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

causation

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In (some parts of) India, lay-homeopaths, i.e. homeopaths who have not been to medical school, are now allowed to administer conventional medicines. It stands to reason that this law must create problems.

It has been reported on 22/1/2022 that a ‘doctor of homeopathy’ has been arrested for allegedly administering the wrong injection to a man, which led to his death, in Madhya Pradesh’s Khandwa district, India.

Deepak Vishwakarma, who runs a clinic in Sindhi Colony, was arrested on Friday under the relevant provisions of the IPC and MP Ayurvigyan Parishad Adhiniyam, the city superintendent of police, Lalit Gathre said.

The doctor’s clinic was sealed after a complaint was lodged against him for administering a wrong injection to a trader, who died two days after taking the jab, the official stated.

During the probe, the police found that Vishwakarma, a practitioner of homeopathy, had given allopathy medicines to his patient Deepak Aartani, according to Ishwar Singh Chouhan of Moghat Road police station.

Another source reported that the patient had an infection and died two days after he was allegedly administered a wrong injection by the doctor. The paper added: This is really tragic and the fact that a doctor’s mistake cost a human life is something that just cannot be acceptable. One hopes proper steps are taken the guilty are punished. It remains to be seen what action is taken as the investigation is still underway.

A third source has this additional information: A cop Ishwar Singh Chauhan told that during the investigation it came to the fore that Deepak Vishwakarma holds a homeopathy degree and had given allopathy medicines to his patient Deepak Artani, due to which the patient contracted an infection and died.

So, the details of this tragedy are scant, too scant to be conclusive. What nevertheless seems to be clear to me is that it is a thoroughly bad idea to allow people who are not medically trained to administer medicines that they do not understand.

For all of you who, like myself, like the occasional glass or two of wine:

THERE IS GOOD NEWS!

Wine is the latest alternative measure against COVID-19.

This, at least, is what an article sent to me seems to suggest:

At the end of the year, American researchers showed in-vitro that polyphenols in grapes and wine disrupt the way the Sars-Cov2 virus that causes Covid-19 replicates and spreads.

The Taiwan Medical University found that the tannins in wine effectively inhibit the activity of two key enzymes of the virus, which can no longer penetrate cell tissue.

“Of all the natural compounds we have tested in the laboratory, tannic acid is the most effective,” said Mien-Chie Hung, a molecular biologist and president of the university, on TVBS. He also recalled the good results obtained with experimental tannic acid treatments in 2003 during the SARS pandemic.

Now I understand why I haven’t caught the bug yet, I thought to myself, while pouring a large glass of red Bordeaux, my favorite. After yet another glass, I began to feel bad. No, not because of an alcohol overdose. Because I omitted something that might be not unimportant: I should really have told you who sent me the article. It was a source entirely devoted to the promotion of wine, a source related to my wine merchant.

Ah well, I thought, pouring a further glass.

When, many hours later, I had finally sobered up, I decided to conduct a few Medline searches. This is when I found this:

Greatly encouraged, I poured another glass.

 

 

 

PS

As, in my experience, COVID deniers are not the brightest buttons in the drawer, I should point out that THIS POST IS MEANT TO BE SATIRE.

Tai chi is a meditative exercise therapy based on Traditional Chinese Medicine. On this blog, we have repeatedly discussed this so-called alternative medicine (SCAM). It involves meditative movements rooted in both Traditional Chinese Medicine and the martial arts. Tai chi was originally aimed at enhancing mental and physical health; today it has become a popular alternative therapy.

This systematic review assessed the efficiency of tai chi (TC) in different populations’ cognitive function improvement.  Randomized controlled trials (RCTs) published from the beginning of coverage through October 17, 2020 in English and Chinese were retrieved from many indexing databases. Selected studies were graded according to the Cochrane Handbook for Systematic Reviews of Intervention 5.1.0. The outcome measures of cognitive function due to traditional TC intervention were obtained. Meta-analysis was conducted by using RevMan 5.4 software. We follow the PRISMA 2020 guidelines.

Thirty-three RCTs, with a total of 1808 participants, were included. The results showed that TC can progress global cognition when assessed in middle-aged as well as elderly patients suffering from cognitive and executive function impairment. The findings are as follows:

  • Montreal Cognitive Assessment Scale: mean difference (MD) = 3.23, 95% CI = 1.88-4.58, p < 0.00001,
  • Mini-Mental State Exam: MD = 3.69, 95% CI = 0.31-7.08, p = 0.03,
  • Trail Making Test-Part B: MD = -13.69, 95% CI = -21.64 to -5.74, p = 0.0007.

The memory function of older adults assessed by the Wechsler Memory Scale was as follows: MD = 23.32, 95% CI = 17.93-28.71, p < 0.00001. The executive function of college students evaluated by E-prime software through the Flanker test was as follows: MD = -16.32, 95% CI = -22.71 to -9.94, p < 0.00001.

The authors concluded that TC might have a positive effect on the improvement of cognitive function in middle-aged and elderly people with cognitive impairment as well as older adults and college students.

These days, I easily get irritated with such conclusions. That TC might improve cognitive function is obvious. If not, there would be no reason to do a review! But does it?

This paper does not provide an answer. All it shows is that TC trials are of lousy quality and that the observed effects might well be due not to TC itself by to non-specific effects.

On this blog and elsewhere, I have heard many strange arguments against COVID-19 vaccinations. I get the impression that most proponents of so-called alternative medicine (SCAM) hold or sympathize with such notions. Here is a list of those arguments that have come up most frequently together with my (very short) comments:

COVID is not dangerous

It’s just a flu and nothing to be really afraid of, they say. Therefore, no good reason exists for getting vaccinated. This, I think, is easily countered by pointing out that to date about 5.5 million people have died of COVID-19. In addition, I fear that the issues of ‘long-COVID’ is omitted in such discussions

It’s only the oldies who die

As an oldie myself, I find this argument quite distasteful. More importantly, it is simply not correct.

Vaccines don’t work

True they do not protect us 100% from the infection. But they very dramatically reduce the likelihood of severe illness or death from COVID-19.

Vaccines are unsafe

We have now administered almost 10 billion vaccinations worldwide. Thus we know a lot about the risks. In absolute terms, there is a vast amount of cases, and it would be very odd otherwise; just think of the rate of nocebo effects that must be expected. However, the risks are mostly minor, and serious ones are very rare. Some anti-vaxxers predicted that, by last September, the vaccinated population would be dead. This did not happen, did it? The fact is that the benefits of these vaccinations hugely outweigh the risks.

Vaccines are a vicious tracking system

Some claim that ‘they‘ use vaccines to be able to trace the vaccinated people. Who are ‘they‘, and why would anyone want to trace me when my credit card, mobile phone, etc. already could do that?

Vaccines are used for population control

They‘ want to reduce the world population through deadly vaccines to ~5 billion, some anti-vaxxers say. Again, who are ‘they‘ and would ‘they‘ want to do that? Presumably ‘they‘ need us to pay taxes and buy their goods and services.

There has not been enough research

If those who make this argument would bother to go on Medline and look for COVID-related research, they might see how ill-informed this argument is. Since 2021, more than 200 000 papers on the subject have emerged.

I trust my immune system

This is just daft. I am triple-vaccinated and also hope that I can trust my immune system – this is why I got vaccinated in the first place. Vaccinations rely on the immune system to work.

It’s all about making money

Yes, the pharma industry aims to make money; this is a sad reality. But does that really mean that their products are useless? I don’t see the logic here.

People should have the choice

I am all for it! But if someone’s poor choice endangers my life, I do object. For instance, I expect other people not to smoke in public places, stop at red traffic lights and drive on the correct side of the street.

Most COVID patients in hospitals have been vaccinated

If a large percentage of the population has been vaccinated and the vaccine conveys not 100% protection, it would be most surprising, if it were otherwise.

I have a friend who…

All sorts of anecdotes are in circulation. The thing to remember here is that the plural of anecdote is anecdotes and not evidence.

SCAM works just as well

Of course, that argument had to be expected from SCAM proponents. The best response here is this: SHOW ME THE EVIDENCE! In response SCAM fans have so far only been able to produce ‘studies’ that are unconvincing or outright laughable.

In conclusion, the arguments put forward by anti-vaxxers or vaccination-hesitant people are rubbish. It is time they inform themselves better and consider information that originates from outside their bubble. It is time they realize that their attitude is endangering others.

 

I came across this article via a German secondary report about it entitled “Scientists discover what else protects from severe symptoms” (Forscher finden heraus, was noch vor schweren Symptomen schützt). The article rightly stressed that vaccination is paramount and then explains that, once you have caught COVID, nutrition can prevent serious symptoms.

Even though I rarely discuss standard nutritional issues on my blog (nutrition belongs to mainstream not so-called alternative medicine [SCAM], in my view), this subject did attract my attention. Here are the essentials of the original scientific paper:

Australian scientists studied the association between habitual frequency of food intake of certain food groups during the COVID-19 pandemic and manifestations of COVID-19 symptoms in adult outpatients with suspected SARS-CoV-2 infection. They included 236 patients who attended an outpatient clinic for suspected COVID-19 evaluation. Severity of symptoms, habitual food intake frequency, demographics and Bristol chart scores were obtained before diagnostic confirmation with real-time reverse transcriptase PCR using nasopharyngeal swab.

The results of the COVID-19 diagnostic tests were positive for 103 patients (44%) and negative for 133 patients (56%). In the SARS-CoV-2-positive group, symptom severity scores had significant negative correlations with the habitual intake frequency of specific food groups. Multivariate binary logistic regression analysis adjusted for age, sex, and occupation confirmed that SARS-CoV-2-positive patients showed a significant negative association between having higher symptom severity and the habitual intake frequency of legumes and grains, bread, and cereals.

The authors concluded that an increase in habitual frequency of intake of ‘legumes’, and ‘grains, bread and cereals’ food groups decreased overall symptom severity in patients with COVID-19. This study provides a framework for designing a protective diet during the COVID-19 pandemic and also establishes a hypothesis of using a diet-based intervention in the management of SARS-CoV-2 infection, which may be explored in future studies.

So, the authors seem to think that they found a causal relationship: A CHANGE IN DIET DECREASES SYMPTOMS. In different sections of the article, they seem to confirm this notion, and they state that they tested the hypothesis of the effect of diet on SARS-CoV-2 infection symptom severity.

Yey, the investigation was merely a correlative study that cannot establish cause and effect. There are many other variables that might be linked to dietary habits which could be the true cause of the observed phenomenon (or contributors to it).

What’s the harm? If the article makes people adopt a healthier diet, all is pukka!

Perhaps, in this case, that might be true (even though one could argue that this paper might support anti-vax notions arguing that vaccination is not important if it is possible to prevent severe symptoms through dietary changes). But the confusion of correlation with causality is both frequent and potentially harmful. And it is unquestionably poor science!

I feel that we need to be concerned about the fact that even reputable journals let such things pass – not least because the above example shows what the popular press subsequently can make of such misleading messages.

 

We all need cheering up a bit, I’m sure.

Luckily, I found just the thing.

The New York Post reported that a former Versace model, Tom Casey, is crediting his youthful looks to drinking his own urine, and to perineum sunning (exposing your butt hole to sunshine). “I drink my own urine every morning — I call it hair of the dog!” Casey proclaimed, “the feeling is electric.” The ex-model also flushes his urine into his rectum and applies it to his skin as a moisturizer. 

“It wasn’t as bad as the mental barrier in my own mind,” the ex-catwalk star reminisced. “I felt a cool buzz. Intuitively, it just felt good. I drank my urine on and off for a while from there.”

Casey began drinking his own urine on a daily basis back in 2008 and hasn’t looked back. He has even completed a “seven-day urine fast,” drinking nothing but his own urine for an entire week. He also bottles his pee, lets it “ferment” and uses it in an enema. “I would cultivate my own urine and ferment it in a sealed Mason jar for two weeks before transferring it into my rectum,” he explained. “Aged urine enemas are so powerful for your health and I got my six-pack abs after doing them. It flushed out my gut and that’s when I got really ripped.”

Casey uses his urine also as a moisturizer, which he believes helps maintain his appearance. “What it did for my mood and muscle building was amazing. I put it on my skin, especially when I’m on the beach, and it’s so electrifying and strengthening,” he cooed. “It’s a big psychological leap for people to use their own urine as a moisturizer but it’s so euphoric and anti-aging. Uric acid is used in high-end skin care products.”

“I’m 55 years old and most people don’t look and feel like I do at my age. No one can deny that I’m ripped, and that’s down to the fact that I love being extremely healthy and practicing natural healing methods.”

Casey claims Big Pharma is terrified of people learning that the secret to their health lies within themselves.

“What so many pharmaceutical companies don’t want to tell you is that we as humans are the secret to health. That’s what I try to teach people in everything I do,” he stated.

“People should be scared if they’re eating s–tty food and doing pharmaceutical drugs. Why should they be scared to try their own urine?”

____________________________

Personally, I feel that Casey believes the sun might be shining out of his arse. In any case, it is hard to deny that the former Versace model is suffering from proctophasia and/or is taking the piss.

This study assessed the effectiveness of Oscillococcinum in the protection from upper respiratory tract infections (URTIs) in patients with COPD who had been vaccinated against influenza infection over the 2018-2019 winter season.

A total of 106 patients were randomized into two groups:

  • group V received influenza vaccination only
  • group OV received influenza vaccination plus Oscillococcinum® (one oral dose per week from inclusion in the study until the end of follow-up, with a maximum of 6 months follow-up over the winter season).

The primary endpoint was the incidence rate of URTIs (number of URTIs/1000 patient-treatment exposure days) during follow-up compared between the two groups.

There was no significant difference in any of the demographic characteristics, baseline COPD, or clinical data between the two treatment groups (OV and V). The URTI incidence rate was significantly higher in group V than in group OV (2.9 versus 1.2 episodes/1000 treatment days, difference OV-V = -1.7; p=0.0312). There was a significant delay in occurrence of an URTI episode in the OV group versus the V group (mean ± standard error: 48.7 ± 3.0 versus 67.0 ± 2.8 days, respectively; p=0.0158). Limitations to this study include its small population size and the self-recording by patients of the number and duration of URTIs and exacerbations.

The authors concluded that the use of Oscillococcinum in patients with COPD led to a significant decrease in incidence and a delay in the appearance of URTI symptoms during the influenza-exposure period. The results of this study confirm the impact of this homeopathic medication on URTIs in patients with COPD.

Primary endpoint, comparison of the number of upper respiratory tract infections in the two treatment groups during follow-up

This prospective, randomized, single-center study was funded by Laboratoires Boiron, was conducted in the Pneumology Department of Charles Nicolle Hospital, Tunis, and was written up by a commercial firm specializing in writing for the pharmaceutical industry. The latter point may explain why it reads well and elegantly glosses over the many flaws of the trial.

If I did not know better, I might suspect that the study was designed to deceive us (Boiron would, of course, never do this!): The primary endpoint was the incidence rate of URTIs (number of URTIs/1000 patient-treatment exposure days) in the two groups during the follow-up period. This rate is calculated as the number of episodes of URTIs per 1000 days of follow-up/treatment exposure. The rates were then compared between the OV and V groups. The following symptoms were considered indicative of an URTI: fever, shivering, runny or blocked nose, sneezing, muscular aches/pain, sore throat, watery eyes, headaches, nausea/vomiting, diarrhoea, fatigue and loss of appetite.

This means that there was no verification whatsoever of the primary endpoint. In itself, this flaw would perhaps not be so bad. But put it together with the fact that patients were not blinded (there were no placebos!), it certainly is fatal.

In essence, the study shows that patients who perceive to receive treatment will also perceive to have fewer URTIs.

SURPRISE, SURPRISE! 

Open-label placebos (OLPs) are placebos without deception in the sense that patients know that they are receiving an inert sugar pill with no activity of its own. Intuitively, we think that such treatments must be ineffective. Yet, there have been several studies that seemed to show otherwise.

The objective of this paper was to systematically review and analyze the effect of OLPs in comparison to no treatment in clinical trials. A systematic literature search was carried out in February 2020. Randomized controlled trials of any medical condition or mental disorder comparing OLPs to no treatment were included. Data extraction and risk of bias rating were independently assessed. 1246 records were screened and 13 studies were included in the systematic review. Eleven trials were eligible for meta-analysis.

These trials assessed the effects of OLPs on

  • back pain,
  • cancer-related fatigue,
  • attention deficit hyperactivity disorder,
  • allergic rhinitis,
  • major depression,
  • irritable bowel syndrome,
  • menopausal hot flushes.

The risk of bias was moderate among all studies.

Click to enlarge.

A significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I2 = 76%) of OLP. Thus, OLPs appear to be a promising treatment in different conditions. Yet, the researchers spotted several caveats and discuss them in some detail.

First, we detected hints of a publication bias in the study sample, but the respective test was not significant. The quantitative basis of the meta-analysis is based on a small number of studies, reflecting the early state of research in this field. Moreover, the set of studies showed some heterogeneity. Finally, four studies were rated to have a high risk of bias, and nine to have some concerns.

In order to assess the impact of these high-risk studies we performed an exploratory best-evidence synthesis. We excluded the four studies with a high risk of bias. In this analysis, the heterogeneity could be reduced to a non-critical value and almost all variance in the set of studies could be explained by a sampling error (I2 = 4%). With the exclusion of these four studies the mean effect size was reduced to a more conservative SMD = 0.49.

Regardless of this reduction of the overall effect, the same conclusions about the treatment-effect of OLPs can be drawn, although the lack of robustness means that interpretations require some caution. The decrease of heterogeneity shows that methodological impairments might be responsible for the considerable unexplained variance in our results. We abstained from carrying out a further sensitivity analysis for explaining heterogeneity because of the small number of studies.

This is certainly an interesting subject. And the above findings are certainly counter-intuitive.

My impression is that the effect of OLPs is small and of doubtful value in clinical practice. My prediction is that, as more and better research emerges, it will diminish further, if not vanish totally. I think that there are several reasons for this:

  • The number of trials is still quite small.
  • The studies obviously lack patient blinding.
  • Positive messages can be included alongside open-label placebos.
  • The “time lag bias” is high.

This type of bias means that, due to initial enthusiasm in a new subject, negative results are published with some delay. I have observed this bias repeatedly in the past. A new treatment initially tends to generate nothing but positive results, and only after a while, when the researchers’ euphoria has subsided, more realistic findings emerge.

Yesterday, it was reported that one of Austria’s best-known opponents of vaccination has died as a result of coronavirus infection. He vehemently refused treatment in hospital. Instead, he insisted on treating himself – and tragically, he is not an isolated case.

Miracle Mineral Solution” (MMS) is being promoted as a treatment for all kinds of diseases – including, of course, the coronavirus. But MMS is nothing more than the bleach and disinfectant chlorine dioxide, or CDL for short. It made headlines when Donald Trump suggested it as a remedy against Covid-19. Subsequently, CDL became highly popular amongst the anti-vax brigade.

Johann Biacsics was one of the leading figures of the anti-vaccination scene in Austria. On 11 November, he was seen in a Vienna hospital with an acute corona infection. At this stage, he had already taken chlorine dioxide because of fever complaints. Biacsics was, of course, not vaccinated and refused treatment. He was firmly convinced that he had already overcome the infection thanks to his treatment with chlorine dioxide.

The senior physician at the Vienna hospital saw things differently. His condition was “life-threatening”, she said. But instead of accepting treatment in hospital, Biacsics discharged himself and said he would rather treat himself. Once home, Biacsics put in an IV line with chlorine dioxide and sodium chloride. Two days later he was dead.

Only two weeks before his death, Biacsics had demonstrated in Vienna against the Austrian Corona measures. In a television interview from September, he can be seen in front of the parliament. “There are mainly vaccinated people in the intensive care units. 67 percent of them are vaccinated,” he said on camera at the time. When the reporter corrected him, he only replied that he had “inside information”.

His followers are now suggesting that he was poisoned. And for once they are, of course, correct. He basically poisoned himself with MMS. His family, meanwhile, blames the hospital and claim that he did not die of COVID, nor that Biacsics’ death is the result of treatment with chlorine dioxide.

Biacsics is not the first Austrian Covid patient who has refused treatment or used “alternative remedies”. And he is not the first who has died as a result. Self-treatment is booming among vaccination opponents and Corona deniers. It was even propagated in the Austrian parliament. For weeks, FPÖ leader Herbert Kickl (who also is COVID-positive) and his party colleagues have been promoting the deworming drug ivermectin – despite warnings from doctors, scientists, and the manufacturer.

All too often, the consequences are fatal: In Styria, two patients died from poisoning with ivermectin, in the district of Rohrbach in Upper Austria, a Corona patient left the intensive care unit in critical condition and died. He had also relied on ivermectin and refused other treatments.

 

Conspiracy beliefs are associated with detrimental health attitudes during the coronavirus pandemic. Prior research on these issues was mostly cross-sectional, however, and restricted to attitudes or behavioral intentions. This investigation was designed to examine to what extent conspiracy beliefs predict health behavior and well-being over a longer period of time.

In this multi-wave study on a large (N = 5745) Dutch research panel (weighted to provide nationally representative population estimates), the researchers examined if conspiracy beliefs early in the pandemic (April 2020) would predict a range of concrete health and well-being outcomes eight months later (December 2020).

The results revealed that Covid-19 conspiracy beliefs prospectively predicted a decreased likelihood of getting tested for corona; if tested, an increased likelihood of the test coming out positive; and, an increased likelihood of having violated corona regulations, deteriorated economic outcomes (job loss; reduced income), experiences of social rejection, and decreased overall well-being. Most of these effects generalized to a broader susceptibility to conspiracy theories (i.e. conspiracy mentality).

The authors concluded that conspiracy beliefs are associated with a myriad of negative life outcomes in the long run. Conspiracy beliefs predict how well people have coped with the pandemic over a period of eight months, as reflected in their health behavior, and their economic and social well-being.

These findings tie in with another recent study that investigated whether individual beliefs and personal characteristics differences affect people’s likelihood of contracting COVID-19. In the early months of the pandemic, U.S. participants responded to a variety of individual difference measures as well as questions specific to the pandemic itself. Four months later, 2120 of these participants were asked whether they had contracted COVID-19. Nearly all of the included individual difference measures significantly predicted whether a person reported testing positive for the virus in this four-month period. Additional analyses revealed that all of these relationships were primarily mediated by whether participants held accurate knowledge about COVID-19.

I find it hard not to despair vis a vis such results. Not that they were not to be expected – if you ignore the existence of risk factors exist for heart attacks, it seems plausible that your likelihood of dying of myocardial infarction is increased. What is particularly desolating are two facts:

  • This pandemic seems to have rendered the voices of stupidity and ignorance loud and popular, even fashionable.
  • Those lunatics who adhere to conspiracy beliefs harm not merely themselves but endanger all of us.

I ask myself how we will ever get past this new age of unreason.

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