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

conflict of interest

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Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the COVID pandemic, US president Donald J Trump endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred.

This paper investigated Donald J Trump’s speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump’s time spent discussing unverified treatments on the United States’ 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software.

From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump’s average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%.

The authors concluded that individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals’ claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19.

Trump is by no means the only politician who misled the public in matters of healthcare through ignorance, or stupidity, or both. Other recent examples that we previously discussed include, for instance:

Yes, Trump is not the only, but he is the most influential and might well be the most ignorant one:

For this reason alone – and there are many more – I hope he will not soon become merely a dark and scary chapter in the history of the US.

This retrospective audit aimed to assess the clinical effectiveness of telehealth interventions in an out-patient, individualized homeopathy clinical setting for 305 individuals with symptoms of positive or probable COVID-19
by a team of professional homeopaths working together in the United States during spring and summer of
2020.

The audit lasted from March to August 2020. It examined the merits of the initiative considering accessibility, effectiveness, safety, efficiency, and appropriateness of the care model.

Positive intervention outcomes were found in every measure:

  • individual remedy prescriptions (83.4% positive),
  • final outcomes of interventions (76.2% positive),
  • degree of recovery following homeopathic interventions (74.4%).

Additionally, ease of access for a range of users, a high level of safety of the interventions, and efficiency of care and team resources indicated consistently positive outcomes.

The authors concluded that, given the significant strain on conventional healthcare systems during the early stages of the pandemic, the complementary medicine interventions studied here offer important considerations for meeting the demands for COVID-19 acute care with agile and adaptive complementary medicine models.

If one were to look for ridiculously poor studies in the realm of homeopathy, one would be spoilt for choice. Amongst the many such papers, this one would achieve a very high ranking. The investigation is nonsensical in:

  • concept,
  • design,
  • endpoints,
  • write-up,
  • conclusion.

The paper prompts me to ask a few questions (and some answers):

Whoever had the notion that an audit can “assess the clinical effectiveness” of a therapy?

Do the authors even know what an audit is?

What institutions are behind such embarrassingly poor work? They are:

  • ‘HOHM Foundation’, New York,
  • the ‘Academy of Homeopathy Education,
  • HOHM Foundation, Philadelphia.

Which journal publishes such rubbish?

It’s INTEGRATIVE MEDICINE REPORTS, a publication that claims to be a “high-quality open access journal”.

And who sponsors such idiocy?

This study was funded by donations to HOHM Partners and to Homeopathy Help Network by clients and community members.

Say no more!

Manfred Lucha has been Baden-Württemberg’s Minister for Social Affairs, Health and Integration since 12 May 2016. He also is a staunch defender of homeopathy.

Lucha has repeatedly spoken out in favour of maintaining the reimbursement of costs for homeopathy by health insurance companies. He described anthroposophy and homeopathy as the essence of the Green Party. In August 2022, Lucha positioned himself against the Baden-Württemberg Medical Association on the subject of homeopathy. The Association had announced that additional training for doctors in homeopathy would be removed from the medical training catalogue. Health Minister Lucha stated that he still believed in the effectiveness of homeopathy and announced a legal review of the decision, as the Ministry of Health has legal supervision over the Medical Association. Lucha also criticised the plan by Federal Health Minister Karl Lauterbach to no longer allow homeopathic treatments to be paid for by health insurance companies. Finally, it seems safe to assume that Lucha is not amused about the new development about which I reported yesterday.

With so much outspoken engagement in the medical field, one would expect that Lucha has a solid background in evidence-based medicine and science. Yet, one would be mistaken.

After an apprenticeship as a chemical worker, Lucha completed secondary school and trained as a nurse at the Weißenau Psychiatric State Hospital. He went on to gain his university entrance qualification and studied social work. In 2005, he also completed a Master’s degree in ‘Management in Social and Health Care’. He then became the technical director of a community psychiatric centre in Friedrichshafen. Lucha is spokesman for the Bodensee district community psychiatric association and deputy federal chairman of the Federal Working Group of Community Psychiatric Associations.

Any education in evidence-based medicine?

No!

So, why does he feel he knows better than the experts?

I am not sure.

 

PS

Mr. Lucha, if you read these lines, please tell us.

To show my appreciation, I would then send you a copy of the German translation of my book on homeopathy.

The German medical profession is struggling to decide what stance it should take on homeopathy. The evidence is clear: homeopathy is a pure placebo therapy. But there are powerful lobby groups trying to prevent the general acceptance of this conclusion. Now, a further step towards progress has been taken.

After two years of heated debate, the Baden-Württemberg Medical Association, Germany, has decided that further training for doctors in homeopathy will be cancelled. In July 2022, the Assembly of Representatives had already voted in favour of removing homeopathy from the further training regulations in Baden-Württemberg. This move prompted fierce opposition on several levels; the Social Affairs Minister Manfred Lucha (Greens), for instance, called it the ‘absolutely the wrong signal’. Homeopathy is an important part of healthcare for many people, he had claimed.

The treatment of patients in Baden-Württemberg with homeopathy will neither be restricted nor prohibited by this step. Doctors who have already completed the further training programme or are still in the process of doing so will not be affected by the change.

The chamber’s evaluation had concluded that there is no scientific evidence showing that homeopathy is effective for any condition. The German Medical Association had arrived at the same verdict and, already in 2022, it had spoken out in favour of the abolition in 2022.

On this blog, we have regularly discussed the German homeopathy debate and its many twists and turns, e.g.:

I am fairly confident that, in the end, the evidence will prevail, the confusion will disappear, and an agreement with broad support will emerge also in Germany:

THE PLACE FOR HOMEOPATHY IS IN THE MEDICAL HISTORY BOOKS! 

 

 

 

Recently, I heard JD Vance (the would-be Vicepresident of the US) proclaim: THE ENEMY ARE THE PROFESSORS! Unsurprisingly, this remark alarmed me; I had not been previously aware of being an enemy of the people.

Vance stressed that this was a quote by Richard Nixon made some 40/50 years ago. I looked up Nixon’s quote and found that the original is apparently a little different:

Never forget, the press is the enemy. The establishment is the enemy. The professors are the enemy. The professors are the enemy. Write that on a blackboard a hundred times and never forget it.

So, why does Vance quote Nixon (arguably not one of the most honest men in the history of US politics) and insist on THE PROFESSORS ARE THE ENEMY? Why was this puzzling quote followed by plenty of applause from his audience?

The answer must be that it is a populist theme that touches a nerve with right-wing voters. But what does the sentence actually mean?

On Vance’s campaign website, he explains that “hundreds of billions of American tax dollars” get sent to universities that “teach that America is an evil, racist nation.” These universities “then train teachers who bring that indoctrination into our elementary and high schools.” Vance doesn’t want public funds to go to institutions that teach “critical race theory or radical gender ideology.” He rather wants them to deliver “an honest, patriotic account of American history.”

Vance and Nixon are not the first politicians to recently claimed that the enemies are the professors. In 2016, the UK conservative Michael Gove refused to name any economist backing Britain’s exit from the European Union, saying that “people in this country have had enough of experts”.

According to Wikipedia, anti-intellectualism is hostility to and mistrust of intellectintellectuals,  and intellectualism, commonly expressed as deprecation of education and philosophy and the dismissal of artliteraturehistory, and science as impractical, politically motivated, and even contemptible human pursuits. Anti-intellectuals may present themselves and be perceived as champions of common folk—populists against political and academic elitism—and tend to see educated people as a status class that dominates political discourse and higher education while being detached from the concerns of ordinary people. Totalitarian governments have, in the past, manipulated and applied anti-intellectualism to repress political dissent. During the Spanish Civil War (1936–1939) and the following dictatorship (1939–1975) of General Francisco Franco,  the reactionary repression of the White Terror (1936–1945) was notably anti-intellectual, with most of the 200,000 civilians killed being the Spanish intelligentsia, the politically active teachers and academics, artists and writers of the deposed Second Spanish Republic (1931–1939). During the Cambodian Genocide (1975–1979), the totalitarian regime of Cambodia led by Pol Pot nearly destroyed its entire educated population.

Fascist movements are notoriously anti-intellectual and anti-science. Adolf Hitler said he regretted that his regime still had some need for its “intellectual classes,” otherwise, “one day we could, I don’t know, exterminate them or something.” And Joseph Goebbels said this: “There was no point in seeking to convert the intellectuals. For intellectuals would never be converted and would anyway always yield to the stronger, and this will always be the man in the street. Arguments must therefore be crude, clear and forcible, and appeal to emotions and instincts, not the intellect. Truth was unimportant and entirely subordinate to tactics and psychology.” And the ‘bon mot’, “when I hear the word culture, I reach for my gun”, is attributed even to several of the top Nazis of the Third Reich.

And here we might have a reason why a certain type of politician dislikes intellectuals and feels that the enemy are the professors. Professors do science, science is about truth, and the truth is something that politiciance like Vance must fear like the pest. It would disclose their agenda as being fascist.

In conclusion, the claim, “THE PROFESSORS ARE THE ENEMY”, is an argument of polititians who have good reason to fear the truth, and it appeals to voters who are too dim to understand the danger posed by those they wish to elect.

 

 

 

 

A new market report predicts that the worldwide market for so-called alternative medicine (SCAM) will grow from $100 billion in 2022 to $438 billion by 2032.

According to the report, the SCAM market is expected to see innovation and expansion through mergers, acquisitions, and partnerships among large companies. Companies that are capitalizing on these trends include health supplement companies, companies that specialize in Ayurvedic health, those that offer TCM solutions, and those that offer more general holistic solutions to health. Major supplement brands include Herb Pharm LLC, Gaia Herbs, NOW Foods, Life Extension, Pure Encapsulations, Douglas Laboratories, Nordic Naturals, Nordic Nutraceuticals, Quality of Life Labs, Nature’s Bounty Co., Valensa International, Herbo Nutra, and Emerson Ecologics.

Other major players mentioned in the report are:

  • AYUSH Ayurvedic Pte Ltd, Dabur India Ltd., Himalaya Global Holdings Ltd., Banyan Botanicals, and Arya Vaidya Pharmacy offer Ayurvedic health and wellness products while aiming to advance the science behind Ayurveda.
  • Sheng Chang Pharmaceutical Company produces traditional Chinese medicines and herbal products that is one of the largest TCM pharma companies.
  • All and One Medical provides healthcare solutions that combine conventional medicine with complementary and alternative therapies to promote overall wellness and preventive care.
  • The John Schumacher Unity Woods Yoga Center is another that focuses on enhancing physical and mental well-being through the practice of Iyengar Yoga and offers classes and workshops.
  • New Life Chiropractic aims to improve overall health and well-being by providing comprehensive chiropractic care that focuses on spinal health and preventive wellness.
  • The Chicago Body Works offers a range of therapies and treatments designed to enhance physical and mental well-being, including massage and bodywork services.
  • Weleda AG aims to connect people with nature by producing natural organic products that support health, beauty, and overall wellness while practicing sustainability and social responsibility.
  • Quantum-Touch Inc. teaches energy healing techniques that promote physical, emotional, and spiritual health.
  • Spectrum Chemical Manufacturing Corporation focuses on delivering high-quality chemicals and laboratory supplies to support scientific research and innovation across various industries, including health and wellness.

I must admit, I do like these market reports. They never fail to amuse me – for two main reasons:

  1. They are as reliable as reading tea leafs.
  2. The only reliable info they do provide is that the SCAM proponents’ often-voiced argument, “we are very different from BIG PHARMA” is pure nonsense.

It has been announced that advertisements for three supplement brands claiming to treat a range of medical conditions, including autism and ADHD, have been banned in the UK.

A paid-for Facebook advert for Aspire Nutrition in April said: “The secret weapon parents of ASD kids swear by”, while text in the form of a review attributed to “Tara K. Verified Buyer”, read: “This has helped my five-year-old with level two autism so much. “Within the first week his meltdowns decreased by 80%. He is communicating so much better… he is starting to show kindness and empathy to his little sister.” Further text read: “As parents of children with autism, we all share the same dream: to see our children thrive in school.”

Another paid-for Facebook ad in January, for Drop Supplements, stated: “For people with stress, anxiety, brain fog, ADHD … Happy Mind Drops – your new secret adaptogen against stress! Prepare yourself to unleash your true potential and banish your mental barriers.”

A third paid-for Facebook ad for Spectrum Awakening stated: “My five-year-old son Scout is diagnosed with receptive expressive language disorder and sensory disorder. Until I found Spectrum Awakening he could barely put a sentence together with very limited speech and words and lots of jargon.” It went on: “The first supplement we tried was Power and Focus and within the first three days he started using way more words. Within a week he was speaking sentences. I’m absolutely amazed that I can’t wait to order more.”

The Advertising Standards Authority (ASA) found that the claims that each supplement, or substances in them, could help to prevent, treat or cure autism breached regulations after investigations.

Aspire Nutrition said they had stopped sending adverts to UK residents who visited their website and had withdrawn the ad entirely for all audiences after being informed of the complaint. Drop Supplements said their adverts featuring Happy Mind made no direct or implied statements about curing, treating or preventing ailments or diseases. However, the ASA said the advert’s claims would be understood by most consumers as implied claims that the product could prevent, treat or cure human disease. Spectrum Awakening did not respond to the ASA’s inquiries.

The ASA told each firm to ensure their future advertising did not claim that food – in these cases in the form of a supplement – could prevent, treat or cure human disease.

____________________

Such work by the ASA is most laudable, in my view. Misleading advertising is endangering the health of consumers thousands of times every day. However, the firms affected by the ASA reprimands are probably not all that worried. In fact, I imagine that they are laughing their heads off:

  • The chances of getting caught for misleading advertising are truly minimal.
  • If they are unlucky and do get caught the punishment is negligible.
  • There is little to stop them re-offending.

It is time that the ASA (and the equivalent organisations in other countries) get more power, more support and more money to effectively go after offenders in such a way that others think twice before breaking advertising rules.

International guidelines have recommended cognitive behavioural therapy, including acceptance and commitment therapy (ACT), as it offers validated benefits for managing fibromyalgia; however, it is inaccessible to most patients.  This study aimed to evaluate the effect of a 12-week, self-guided, smartphone-delivered digital ACT programme on fibromyalgia management.

In the PROSPER-FM randomised clinical trial conducted at 25 US community sites, adult participants aged 22–75 years with fibromyalgia were recruited and randomly assigned (1:1) to the digital ACT group or an active control group that offered daily symptom tracking and monitoring and access to health-related and fibromyalgia-related educational materials. Randomisation was done with a web-based system in permuted blocks of four at the site level. We used a blind-to-hypothesis approach in which participants were informed they would be randomly assigned to one of two potentially effective therapies under evaluation. Research staff were not masked to group allocation, with the exception of a masked statistics group while preparing statistical programming for the interim analysis. The primary endpoint was patient global impression of change (PGIC) response rate at week 12. Analyses were by intention to treat. The trial was registered with ClinicalTrials.govNCT05243511 (now fully closed).

Between Feb 8, 2022, and Feb 2, 2023, 590 individuals were screened, of whom 275 (257 women and 18 men) were randomly assigned to the digital ACT group (n=140) and the active control group (n=135). At 12 weeks, 99 (71%) of 140 ACT participants reported improvement on PGIC versus 30 (22%) of 135 active control participants, corresponding to a difference in proportions of 48·4% (95% CI 37·9–58·9; p<0·0001). No device-related safety events were reported.

The authors concluded that digital ACT was safe and efficacious compared with digital symptom tracking in managing fibromyalgia in adult patients.

___________________

These conclusions might well be valid – but then again, they might not!

Here is why I have my doubts:

  • The patients treated with digital ACT knew that they were getting a novel and thus exciting treatment.
  • The patients randomised to the control group, on the other hand, would most likely be disappointed not to receive this therapy. In other words, there were high expectations in the experimental group and disappointment in the control group.
  • In addition, the unmasked researchers would have had the ambition that their innovation would be successful. Thus they would have used verbal and non-verbal communications with the ACT patients to bring about the desired result.

It is therefore conceivable – I think even likely – that these factors would add up to generate a false-positive finding, particularly since the endpoint was entirely subjective.
In view of all this, I am surprised that a journal like THE LANCET has published such a flimsy study with such a over-optimistic conclusion, and I suggest re-phrasing the conclusions as follows:

Digital ACT seemed safe and effective compared with digital symptom tracking in managing fibromyalgia in adult patients. However, due to the design of the study, it is possible that digital ACT is entirely ineffective and the positive outcome is caused by a number of context effects.

To accuse anyone of an abuse of science is a hefty charge, I know. In the case of proponents of so-called alternative medicine (SCAM) doing science, it is, however, often justified. Let me explain this by using the example of chiropractors (I could have chosen homeopathy, faith heaalers, acupuncturists or almost any other type of SCAM professional, but in recent times it was the chiros who provided the clearest examples of abuse).

Science can be seen as a set of tools that is used to estabish the truth. In therapeutics, science is employed foremost to answer three questions:

  1. Is the therapy plausible?
  2. Is the therapy effective?
  3. Is the therapy safe?

The way to answer them is to falsify the underlying hypotheses, i.e. to demonstrate that:

  1. The therapy is not plausible.
  2. The therapy is not effective.
  3. The therapy is not safe.

Only if rigorous attempts at falsifying these hypotheses have falied can we conclude that:

  1. The therapy is plausible.
  2. The therapy is effective.
  3. The therapy is safe.

I know, this is rather elementary stuff. It is taught during the first lessons of any decent science course. Yet, proponents of SCAM are either not being properly taught or they are immune to even the most basic facts about science. On this blog, we regularly have the opportunity to observe exactly that when we read and are bewildered by the comments made by SCAM proponents. This is often clearest in the case of chiropractors.

  1. They cherry-pick the evidence to persuade us that their hallmark intervention, spinal manipulation, is plausible.
  2. They cherry-pick the evidence to persuade us that their hallmark intervention, spinal manipulation, is effective.
  3. They cherry-pick the evidence to persuade us that their hallmark intervention, spinal manipulation, is safe.

If they conduct research, they set up their investigations in such a way that they confirm their beliefs:

  1. Spinal manipulations are plausible.
  2. Spinal manipulations are effective.
  3. Spinal manipulations are safe.

In other words, they do not try to falsify hypotheses, but they do their very best to confirm them. And this, I am afraid, is nothing other than an abuse of science.

QED

And how can the average consumer (who may not always be in a position to realize whether a study is reliable or not) tell when such abuse of science is occurring? How can he or she decide who to trust and who not?

A simplest but sadly not fool-proof advice might consist in 2 main points:

  1. Never rely on a single study.
  2. Check whether there is a discrepancy in the results and views of SCAM proponents and independent experts; e.g.:
    • Chiropractors claim one thing, while independent scientists disagree or are unconvinced.
    • Homeopath claim one thing, while independent scientists disagree or are unconvinced.
    • Acupuncturists claim one thing, while independent scientists disagree or are unconvinced.
    • Energy healers claim one thing, while independent scientists disagree or are unconvinced.
    • Naturopaths claim one thing, while independent scientists disagree or are unconvinced.
    • Etc., etc.

In all of those cases, your alarm bells should ring and it might be wise to be cautious and avoid the treatment in question.

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