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

conflict of interest

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It is today exactly 8 years that I am writing this blog. To mark the occasion, I am trying to write my shortest post ever. It focusses on a question that has often occupied my mind and rarely leaves the comments sections of this blog: What makes a healthcare professional use a bogus SCAM therapy? Think, for instance, of any practitioner of homeopathy. What makes him or her tick? Why does (s)he practice homeopathy and not real medicine? After years of thinking about it, the answer turns out to be really quite simple. There are only three possibilities:

Practitioners who employ disproven treatments either

try to con you

or

they have been conned themselves

or

both.

________________________

Think of it, there is no other explanation!

If, however, you do know of another one, please let me know.

AND THANKS FOR MAKING THIS BLOG A SUCCESS.

 

 

This recent review claimed to evaluate the evidence on the use of human and veterinary homeopathy, evidence level 1a studies were considered. Focusing on the external evidence on the use of homeopathy in infections, some evidence level 1a, 1b, 2c studies, and a case report, are described in more detail.

In conclusion, evidence for the effectiveness of human and veterinary homeopathy in general, and in particular, of homeopathic treatment for infections, is available. Especially, individualized homeopathy demonstrates effects at all quality levels according to Cochrane criteria, even in the methodologically high-quality studies. As in most areas of veterinary medicine and medicine, further good/excellent studies are necessary. In compliance with the principles of homeopathy, further methodologically high-quality trials focusing on the homeopathic treatment of infections are the next logical step. The selection of the simile (individually fitting homeopathic medicinal product) by appropriately trained homeopathic doctors/veterinarians is essential for the effectiveness of homeopathy. Implementation of studies at university facilities is a prerequisite for quality assurance. Consequently, further integration of homeopathy at universities is a necessary requirement for the patients’ best interests.

Who wrote this bizarre paper?

The authors who state to have no conflicts of interest are P Weiermayer 1M Frass 2T Peinbauer 3L Ellinger 4

  • 1Tierärztin, Tierarztpraxis Dr. Weiermayer, Diplom der Europ. Akademie für Veterinärhomöopathie (EAVH), Fachtierärztin für Homöopathie, Sprecherin der Sektion Forschung der Wissensch. Gesellsch. für Homöopathie (WissHom), Präsidentin ÖGVH, Wien, Österreich.
  • 2Facharzt für Innere Medizin und Internistische Intensivmedizin, em. Professor für Innere Medizin der Medizinischen Universität Wien, Diplom der Österreichischen Ärztekammer (ÖÄK) für Homöopathie sowie für Begleitende Krebsbehandlung, Wien, Österreich.
  • 3Arzt für Allgemeinmedizin, ÖÄK-Diplom für Homöopathie, Universitätslektor für Allgemeinmedizin und Modulbeauftragter für Komplementärmedizin, Medizinische Fakultät, Johannes Kepler Universität Linz, Österreich.
  • 4Tierärztin, Centaurea, Apeldoorn, Holland.

This already explains quite a lot, I think.

The paper itself is in German, so I will try to make some sense of part of it for you.

In their ‘methods section’, the authors explain that they evaluated meta-analyses and systematic reviews (SRs) of homeopathy for various conditions. Furthermore, they considered the ‘1st and 2nd’ NHMRC reports. Specifically for the question whether homeopathy is the answer to antibiotic resistance, the authors also considered RCTs, observational studies, heath service research and even case-studies. The authors then elaborate at length on the assumptions of homeopathy, on legal issues and on the nature of evidence-based medicine all of which I disregard for the moment (suffice to say that this material has been often and better reviewed before).

When finally discussing the evidence on homeopathy for human conditions, the authors state that, up until 2014, six comprehensive SRs had been published. In their opinion, these are the following 6 papers:

  1. Kleijnen, J., Knipschild, P., Ter Riet, G. (1991): Clinical trials
    of homeopathy. BMJ 302(6772): 316-23.
  2. Linde, K., Clausius, N., Ramirez, G., Melchart, D., Eitel, F.,
    Hedges, L.V., Jonas, W.B. (1997): Are the clinical effects of
    homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 350(9081): 834–843.
  3. Linde, K., Scholz, M., Ramirez, G., Clausius, N., Melchart,
    D., Jonas, W.B. (1999): Impact of study quality on outcome
    in placebo-controlled trials of homeopathy. J Clin Epidemiol 52(7): 631–636.
  4. Cucherat, M., Haugh, M.C., Gooch, M., Boissel, J.P. (2000): Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol 56(1): 27–33.
  5. Mathie, R.T., Lloyd, S.M., Legg, L.A., Clausen, J., Moss, S.,Davidson, J.R.T., Ford, I. (2014a): Randomised placebocontrolled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 3: 142.
  6. Shang, A., Huwiler-Müntener, K., Nartey, L., Jüni, P., Dörig, S., Sterne, J.A.C., Pewsner, D., Egger, M. (2005): Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 366(9487): 726–32.

(As it happens, I have reviewed these papers here and come to very different conclusions)

Without bothering about a critical assessment of these papers, the authors report that all arrived at a positive conclusion, except the last one. They then claim that the ‘1st’ NHMRC report was partly positive but was initially suppressed by the Australian government. Instead it was replaced with the 2nd NHMRC report which was designed to arrive at a wholly negative conclusion. Likewise, the ‘EASAC Statement’ neglected some of the available positive evidence. These facts, the authors believe, discredits all of these negative reports.

The authors then discuss the various reviews by Mathie et al and point out that, in their view, these papers are superior to all other documents as they arrive at very clearly positive conclusions.

Next the authors focus on the field of veterinary homeopathy, while admitting weaker and weaker evidence, inclusing case-reports. This is also where I lost the will to live and gave up my detailed criticism of the text; the task is too tedious and simply not worth it, I felt.

In summary, here are few points relating to the human evidence:

The authors seem to have no intention of conducting an objective, systematic review. Such a project is essentially based on two principles. Firstly, it needs to include all eligible evidence according to pre-defined criteria. Secondly, it must include a critical evaluation of the admitted evidence. This review fails on both of these principles.

There are virtually dozens of systematic reviews which the authors decided to ignore. Here are just six of them:

  1. … homoeopathy as a whole may be considered as a placebo treatment.
  2. We tested whether p-curve accurately rejects the evidential value of significant results obtained in placebo-controlled clinical trials of homeopathic ultramolecular dilutions. Our results suggest that p-curve can accurately detect when sets of statistically significant results lack evidential value.
  3. We found no evidence to support the efficacy of homeopathic medicinal products
  4. … no firm conclusions regarding the effectiveness and safety of homeopathy for the treatment of IBS can be drawn.
  5. Due to both qualitative and quantitative inadequacies, proofs supporting individualized homeopathy remained inconclusive.
  6. … the use of homeopathy currently cannot claim to have sufficient prognostic validity where efficacy is concerned.

Why do they do it? A reasonable reply to this question might be, because their findings did not fit the preconceived ideas of the authors. This omission alone makes the article little more than a poorly conceived marketing brochure.

Even more important is the second omission. The paper  lacks any kind of critical evaluation of the included evidence. On the contrary, the authors praise the evidence that generated what they think was a positive result (even in cases where the actual result was not all that positive; for instance: A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions) and bash all negative findings. This goes as far as perpetuating untruth about the two NHMRC reports: what they call the 1st report was a draft that had been rejected because it was deemed to be of sub-standard quality. What is here called the ‘2nd’ report is thus the only valid document ever published. Similarly, the authors pretend that the Mathie reviews were all clearly positive and fail to mention even the most obvious problems with these articles, such as the facts that Mathie was paid by a homeopathy-lobby group or that even he included important caveats in his conclusions.

As to the focus of the review, the question whether homeopathy might be a solution to antibiotic resistance, the authors found virtually no compelling evidence from trials directly comparing antibiotics with homeopathy. This seems to bother the authors little – they conclude that “the data demonstrate the potential of a significant reduction of antibiotic usage through homeopathic treatments”. They seem to have reached this conclusion by turning a blind eye to all the evidence that does not fit their preconceived idea.

As the paper is published in German and in a journal which hardly anyone will ever read, one could easily argue that none of all this does really matter because it is merely a storm in a very small tea cup. Perhaps that’s true. But this paper nevertheless might attain some significance because it is already being heavily promoted by the homeopathy lobby. And no doubt, it will thus be cited in the English literature which, in turn, will be read by people who do not read German, unable to check the original and are thus likely to believe the nonsense promoted by Frass and friends.

For this reason, I want to conclude by making it quite clear that

this ‘review’ is a dilettante attempt to white-wash the evidence on homeopathy and mislead the public.

 

Patients with advanced non-small cell lung cancer (NSCLC) have limited treatment options. Alongside conventional anticancer treatment, additive homeopathy might help to alleviate side effects of conventional therapy. The aim of this study was to investigate whether additive homeopathy might influence quality of life (QoL) and survival in NSCLC patients.

In this prospective, randomized, placebo-controlled, double-blind, three-arm, multi-centre, phase III study, the researchers evaluated the possible effects of additive homeopathic treatment compared to placebo in patients with stage IV NSCLC, with respect to QoL in the two randomized groups and survival time in all three groups. Treated patients visited the university teaching hospital every 9 weeks: 150 patients with stage IV NSCLC were included in the study.

  1. 51 patients received individualized homeopathic remedies plus conventional treatments,
  2. 47 received placebo plus conventional treatments,
  3. 52 control patients without any homeopathic treatment were treated with conventional therapies and observed for survival only.

For groups 1 and 2, the study was double-blind. The constituents of the different homeopathic remedies were mainly of plant, mineral, or animal origin. The remedies were manufactured by stepwise dilution and succussion, thereby preparing stable GMP grade formulations.

QoL as well as functional and symptom scales showed significant improvement in the homeopathy group when compared with placebo after 9 and 18 weeks of homeopathic treatment (p < .001). Median survival time was significantly longer in the homeopathy group (435 days) versus placebo (257 days; p = .010) as well as versus control (228 days; p < .001). Survival rate in the homeopathy group differed significantly from placebo (p = .020) and from control (p < .001).

The authors concluded that QoL improved significantly in the homeopathy group compared with placebo. In addition, survival was significantly longer in the homeopathy group versus placebo and control. A higher QoL might have contributed to the prolonged survival. The study suggests that homeopathy positively influences not only QoL but also survival. Further studies including other tumour entities are warranted.

First of all, let me thank my friend Dana Ullman for alerting me to this new and interesting study. I have read what seems to be the full paper several times and have to admit that it puzzles me (and perhaps this version is just some type of pre-publication paper). Firstly, there seems to be no methods section (the abstract is followed by several tables and a discussion), and I am left guessing much of the details. Secondly, the paper raises several questions in my mind:

  1. What is the purpose of group 3? The authors call it a control group and state it allows assessing the real homeopathic effect on the homeopathic cohort as the real effect will be the natural historical effect minus the placebo effect and the homeopathic effect. Does that make sense?
  2. Was the study under-powered? From my reading of the text, the answer seems to be yes.
  3. What is the full list of conventional treatments the patients received, and did they differ between the 3 groups?
  4. If I understand it correctly, the study patients did not receive immuno-oncological therapy. Does that fact not render the study unethical?
  5. What homeopathic potencies were prescribed in group 1? The paper says: The constituents of the different homeopathic remedies were mainly of plant, mineral, or animal origin. This is unlikely, as most homeopathic remedies contain nothing.
  6. The authors seem to have used individualised homeopathy according to Hahnemann’s instructions. Did Hahnemann not strictly forbid combining his approach with other types of treatment?
  7. How well respected is THE ONCLOLOGIST, the journal that published the paper?
  8. Was the article peer-reviewed? If so, by whom?
  9. Was the placebo indistinguishable from the verum?
  10. Was the success of patient-blinding checked?
  11. Have similar findings regarding survival been reported previously? The authors call this finding ‘unexpected’; I find it more than that; it is baffling.
  12. Should we accept such surprising findings, or would it be more prudent to wait until independent replications are available?
  13. The first author of this trial is Prof Frass who has featured on this blog several times before (see for instance here, here, here, here and here). Frass has published several studies of homeopathy and invariably manages to produce positive results. Am I the only one to find this odd?

I would be most grateful, if the readers of this blog could assist me in finding answers to some of the above questions.

Recently, I had a notable comment on one of my posts:

“these treatments are not the best we can offer to LBP-patients.”
Have to agree with you. As a stand alone treatment the research is underwhelming. When used as part of a suite of therapies they have some utility. All therapeutic approaches when studied in isolation are underwhelming (including exercise and rehab). Research needs to reflect how chiro’s/physio’s/osteo’s practice.

The post was about a new RCT suggesting that neither spinal manipulation nor spinal mobilization is effective treatments for chronic low back pain. And the comment came, of course, from an ardent defender of chiropractic. As I have heard this type of argument so often – from virtually all types of providers of so-called alternative medicine (SCAM) – it is perhaps worth considering it in more detail.

What does it mean?

It means that those SCAM-providers who believe in the argument think that, in order for their SCAM to work, it needs to be accompanied by some other therapy. To me, this assumption has always raised doubts.

  • My fake 5£ note is worth nothing, unless you add a real fiver to it.
  • This mine sweeper will work fine, as long as you use another one in parallel.
  • This drink is very strong, but you need a double vodka in order to feel it.

Yes, of course, I am exaggerating. So, let’s use a few more sensible examples from the realm of healthcare:

  • This new medication is effective only if you combine it with the standard drug for this disease.
  • Ultrasound therapy reduces shoulder pain, as long as you also take a pain-killer.
  • This slimming aid works wonders, if you stop eating while you take it.
  • Chiropractic manipulations work wonders, but you need to combine them with exercise therapy.
  • Crystal healing is very effective, as long as you don’t discontinue your conventional treatments.

A + B is only more than B, if A amounts to more than zero.

If A is zero, A + B = B.

If A is negative, A + B is less than B.

Of course, the argument could also mean that treatment A needs the addition of treatment B, because there is a synergism between the two. Synergism is the interaction of treatments such that the total effect is greater than the sum of the individual effects. It is a phenomenon that occurs with certain medications; it can be studied and must be proven before we can accept it as relevant. Has synergism been studied for any of the SCAMs? No, not as far as I am aware. This means, in SCAM, it is unproven. Until it is proven, we thus should not claim it.

So, what does it mean when SCAM-providers say AS A STAND-ALONE THERAPY MY SCAM IS NO GOOD; IT NEEDS ANOTHER TREATMENT TO WORK?

Call me a cynic, but I think it is an admission that the SCAM in question is ineffective (or perhaps even detrimental).

Recently, I have received this message via the comments section of my blog:

“you’re actually an evil old nut-job Ed—been following your pharma ‘science’ bullshit for years—all opinion and ignorance and anti-science”

Don’t get me wrong, such attacks do not bother me – not any more. On the contrary, they amuse me. At one stage, I even started collecting them. Nowadays, I usually ignore them.

But this one is somewhat special. Therefore, I decided to analyse it a bit. The author essentially makes 9 claims:

  1. I am evil.
  2. I am old.
  3. I am a nut-job.
  4. I am called Ed.
  5. I conduct pharma science.
  6. I publish bullshit.
  7. All I state is opinion.
  8. I am ignorant.
  9. I am anti-science.

Yes, that’s quite a list. Let me try to tackle it one by one.

  1. Am I evil? I have had many ad hominem attacks before but, as far as I remember, nobody has yet alleged that I am evil. I looked it up, evil means: wicked · bad · wrong · morally wrong · wrongful · immoral · sinful · ungodly · unholy · foul · vile · base · ignoble · dishonorable · corrupt · iniquitous · depraved · degenerate · villainous · nefarious · sinister · vicious · malicious · malevolent · demonic · devilish · diabolic · diabolical · fiendish · dark · black-hearted · monstrous · shocking · despicable · atrocious · heinous · odious · contemptible · horrible · execrable · lowdown · stinking · dirty · shady · warped · bent · crooked · dastardly · black · egregious · flagitious · peccable. I am obviously the wrong person to judge, but I do not think that these attributes describe me all that well.
  2. Yes, I am old, 72 to be precise.
  3. Am I a nut-job? I looked that one up too. It’s a mentally unbalanced person. Call me biased, but I don’t think that this applies to me at all.
  4. No, I am not called Ed.
  5. I am not quite sure what ‘pharma science’ is supposed to mean, but one thing I do know for sure: since I research so-called alternative medicine (SCAM) – and that’s about 30 years now – I have not taken research funds from the pharmaceutical industry. And before I very rarely did.
  6. As I have published a sizable amount of papers and blog-posts, there must have been a bit of BS in some of it. But I do not think it can be much.
  7. All I state is opinion? Oh really! Opinion comes into blog-posts regularly; without it my stuff would be boring like hell. But ALL of it? I don’t think so.
  8. Am I ignorant? Yes, certainly; there are lots of things I don’t know, even in medicine. But in SCAM I do know quite a bit – even if I say so myself.
  9. Anti-science? That last allegation is probably the most far-fetched of them all. No, I am not anti-science, never have been and never will be.

So, Paul – the author of the comment preferred to remain anonymous and simply calls himself Paul – I have tried to give you credit where I could but, on the whole, I fear your ad hominem attack is yet another victory of reason over unreason. I thank you Paul for two reasons:

  • firstly for the just-mentioned victory; it always feels good to be on a winning side,
  • secondly for the stimulus and motivation to carry on doing what I have been doing for many years; your comment has shown me how much needed my work is in disclosing quackery, correcting errors, teaching critical thinking and responsibly informing the public.

THANKS PAUL

Guest post by Ken McLeod

‘Ayurvedic Medicine,’ or Ayurveda, is an alternative medicine system which originated in India as long as 5,000 years ago, according to its proponents.  Science-based medicine refers to it  as pseudoscientific and the Indian Medical Association (IMA) characterises  it as quackery. [1] Ayurvedic practitioners claim that its popularity through the ages vindicates it as safe and effective.

That last bit is of course the appeal to antiquity, or the appeal to tradition (also known as argumentum ad antiquitatem. [2] This proposes that if something was supported by people for a long time it must be valid.   That is bunkum; many ancient ideas have long since been discredited; the Earth is not flat, no matter for how long people thought it was.

Nevertheless, ‘Ayurvedic Medicine’ has many practitioners and supporters in the supposedly rational West, including Bondi Junction here in Australia.  Despite the many warnings about it, [3] people still go to practitioners, and occasionally they are injured.

One such injury and the consequent complaint to the New South Wales regulator, the Health Care Complaints Commission, (HCCC), has resulted in a Public Warning dated 18 September concerning levels of heavy metals in Ayurvedic Medication.  [4]

The HCCC said:

‘The NSW Health Care Complaints Commission is concerned about a complaint received regarding the prescription of “Manasamithra Vatika,” (Manasamitram Pills) an Ayurvedic medication.

‘The complaint related to prescription of this medication to a child for treatment of autism.

‘This medication was found to contain concerning levels of lead and other heavy metals.’

That’s all very bland, no headlines there.  But then it got into:

“The Commission strongly urges those individuals seeking alternative therapies to be vigilant in their research prior to proceeding with any natural therapy medications or medicines and to discuss any such proposed therapies with their treating registered health practitioner.”

Not so bland there; that’s very comprehensive; ‘any natural therapy medications or medicines’ and ‘discuss any such proposed therapies with their treating registered health practitioner.” ‘Note the HCCC’s emphasis on “registered.”  That rules out Ayurvedic Medicine practitioners, homeopaths, and other assorted cranks; go to a real doctor.

Surely that is headline material; a regulator responsible for promoting the health of citizens warns them to go to real doctors before going to these quacks.

Then it gets better, (or worse if you are an Ayurvedic Medicine practitioner).  At the same time the HCCC issued an Interim Prohibition Order against Mr Rama Prasad (“Ayurveda Doctor Rama Prasad.”) [5] The HCCC’s Order says:

‘The NSW Health Care Complaints Commission (“the Commission”) is currently investigating Mr Rama Prasad in relation to his prescribing of the Ayurvedic Medication “Manasamithra Vatika” (Manasamitram Pills) to both children and adults and about his claims that his treatments can reverse several aspects of autism in children.

‘The Ayurvedic Medication “Manasmithra Vatika” (Manasamitram Pills) was found to contain elevated levels of lead and other heavy metals.

‘One case with mildly elevated blood level was notified to the South Eastern Sydney Public Health Unit after consuming this product.

‘Clients residing in NSW who are considered to have been placed at possible risk have now been contacted by NSW Health public health personnel.

‘The Commission has issued an interim prohibition order in relation to Mr Rama Prasad, under section 41AA of the Health Care Complaints Act 1993 (‘The Act’). Mr Prasad is currently prohibited from providing any health services, either in paid employment or voluntarily, to any member of the public.

‘This interim prohibition order will remain in force for a period of eight weeks and may be renewed where appropriate in order to protect the health or safety of the public.’

That should send chills down the spine of any Ayurvedic Medicine practitioner.  A complete Prohibition Order ordering Prasad not to engage in providing any health service as defined in the Act  [6] for eight weeks, which may be renewed or even made permanent, depending on what the investigation finds.  The Act includes a comprehensive list of activities that comprise a ‘health service’:

‘health service includes the following services, whether provided as public or private services:

  • (a)  medical, hospital, nursing and midwifery services,
  • (b)  dental services,
  • (c)  mental health services,
  • (d)  pharmaceutical services,
  • (e)  ambulance services,
  • (f)  community health services,
  • (g)  health education services,
  • (h)  welfare services necessary to implement any services referred to in paragraphs (a)–(g),
  • (i)  services provided in connection with Aboriginal and Torres Strait Islander health practices and medical radiation practices,
  • (j)  Chinese medicine, chiropractic, occupational therapy, optometry, osteopathy, physiotherapy, podiatry and psychology services,
  • (j1)  optical dispensing, dietitian, massage therapy, naturopathy, acupuncture, speech therapy, audiology and audiometry services,
  • (k)  services provided in other alternative health care fields,
  • (k1)  forensic pathology services,’

Note the inclusion of ‘health education.’  This is where so many cranks fall foul of the law;  setting yourself up as a health educator makes you subject to the Act.   Even if you claim to be a master chef, homeopath or Ayurvedic Medicine Practitioner, you are not exempt.

It’s early days yet in this particular saga, and there are many questions to be answered, for example:

  • – How did this “medicine” get past Australia’s Therapeutic Goods Administration, (Australia’s equivalent to the US FDA)?
  • – Did the TGA list or register it?
  • – If not why not? If it was who is responsible?
  • – Was this detected only after a child was so sickened that they were taken to hospital?
  • – Why is the practitioner concerned still advertising his Ayurvedic medicine courses? [7]  Is this a breach of his Prohibition Order which prohibits ‘health education services’?’

So stay tuned for updates as this case progresses.  In the meantime note that an Australian Health regulator is advising the public to seek advice from real doctors before going to alternative therapists, including ‘Ayurvedic Medicine’ practitioners.  That is a real headline.

[1] https://en.wikipedia.org/wiki/Ayurveda

[2] https://en.wikipedia.org/wiki/Appeal_to_tradition

[3] Such as from the Victoria Dept of Health at https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda

[4] https://www.hccc.nsw.gov.au/decisions-orders/public-statements-and-warnings/public-warning-under-s94a-of-the-health-care-complaints-act-concerning-levels-of-heavy-metals-in-ayurvedic-medication

[5] https://www.hccc.nsw.gov.au/decisions-orders/media-releases/2020/mr-rama-prasad-ayurveda-doctor-rama-prasad-interim-prohibition-order

[6] Health Care Complaints Act 1993 https://www.legislation.nsw.gov.au/view/html/inforce/current/act-1993-105

[7] https://www.enlightenedevents.com.au/events/certificate-in-clinical-ayurveda-dr-rama-prasad

‘Infodemics’ are outbreaks of false information including rumours, stigma, and conspiracy theories. All of these have been common during the COVID-19 pandemic. The detection, assessment, and response to rumours, stigma, and conspiracy theories in real time are a challenge.

An international team of researchers followed and examined COVID-19-related rumours, stigma, and conspiracy theories circulating on online platforms, including fact-checking agency websites, Facebook, Twitter, and online newspapers, and their impacts on public health. Information was extracted between December 31, 2019 and April 5, 2020, and descriptively analysed. The team performed a content analysis of the news articles to compare and contrast data collected from other sources.

The researchers identified 2,311 reports of rumours, stigma, and conspiracy theories in 25 languages from 87 countries. Claims were related to:

  • illness, transmission and mortality (24%),
  • control measures (21%),
  • treatment and cure (19%),
  • cause of disease including the origin (15%),
  • violence (1%),
  • and miscellaneous (20%).

Of the 2,276 reports for which text ratings were available, 1,856 claims were false (82%).

The authors concluded that misinformation fuelled by rumours, stigma, and conspiracy theories can have potentially serious implications on the individual and community if prioritized over evidence-based guidelines. Health agencies must track misinformation associated with the COVID-19 in real time, and engage local communities and government stakeholders to debunk misinformation.

These findings are as perplexing as they are frightening. On this blog, we have since the beginning of the pandemic focussed on the SCAM for COVID-19. We have seen that this health crisis provided an occasion for almost any quackery on the planet:

  • homeopaths,
  • supplement salesmen,
  • TCM-practitioners,
  • chiropractors,
  • anti-vaxxers,
  • Siddha-doctors,
  • Vitamin-peddlers,
  • politicians,
  • evangelists,
  • acupuncturists,
  • herbalists,
  • essential oil salesmen.

They all crept out of the woodwork. Their methods may differ, but their aim seems to be the same: to make a fast buck regardless of how many people their activities might kill.

Chronic rhinosinusitis (CRS) is a common disorder. This trial tested the efficacy of individualized homeopathy (IH) in comparison with placebo in patients with CRS.

This double-blind, randomized (1:1), placebo-controlled, preliminary trial (n = 62) was conducted at the National Institute of Homoeopathy, West Bengal, India. Primary outcome measure was the sino-nasal outcome test-20 (SNOT-20) questionnaire; secondary outcomes were the EQ-5D-5L questionnaire and EQ-5D-5L visual analogue scale scores, and five numeric rating scales (0-10) assessing intensity of sneezing, rhinorrhoea, post-nasal drip, facial pain/pressure, and disturbance in sense of smell, all measured at baseline and after the 2nd and 4th months of intervention. Group differences and effect sizes (Cohen’s d) were calculated on the intention-to-treat sample.

The two groups were comparable at baseline. Attrition rate was 6.5% (IH: 1, Placebo: 3). Although improvements in both primary and secondary outcome measures were higher in the IH group than placebo, with small to medium effect sizes, the group differences were statistically non-significant (all p > 0.05, unpaired t-tests). Calcarea carbonicaLycopodium clavatumSulphurNatrum muriaticum and Pulsatilla nigricans were the most frequently prescribed medicines. No harmful or unintended effects, homeopathic aggravations or any serious adverse events were reported from either group.

The authors who are affiliated with the following institutions:

  • Department of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, West Bengal, India.
  • Department of ENT, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, West Bengal, India.
  • Department of Paediatrics, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, West Bengal, India.
  • Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, West Bengal, India.
  • Department of Repertory, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, West Bengal, India.
  • Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, West Bengal, India.

concluded that there was a small but non-significant direction of effect favoring homeopathy, which ultimately renders the trial as inconclusive. Rigorous trials and independent replications are recommended to arrive at a confirmatory conclusion.

Sorry, but this is the wrong conclusion. In the name of honesty and research integrity, it should read something like this:

Our study failed to show that IH has a significant effect on CRS.

But of course, this is no surprise. Why should IH work for CRS? The only remotely interesting finding here, in my view, is the fact that the authors noted not a single homeopathic aggravation (i. e. the occurrence of the ‘drug picture’ in a patient and thus a kind of homeopathic ‘proving’). Using IH, homeopaths would expect aggravations with some regularity. Could it be that homeopathic aggravations (and ‘provings’) are, like all effects of homeopathy, the result of misinterpretation, fantasy and wishful thinking? Investigating the issue systematically, we found already 17 years ago that this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists.

Opioid over-use has become a huge problem, particularly in the US. Proponents of complementary and alternative medicine (CAM) – or so-called alternative medicine (SCAM) as I prefer to call it these days – have been keen to suggest that they have a solution to this problem. But is this really true? So far, the evidence was slim, to say the least.

This systematic review evaluated the effectiveness of the integrative medicine (IM) approach or any of the CAM therapies to reduce or cease opioid use in CP patients.

The electronic searches yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, 7 were retrospective studies, 4 studies were prospective observational, 3 were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioural therapy (CBT), and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design.

The authors concluded that there is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.

The authors who are from the Canadian College of Naturopathic Medicine in Ontario, Canada (and who claim to have no conflict of interest) seem to have forgotten to discuss some not so unimportant details and questions:

  • Why did they include studies with extremely weak designs in their review (such studies are likely to produce false positive findings)?
  • Why did they consider treatments such as CBT as CAM (most experts would characterise them as conventional psychological therapies)?
  • Why did they not conduct a separate analysis of the RCT-evidence (is it because that would not have generated the result they wanted?)?

My reading of the RCTs – the only type of study that might give a reliable answer to the question posed- is that they do not show a opioid-sparing effect of CAM use, particularly if we eliminate those studies that tested treatments which are not truly CAM. In any case, as I have said several times before, the way to avoid over-prescribing opioid is not through using more therapies of doubtful effectiveness but through prescribing less opioids. And to achieve that, doctors should just do what they learnt in medical school (at least I did all those years ago).

The definitions of a quack as used in healthcare vary somewhat:

Richard Lanigan, in his post entitled Skeptics like Edzard Ernst remind me of Humpty Dumpty in their use of words. They make them up as they go along prefers the the definition from the Oxford dictionary: “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine” (actually, the version of the Oxford dictionary I accessed defines a quack not quite like this but as a person who dishonestly claims to have medical knowledge or skills).

More importantly, Richard claims in an oddly incoherent post that not the chiropractors but the critics of chiropractic are are the true quacks:

It would appear “quacks” are people who pretend to have expertise in subjects they know little about, presumably subjects like, chiropractic medicine or acupuncture. I practice chiropractic, I dont diagnose or treat illness or disease, I dont make medical claims. You may not like chiropractic or understand it, however practicing chiropractic would not appear to conform to the definition of “quackery”, however claiming to have “special knowledge” about chiropractic and having only been trained as a medical practitioner may in fact make you a “quack” professor Ernst. All I do is maintain movement in spinal joints that become stiff from sedentary lifestyles, movement effects function of mechano receptors(nerves) in spinal joints. You may not believe that is possible, you may not believe maintaining joint function is important or that it effects wellbeing, you are perfectly entitled to your opinion, however I am not so confident of you depth and breath knowledge in anatomy and physiology. You might start by asking, why joints were immobility post surgery in the 80s and now post surgical treatment is all about maintaining joint motion as chiropractors have been advocating for years.

If I understand this correctly, this means: any non-chiropractor who criticises chiropractic is a quack. Moreover, it means that, as chiropractic is very rarely criticised by a chiropractor, chiropractors cannot be quacks.

I find this fascinating. It amounts to the legitimisation of any healthcare profession, however bizarre, unproven, disproven or dangerous their practice might be:

  • crystal therapists cannot be accused of quackery, because only their kind understand their business;
  • rebirthing practitioners cannot be accused of quackery, because only their kind understand their business;
  • applied kinesiologists cannot be accused of quackery, because only their kind understand their business;
  • bioresonance practitioners cannot be accused of quackery, because only their kind understand their business;
  • Bach flower therapists therapists cannot be accused of quackery, because only their kind understand their business;
  • colour therapists cannot be accused of quackery, because only their kind understand their business;
  • colon therapists cannot be accused of quackery, because only their kind understand their business;
  • dowsers cannot be accused of quackery, because only their kind understand their business;
  • ear candle practitioners cannot be accused of quackery, because only their kind understand their business;
  • feng shui practitioners cannot be accused of quackery, because only their kind understand their business;
  • faith healers cannot be accused of quackery, because only their kind understand their business;
  • gua sha practitioners cannot be accused of quackery, because only their kind understand their business;
  • iridologists cannot be accused of quackery, because only their kind understand their business;
  • homeopaths cannot be accused of quackery, because only their kind understand their business;
  • naprapathy therapists cannot be accused of quackery, because only their kind understand their business;
  • neurolinguistic programmers cannot be accused of quackery, because only their kind understand their business;
  • osteopaths cannot be accused of quackery, because only their kind understand their business;
  • pranic healers cannot be accused of quackery, because only their kind understand their business;
  • psychic surgeons cannot be accused of quackery, because only their kind understand their business;
  • radionics practitioners cannot be accused of quackery, because only their kind understand their business;
  • reflexologists cannot be accused of quackery, because only their kind understand their business;
  • Reiki masters cannot be accused of quackery, because only their kind understand their business;
  • shiatsu practitioners cannot be accused of quackery, because only their kind understand their business;
  • therapeutic touchers cannot be accused of quackery, because only their kind understand their business;
  • vaginal steamers cannot be accused of quackery, because only their kind understand their business;
  • etc, etc.

I can, of course, easily see why Richard Lanigan would like this concept to be true. Alas, Richard (and all the other SCAM-enthusiasts who make similar arguments), it does not work like this! A quack might be defined as listed above or in many other ways. But, in so-called alternative medicine (SCAM), a quack foremost is a person who habitually misleads the public by making claims that are not supported by sound evidence. And as some wise guy once observed: honest conviction renders a quack only more dangerous. As to the professional background of a quack:

I do not care a hoot!

I have done my best to disclose quackery no matter whether it came from a medic or a SCAM-practitioner, a physio or a nurse, an entrepreneur or a fruitcake, an evangelist or a politician, royalty or commoner. And, believe me, Richard (plus all the other SCAM-enthusiasts who make similar arguments), I will carry on doing so, whether it fits into your little scheme of wishful thinking or not.

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