charlatan
Newsweek recently reported that a herbalist has been charged with the death of a 13-year-old diabetic boy. Allegedly, the therapist replaced the boy’s insulin with herbal remedies. Tim Morrow, 83, was charged with
- child abuse causing death
- and with practicing medicine without a license.
Morrow stated that god had guided him to use herbs rather than conventional medicine and that he successfully treated treat his own prostate cancer in this way. Marrow can be seen on multiple YouTube videos from his ‘University of Common Sense’ promoting his bizarre ideas of health and disease.
Perhaps god also guided Marrow to make lots of money? He runs regular seminars and a thriving herbal on-line business, the ‘Common Sense Herbal Products‘. There are few ailments, for which ‘Common Sense Herbal Products’ do not seem to offer a herbal cure.
One of the remedies, ‘Pancreas Reg‘, for instance, claims to “act as natural insulin”. The 270 Tablets tub of this product costs US $74.22. It is easy to see, I find, how bold claims attract gullible customers depriving them not just of their money but also of their health.
Morrow started treating the boy suffering from Type 1 diabetes after he met his mother at one of his seminars. When the boy subsequently became semi-comatose, Morrow told his parents to treat their son with his herbal remedies rather than insulin which had been prescribed by qualified medical doctors. The boy, Edgar L., died only hours later. There is little doubt that he would have survived, if he had undergone conventional treatment, the medical examiner concluded.
“The allegations in this case underscore the serious health and safety risks of taking medical advice from someone who lacks a license and the proper training that goes with it,” the medical examiner said in a statement. “No family should have to suffer the tragedy of losing a child because of irresponsible, un-credentialed medical advice.”
On this blog, during lectures etc., I often stress that by far the biggest danger of seemingly harmless alternative therapies is that they are used to replace effective treatments for serious conditions. Diabetes is such a condition, and there are numerous instances where the advice of incompetent practitioners has endangered the lives of diabetics.
Three examples will have to suffice as examples of the plethora of such unethical neglect:
- “In homeopathy, diabetes is seen as a reflection of the body’s inability to function optimally. There is an imbalance that results in the body’s incapacity to effectively utilize the insulin that it produces, or to produce sufficient insulin for its needs. While symptoms often disappear after conventional treatment, the vital force does not. Homoeopathy can be used effectively in the treatment of diabetes. Here we mainly concentrate on functioning of the pancreas in efficient insulin production. The metabolic condition of a patient suffering from diabetes requires both therapeutic and nutritional measures to correct the illness. Homeopathy can regulate sugar metabolism while helping to resolve the metabolic disturbances that lead to diabetes. Furthermore, homeopathy helps stimulate the body’s self-healing powers in order to prevent complications such as open leg sores and other dysfunctions of the blood vessel, loss of vision, kidney failure. Homeopathic treatment does not target one illness, an organ, a body part or a symptom. Remedies are prescribed based on an assembly of presenting symptoms, their stresses in life.”
- “Management of Blood sugar. The commonly used remedies are Uranium Nitricum, Phosphoric Acid, Syzygium Jambolanum, Cephalandra Indica etc. These are classical Homeopathic remedies. These are used in physiologically active doses such as Mother tincture, 3x etc. depending up on the level of the blood sugar and the requirement of the patient. Several pharmaceutical companies have also brought in propriety medicines with a combination of the few Homeopathic medicines. Biochemic remedies which is a part of Homeopathy advocates Biocombination No 7 as a specific for Diabetes. Another Biochemic medicine Natrum Phos 3x is widely used with a reasonable success in controlling the blood sugar. Scientific studies on the impact of homeopathic medicines in bringing down blood sugar are limited, but many of the above remedies have some positive effects either as a stand-alone remedy or as an adjunct along with other medications.”
- “Modern medicine has no permanent cure for diabetes but alternative medicines like yoga ,mudra,ayurveda is very useful to control and even cure diabetes.Ayurveda is an alternative medicine to cure diabetes.”
But these are very rare instances!!!
That’s what apologists usually respond.
Yet, the truth is that NOBODY knows how often such harm occurs.
Why?
There is no monitoring system anywhere that would provide such information.
The ‘best homeopathy doctor in Delhi‘ is so ‘marvellous’ that he and his colleagues offer homeopathic treatment for HIV/AIDS:
START OF QUOTE
Antiretroviral Therapy (ART) is recommended for each and every case of AIDS where CD4 count goes less than 350. Aura Homeopathy does not offer cure for AIDS. However, several research and clinical studies done by various Research centre including few from CCRH (Central Council for Research in Homeopathy, Govt. of India), have prove the supportive role of homeopathic medicines. Homeopathy medicine only relief symptoms but also reduced frequency of opportunistic infections, increase appetite, weight, and sense of well being, etc. At Aura Homeopathy, we apply classical homeopathy protocols on HIV/AIDS patients, as a part of our Clinical trial and Research projects. The results were very encouraging.
At Aura Homeopathy, we have seen an increase in the CD4 count in number of patients, after using Aura homeopathy medicines. Dr.Abhishek recommend’s Homeopathy as supporting line of therapy for all HIV patients.
END OF QUOTE
When I read this I wanted to be sick; but instead I did something a little more sensible: I conducted a quick Medline search for ‘homeopathy, AIDS’.
It returned 30 articles. Of these, there were just 4 that presented anything remotely resembling data. Here are their abstracts:
Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine and homeopathy (TIMH), which is used by up to two-thirds of its population to help meet primary health care needs, particularly in rural areas. India has an estimated 2.5 million HIV infected persons. However, little is known about TIMH use, safety or efficacy in HIV/AIDS management in India, which has one of the largest indigenous medical systems in the world. The purpose of this review was to assess the quality of peer-reviewed, published literature on TIMH for HIV/AIDS care and treatment.
Of 206 original articles reviewed, 21 laboratory studies, 17 clinical studies, and 6 previous reviews of the literature were identified that covered at least one system of TIMH, which includes Ayurveda, Unani medicine, Siddha medicine, homeopathy, yoga and naturopathy. Most studies examined either Ayurvedic or homeopathic treatments. Only 4 of these studies were randomized controlled trials, and only 10 were published in MEDLINE-indexed journals. Overall, the studies reported positive effects and even “cure” and reversal of HIV infection, but frequent methodological flaws call into question their internal and external validity. Common reasons for poor quality included small sample sizes, high drop-out rates, design flaws such as selection of inappropriate or weak outcome measures, flaws in statistical analysis, and reporting flaws such as lack of details on products and their standardization, poor or no description of randomization, and incomplete reporting of study results.
This review exposes a broad gap between the widespread use of TIMH therapies for HIV/AIDS, and the dearth of high-quality data supporting their effectiveness and safety. In light of the suboptimal effectiveness of vaccines, barrier methods and behavior change strategies for prevention of HIV infection and the cost and side effects of antiretroviral therapy (ART) for its treatment, it is both important and urgent to develop and implement a rigorous research agenda to investigate the potential risks and benefits of TIMH and to identify its role in the management of HIV/AIDS and associated illnesses in India.
2nd paper (I am a co-author of this one)
The use of complementary and alternative medicine (CAM) is widespread. Yet, little is known about the evidence supporting its use in HIV/AIDS. We conducted a systematic review of randomized clinical trials assessing the effectiveness of complementary therapies for HIV and HIV-related symptoms. Comprehensive literature searches were performed of seven electronic databases. Data were abstracted independently by two reviewers. Thirty trials met our predefined inclusion/exclusion criteria: 18 trials were of stress management; five of Natural Health Products; four of massage/therapeutic touch; one of acupuncture; two of homeopathy. The trials were published between 1989 and 2003. Most trials were small and of limited methodological rigour. The results suggest that stress management may prove to be an effective way to increase the quality of life. For all other treatments, data are insufficient for demonstrating effectiveness. Despite the widespread use of CAM by people living with HIV/AIDS, the effectiveness of these therapies has not been established. Vis à vis CAM’s popularity, the paucity of clinical trials and their low methodological quality are concerning.
3rd paper (author is our old friend Dana Ullman!)
Homeopathic medicine developed significant popularity in the nineteenth century in the United States and Europe as a result of its successes treating the infectious disease epidemics during that era. Homeopathic medicine is a medical system that is specifically oriented to using nanopharmacologic and ultramolecular doses of medicines to strengthen a person’s immune and defense system rather than directly attacking the microbial agents.
To review the literature referenced in MEDLINE and in nonindexed homeopathic journals for placebo-controlled clinical trials using homeopathic medicines to treat people with AIDS or who are human immunodeficiency virus (HIV)-positive and to consider a different theoretical and methodological approach to treating people with the viral infection.
A total of five controlled clinical trials were identified. A double-blinded, placebo-controlled study was conducted on 50 asymptomatic HIV-positive subjects (stage II) and 50 subjects with persistent generalized lymphadenopathy (stage III) in whom individualized single-remedy homeopathic treatment was provided. A separate body of preliminary research was conducted using homeopathic doses of growth factors. Two randomized double-blinded, placebo-controlled studies were conducted with a total of 77 people with AIDS who used only natural therapies over a 8-16-week period. Two other studies were conducted over a 2.5-year period with 27 subjects in an open-label format.
The first study was conducted by the Regional Research Institute for Homeopathy in Mumbai, India, under the Central Council for Research in Homeopathy, with the approval of the Ministry of Health and Family Welfare, Government of India. The second body of studies was conducted in clinic settings in California, Oregon, Arizona, Hawaii, New York, and Washington.
The first study found no statistically significant improvement in CD4 T-lymphocytes, but did find statistically significant pretest and post-test results in subjects with stage III AIDS, in CD4 (p = 0.008) and in CD8 (p = 0.04) counts. The second group of studies found specific physical, immunologic, neurologic, metabolic, and quality-of-life benefits, including improvements in lymphocyte counts and functions and reductions in HIV viral loads.
As a result of the growing number of people with drug-resistant HIV infection taking structured treatment interruptions, homeopathic medicine may play a useful role as an adjunctive and/or alternative therapy.
In 1996, [name removed] was convicted on charges of conspiracy and introducing an unapproved drug into interstate commerce and the 2nd U.S. Circuit Court of Appeals upheld the conviction. [Name removed]’s company, Writers and Researchers Inc. sold a drug called 714X to individuals and physicians, promoting it as a nontoxic therapy for AIDS, cancer, and other chronic diseases. The Food and Drug Administration (FDA) warned [name removed] that his marketing was illegal because the product had not been proven safe and effective for use in treating disease. [Name removed] argued that the product was a homeopathic drug, revealed by FDA tests to contain 94 percent water, and a mixture of nitrate, ammonium, camphor, chloride, ethanol, and sodium. The courts found that 714X was subject to FDA scrutiny because it was touted as a cure for cancer and AIDS.
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So, what does this collective evidence tell us?
I think it makes it abundantly clear that there is no good reason to suggest that HIV/AIDS patients can be helped in any way by homeopathy. On the contrary, homeopathy might distract them from essential conventional care and it would needlessly harm their bank balance. It follows that claims to the contrary are bogus, unethical, reckless, and possibly even criminal.
Clinical trials are a most useful tool, but they can easily be abused. It is not difficult to misuse them in such a way that even the most useless treatment appears to be effective. Sadly, this sort of thing happens all too often in the realm of alternative medicine. Take for instance this recently published trial of homeopathy.
The objective of this study was to investigate the usefulness of classical homeopathy for the prevention of recurrent urinary tract infections (UTI) in patients with spinal cord injury (SCI). Patients were admitted to this trial, if they had chronic SCI and had previously suffered from at least three UTI/year. They were treated either with a standardized prophylaxis alone, or with a standardized prophylaxis in combination with homeopathy. The number of UTIs, general and specific quality of life (QoL), and satisfaction with homeopathic treatment were assessed prospectively over the period of one year. Ten patients were in the control group and 25 patients received adjunctive homeopathic treatment. The median number of self-reported UTI in the homeopathy group decreased significantly, whereas it remained unchanged in the control group. The domain incontinence impact of the KHQ improved significantly, whereas the general QoL did not change. The satisfaction with homeopathic care was high.
The authors concluded that adjunctive homeopathic treatment lead to a significant decrease of UTI in SCI patients. Therefore, classical homeopathy could be considered in SCI patients with recurrent UTI.
Where to begin?
Here are just some of the most obvious flaws of and concerns with this study:
- There is no plausible rationale to even plan such a study.
- The sample size was far too small for allowing generalizable conclusions.
- There was no adequate randomisation and patients were able to chose the homeopathy option.
- The study seems to lack objective outcome measures.
- The study design did not allow to control for non-specific effects; therefore, it seems likely that the observed outcomes are unrelated to the homeopathic treatments but are caused by placebo and other non-specific effects.
- Even if the study had been rigorous, we would need independent replications before we draw such definitive conclusions.
- Two of the authors are homeopaths, and it is in their clinics that the study took place.
- Some of the authors have previously published a very similar paper – except that this ‘case series’ included no control group at all.
- The latter paper seems to have been published more than once.
- Of this paper, one of the authors claimed that ” the usefulness of classical homeopathy as an adjunctive measure for UTI prophylaxis in patients with NLUTD due to SCI has been demonstrated in a case series”. He seems to be unaware of the fact that a case series cannot possible lend itself to demonstrate this.
- I do wonder: did they just add a control group to their case series thus pretending it became a controlled clinical trial?
What strikes me most with such pseudo-research is its abundance and the naivety – or should I call it ignorance? – of the enthusiasts who conduct it. Most of them, I am fairly sure do not mean to do harm; but by Jove they do!
Yesterday, I saw a Tweet stating:
Homeopath in Cornwall specialising in Women’s Health #fertility #naturalconception #pcos #pms
It was followed by a list of specific indications:
- Pregnancy
- Infertility
- PCOS
- PMS
- Fibroids
- Depression
- Anxiety and much more…
I responded to this Tweet by tweeting:
Homeopath in Cornwall specialising in misleading women
Minutes later I received a response from a homeopathy-fan:
That could be called libel Edzard. I would be careful.
So, should I be careful, and if so why?
Reading the thinly veiled threat, I wasn’t exactly shaking in my boots with fear (I was deeply involved in helping Simon Singh in his defence against the BCA’s libel action), but I nevertheless wanted to be sure of my position and conducted some ‘rough and ready’ searches for recent evidence to suggesting that homeopathy is effective for any of the conditions mentioned above. Here is what I found:
- Pregnancy. Yes, there is an RCT! It concluded that “homeopathy does not appear to prevent excessive body mass gain in pregnant women…” And another one concluding that “neither Pentazocine, or Chamomilla recutita offer substantial analgesia during labor.”
- Infertility. No RCT or other sound evidence.
- PCOS. Nothing
- PMS. No clinical trials.
- Fibroids. No clinical trials
- Depression. Even leading homeopaths seem to agree that there is no good evidence.
- Anxiety. Again, I could not find any sound evidence.
Don’t get me wrong, these statements are not based on full systematic reviews; that would take a while and hardly seems worth it. (If you want a good systematic review, I recommend this one; it concluded: “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.“) But my quick glance at the evidence is enough, I think, to justify my statement that the above claims by a homeopath are misleading. In fact, I believe that I could have used much stronger terminology without the slightest risk of being sued.
PERHAPS NEXT TIME!
A friend recently sent me the link to a video about ‘FUNCTIONAL CRANIAL RELEASE’ (well-worth watching, particularly, if you need cheering up) and when I heard a patient after the treatment exclaim: “kind’a like an orgasm”, I needed no further convincing; I just had to look into this extraordinary and little-known jewel of an alternative therapy.
If you watched the video, you might think FCR is simply pumping some air up your nostrils, but you are wrong: it is much more, and it is very scientific!
Functional Cranial Release (FCR) is the art and science of restoring normal brain and nervous system function by using Functional Neurology along with NeuroCranial Restructuring to improve the brain’s ability to function better. FCR was created by Dr. John Lieurance who currently practices in Sarasota, Florida. Dr Timothy Lim was personally trained by Dr John Lieurance and now offers FCR or Functional Cranial Release in Singapore. We have clients who fly in from all over the South East Asia and Oceania regions just to receive FCR treatment.
Functional Cranial Release‘s (FCR) unique system improves the body’s function in the following ways:
- Restores the brain’s ability to oxygenate itself through both improving air flow through the nasal passage and also the normal pumping action inherent in cranial rhythm that moves nutrients such as oxygen and neurotransmitters that bath the central nervous system keeping it healthy.
- Utilizes neurological testing to determine which pathways and brain centers are either firing too much or too little by testing the following; Examination of your eye’s movements and reflexes, your muscles or motor system, the autonomic nervous system, your circulation, your sensory system, the vestibular system (or) your ability to balance [repeatedly using a computerized balance platform]. Adjusting those pathways through the specific use of various modalities including one or more of the following; Very Specific Chiropractic Adjustments of the spine, extremities, and cranium, Soft Tissue or Massage, Eye Pattern & Eye Exercises, Canalith Repositioning (or) Eply’s, Vestibular Rehabilitative Modalities or VRT, and many others too numerous to list. The modalities used depend on the specific needs of each patient.
- A series of Cranial Releases are performed where the connective tissues that surround your brain and spinal cord called the Dura Mater are specifically released using endonasal balloon inflations. This is done in combination with the above mentioned functional neurologic modalities to provide the therapeutic effect to balance and normalize brain function. This normalization results in healing.
I bet you now wonder who this fabulous doctor Lieurance is. Wonder no more; he describes himself very well here:
Dr. John Lieurance, is a Naturopathic & Chiropractic Physician who has been in private practice in Sarasota for 20 years. He works at Advanced Rejuvenation, a multi-disciplinary clinic, with a focus on Chiropractic Functional Neurology, Functional Cranial Release (FCR), and musculoskeletal ultrasound.
It is easy to see that he is a real doctor, just look at his white coat and stethoscope!
And this website provides more valuable information about FCR:
Is FCR a Chiropractic adjustment ? Yes, FCR falls under the scope of Chiropractic care and is billed as a Chiropractic adjustment. If you are covered for Chiropractic care under your health insurance plan, then your FCR procedure will also be covered.
But what makes FCR so very attractive is that the list of conditions for which it is recommended is impressive and long; it even includes serious diseases such as Parkinson’s and stroke …
and don’t forget: ORGASM!!!
Yesterday, I received the following interesting tweet from my friend Natalie Grams:
Edzard, YOU are just influenced by ideological biases (they told me so yesterday – so it must be true;-)
If I understand it correctly, Natalie was a guest in a public discussion about homeopathy somewhere in Austria during which my name must have been mentioned, and some homeopath or homeopathy-fan made the above allegation about me. Sadly, I was not present (but it is typical that allegations against me are rarely made to me in person) to discuss it further.
I am very much used to allegations against me and, in a strange way, have even grown to enjoy them. Here are some of my favourites:
- I have undeclared ties to the pharmaceutical industry.
- I am incompetent or not even qualified.
- I was employed at Exeter to ditch alternative medicine.
- I have never done any original research.
- I sit in the ivory towers of academia.
- I have no clinical experience.
- I am basically a liar.
Even though they have been repeated ad nauseam, all of these accusations are untrue and have been refuted so often that I do not want to go into them again (for those interested, see for instance here, here, here and here).However, the allegation that I am ‘influenced by ideological biases’ is a new one, at least to me. And therefore, it might deserve some serious consideration.
Let’s start by getting our definitions straight:
- An ideology is a system of ideas and ideals.
- Bias is an inclination or prejudice for or against one person or group, especially in a way considered to be unfair.
Now let’s see how these two terms apply to me and my work.
- According to the definition above, I am clearly influenced by an ideology. Yes, I do have ideals! For instance, I believe in science, want to see sound evidence, hope to improve healthcare, insist that patients deserve the best treatments available, and feel that ethics are of paramount importance in healthcare.
- To make things worse, I am even proud of this ideology and I pity those who do not share it.
- What about bias? Do I hold a grudge against one person or a group of people? As I just stated, I pity those who do not share my ideals, and if I am brutally honest, I do not like charlatans, liars or entrepreneurs selling false hope.
- The question is whether this attitude is unfair. Personally, I do not believe it is, but I have to not deny that this is merely my perspective. There may be – and clearly are – other viewpoints.
So, to conclude this somewhat rambling post, I ready to admit that the Austrian homeopaths might have had a point:
FROM THE PERSPECTIVE OF A CHARLATAN, I PROBABLY DO SEEM TO BE INFLUENCED BY ‘IDEOLOGICAL BIASES’.
“MDs do not make false claims HAHAHA.”
This is from a comment I recently received on this blog.
It made me think.
Yes, of course, MDs do not always reveal the full truth to their patients; sometimes they might even tell lies (in this post, I shall use the term ‘lies’ for any kind of untruth).
So, what about these lies?
The first thing to say about them is obvious: THEY CAN NEVER JUSTIFY THE LIES OF OTHERS.
- the lies of the Tories cannot justify the lies of Labour party members,
- the lies of a plaintiff in court cannot justify any lies of the defendant,
- the lies of MDs cannot justify the lies of alternative practitioners.
The second thing to say about the lies of MDs is that, in my experience, most are told in the desire to protect patients. In some cases, this may be ill-advised or ethically questionable, but the motivation is nevertheless laudable.
- I might not tell the truth when I say (this really should be ‘said’, because I have not treated patients for many years) THIS WILL NOT HURT AT ALL. In the end, it hurt quite a bit but we all understand why I lied.
- I might claim that this treatment is sure to work (knowing full well that such a prediction is impossible), but we all know that I said so in order to maximise my patient’s compliance and expectation in order to generate the best possible outcome.
- I might dismiss a patient’s fear that his condition is incurable (while strongly suspecting that it is), but I would do this to improve his anxiety and well-being.
Yet, these are not the type of lies my commentator referred to. In fact, he provided a few examples of the lies MDs tell, in his opinion. He claimed that:
- They tell them that diabetes is not curable. False claim
- They compare egg intake with smoking on their affect to your health. False claim
- They say arthroscopic surgery of the knee is beneficial. False claim
- They state that surgery, chemo, and radiation is the only treatment for cancer. False claim
- They say that family association is the cause of most inflammatory conditions. False claim
I don’t want to go into the ‘rights or wrongs’ of these claims (mostly wrongs, as far as I can see). Instead, I would argue that any MD who makes a claim that is wrong behaves unethical and should retrain. If he erroneously assumes the claim to be correct, he is not fully informed (which, of course is unethical in itself) and needs to catch up with the current best evidence. If he makes a false claim knowing that it is wrong, he behaves grossly unethical and must justify himself in front of his professional disciplinary committee.
As this blog focusses on alternative medicine, let’s briefly consider the situation in that area. The commentator made his comments in connection to a post about chiropractic, so let’s look at the situation in chiropractic.
- Do many chiropractors claim to be able to treat a wide array of conditions without good evidence?
- Do they misadvise patients about conventional treatments, such as vaccinations?
- Do they claim that their spinal manipulations are safe?
- Do they tell patients they need regular ‘maintenance treatment’ to stay healthy?
- Do they claim to be able to diagnose subluxations?
- Do they pretend that subluxations cause illness and disease?
- Do they claim to adjust subluxations?
If you answered several of these questions with YES, I probably have made my point.
On reflection, it turns out that clinicians of all types do tell lies. Some are benign/white lies and others are fundamental, malignant lies. Most of us probably agree that the former category is largely negligible. The latter category can, however, be serious. In my experience, it is hugely more prevalent in the realm of alternative medicine. When it occurs in conventional medicine, appropriate measures are in place to prevent reoccurrence. When it occurs in alternative medicine, nobody seems to bat an eyelash.
My conclusion from these random thoughts: the truth is immeasurably valuable, and lies can be serious and often are damaging to patients. Therefore, we should always pursue those who tell serious lies, no matter whether they are MDs or alternative practitioners.
Sipjeondaebo-tang is an East Asian herbal supplement containing Angelica root (Angelicae Gigantis Radix), the rhizome of Cnidium officinale Makino (Cnidii Rhizoma), Radix Paeoniae, Rehmannia glutinosa root (Rehmanniae Radix Preparata), Ginseng root (Ginseng Radix Alba), Atractylodes lancea root (Atractylodis Rhizoma Alba), the dried sclerotia of Poria cocos (Poria cocos Sclerotium), Licorice root (Glycyrrhizae Radix), Astragalus root (Astragali Radix), and the dried bark of Cinnamomum verum (Cinnamomi Cortex).
But does this herbal mixture actually work? Korean researchers wanted to find out.
The purpose of their study was to examine the feasibility of Sipjeondaebo-tang (Juzen-taiho-to, Shi-Quan-Da-Bu-Tang) for cancer-related anorexia. A total of 32 participants with cancer anorexia were randomized to either Sipjeondaebo-tang group or placebo group. Participants were given 3 g of Sipjeondaebo-tang or placebo 3 times a day for 4 weeks. The primary outcome was a change in the Anorexia/Cachexia Subscale of Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The secondary outcomes included Visual Analogue Scale (VAS) of anorexia, FAACT scale, and laboratory tests.
The results showed that anorexia and quality of life measured by FAACT and VAS were improved after 4 weeks of Sipjeondaebo-tang treatment. However, there was no significant difference between changes of Sipjeondaebo-tang group and placebo group.
From this, the authors of the study concluded that sipjeondaebo-tang appears to have potential benefit for anorexia management in patients with cancer. Further large-scale studies are needed to ensure the efficacy.
Well, isn’t this just great? Faced with a squarely negative result, one simply ignores it and draws a positive conclusion!
As we all know – and as trialists certainly must know – controlled trials are designed to compare the outcomes of two groups. Changes within one of the groups can be caused by several factors unrelated to the therapy and are therefore largely irrelevant. This means that “no significant difference between changes of Sipjeondaebo-tang group and placebo group” indicates that the herbal mixture had no effect. In turn this means that a conclusion stating that “sipjeondaebo-tang appears to have potential benefit for anorexia” is just fraudulent.
This level of scientific misconduct is remarkable, even for the notoriously poor Evid Based Complement Alternat Med.
I strongly suggest that:
- The journal is de-listed from Medline because similarly misleading nonsense has been coming out of this rag for some time.
- The paper is withdrawn because it can only mislead vulnerable patients.
The Royal London Homeopathic Hospital, recently re-named as the Royal London Hospital for Integrated Medicine (RLHIM), has been one of the most influential homeopathic hospitals in the world. It was founded in 1849 by Dr Frederick Foster Hervey Quin. In 1895, a new and larger hospital was opened on its present site in Great Ormond Street. Many famous homeopaths have worked there, including Robert Ellis Dudgeon, John Henry Clarke, James Compton Burnett, Edward Bach, Charles E Wheeler, James Kenyon, Margaret Tyler, Douglas Borland, Sir John Weir, Donald Foubister, Margery Blackie and Ralph Twentyman. In 1920, the hospital received Royal Patronage from the Duke of York, later King George VI, who also became its president in 1924, and in 1936, the Hospital was honoured by the Patronage of His Majesty the King gaining its ‘Royal’ prefix in 1947. Today, Queen Elizabeth II is the Hospital’s Patron.
On 18 June 1972, 16 of the hospital’s doctors and colleagues on board were killed in a plane crash. During the following years, several reductions in size and income took place. From 2002 to 2005, the hospital underwent a £20m redevelopment and, in 2010, its name was changed to Royal London Hospital for Integrated Medicine.
The hospital just published a new brochure for patients. It contains interesting information and therefore, I will quote directly from this document.
START OF QUOTES
The Royal London Hospital for Integrated Medicine (RLHIM) is part of University College London Hospitals NHS Foundation Trust and accepts all NHS referrals. GP referrals are by letter or via Choose and Book. Patients can also be referred by their NHS hospital consultant.
NHS Choices provides information and an opportunity to provide feedback about our service at www.nhs.uk
….
The General Medicine Service is led by three consultant physicians. The team also includes other doctors and nurses, a dietitian, a physiotherapist, an occupational therapist and a psychotherapist. The service sees patients with chronic and complex conditions. The team is trained in many areas of complementary medicine. These are used alongside orthodox treatment, allowing them to offer a fully integrated General Medicine service. The General Medicine Service offers a full range of diagnostic tests as well as a variety of treatments and advice on orthodox treatment.
From 3rd April 2018, The Royal London Hospital for Integrated Medicine (RLHIM) will no longer be providing NHS-funded homeopathic remedies for any patients as part of their routine care. This is in line with the funding policy of Camden Clinical Commissioning Groups, the local NHS body that plans and pays for healthcare services in this area.
Should you choose you will be able to purchase these medicines from the RLHIM pharmacy, while other homeopathic pharmacies may also be able to supply the medicines. You can speak to your clinician or the RLHIM pharmacy at your next visit about this…
Conditions commonly seen include:
- Recurrent infections, such as colds, sore throats, cystitis, thrush, chest infections and bacterial infections
- Some persistent symptoms where tests have not revealed a serious underlying disorder
- Asthma or chronic obstructive pulmonary disease (COPD)
- Digestive disorders, for example acid reflux, Irritable Bowel Syndrome and inflammatory bowel disease
- Endocrine (glandular) disorders such as under-active thyroid
- Type II diabetes
- Some types of heart disease, high blood pressure and palpitations (requiring no orthodox treatment)
- Chronic headache such as migraine or tension-type headache
- Side effects of prescribed medications
END OF QUOTES
Clearly, the big news here is that the RLHIM has been forced to stop providing NHS-funded homeopathics. This could be indicative of what might soon happen throughout NHS England.
But there are other items that I find remarkable: “The General Medicine Service offers a full range of diagnostic tests as well as a variety of treatments and advice on orthodox treatment.” Call me a nit-picker, but this is not INTEGRATED! Integrated medicine means employing both alternative as well as conventional therapies in parallel. The best of BOTH worlds and all that…
In the same vein is the statement that they treat “some types of heart disease, high blood pressure and palpitations (requiring no orthodox treatment)” I am sorry, but this again is not INTEGRATED MEDICINE! I ask myself, is it ethical to mislead patients, colleagues, NHS officials and everyone else pretending to deliver ‘integrated medicine’, while in fact all they seem to offer is ‘alternative medicine’?
The RLHIM has recently dropped the term HOMEOPATHY from its name. Soon it might have to also abandon the term INTEGRATED, because it does not seem to be able to provide a safe level of conventional medicine.
How shall we then call it?
Suggestions please!
Doctor Jonas is an important figure head of US ‘Integrative Medicine’. As we discussed in a recent post, he pointed out that many US hospital doctors fail to answer the following questions relating to their chronically ill patients:
- “What matters most for this patient?
- What is the person’s lifestyle like – their nutrition, movement and sleep?
- How does that patient manage their stress?
- Does that patient have a good support system at home?
- What supplements does that patient take? Has your patient seen any CAM practitioners to cope with their condition?
- Why do they want to get well?”
In my previous post, I tried to explain that this is embarrassing – embarrassing for doctor Jonas, I meant.
But Jonas also claims that most US hospital doctors he addressed during his lecture tour, were unable to answer these questions. And that might be embarrassing not for Jonas, but for those physicians. Let’s consider this possibility for a moment.
The way I see it, the doctors in question might not have answered to Jonas for the following reasons:
- They felt that the questions were simply too daft to bother.
- They were too polite to tell Jonas what they think of him.
- They were truly unable to answer the questions.
Here I want to briefly deal with the last category.
I do not doubt for a minute that this category of physician exists. They have little interest in what matters to their patients, don’t ask the right questions, have no time and even less empathy and compassion. Yet nobody can deny that medical school teaches all of these qualities, skills and attitudes. And there is no doubt that good doctors practice them; it is not a choice but an ethical and moral imperative.
So, what went wrong with these doctors?
Probably lots, and I cannot begin to tell you what exactly. However, I can easily tell you that those doctors are not practicing good medicine. Similarly, I can tell you what these doctors ought to do: re-train and be reminded of what medical school has once taught them.
And what about those physicians who advocate ‘integrated medicine’ reminding everyone of the core values of healthcare?
Aren’t they fabulous?
No, they aren’t!
Why?
Because they too have evidently forgotten what they should have learnt at medical school. If not, they would not be able to pretend that ‘integrative medicine’ has a monopoly on core values of all healthcare. Their messages are akin to a new ‘school’ of ship-building insisting that it is beneficial to build ships that do not leak.
What I am trying to say in my clumsy way is this:
DOCTORS WHO PRACTICE BAD MEDICINE SHOULD RE-TRAIN – TOGETHER WITH THOSE PHYSICIANS WHO ADVOCATE ‘INTEGRATIVE MEDICINE‘, BECAUSE THEY BOTH HAVE FORGOTTEN WHAT THEY LEARNT AT MEDICAL SCHOOL.
