case report
Turmeric is a commonly used herbal product implicated in causing liver injury. The aim of this case series
was to describe the clinical, histologic, and human leukocyte antigen (HLA) associations of turmeric-associated liver injury enrolled in the U.S. Drug Induced Liver Injury Network (DILIN).
All adjudicated cases enrolled in DILIN between 2004-2022 in which turmeric was an implicated product were reviewed. Causality was assessed using a 5-point expert opinion score. Available products were analyzed for the presence of turmeric using ultra-high-performance liquid chromatography. Genetic analyses included HLA sequencing.
Ten cases of turmeric-associated liver injury were found, all enrolled since 2011 and six since 2017. Of the 10 cases, 8 were women, 9 were White and the median age was 56 years (range, 35-71). Liver injury was hepatocellular in 9 patients and mixed in one. Liver biopsies in 4 patients showed acute hepatitis or mixed cholestatic-hepatitic injury with eosinophils. Five patients were hospitalized, and one patient died of acute liver failure. Chemical analysis confirmed the presence of turmeric in all 7 products tested; 3 also contained piperine (black pepper). HLA typing demonstrated that 7 patients carried HLA-B*35:01, 2 of whom were homozygous, yielding an allele frequency of 0.450 compared to population controls of 0.056-0.069.
The authors concluded that liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.
Turmeric or curcumin is said to cause multiple effects, such as inhibiting inflammation, oxidative stress, tumor cell proliferation, cell death, and infection. Yet, sound clinical trials to test whether these effects might translate into health benefits are rare. In addition, the bioavailability of oral turmeric supplements is known to be low.
Turmeric has been used in food for millennia and is thus generally considered to be safe. Known adverse effects include gastrointestinal problems such as nausea and diarrhea and allergic reactions. Clearly, the new case series casts considerable doubt on the safety of turmeric. Yet, one ought to point out that the number of cases is low (but, on the other hand under-reporting can be assumed to be high). Furthermore, we should take into account that the quality of commercially available products is often low. One must therefore ask whether the liver injuries were truly caused by turmeric itself or by contaminants.
My conclusion is that turmeric is unquestionably an interesting plant with considerable potential as a medicine. At present, there is much hype surrounding it. Yet, hype is almost always contra-productive. If we want to know the true value of turmeric, we need to solve the bioavailability problem and do much more research into its safety and efficacy for defined conditions.
It has been reported that a father accused of withholding insulin from his eight-year-old diabetic daughter and relying on the healing power of God has been committed to stand trial for her alleged murder.
Jason Richard Struhs, his wife Kerrie, and 12 others from a fringe religious group have been charged over the death of type 1 diabetic Elizabeth Rose Struhs. Police alleged she had gone days without insulin and then died. The police prosecutor detailed statements from witnesses and experts, including pediatric consultant Dr. Catherine Skellern, who said Elizabeth’s death “would have been painful and was over a prolonged period of days”.
“There is [also] body-worn camera footage at the scene … where Jason Struhs has recounted the events of the week leading up to the death of Elizabeth,” said the prosecutor. “This details the decision that Jason Struhs has made to stop the administration of insulin, and he stated that he knew the consequences, and he stated in that recording that he will ‘probably go to jail like they put Kerrie in jail’.”
During the hearing, Struhs, who appeared from jail by videolink, mainly sat with his head bowed and hands clasped against his forehead as magistrate Clare Kelly described the evidence against him. “It is said that Mr. Struhs, his wife Kerrie Struhs, and their children, including Elizabeth, were members of a religious community… The religious beliefs held by the members of the community include the healing power of God and the shunning of medical intervention in human life.” She also described a statement from Skellern suggesting Elizabeth would have spent her final days suffering from “insatiable thirst, weakness and lethargy, abdominal pain, incontinence, and the onset of impaired levels of consciousness”. The evidence read into court was an attempt by prosecutors to firm up an additional charge of torture. She said a post-mortem found Elizabeth’s cause of death was diabetic ketoacidosis, caused by a lack of insulin. “It is a life-threatening condition, which requires urgent medical treatment,” Kelly said.
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Cases like these are tragic, all the more so because they might have been preventable with more information and critical thinking. They make me desperately sad, of course, but they also convince me that my work with this blog should continue.
The objective of this study was to evaluate the effect of acupuncture on cognitive task performance in college students.
Sixty students aged 18-25 years were randomly allocated into acupuncture group (AG) (n=30) and control group (CG) (n=30). The AG underwent 20 min of acupuncture/day, while the CG underwent their normal routine for 10 days. Assessments were performed before and after the intervention.
Between-group analysis showed a significant increase in AG’s six-letter cancellation test (SLCT) score compared with CG. Within-group analysis showed a significant increase in the scores of all tests (i.e. SLCT, forward and backward Digit span test [DST]) in AG, while a significant increase in backward DST was observed in CG.
The authors concluded that acupuncture has a beneficial effect on improving the cognitive function of college students.
I am unable to access the full paper [it is behind a paywall]. Thus, I am unable to assess the study in further detail. As I am skeptical about the validity of the effect, I can only assume that it is due to the expectation of the volunteers receiving acupuncture. There was not even an attempt to control for placebo effects!
The over-stated conclusion made me wonder what else the 1st author has published. It turns out he has three more Medline-listed papers to his name all of which are about so-called alternative medicine (SCAM).
The 1st one is an RCT similar to the one above, i.e. without an attempt to control for placebo effects. Its conclusion is equally over-stated: Acupuncture could be considered as an effective treatment modality for the management of primary dysmenorrhea.
The other two papers refer to one case report each. Despite the fact that case reports (as any researcher must know) do not lend themselves to conclusions about the effectiveness of the treatments employed, the authors’ conclusions seem to again over-state the case:
- This suggests that integrative Naturopathy and Yoga therapies could be considered as an adjuvant to conventional medicine in rheumatoid arthritis associated with type-2 diabetes and essential hypertension.
- Though the results are encouraging, further studies are required with larger sample size and advanced inflammatory markers.
What does that tell us?
I don’t know about you, but I would not rely on acupuncture to improve my mental performance.
Pancoast tumors, also called superior sulcus tumors, are a rare type of cancer affecting the lung apex. These tumors can spread to the brachial plexus and spine and present with symptoms that appear to be of musculoskeletal origin. Patients with an advanced Pancoast tumor may thus feel intense, constant, or radiating pain in their arms, around their chest wall, between their shoulder blades, or traveling into their upper back or armpit. In addition, a Pancoast tumor may cause the following symptoms:
- Swelling in the upper arm
- Chest tightness
- Weakness or loss of coordination in the hand muscles
- Numbness or tingling sensations in the hand
- Loss of muscle tissue in the arm or hand
- Fatigue
- Unexplained weight loss
This case report details the story of a 59-year-old Asian man who presented to a chiropractor in Hong Kong with a 1-month history of neck and shoulder pain and numbness. His symptoms had been treated unsuccessfully with exercise, medications, and acupuncture. He had a history of tuberculosis currently treated with antibiotics and a 50-pack-year history of smoking.
Cervical magnetic resonance imaging (MRI) revealed a small cervical disc herniation thought to correspond with radicular symptoms. However, when the patient did not respond to a brief trial of chiropractic treatment, the chiropractor referred the patient back to the chest hospital for further testing, which confirmed the diagnosis of a Pancoast tumor. The patient was then referred for medical care and received radiotherapy and chemotherapy. At 2 months’ follow-up, the patient noted feeling lighter with less severe neck and shoulder pain and numbness. He also reported that he could sleep longer but still had severe pain upon waking for 2–3 hours, which subsided through the day.
A literature review identified six previously published cases in which a patient presented to a chiropractor with an undiagnosed Pancoast tumor. All patients had shoulder, spine, and/or upper extremity pain.
The authors concluded that patients with a previously undiagnosed Pancoast tumor can present to chiropractors given that these tumors may invade the brachial plexus and spine, causing shoulder, spine, and/or upper extremity pain. Chiropractors should be aware of the clinical features and risk factors of Pancoast tumors to readily identify them and refer such patients for medical care.
This is an important case report, in my view. It demonstrates that symptoms treated by chiropractors, osteopaths, and physiotherapists on a daily basis can easily be diagnosed wrongly. It also shows how vital it is that the therapist reacts responsibly to the fact that his/her treatments are unsuccessful. Far too often, the therapist has an undeniable conflict of interest and will say: “Give it more time, and, in my experience, symptoms will respond.”
The chiropractor in this story was brilliant and did the unusual thing of not continuing to treat his patient. However, I do wonder: might he be the exception rather than the rule?
Lots of people have commented on King Charles’ swollen hands which can be seen in many pictures, not least the one on the cover of my biography of Charles. The king himself repeatedly referred to his ‘sausage fingers’ and has made light of the issue as far back as 1982. When William was born. At that time, he wrote to a friend: “I can’t tell you how excited and proud I am. He really does look surprisingly appetising and has sausage fingers just like mine.”
Now that he is King, we might need to worry; are his ‘sausage fingers’ a sign of a serious underlying disease?
Swollen fingers are normally due to fluid retention which can have many causes, e.g.:
- allergy,
- arthritis,
- bursitis,
- carpal tunnel syndrome,
- diabetes,
- gout,
- heart failure,
- injury,
- infection,
- kidney failure,
- lymphoedema,
- scleroderma,
- sickle cell disease,
- syphilis,
- tendinitis,
- tuberculosis.
The list is long and it contains some worrying diseases. Luckily, we can exclude many of them simply because Charles has had ‘sausage fingers’ for so many years. Thus, plausible options could be diabetes and scleroderma. The former can probably be excluded mainly because we would have long known about it.
But what about scleroderma?
Scleroderma (or systemic sclerosis, as it is also called) is a serious autoimmune condition that may be localized or generalized. The latter form is more serious. In 2020, it was noted that Charles’s feet also seemed to be swollen. In addition, his face often looks flushed (see also the cover of my book).
I know far too little about Charles’s health to make even a tentative diagnosis. Some features of scleroderma fit quite well, while others do not. In any case, I do hope Charles’s swellings have a more benign explanation. But, if scleroderma is the cause, the question obviously arises: is there a so-called alternative medicine (SCAM) for it?
A recent review stated that some study results have shown that vitamins D and E, probiotics, turmeric, l-arginine, essential fatty acids, broccoli, biofeedback, and acupuncture may be beneficial in systemic sclerosis care. However, large randomized clinical trials have not been conducted. In other words, SCAM has no proven benefit for the condition, and I would not recommend it.
Charles does know that, of course. In the past, he regularly made grand proclamations in favor of SCAM but, as soon as he was really ill, he always employed the best conventional healthcare can offer.
When I first heard about it, I thought it was a hoax – nobody can be that daft, I felt. Then I did a bit of research and found that I had been wrong: some people evidently can be that daft and are trying to promote a new SCAM.
Yes, I am speaking of SPERM SMOOTHIES.
And it’s not even a new thing. One sperm smoothie fan boasted 2 years ago: “My immune system is far stronger than it’s ever been. I no longer catch colds or the flu — even when my children get sick from school! I have such high energy levels, feel positive and enthusiastic and have focus and clarity throughout my day whilst most parents feel tired, crave junk food and struggle with forgetfulness.”
In 2021, THE SUN reported this :
Tracy Kiss, 33, from Buckinghamshire, previously told how she put a spoonful of her best friend’s donated semen into her drink every morning in a bid to boost her immunity.
The personal trainer, who is mum to Millie and Gabrille, has previously advocated using sperm as a facial ointment.
She spoke as celebrity facialist Chelsee Lewis claimed it actually worked to reduce wrinkles.
On her bizarre beverage concoction, Tracy said: “I’d been feeling run down and had no energy, but now I’m full of beans and my mood has improved.
“It can taste really good – depending on what my friend has been eating. My other mates think I’m strange, but I don’t give a toss.”
Tracy, who is a vegan, roped her single pal into giving her his semen. She previously told how he pops round with a fresh tub three times a week.
“I know he’s healthy, doesn’t smoke, drink or do drugs and I made him have an STI check,” she said.
“When I first approached him, he was concerned I’d use it to impregnate myself.
“But once I’d convinced him it was for my beauty regime he agreed – after all, he has a regular supply at hand!”
Tracy, a qualified nutritional adviser and personal trainer, told how she kept it in her fridge.
She mixes the semen with fruit, seeds, coconut or almond milk – but is also happy to drink it on its own.
“Every batch tastes different, depending on what he’s been eating,” she said.
“If he’s been drinking alcohol or eaten something particularly pungent like asparagus, I ask him to give me a heads up so I know not to drink it neat.
“Things like pineapple and peppermint make it taste better, but I’ll happily take it straight off a spoon usually.”
Tracy has filmed a YouTube video where she talks through her unusual remedy and explains what it tastes like.
“We look at its smoothness and texture, discuss its benefits and then I show people who I use a teaspoon to eat the sperm,” she said.
“Sperm is an awesome product and we should stop being so ridiculous about it – the health benefits have been well researched and more women and men should take advantage of it particularly as its made by our own bodies and doesn’t contain e-numbers and chemicals.”
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The question I ask myself is this: are sperm smoothies really a new SCAM or are they just a way for some strange people to get their 5 minutes of fame? I sincerely hope it is the latter.
As numerous of my posts have demonstrated, chiropractic manipulations can cause severe adverse effects, including deaths. Several hundred have been documented in the medical literature. When discussing this fact with chiropractors, we either see denial or we hear the argument that such events are but extreme rarities. To the latter, I usually respond that, in the absence of a monitoring system, nobody can tell how often serious adverse events happen. The resply often is this:
You are mistaken because the Royal College of Chiropractors’ UK-based Chiropractic Patient Incident Reporting and Learning System (CPiRLS) monitors such events adequately.
I have heard this so often that it is time, I feel, to have a look at CPiRLS. Here is what it says on the website:
CPiRLS is a secure website which allows chiropractors to view, submit and comment on patient safety incidents.
Access to CPiRLS
CPiRLS is currently open to all UK-based chiropractors, all ECU members and members of the Chiropractic and Osteopathic College of Australasia. To access the secure area of the CPiRLS website, please click the icon below and insert the relevant CPiRLS username and password when prompted.
In the UK, these can normally be found on your Royal College of Chiropractors’ membership card unless the details are changed mid-year. Alternatively, email [email protected] from your usual email address and we will forward the details.
Alternatively, in the UK and overseas, secure access details can be obtained from your professional association.
National associations and organisations wishing to use CPiRLS, or obtain trial access to the full site for evaluation purposes, should contact The Royal College of Chiropractors at [email protected]
Please click the icon below to visit the CPiRLS site.
Yes, you understood correctly. The public cannot access CPiRLS! When I click on the icon, I get this:
Welcome to CPiRLS
CPiRLS, The Chiropractic Patient Incident Reporting and Learning System – is an online reporting and learning forum that enables chiropractors to share and comment on patient safety incidents.
The essential details of submitted reports are published on this website for all chiropractors to view and add comments. A CPiRLS team identifies trends among submitted reports in order to provide feedback for the profession. Sharing information in this way helps to ensure the whole profession learns from the collective experience in the interests of patients.
All chiropractors are encouraged to adopt incident reporting as part of a blame-free culture of safety, and a routine risk management tool.
CPiRLS is secure and anonymous. There is no known way that anyone reporting can be identified, nor do those running the system seek to identify you. For this security to be effective, you require a password to participate.
Please note that reporting to CPiRLS is NOT a substitute for the reporting of patient safety incidents to your professional association and/or indemnity insurers.
So, how useful is CPiRLS?
Can we get any information from CPiRLS about the incidence of adverse effects?
No!
Do we know how many strokes or deaths have been reported?
No!
Can chiropractors get reliable information from CPiRLS about the incidence of adverse effects?
No, because reporting is not mandatory and the number of reports cannot relate to incidence.
Are chiropractors likely to report adverse effects?
No, because they have no incentive and might even feel that it would give their profession a bad name.
Is CPiRLS transparent?
No!
Is CPiRLS akin to postmarketing surveillance as it exists in conventional medicine?
No!
How useful is CPiRLS?
I think I let my readers answer this question.
In a previous post, I explained that anthroposophic education was founded by Steiner in 1919 to serve the children of employees of the Waldorf-Astoria cigarette factory in Stuttgart, Germany. Pupils of Waldorf or Steiner schools, as they are also frequently called, are encouraged to develop independent thinking and creativity, social responsibility, respect, and compassion.
Waldorf schools implicitly infuse spiritual and mystic concepts into their curriculum. Like some other alternative healthcare practitioners – for instance, doctors promoting integrative medicine, chiropractors, homeopaths, and naturopaths – doctors of anthroposophic medicine tend to advise against childhood immunizations. For this and other reasons, Waldorf schools have long attracted criticism.
Now it has been reported that the district government of Münster has withdrawn the school permit of a Waldorf school in Rheine, Germany, because of “serious deficiencies in the teaching operation”. For the 71 children, school operation ends with the start of the fall vacations at the beginning of October, as the district government announced on Tuesday. Already since the end of 2020 there had been numerous complaints. The school board had not succeeded in eliminating the deficiencies, a proper operation is currently and prospectively not guaranteed.
The list of problems described by the district government is long: there were repeated violations in the health protection of children. A spokesman for the district government said that there had been massive and repeated violations of Corona’s protective measures. In addition, there was a risk of accidents in the playground. The school board had also been unable to stop the misconduct of individual teachers, the district government criticized. “In addition, there is an insufficient supply of teachers, school organizational deficits and a massively disturbed school peace,” it said.
In the end, the basis of trust required for continued operation of the school was no longer given, so the school permit had to be revoked for the sake of the children. “This is an absolutely exceptional case,” the spokesman said. It is presumably the first case under the jurisdiction of the Münster district government, he added.
Israel’s Health Ministry announced the revocation of Dr. Aryeh Avni’s medical license, after he called to violate the ministry’s COVID guidelines during the pandemic and published defamatory articles against the medical community. The Jerusalem District Court rejected Avni’s appeal following the decision to revoke his medical license. Avni, who was a specialist in general surgery, engaged for years in so-called alternative medicine (SCAM) and had previously been caught forging vaccination certificates. He claimed in court that he operates in the context of freedom of expression and that his objective is to help the public and to rescue patients from the harm caused by medications and vaccines.
About a year and a half ago, the Health Ministry’s disciplinary committee recommended that Avni’s license be suspended for two years, but former Judge Amnon Shtrashnov, who was granted authority by the health minister, rejected the recommendation and ordered the permanent revocation of Avni’s license. In his decision, Shtrashnov called Avni “a charlatan, a clear coronavirus denier and a dangerous trickster, who behaves that way under the aegis of a licensed doctor.” “There must be a distinction between expressing an opinion and incitement, while conducting a smear campaign against medical authorities in order to dissuade the public from acting in accordance with their directive,” District Court Judge Nimrod Flax said in his decision. “A doctor who chooses to conduct a delegitimization campaign of this kind excludes himself, and is behaving in a manner unbefitting a licensed doctor. “And we will say once again – expressing an opinion, absolutely; conducting a campaign of incitement and defamation against his fellow doctors, while attempting to bias public opinion and to prevent the public from acting in accordance with the recommendations of the medical authorities, absolutely not,” added Judge Flax. “In general, criticism of the directives and decisions of the health care system and those who head it is legitimate, but that’s when these things are said in polite language and are based on true facts,” added the judge. “Granting approval to the appellant to continue to possess a medical license, while he continues with his previous practices, and in particular preaches to violate medical directives given by the authorized bodies, cannot accord with the public interest,” added the judge.
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Dr. Avni has a website where he writes about himself: “During his work in the hospital but also in his private life, Dr. Avni was exposed to the dismal results of conventional cancer treatments, he lost his wife and sister. The difficult events made him think that allopathic medicine is not the only option and he started looking for other solutions. Better, and less dangerous in terms of “do no harm”.
This is how Dr. Avni came in his decades of journey to many methods and treatments that have in common that they treat problems from the root and not only the symptom, they are not harmful, in repairing one disease they do not increase the risk of new disease, they treat the person and do not see only the “disease” And their natural origin.
The more he delved into his research, the more Dr. Avni discovered to his amazement that there were powerful forces trying to silence and obscure vital information about these treatments. In the United States, for example, several dozen doctors died prematurely and for “strange” reasons, these were doctors who opposed vaccines or conventional cancer treatments. In recent years, Dr. Avni has also faced constant persecution by the media and the Ministry of Health, and once his license was suspended. But Dr. Avni did not flinch or fold, this is his life mission and for that we appreciate him and thank him! And we are not the only ones.
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Personally, I feel that the world is a safer place without anti-vax doctors in clinical practice. Other countries should perhaps follow the example of Israel and be more ready to revoke the licenses of anti-vax charlatans.
England’s record goalscorer Ellen White has revealed she suffered a punctured lung while receiving acupuncture treatment. The injury accelerated her decision to retire. White, 33, said she was still coming to terms with the “traumatic” injury.
Manchester City had sourced a “specialist” – evidently not such an excellent acupuncturist because the complication is avoidable with proper knowledge of anatomy – outside the club to provide her with acupuncture to treat her back problem because of a high number of injuries in the squad at the time. “If you’d said to me two or three years ago that you’re going to retire, I would have said ‘absolutely not’, but I’ve got to a time in my career,” she said. “I had a challenging time last year – coming back from the Olympics, I basically punctured my lung, and it was a lot for me to have to go through and a big reason that accelerated my want to retire.”
The injury happened when she returned to her club with a back spasm last summer. “It punctured my lung which isn’t something that happens normally, obviously,” she said. “It was a really traumatic time for me and something that I’m still figuring out now, still working through. I had to wait for the lung to basically inflate again. I had a needle put into my chest to drag all the air out then hopefully the lung would inflate again – which it has. At the time, I think for me, I just got into a zone of: ‘I need to get back playing. We’ve got these games – I want to be back playing for my club; I want to be back playing for England. I went very tunnel vision,” she said. “It wasn’t until a good two or three months later, it just hit me like a train, what actually happened and how traumatic it was.”
Despite her quick return to goalscoring form, which included becoming the Lionesses record goalscorer in November, the striker says she is still affected by the injury and suffers “phantom pain” where it feels like it is happening again. “It’s important for me now to tell my story, and say it was a big factor in my year and leading up to the decision of wanting to retire. Obviously, there are other factors that come into that as well. I don’t want it to happen to anybody else again is my main thing. I don’t want to walk away from the sport having not told it and not say that I want things in place for it not to happen to anyone else.”
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Pneumothorax is by far the most common of all the serious, potentially fatal complications caused by acupuncture. In thin individuals, several acupuncture points over the upper thorax are just a few centimeters away from the lung. Therefore, it is easily possible to puncture a lung by inserting an acupuncture needle. This is from my 2010 review of the subject:
About 90 deaths after acupuncture have been anecdotally documented in the medical literature. Thus, acupuncture has been associated with more deaths than most other ‘alternative’ therapies except herbal medicine … The fatalities are usually due to an acupuncture needle penetrating a vital organ. This, in turn, can cause pneumothorax, cardiac tamponade, or major haemorrhage. Most instances of this nature are reported in the Asian literature which, for most of us, is not easily accessible.
A 2013 review of ours located 1104 cases that had been reported in the Korean literature alone. However, the truth of the matter is that nobody can be sure of the exact incidence figures. Why? Because there is no monitoring system that would reliably record such incidences.
I would argue that every single case of acupuncture-induced pneumothorax tells us that the acupuncturist was not adequately trained. With proper knowledge of anatomy, such complications should not happen. Therefore, such instances are a rude reminder that so-called alternative medicine (SCAM) is far too often in the hands of “specialists” who are a danger to the public.
