Rosenheim, vaccination takes place in the local Volkshochschule, the German institution of adult education (as DER SPIEGEL disclosed [with my help] in 2018, these institutions are deeply steeped in woo and the Volkshochschule in Rosenheim even offers a course led by a Heilpraktiker). Although there is only a small, inconspicuous sign in the window outside of the Volkshochschule in Rosenheim, the queue of people wanting to be vaccinated is long. It stretches across the entire first floor; above the heads of the waiting people, the courses on offer flicker on a monitor: Crochet and knitting in the sewing room, integration courses, language courses in English and Spanish at different levels. Yoga for the elderly, Tai Chi.

Thanks to Richard Rasker, a regular commentator on this blog, I learnt a new word – a word that I intend to use regularly from now on:

proctophasia

You won’t find the term in the dictionary, and even the most decorated specialist might not (yet?) be familiar with it. Proktophasia afflicts predominantly the most ardent evangelists amongst the proponents of so-called alternative medicine (SCAM), COVID-deniers, and anti-vaxxers. And this is, of course, the reason why the affliction surfaces regularly on this blog, and why Richard was able to recognize it and give it its proper terminology.

The symptoms of proctophasia are easily remembered, once we know that this medical term is derived from ‘speaking out of one’s arse’, a less than polite term for talking utter rubbish. Accordingly, proctophasia shows itself in the following manner:

  • talking rubbish,
  • talking rubbish,
  • talking rubbish,
  • talking rubbish,
  • talking rubbish,
  • talking rubbish,
  • talking rubbish,
  • talking rubbish,
  • talking rubbish even after being corrected,
  • repeating one’s own stupid arguments ad nauseam,
  • repeating one’s own stupid arguments ad nauseam,
  • repeating one’s own stupid arguments ad nauseam,
  • repeating one’s own stupid arguments ad nauseam,
  • repeating one’s own stupid arguments ad nauseam,
  • being offended when, eventually, someone arrives at the correct diagnosis of ‘speaking out of one’s arse’,
  • being nevertheless undeterred and repeating one’s own stupid arguments ad nauseam.

As such, the diagnosis is not all that difficult to make. The crucial question, however, is this:

can proctophasia be treated successfully? 

It does seem unlikely that any form of SCAM is effective in the management of proctophasia. Formal trials have, as far as I know, not been conducted. Yet, we can assume from the fact that the proctophasia victims who made themselves known in the comments sections of this blog are on multiple SCAM treatments, and their condition does not seem to improve noticeably. On the contrary, one could even speculate that SCAM is the cause of the disease (but, of course, this hypothesis would need to be tested before we should accept it as fact).

Until there is a cure, what can be done?

I am afraid not much. In the past, I have had to ban some particularly seriously afflicted individuals. No doubt, I will have to take such drastic measures again in the future. But I always do that with a heavy heart.

Why?

Because one feature of the typical proctophasia victim has not yet been mentioned. These people can be hilariously funny – more so than any stand-up comedian. And that is the reason why I will continue to be as patient with them as I possibly can. In other words, proctophasia significantly increases the entertainment value of this blog.

Thanks, guys!

 

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