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

bogus claims

1 2 3 71

I have often discussed the fact that many proponents of so-called alternative medicine (SCAM) have in recent years adopted the following argument: even if our SCAM were just a placebo, it would still be useful. After all, placebo effects are real and increasingly backed by sound science. The argument is deeply flawed, yet it convinces many lay people.

A recent article by Fabrizio Benedetti, the leading researcher in the area of placebo, is addressing exactly this issue. I feel that it is sufficiently important to quote it extensively here:

… a number of biochemical pathways, such as endogenous opioids and cannabinoids,5,6 and brain regions, like the prefrontal cortex, have been found to be involved in placebo analgesia. Likewise, dopamine and the basal ganglia circuitry have been found to mediate placebo responses in Parkinson’s disease. Although this is wonderful news for science, this may not be the case for society. The number of nonmedical organizations and healers that rely on this hard science, and actually justify their odd and bizarre procedures, has increased over the past few years. The main claim is that any procedure boosting patients’ expectations, which represent the main mediator of placebo effects, is acceptable because it can activate the same biochemical pathways and neural networks that have been made credible by hard science…

The crucial point here is that when hard science started investigating placebo effects, it unconsciously produced a shift in quackery thinking. In fact, charlatans are becoming more and more aware that their bizarre interventions could work through a placebo effect. Indeed, whereas hard science has so far denied any scientific basis for nonconventional therapies, now the very same hard science certifies that the placebo effect has scientific grounds. Therefore, quacks are no longer interested in showing that their pseudo-interventions work; rather, they justify their use on the basis of the possibility that these bizarre interventions may induce strong placebo effects…

… A first point that should be emphasized is that placebos do not cure, but rather, they may sometimes improve quality of life. There is plenty of confusion on this point, and unfortunately, many claim that they can cure virtually all illnesses with placebos. Hard science tells us that placebos can reduce symptoms such as pain and muscle rigidity in Parkinson’s disease, yet the progression of the disease is not affected; for example, in Parkinson’s disease, neurons keep degenerating even though some symptoms can be reduced for a short time.4 The second point is related to the first. The type of disease is crucial, and we need to make people understand that pain is different from cancer and that anxiety differs from infectious diseases. The psychological component of some illnesses can indeed be modulated by placebos, but placebos cannot stop cancer growth, nor can they kill the bacteria of pneumonia. The third point is related to the difference between real placebo effects and spontaneous remissions. So far, hard science has studied the placebo effect within a time span of hours/days, thereby limiting our knowledge to short-lasting effects. Consequently, long-lasting effects can be often attributed to spontaneous remissions.

In addition to these three important points, we should also make patients understand that a diagnosis is required before any sort of therapy. An apparently trivial pain may conceal a danger; thus, it must never be treated unless a diagnosis has been made before, and this can be made only by physicians. Moreover, not only should we discuss and consider the positive effects of placebos and the impact they may have in clinical trials and medical practice, but we should also pay much of our attention to the negative counterpart, that is, the misuse and abuse by quacks, charlatans, shamans, and nonmedical organizations. Thus, we need to inform the whole society that the benefits following a nonconventional healing procedure are attributable to a placebo effect in most of the cases. Last but not least, we need to be more honest on the real efficacy of many pharmacological and nonpharmacological treatments, acknowledging that some of them are useful whereas some others are not: This will boost patients’ trust and confidence in medicine further, which I believe are the best foes of quackery…

…Unfortunately, quackery has today one more weapon on its side, which is paradoxically represented by the hard science–supported placebo mechanisms. This new “scientific quackery” can do a lot of damage; thus, we must be very cautious and vigilant as to how the findings of hard science are exploited. The study of the biology of these vulnerable aspects of mankind may unravel new mechanisms of how our brain works, but it may have a profound negative impact on our society as well. We cannot accept a world where expectations can be enhanced with any means and by anybody. This is a perspective that would surely be worrisome and dangerous. I believe that some reflections are necessary in order to avoid a regression of medicine to past times, in which quackery and shamanism were dominant. Unfortunately, the new knowledge about placebos by hard science is now backfiring on it. What we need to do is to stop for a while and reflect on what we are doing and how we want to move forward. A crucial question to answer is, Does placebo research boost pseudoscience?

__________________________________________________________________

I am immensely thankful to Prof Benedetti to make such clear and long-overdue statements. They will be most helpful in refuting the myth that homeopathy, para-normal healing, reflexology, acupuncture, chiropractic, etc., etc. are legitimate and uselful therapies, even if they are not better than a placebo. Using placebo therapies in routine care is not in the best interest of either the patient or progress.

Some of you might have followed my recent discussion with a homeopath. It followed a typical path, and I decided therefore to try and analyse this exchange here. Perhaps others can learn from this example when debating with homeopaths or other providers of so-called alternative medicine (SCAM).

THE START

These conversations often start ‘out of the blue’ by some falsehood being trumpeted on social media. In the present case, the encounter commenced by someone tweeting this message to me: “…remember that asthma trial whose results you faked?” As I did not even remember having ever met the man, I was perplexed. And as I have not faked the study in question nor any other results, I did not think his remark was credible or funny. My mention of the fact that the aggressor was being libellous seemed to bring an end to this unhappy dialogue.

But not for very long. When the man insulted me again – this time very publicly in a UK newspaper – I decided to look into it a bit closer. The aggressor turned out to be in charge of the well-known UK homeopathic pharmacy, Ainsworth, and thus had an overt conflict of interest in defaming my often critical stance on homeopathy. Intriguingly, he had also published his own study of homeopathy. When I assessed this research, it turned out to be both incompetent and unethical. I had hoped that he would defend his work and discuss its limitations with me in a rational fashion. Yet, at this stage, he remained silent.

I then decided to write a further post in the hope of getting some sort of response from him. Alas, my hope was disappointed again. Even when I challenged him and his ROYAL WARRANT directly, he remained silent.

THE BUILD-UP

It needed a seemingly unrelated post of mine for him to find his voice:

Dear Ezard
We can all go round in endless circles arguing whether the Earth is Flat, but eventually someone has to venture out in a boat to the horizon to determine the fact. A cursory reading of Hahnemann encourages every student of homoeopathy to gain their own experience empirically. We all know you and your friends on this blog are standing on the shore proclaiming the Earth to be flat, but when are you going to pedal out,to bravely cite actual cases you have treated with homoeopathy as evidence of your position? What the audience reading this wants to know is what experience and knowledge any of you actually have of the subject you spend so much time criticising?

At this stage a had grown a little weary of Mr Pinkus and his innuendos. My response was thus a little impatient:

Dear Tony
I don’t think highly of people who
1) are too daft to spell my name correctly,
2) imply I have no experience in homeopathy,
3) pretend that I make a secret of it, while, in fact, I published this multiple times (i.e. https://www.amazon.co.uk/Scientist-Wonderland-Searching-Finding-Trouble/dp/1845407776),
4) accuse others of being flat earthers, while evidently being one themselves,
5) do all this without declaring their massive conflict of interest.
Best regards
Edzard

What followed was Pinkus’ increasingly irrational attempts to defame me by revealing to the world that I (and other critics of homeopathy) lacked sufficient clinical experience with homeopathy and therefore were not competent to discuss the subject. Explanations by myself and others that,

  • firstly I did have knowledge and experience of homeopathy,
  • and secondly no experience is required for a critical evaluation of any treatment,

all fell on deaf ears.

THE END

The conclusion of this odd discussion was Pinkus’ triumphant declaration of victory:

I came to this blog to see if anyone in the discussion had any serious intention to discuss the subject of homoeopathy. In order to do this there are certain prerequisites for a sensible debate and one of these is actual knowledge and experience of the subject matter under discussion. To this end I asked if anyone has case they treated in order to discuss the merits and demerits of the experience. No one offered one. I repeated the request and the silence changed to attacks on me even asking.

Any scientist worthy of the challenge, and certainly someone who proudly styles himself as a Professor of CAM with experience and knowledge, would be only too glad to share this with others. Sadly though I have met with rebuke and insult but no evidence to support the opposition to homoeopathy saving some incoherent rant about the needlessness of empirical experience. The cornerstone of Hahnemann’s work on homoeopathy and the one thing he advocated to other doctors. “Don’t take my word for it, prove it to yourself”

When you find the need to attack me to defend your incessant argument that homoeopathy is implausible I really cannot take you seriously.

Here we have a blog hosted by a chap who claims to be an expert on the subject but now claims he hasn’t practiced it for over 40 years. Won’t say what he did when he practised, what he learned and when asked to give at least once case he treated, refuses and creates some diversion to cover his ignorance of the question. Now that’s what I call a charlatan.

I understand you have made a living out of this but it must be a miserable existence old chap

______________________________________________________________________

I find this exchange rather typical for an argument with  SCAM-fanatics. It follows a fairly standard strategy:

  • aggression form a complete stranger,
  • attempt of a rational defence,
  • more aggression and insults
  • attempts to debate the published evidence,
  • silence from the aggressor who seems unable to defend his evidence,
  • more aggression at an unexpected opportunity,
  • further attempts to rationalise and discuss the facts,
  • the aggressor questions his opponent’s competence,
  • more attempts to rationalise and provide valid explanations,
  • conclusion of the discussion with aggressor trying to occupy the moral high ground.

Of course, this is eerily similar to playing chess with a pigeon.

So, what, if anything, can we learn from this?

Mainly three things, I think:

  1. Either you don’t argue with fanatics at all,
  2. or you realise from the beginning what is about to happen; in this case, have fun exposing irrationality in the hope that others might profit from your experience.
  3. In any case, do not expect that your aggressor will be able to learn anything.

These days, I am often not sure what puzzles me more, Boris Johnson or homeopathy. Come to think of it, our PM seems, in fact, to have a lot in common with homeopathy/homeopaths. With my tongue lodged firmly in my cheek, I can see some communalities:

  • They are both popular in the UK but have their origins elsewhere.
  • They were both laughed at by people who are serious.
  • They have both been around for far too long.
  • They both are useless.
  • They both have plenty of charisma.
  • They both, however, have little more than that.
  • They have a long history of misleading the public.
  • They have both been taken to court.
  • They both failed to accept the judgement when it went against them.
  • They are both particularly successful with the female section of the population.
  • They both thrive on personal attacks.
  • They both make far-reaching claims which turn out to be false.
  • They both claim to want only the best for the public.
  • They both consider themselves as progressive.
  • In truth, however, they are both deeply regressive.
  • They both do not to think that ethics are all that important.
  • They both irritate people who are rational thinkers.
  • They both negate the evidence and act in overt contradiction to the evidence.
  • They both tend to think that popularity is a measure of efficacy.
  • They both managed to mislead even the Queen.
  • Nevertheless, they both enjoy royal support (at least for the time being).
  • They both seem to think that the laws (of the land/of nature) do not apply to them.
  • They are both only bearable when highly diluted.
  • They are both a complete waste of money.
  • They are both dangerous when the public follow their advice.

Have I forgotten anything?

Do tell me, please.

It is hard to deny that many practitioners of so-called alternative medicine (SCAM) advise their patients to avoid ‘dangerous chemicals’. By this they usually mean prescription drugs. If you doubt how strong this sentiment often is, you have not followed the recent posts and the comments that regularly followed. Frequently, SCAM practitioners will suggest to their patients to not take this or that drug and predict that patients would then see for themselves how much better they feel (usually, they also administer their SCAM at this point).

Lo and behold, many patients do indeed feel better after discontinuing their ‘chemical’ medicines. Of course, this experience is subsequently interpreted as a proof that the drugs were dangerous: “I told you so, you are much better off not taking synthetic medicines; best to use the natural treatments I am offering.”

But is this always interpretation correct?

I seriously doubt it.

Let’s look at a common scenario: a middle-aged man on several medications for reducing his cardiovascular risk (no, it’s not me). He has been diagnosed to have multiple cardiovascular risk factors. Initially, his GP told him to change his life-style, nutrition and physical activity – to which he was only moderately compliant. Despite the patient feeling perfectly healthy, his blood pressure and lipids remained elevated. His doctor now strongly recommends drug treatment and our chap soon finds himself on statins, beta-blockers plus ACE-inhibitors.

Our previously healthy man has thus been turned into a patient with all sorts of symptoms. His persistent cough prompts his GP to change the ACE-inhibitor to a Ca-channel blocker. Now the patients cough is gone, but he notices ankle oedema and does not feel in top form. His GP said that this is nothing to worry about and asks him to grin and bear it. But the fact is that a previously healthy man has been turned into a patient with reduced quality of life (QoL).

This fact takes our man to a homeopath in the hope to restore his QoL (you see, it certainly isn’t me). The homeopath proceeds as outlined above: he explains that drugs are dangerous chemicals and should therefore best be dropped. The homeopath also prescribes homeopathics and is confident that they will control the blood pressure adequately. Our man complies. After just a few days, he feels miles better, his QoL is back, and even his sex-life improves. The homeopath is triumphant: “I told you so, homeopathy works and those drugs were really nasty stuff.”

When I was a junior doctor working in a homeopathic hospital, my boss explained to me that much of the often considerable success of our treatments was to get rid of most, if not all prescription drugs that our patients were taking (the full story can be found here). At the time, and for many years to come, this made a profound impression on me and my clinical practice. As a scientist, however, I have to critically evaluate this strategy and ask: is it the correct one?

The answer is YES and NO.

YES, many (bad) doctors over-prescribe. And there is not a shadow of a doubt that unnecessary drugs must be scrapped. But what is unnecessary? Is it every drug that makes a patient less well than he was before?

NO, treatments that are needed should not be scrapped, even if this would make the patient feel better. Where possible, they might be altered such that side-effects disappear or become minimal. Patients’ QoL is important, but it is not the only factor of importance. I am sure this must sound ridiculous to lay people who, at this stage of the discussion, would often quote the ethical imperative of FIRST DO NO HARM.

So, let me use an extreme example to explain this a bit better. Imagine a cancer patient on chemo. She is quite ill with it and QoL is a thing of the past. Her homeopath tells her to scrap the chemo and promises she will almost instantly feel fine again. With some side-effect-free homeopathy see will beat the cancer just as well (please, don’t tell me they don’t do that, because they do!). She follows the advice, feels much improved for several months. Alas, her condition then deteriorates, and a year later she is dead.

I know, this is an extreme example; therefore, let’s return to our cardiovascular patient from above. He too followed the advice of his homeopath and is happy like a lark for several years … until, 5 years after discontinuing the ‘nasty chemicals’, he drops dead with a massive myocardial infarction at the age of 62.

I hope I made my message clear: those SCAM providers who advise discontinuing prescribed drugs are often impressively successful in improving QoL and their patients love them for it. But many of these practitioners haven’t got a clue about real medicine, and are merely playing dirty tricks on their patients. The advise to stop a prescribed drug can be a very wise move. But frequently, it improves the quality, while reducing the quantity of life!

The lesson is simple: find a rational doctor who knows the difference between over-prescribing and evidence-based medicine. And make sure you start running when a SCAM provider tries to meddle with necessary prescribed drugs.

The ‘OFFICIAL HOMEOPATHY RESOURCE‘ is an odd publication which, until very recently, I did not know about. They inform us about homeopathy as follows:

Homeopathy is a non-corporate  200-year-old system of medicine used successfully by tens of millions worldwide, and the second most utilized complementary health discipline in the world (according to the World Health Organization 2005).  It has a laudable 200-year clinical record.  There are literally hundreds of high quality basic science, pre-clinical and clinical studies showing it works.

This is the online web site for accurate information on homeopathy, homeopaths and homeopathic organizations. Its hard to get accurate information on this popular and traditional healing modality as a result of Drug Company Sponsored Blogs, Web Sites and their sponsored “Science Writers”.

Finally, there is a positive and comprehensive resource and you have found it. We hope you enjoy this site’s information and decide on or continue homeopathic treatment to experience it’s benefits.

THIS IS AN INDEPENDENT MEDIA SOURCE

About Comments on this Web Site:

We welcome POSITIVE comments about your experience with homeopathy or positive feedback about a particular topic.

Thank you for your positive support of homeopathy and getting the word out there.

The articles and posts contained herein are educational and informational and should not be considered medical advise. We recommend that you see a licensed medical practitioner.

__________________________________________________________

So far so good; well not SO good actually: this short text opens a lot of questions. But this is not what I want to address today. The ‘OFFICIAL HOMEOPATHY RESOURCE’ appeared on my screen only for one reason; they just published a whole, albeit short article about me! It is entitled ‘Pharmaceutical Company Found Guilty of Fuelling Opioid Epidemic But Sponsored Skeptics Continue Attacks on Safe Alternatives‘. Here it is in its full and unabbreviated beauty:

Even though the pharmaceutical industry has paid billions in fines over the years for failures and deceptions that have caused serious injuries and death, the pharmaceutical sponsored skeptic organizations and skeptics like Edzard Ernst spread outright lies about the false dangers of alternatives. They try to take the heat off the failures and dangers of drugs by smearing safe alternatives like homeopathy. They even go to the point of going to government organizations and falsely claiming alternatives are dangerous. They say nothing or a minimum about their sponsors.

One such skeptic Edzard Ernst attempts to present himself as an expert which most skeptics do. As a means of puffing himself up and making it seemed like he knows something about homeopathy, he claimed he was a homeopath and switched to allopathic medicine when homeopathy did not work. This has been proven to be an outright lie. He has had no training in homeopathy.

Unfortunately skeptics, like lemmings, support only pharmaceutical company generated science as if it was the holy grail.

Homeopathy has been proven to be very effective in pain relief and is non-addictive.

_____________________________________________________________________

I am afraid they must have missed what I disclosed repeatedly about my sponsors. Let me therefore repeat it especially for them (I tried to find out who exactly ‘THEY’ are, but they are not disclosing this information, as far as I can see):

  • I am sponsored to the tune of zero £.
  • There is not a single commercial company that backs me.
  • This blog receives no funding from anywhere.
  • Its running costs are paid by me.
  • I live off my pension and savings and receive no other income.

I will not bother to correct the other falsehoods in the text above. I think, they are too obvious to bother. To those of my readers who find them not obvious, I recommend reading my memoir and my book entitled ‘Homeopathy, the Undiluted Facts‘ and considering ‘Ernst’s law‘.

I have written about this more often than I care to remember, and today I do it again.

Why?

Because it is important!

Chiropractic is not effective for kids, and chiropractic is not harmless for kids – what more do we need to conclude that chiropractors should not be allowed anywhere near them?

And most experts now agree with this conclusion; except, of course, the chiropractors themselves. This recent article in THE CHRONICLE OF CHIROPRACTIC is most illuminating in this context:

It was only a matter of time before the attack on the chiropractic care of children spread to the United States from Australia and Canada and its also no surprise that insurance companies would jump on the bandwagon first.  According to Blue Cross and Blue Shield Children under the age of 5 years should not receive chiropractic care (spinal manipulation) ” . . . because the skeletal system is not mature at this time.”

The Blues further contend that:

“Serious adverse events may be associated with pediatric spinal manipulation in children under the age of 5 years due to the risks of these procedures in children this age.”

The Blues claims that their determination is based on standards of care – though they do not state which ones.

“This determination was based on standards of care in pediatric medicine as well as current medical evidence.”

This is not the first time Blue Cross attacked the chiropractic care of children. In 2005 CareFirst Blue Cross claimed that:

“Spinal manipulation services to treat children 12 years of age and younger, for any condition, is considered experimental and investigational.”

The ridiculous and false claims by Blue Cross come on the heels of a ban placed on spinal manipulation of infants by the Chiropractic Board of Australia (see related story) and attacks on chiropractors who care for children in Canada by chiropractic regulatory boards there.

There is in fact plenty of evidence to support the chiropractic care of infants and children and there are practice guidelines (the highest level on the research hierarchy pyramid) that support such care.

The real issue is not whether or not evidence exists to support the chiropractic care of children – the real issue is power and the lack of any necessity for evidence for those with the power.

__________________________________________________________________

END OF QUOTE

What can we learn from this outburst?

  1. Chiropractors often take much-needed critique as an ‘attack’. My explanation for this phenomenon is that they sense how wrong they truly are, get defensive, and fear for their cash-flow.
  2. When criticised, they do not bother to address the arguments. This, I believe, is again because they know they are in the wrong.
  3. Chiropractors are in denial as to what they can and cannot achieve with their manipulations. My explanation for this is that they might need to be in denial – because otherwise they would have to stop practising.
  4. They often insult criticism as ridiculous and false without providing any evidence. The likely explanation is that they have no reasonable evidence to offer.
  5. All they do instead is stating things like ‘there is plenty of evidence’. They don’t like to present the ‘evidence’ because they seem to know that it is worthless.
  6. Lastly, in true style, they resort to conspiracy theories.

To any critical thinker their behaviour thus makes one conclusion virtually inescapable: DON’T LET A CHIROPRACTOR NEAR YOUR KIDS!

The journal NATURE has just published an excellent article by Andrew D. Oxman and an alliance of 24 leading scientists outlining the importance and key concepts of critical thinking in healthcare and beyond. The authors state that the Key Concepts for Informed Choices is not a checklist. It is a starting point. Although we have organized the ideas into three groups (claims, comparisons and choices), they can be used to develop learning resources that include any combination of these, presented in any order. We hope that the concepts will prove useful to people who help others to think critically about what evidence to trust and what to do, including those who teach critical thinking and those responsible for communicating research findings.

Here I take the liberty of citing a short excerpt from this paper:

CLAIMS:

Claims about effects should be supported by evidence from fair comparisons. Other claims are not necessarily wrong, but there is an insufficient basis for believing them.

Claims should not assume that interventions are safe, effective or certain.

  • Interventions can cause harm as well as benefits.
  • Large, dramatic effects are rare.
  • We can rarely, if ever, be certain about the effects of interventions.

Seemingly logical assumptions are not a sufficient basis for claims.

  • Beliefs alone about how interventions work are not reliable predictors of the presence or size of effects.
  • An outcome may be associated with an intervention but not caused by it.
  • More data are not necessarily better data.
  • The results of one study considered in isolation can be misleading.
  • Widely used interventions or those that have been used for decades are not necessarily beneficial or safe.
  • Interventions that are new or technologically impressive might not be better than available alternatives.
  • Increasing the amount of an intervention does not necessarily increase its benefits and might cause harm.

Trust in a source alone is not a sufficient basis for believing a claim.

  • Competing interests can result in misleading claims.
  • Personal experiences or anecdotes alone are an unreliable basis for most claims.
  • Opinions of experts, authorities, celebrities or other respected individuals are not solely a reliable basis for claims.
  • Peer review and publication by a journal do not guarantee that comparisons have been fair.

COMPARISONS:

Studies should make fair comparisons, designed to minimize the risk of systematic errors (biases) and random errors (the play of chance).

Comparisons of interventions should be fair.

  • Comparison groups and conditions should be as similar as possible.
  • Indirect comparisons of interventions across different studies can be misleading.
  • The people, groups or conditions being compared should be treated similarly, apart from the interventions being studied.
  • Outcomes should be assessed in the same way in the groups or conditions being compared.
  • Outcomes should be assessed using methods that have been shown to be reliable.
  • It is important to assess outcomes in all (or nearly all) the people or subjects in a study.
  • When random allocation is used, people’s or subjects’ outcomes should be counted in the group to which they were allocated.

Syntheses of studies should be reliable.

  • Reviews of studies comparing interventions should use systematic methods.
  • Failure to consider unpublished results of fair comparisons can bias estimates of effects.
  • Comparisons of interventions might be sensitive to underlying assumptions.

Descriptions should reflect the size of effects and the risk of being misled by chance.

  • Verbal descriptions of the size of effects alone can be misleading.
  • Small studies might be misleading.
  • Confidence intervals should be reported for estimates of effects.
  • Deeming results to be ‘statistically significant’ or ‘non-significant’ can be misleading.
  • Lack of evidence for a difference is not the same as evidence of no difference.

CHOICES:

What to do depends on judgements about the problem, the relevance (applicability or transferability) of evidence available and the balance of expected benefits, harm and costs.

Problems, goals and options should be defined.

  • The problem should be diagnosed or described correctly.
  • The goals and options should be acceptable and feasible.

Available evidence should be relevant.

  • Attention should focus on important, not surrogate, outcomes of interventions.
  • There should not be important differences between the people in studies and those to whom the study results will be applied.
  • The interventions compared should be similar to those of interest.
  • The circumstances in which the interventions were compared should be similar to those of interest.

Expected pros should outweigh cons.

  • Weigh the benefits and savings against the harm and costs of acting or not.
  • Consider how these are valued, their certainty and how they are distributed.
  • Important uncertainties about the effects of interventions should be reduced by further fair comparisons.

__________________________________________________________________________

END OF QUOTE

I have nothing to add to this, except perhaps to point out how very relevant all of this, of course, is for SCAM and to warmly recommend you study the full text of this brilliant paper.

The ‘College of Medicine and Integrated Health’ (CMIH) has been the subject of several previous blog posts (see for instance here, here and here). Recently, they have come up with something new that, in my view, deserves a further comment.

The new ‘SELF CARE TOOL KIT’ began, according to the CMIH, in 2009 with a national multi-centre project commissioned by the UK Department of Health, to consider the best way to integrate self care into family practice. The project involved two large family health centres and two university departments. One output was the Self Care Library (SCL).

The Self Care Library (SCL) is an online patient resource providing free evidence-based information about self-care.  The funding for the SCL did, however, not survive, and the facility was assigned to the CMIH. Thanks to funding from ‘Pukka Herbs Vitamins, Herbal Remedies & Health Supplements‘, the CMIH was able to transfer the content and to begin updating entries. Simon Mills, the coordinator of the original project who is now employed by Pukka, has led this transformation and helped the College set up the new parent portal, Our Health Directory.

The Self Care Toolkit is thus the new SCL. All concerned with this project are experienced in clinical practice and can separate the theory from real life needs. We all have academic lives as well so can be hard-nosed with the evidence base as well.

_______________________________________________________________

The above text is essentially based on the information provided by the CMIH. A few critical remarks and clarifications might therefore be in order:

  • What does ‘separate the theory from real life needs’ mean? Does it mean that the scientific evidence can be interpreted liberally (see below)?
  • Is it a good idea to have a commercial sponsor for such a project?
  • Is it wise that the main person in charge is on the payroll of a manufacturer of dietary supplements?
  • Is there any oversight to minimise undue bias and prevent the public from being misled?
  • Is it really true that all people involved have academic lives? Simon Mills (who once was a member of my team) has no longer an academic appointment, as far as I know.

But, you are right, these are perhaps mere trivialities. Let’s see what the ‘Self Care Tool Kit’ actually delivers. I have chosen the entry on DEPRESSION to check its validity. Here it is:

_______________________________________________________________

It isn’t likely that taking extra vitamins will make much difference to low mood or depression. It is true that many people don’t get quite enough B, C and D vitamins in their food. And it’s also true that the brain and nervous system need these vitamins. Because they don’t get stored in the body, our daily diet has to supply them. Research has shown that people with low blood levels of the B vitamin folic acid are more likely to be depressed and less likely to do well on anti-depressant medicines. So, if you are eating a very poor diet, taking extra vitamins just might help. It’s also worth remembering that alcohol, refined sugars, nicotine and caffeine all take these vitamins out of the body. Yet most people who feel depressed probably won’t benefit from taking vitamins alone. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds.

Some people say that taking high doses of vitamin C (1-2 g and more a day) helps lift their mood. There is a little research to support this and none showing that high doses of vitamin C actually help clinical depression. Vitamin C levels fall after surgery or inflammatory disease. The body needs more vitamin C when coping with stress, pregnancy and breast feeding. Aspirin, tetracycline and contraceptive pills take vitamin C out of the body. Smokers also need extra vitamin C because nicotine removes it. Fresh fruit and vegetables are the best sources of vitamin C.

Doctors are increasingly concerned about low vitamin D, especially in the Asian community. A lack of vitamin D can lead to depression. Oily fish and dairy products are good sources of vitamin D, and sunlight helps the body make vitamin D. Do you get enough sunshine and eat a good diet? It is estimated that worldwide over 1 billion people get too little vitamin D.

Evidence
Taking supplements of vitamins B and D might help some people, whose diet is poor, but more research is needed.

Safety
Very high doses of vitamins and minerals can upset the body and cause side-effects. Get medical advice if you intend to take large doses. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds.

Cost
If your diet is poor and you don’t get into the sun, ask your doctor about a vitamin D blood test. If it’s normal, there’s no point in taking vitamin D. If it’s low, your GP will prescribe it for you or you can buy a vitamin D supplement.

___________________________________________________________________

In my view, this text begs several questions:

1) Am I right in thinking that phraseology such as the one below will encourage patients suffering from depression to try the supplements mentioned?

  • people with low blood levels of the B vitamin folic acid are more likely to be depressed and less likely to do well on anti-depressant medicines..
  • Some people say that taking high doses of vitamin C (1-2 g and more a day) helps lift their mood…
  • There is a little research to support this and none showing that high doses of vitamin C actually help clinical depression…
  • A lack of vitamin D can lead to depression.
  • Taking supplements of vitamins B and D might help some people…
  • … your GP will prescribe it for you or you can buy a vitamin D supplement.

2) How does that tally with the latest evidence? For instance:

3) The CMIH state: ‘This site gives you information NOT medical advice.’  But, in view of the actual text above, is this true?

4) Depression is a life-threatening condition. Is there a risk that patients trust the CMHI’s (non-) advice and commit suicide because of its ineffectiveness?

5) Do Pukka, the sponsor of all this, happen to supply most of the self care remedies promoted in the ‘Self Care Tool Kit’?

The answer to the last question, I am afraid, is YES!

Leprosy can be a devastating infection. But, since many years, it is treatable. The WHO developed a multidrug therapyTrusted Source in 1995 to cure all types of leprosy. It’s available free of charge worldwide. Additionally, several antibiotics are used to kill the bacteria that causes leprosy, e.g.:

  • dapsone
  • rifampin
  • clofazimine
  • minocycline
  • ofloxacin

Yes, leprosy is treatable … that is, unless you follow the advice issued in this article and treat it with homeopathy:

Homoeopathy remedies are given on the basis of similar signs and symptoms along with the miasmatic classification of diseases. Homoeopathy physicians said that leprosy is characteristics of syphilis miasm due to their mental and physical conditions. Mentally person thinks that he/she may be isolated and left alone in a corner of society due to dirty looking of the skin and tendency to spread of disease from direct contact. They feel alone and make hypothesis that the society needs outbreak from me because of physical disabilities like paralysis, and loss of controls on body functions. A well selected homoeopathy remedy helps out patient to come out from this condition and make possible to live in society from permanent restoration of health.

  • SULPHUR – ‘It is mainly known as king of anti-psoric’ in wide range of homoeopathy. Hahnemann says that sulphur has reputation as a remedy against itch perhaps as old medicine i.e., as early as 2000 years ago. Skin of sulphur indicates vesicular skin eruptions and skin may treated by medicated soaps and washes. Clinical trials says that sulphur have similar signs and symptoms as indicated by disease.
  • GRAPHITES – It is a great remedy for all sorts of skin eruptions with a tendency towards malignancy. It also indicates various symptoms of leprosy and may be used in treatment.
  • PETROLEUM – The skin of petroleum has cracks and fissures all over the body and indicates various similar symptoms as of disease condition.
  • RHUS TOXICODENDRON – Skin shows erysipelas vesicular eruptions, vesicles are yellow, from left to right with much swelling, inflammation, burning, itching and stinging that are very much similar to leprosy sign and symptoms, so it may be prescribed.
  • CICUTA VIROSA – This homoeopathic medicine used in the conditions when patients are anxious about their future and epileptic attacks with spasmodic movements of the limbs.
  • ALOE SOCOTRINA – This homoeopathy medicine works when the patients are fear of death and angry from themselves for their conditions. This medicine have tendency to acts upon the abdominal and lumbar region of the patient.
  • BLATTA ORIENTALIS – It is used when the patient is anxious about their skin and health. Patient suffers from the chronic inflammations of the chest and other lung infections that are also found in disease.

Leprosy is a non-fatal infectious disease caused by bacteria Myobacterium leprae and spread by direct contact and other mode of transmissions. It may be treated with homoeopathic medicines if well selected medicine related to mental and physical symptoms is taken by patients. Homoeopathy medicines help out patients to rearrange the vital force to fight against infectious bacteria and makes possible that the body itself fight against the disease.

To be sure, I ran a quick Medline search. You guessed the result, I suppose: not a single hint from anything resembling a clinical trial that homeopathy might be an effective therapy of leprosy.

One question, however, does remain open: how do homeopaths who claim such irresponsible nonsense sleep?

(And in case you think that the above post is a rare exception, you have not recently searched the Internet!)

… Many proponents of so-called alternative medicine (SCAM) are keen to point out that, while mainstream medicine may be good at treatment of diseases, particularly acute conditions, SCAM’s forte lies in the prevention of disease. Patients seem to have intuitively accepted this notion; a recent survey suggest that more than 50% of those Americans who use SCAM do so not to treat ailments but to remain healthy, i.e. to prevent disease and illness. If one looks closer at the evidence for or against SCAM’s role in disease prevention, one is stunned by the contrast of firmly held beliefs and the lack of reliable evidence to support them…

… Unfortunately the subject is more complex than normally appreciated within SCAM. Until we have convincing data, it is not possible to state with confidence that a given form of SCAM is effective in preventing a given condition. It follows

  1. that we now should prepare to carry out the much needed (but difficult) research related
    to preventative,
  2. that we should be cautious and abstain from overstating the largely unproven role of SCAM in the prevention of disease and illness.

These lines were written by me and published exactly 20 years ago. As far as I can see, very little has changed since.

  • SCAM providers continue to make big claims about disease prevention.
  • Many consumers continue to believe them.
  • And the evidence continues to be absent or flimsy.

It follows, I fear, that charlatans who advocate their SCAM as a means to prevent disease are dishonestly defrauding the public.

I do hope that someone disagrees with me and shows me the evidence proving me wrong!

1 2 3 71
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories