conflict of interest
Cervical spine manipulation (CSM) is a popular manipulative therapy employed by chiropractors, osteopaths, physiotherapists and other healthcare professionals. It remains controversial because its benefits are in doubt and its safety is questionable. CSM carries the risk of serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke.
Chinese physicians recently reported a rare case of a ‘locked-in syndrome’ (LIS) due to bi-lateral VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after receiving treatment with CSM. Although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnoea at 4 hours after admission. He was diagnosed with LIS. Cervical and brain computed tomography angiography revealed bi-lateral VADs. Aorto-cranial digital subtraction angiography showed a vertebro-basilar thrombosis which was blocking the left vertebral artery, and a stenosis of right vertebral artery. The patient underwent emergency arterial embolectomy; subsequently he was treated with antiplatelet therapy and supportive therapy in an intensive care unit and later in a general ward. After 27 days, the patient’s physical function gradually improved. At discharge, he still had a neurological deficit with muscle strength grade 3/5 and hyperreflexia of the limbs.
The authors concluded that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to CSM have pre-existing craniocervical artery dissection.
Informed consent is an ethical imperative with any treatment. There is good evidence to suggest that few clinicians using CSM obtain informed consent from their patients before starting their treatment. This is undoubtedly a serious violation of medical ethics.
So, why do they not obtain informed consent?
To answer this question, we need to consider what informed consent would mean. It would mean, I think, conveying the following points to the patient in a way that he or she can understand them:
- the treatment I am suggesting can, in rare cases, cause very serious problems,
- there is little good evidence to suggest that it will ease your condition,
- there are other therapies that might be more effective.
Who would give his or her consent after receiving such information?
I suspect it would be very few patients indeed!
AND THAT’S THE REASON, I FEAR, WHY MANY CLINICIANS USING CSM PREFER TO BEHAVE UNETHICALLY AND FORGET ABOUT INFORMED CONSENT.
Samuel Hahnemann, the founder of homeopathy, gave a lecture on the subject of veterinary homeopathy in the mid-1810s. Ever since, homeopathy has been used for treating animals. Von Boennighausen, a Dutch lawyer and early convert to homeopathy, was one of the first influential proponents of veterinary homeopathy.
However, veterinary medical schools tended to take a very dim view of homoeopathy, and the number of veterinary homeopaths initially remained small. In the 1920ies, veterinary homoeopathy was revived in Germany. Members of the “Studiengemeinschaft für tierärztliche Homöopathie” (Study Group for Veterinary Homoeopathy), which was founded in 1936 and had Nazi support, started to investigate this approach.
Today, veterinary homeopathy is popular, not least because of the general boom in alternative medicine. Prince Charles has become one of its most prominent advocate. In his book HARMONY, he writes:
“…one of the big arguments used against homeopathy is that it does not really work medically. The criticism is that people simply believe they feel they are going to feel better and so they think they are better. They have responded to the so-called ‘placebo effect’. It is for this reason that critics of homeopathy argue that it is a trick of the mind and its remedies are nothing more than sugar pills. What none of those who take this view ever seem to acknowledge is that these remedies also work on animals, which are surely unlikely to be influenced by the placebo effect. I certainly remember that when I started to introduce homeopathic remedies on the Duchy Home Farm, farm staff who had no view either way reported that the health of an animal that had been treated had improved so I wonder what it is that prevents the medical profession from even considering the evidence that now exists of trials of homeopathic treatments carried out on animals? It is not the quackery they claim it to be. Or if it is, then I have some very clever cows in my shed!”
[I do love this quote; it so very clearly shows the frightfully muddled thinking of this man.]In many countries, veterinary homeopaths have their own professional organisations. In other countries, however, veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are allowed to use homeopathy on animals, but ironically anyone regardless of background can use it on human patients. In the US, homeopathic vets are organised in the Academy of Veterinary Homeopathy.
But what do homeopathic vets treat? One website informs us that the conditions frequently treated are: arthritis, lameness, cruciate rupture, chronic diarrhoea, atopy, allergy, autoimmune disorders (auto-immune), periodic ophthalmia (moon blindness, moonblindness, recurrent uveitis, recurrent ophthalmia, ERU), head shaking (headshaking, head-shaking), hip dysplasia, COPD, sweet itch, laminitis, corneal ulcer, elbow dysplasia, RAO, DJD, OCD, bone cysts, pasteurellosis (pasteurella), chlamydia, cryptosporidia, pneumonia, meningitis, mastitis, ringworm, epilepsy, pyoderma, eczema, dermatitis, eosinophilic myositis, eosinophilic granuloma, rodent ulcer, miliary eczema (miliary dermatitis), kidney problems, liver problems (hepatopathy), cystitis.
Now I can almost hear you shout: WHERE IS THE EVIDENCE???
May I refer you to a previous post on the matter?
It discussed a review aimed to assess risk of bias and to quantify the effect size of homeopathic interventions compared with placebo for each eligible peer-reviewed trial. Judgement in 7 assessment domains enabled a trial’s risk of bias to be designated as low, unclear or high. A trial was judged to comprise reliable evidence, if its risk of bias was low or was unclear in specified domains. A trial was considered to be free of vested interest, if it was not funded by a homeopathic pharmacy.
The 18 RCTs found by the researchers were disparate in nature, representing 4 species and 11 different medical conditions. Reliable evidence, free from vested interest, was identified in only two trials:
- homeopathic Coli had a prophylactic effect on porcine diarrhoea (odds ratio 3.89, 95 per cent confidence interval [CI], 1.19 to 12.68, P=0.02);
- individualised homeopathic treatment did not have a more beneficial effect on bovine mastitis than placebo intervention (standardised mean difference -0.31, 95 per cent CI, -0.97 to 0.34, P=0.35).
The authors conclusions are clear: Mixed findings from the only two placebo-controlled RCTs that had suitably reliable evidence precluded generalisable conclusions about the efficacy of any particular homeopathic medicine or the impact of individualised homeopathic intervention on any given medical condition in animals.
…homeopaths…will try to claim that [the review] was a biased piece of research conducted, most likely, by notorious anti-homeopaths who cannot be trusted. So who are the authors of this new publication?
They are RT Mathie from the British Homeopathic Association and J Clausen from one of Germany’s most pro-homeopathic institution, the ‘Karl und Veronica Carstens-Stiftung’.
At this stage, some of my readers are quite angry, I imagine. They might wonder how to protect defenceless animals from homeopathic quacks. But how?
Simple! Just sign the petition to ban veterinary homeopathy! I mean it – please do!!!
Over the years, I had to get used to some abominably poor research in alternative medicine, particularly homeopathy. This new paper takes the biscuit, in my fairly well-informed opinion.
The article in question reports a survey investigating the management of paediatric tonsillopharyngitis, with a focus on natural remedies. For that purpose, 138 paediatricians, general practitioners and ear-nose-throat (ENT) specialists from 7 countries were sent a self-made, non-validated questionnaire.
The results indicate that a rapid strept test (RST) to diagnose acute tonsillopharyngitis was routinely used by 41% of the respondents. The use of RST allowed 200 diagnosis/year compared with 125 diagnosis/year for clinicians who did not use this tool. Homeopathic remedies were prescribed as a supportive therapy by 62% of participants. Among different homeopathic remedies, SilAtro-5-90 was the most frequently prescribed. In the chronic setting, homeopathy was suggested as a supportive therapy by 59% of all participants, phytotherapy by 28% and vitamins/nutritional supplementation by 37%.
The authors of this paper concluded from these results that the management of tonsillopharyngitis in paediatric patients still remains empiric. Natural remedies, and homeopathy in particular, are used in the management of URTIs. An integrative approach to these infections may help reduce excessive antibiotic prescription.
No wonder that homeopathy and research into it are the laughing stock of the scientific community!
A survey of this nature is already a fairly daft idea. What could it possibly show? That health care professionals who like homeopathy answer, while the vast majority don’t!
But the pinnacle of silliness must be the conclusions drawn from such ‘research’. Let’s take them step by step:
- the management of tonsillopharyngitis in paediatric patients still remains empiric – this is not true nor is it borne out by the data generated.
- Natural remedies, and homeopathy in particular, are used in the management of URTIs – this may be true, but it has been known before; we therefore do not need to waste time and effort to re-state it.
- An integrative approach to these infections may help reduce excessive antibiotic prescription – this is not supported by the data and it also seems nonsensical: if it truly successful in reducing antibiotic prescribing, it is arguably no longer integrative but alternative.
So?
Say no more!
When given the diagnosis ‘CANCER’, most people go into some sort of shock. Once they have recovered, they are likely to learn that they now face many months of very aggressive treatments which will reduce their quality of life to almost zero. This, they are told, is no guarantee but will merely increase their chances to survive the cancer.
Understandably, before they make what might be the most important decision of their lives, patients are desperate and tempted to look elsewhere to find out for themselves what their options are. It would be foolish to simply accept what their team of health care professionals have been saying. With decisions as important as this one, it is wise to listen to second and possibly third opinions. Who could argue with this logic?
Most cancer patients then go on the Internet and have a look at what alternatives are on offer. Here they find virtually millions of sites offering information. A person with pancreatic cancer might thus be unfortunate enough to stumble over a site called What Alternative Medicine works best against Pancreatic Cancer? If she does, her life is at risk.
You think I am exaggerating? In this case, let me quote from this website (I made no changes whatsoever, not even corrections of the spelling mistakes):
Just to remind you this particular thread is concerned with alternative treatments for cancer. People here are seeking information about alternative medicine. Now we all know that immunotherapy represents potentially a great leap forward in the treatment of cancer in the mainstream medical community although the stats are still pretty low for repsonse most of which have been done on melanoma patients. Nonetheless impresive compared to the useless toxic treatments peddled by the drug industry over the last 30 years. Interferon being one of the worst treatments inflicted on many a poor cancer patient along with chemo and radiation for which many cancers have little or no response and are extremely toxic. I make no false claims about the work of Dr Kelley or Dr Gonzalez for that matter. For those willing to dig a little and research their work they will find a body of good evidence for their protocol.
You might say that this is an extreme exception of irresponsible, life-threatening misinformation. But I disagree. The Internet is full with sites of this nature. They promote treatments for which there is no good evidence; what is worse, they encourage patients to forego conventional treatments which might save their lives. If anyone then dares to point this out, he will be attacked for being in the pocket of ‘Big Pharma’.
I know, a little insignificant post like mine will change very little, but I also feel strongly that, if I do not keep banging on about this issue, who else will warn patients that misinformation from the Internet and other sources can kill?
Recently I had an unpleasant exchange with an Australian naturopath by the name of Brett Smith. It started by him claiming that ‘chemo’ only kills cancer patients and enriches the pharmaceutical industry. And then it got worse, much worse, and very unpleasant. This got me interested in Mr Smith and prompted me to look him up. Brett Smith describes himself on his website:
Brett is a graduate of Sydney University masters degree program in Herbal Medicine run through it’s acclaimed faculty of pharmacy. He also earned a degree in Health Science from the University of New England making him one of the most qualified Naturopaths in Australia. Brett ran a successful naturopathic clinic in Bondi Junction for 6 years before selling it and founding HealthShed.com and writing and researching a book on Type 2 Diabetes.
In a world of chaos and confusion, the one area you have some semblance of control over is your health. One of the issues around this subject that frustrates me is the conflicting information consistently bombarding us. If we can land a pod on Mars why do we still not know the fundamental pathways to human health.
One of the reasons is the big food corporations that have a vested interest in keeping you reaching to the shelves for their dead foods and the one thing I can assure you of, without any doubt, is that dead food makes dead people. If people understood the true power of foods, herbs and the odd supplement in reaching their health potentials we could eradicate many diseases scourging the planet today – heart disease, diabetes, alzheimer’s, thyroid conditions, asthma, the list is seriously endless.
The other part of the problem is us. We choose the “easy” option too many times, generation after generation after generation. What chance do our children have? Always looking for the Magic Pill. Another thing I can assure you of is that the vast majority of pharmaceutical drugs prescribed is completely unnecessary.
Natural therapists risks making the same mistakes as the pharmaceutical medical industry in becoming an elitist therapy guided by profit at expense of the patient.
I’m committed to helping inspire and empower people to optimal health through simple yet highly effective methods. Despite all the white noise, optimum health is open to us all, rich or poor, old or young. In fact, it’s your birth right. Claim it.
I also looked up his ‘health shed’. Amongst other things, it turns out to be a treasure trove of utter nonsense and anti-medical propaganda written by several experts of equally high standing – worth reading, if you have a minute! To give you a flavour, I have chosen a post entitled Which is Greater Threat, Measles or Measles Vaccine?:
Brett Smith N.D
Sometimes in life you just have to put your neck (and your reputation) on the line. I’ve been told on more than one occasion not to run vaccination stories. I’m sorry but I cannot ignore this ‘debate’ right now. Immunisation is a beautiful theory and with the right delivery method and ingredients may have a future, but as it is now we need to stop and have a very close look at this issue. Vaccines are not safe for everyone and vaccine injuries are not rare. Hep B shots on a one day old infant is actually criminal and I will debate any expert anytime, anywhere on that particular subject. Until then hear what Dr Jeffrey Dach has to say on the subject.
by Jeffrey Dach MD
A recent measles outbreak at Disneyland of at least 70 cases (Jan 2015) has created quite a stir in the media. Five of the cases were fully vaccinated, indicating the measles vaccine confers only temporary immunity. Clearly there is no “failure to vaccinate”, as measles has broken out in highly vaccinated populations. It is obviously a failure of the vaccine. Unlike the vaccine, real measles infection confers life-long immunity.
Measles in 2008
In 2008, a similar resurgence in measles cases was reported. An increase in reported cases of measles from 42 to 131 prompted a 2008 New York Times editorial warning of re-emergence of “many diseases” if vaccination rates drop. A quote from the New York Times:
“If confidence in all vaccines were to drop precipitously, many diseases would re-emerge and cause far more harm than could possibly result from vaccination.”
Confidence in Vaccines Has Been Lost
Unfortunately, confidence in vaccines has already been lost according to Shona Hilton in her article, ”Who do parents believe about MMR”. According to Shona Hilton, young parents are mistrustful of the media and the pediatricians who have financial incentives to push vaccines.
What is the Evidence for an Autism/ Vaccine Link?
The Hanna Poling Case
In the case of Hannah Poling, the federal vaccine court has agreed to compensate Poling’s family, conceding that her autism was caused by vaccination. The federal court has already paid out more than $1.5 billion for vaccine related injury or death.
Italian Court Conceded MMR Caused Autism
In 2012, the Italian Health Ministry conceded the MMR vaccine caused autism in nine-year-old Valentino Bocca. Exactly how many other cases exist is unknown because court records are usually sealed from public view.
Abnormal MMR Antibody Response in Autistic Kids
An important finding was found in a 2002 report in Biomedical Science by Dr. Singh entitled ” Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism.”
The authors found elevated antibody levels to MMR (Measles Mumps Rubells Vaccine) in 60% of autistic children, none in controls. The elevated MMR antibodies in autistic children detected “measles HA protein”, which is unique to the measles subunit of the vaccine. Over 90% of the autistic children with elevated MMR antibodies, also had elevated MBP (myelin basic protein) antibodies, suggesting a strong association between MMR and CNS autoimmunity in autism. The authors state:
“Stemming from this evidence, we suggest that an inappropriate antibody response to MMR, specifically the measles component thereof, might be related to pathogenesis of autism.”
“In light of these new findings, we suggest that a considerable proportion of autistic cases may result from an atypical measles infection that does not produce a rash but causes neurological symptoms in some children. The source of this virus could be a variant MV or it could be the MMR vaccine.”
A second paper in 2003 by the same group confirmed these findings: Singh, Vijendra K., and Ryan L. Jensen. ” Elevated Levels of Measles Antibodies in children with Autism.” Pediatric neurology 28.4 (2003): 292-294.
According to Bernadine Healy MD, Director of the National Institute of Health (NIH) in 1991, there is credible published, peer-reviewed scientific studies that support the idea of an association between autism and vaccines. Rather than oppose all vaccinations, Dr Healy suggests modifying the vaccination schedule to make them safer. Left Image Courtesy of Bernadine Healy MD Huffington Post.
How to Make the Vaccine Schedule Safer?
Don Miller MD in this article on Lew Rockwell, provides a safer vaccination schedule. For example, the vaccination schedule can be made safer by waiting until child’s immune system is better developed after age 2, by moving from the combined MMR shot to individual doses, avoiding thimerosol, and avoiding the live vaccines…
Vitamin A and measles
Numerous medical publications have shown health benefits for Vitamin A in treatment of measles.
Conclusion
Clearly, there is a trade off in terms of benefits and risks of vaccines. Rather than deny the adverse effects of vaccines, we should be openly discussing how to make the vaccine schedule safer, as Don Miller MD and Bernadine Healy MD suggest.
If this had been a exceptional excursion into quackery, I would probably not have mentioned it. But Smith’s ‘health shed’ is full of it. Here are just three further examples:
The Truth About Chemotherapy – History, Effects and Natural Alternatives
The Amazing Cancer-Fighting Properties of Pineapple
Amazing Herb Kills 98% Of Cancer Cells In Just 16 Hours
Such dangerous nonsense tends to make me first speechless and then quite angry. This man claims to be one of the best educated naturopaths in Australia. If that is true, what is the rest of the naturopaths like? He wants to ’empower people to optimal health’. In truth, he and many like him are experts on misinformation that potentially could shorten the lives of many patients.
A 2016 article set out to define the minimum core competencies expected from a certified paediatric doctor of chiropractic using a Delphi consensus process. The initial set of seed statements and sub-statements was modelled on competency documents used by organizations that oversee chiropractic and medical education. The statements were then distributed to the Delphi panel, reaching consensus when 80% of the panelists approved each segment. The panel consisted of 23 specialists in chiropractic paediatrics from across the spectrum of the chiropractic profession. Sixty-one percent of panellists had postgraduate paediatric certifications or degrees, 39% had additional graduate degrees, and 74% were faculty at a chiropractic institution and/or in a postgraduate paediatrics program. The panel was initially given 10 statements with related sub-statements formulated by the study’s steering committee. On all 3 rounds of the Delphi process the panelists reached consensus; however, multiple rounds occurred to incorporate the valuable qualitative feedback received.
The results of this process reveal that the Certified Paediatric Doctor of Chiropractic requires 8 sets of skills. (S)he will …
1) Possess a working knowledge and understanding of the anatomy, physiology, neurology, psychology, and developmental stages of a child. a) Recognize known effects of the prenatal environment, length of the pregnancy, and birth process on the child’s health. b) Identify and evaluate the stages of growth and evolution of systems from birth to adulthood. c) Appraise the clinical implications of developmental stages in health and disease, including gross and fine motor, language/communication, and cognitive, social, and emotional skills. d) Recognize normal from abnormal in these areas. e) Possess an understanding of the nutritional needs of various stages of childhood.
2) Recognize common and unusual health conditions of childhood. a) Identify and differentiate clinical features of common physical and mental paediatric conditions. b) Identify and differentiate evidence-based health care options for these conditions. c) Identify and differentiate clinical features and evidence-based health care options for the paediatric special needs population.
3) Be able to perform an age-appropriate evaluation of the paediatric patient. a) Take a comprehensive history, using appropriate communication skills to address both child and parent/ guardian. b) Perform age-appropriate and case-specific physical, orthopaedic, neurological, and developmental examination protocols. c) When indicated, utilize age-appropriate laboratory, imaging, and other diagnostic studies and consultations, according to best practice guidelines. d) Appropriately apply and adapt these skills to the paediatric special needs population. e) Be able to obtain and comprehend all relevant external health records.
4) Formulate differential diagnoses based on the history, examination, and diagnostic studies.
5) Establish a plan of management for each child, including treatment, referral to, and/or co-management with other health care professionals. a) Use the scientific literature to inform the management plan. b) Adequately document the patient encounter and management plan. c) Communicate management plan clearly (written, oral, and nonverbal cues) with both the child and the child’s parent/guardian. d) Communicate appropriately and clearly with other professionals in the referral and co-management of patients.
6) Deliver skilful, competent, and safe chiropractic care, modified for the paediatric population, including but not limited to: a) Manual therapy and instrument-assisted techniques including manipulation/adjustment, mobilization, and soft tissue therapies to address articulations and/or soft tissues. b) Physical therapy modalities. c) Postural and rehabilitative exercises. d) Nutrition advice and supplementation. e) Lifestyle and public health advice. f) Adapt the delivery of chiropractic care for the paediatric special needs population.
7) Integrate and collaborate with other health care providers in the care of the paediatric patient. a) Recognize the role of various health care providers in paediatric care. b) Utilize professional inter-referral protocols. c) Interact clearly and professionally as needed with health care professionals and others involved in the care of each patient. d) Clearly explain the role of chiropractic care to professionals, parents, and children.
8) Function as a primary contact, portal of entry practitioner who will. a) Be proficient in paediatric first aid and basic emergency procedures. b) Identify and report suspected child abuse.
9) Demonstrate and utilize high professional and ethical standards in all aspects of the care of paediatric patients and professional practice. a) Monitor and properly reports of effects/adverse events. b) Recognize cultural individuality and respect the child’s and family’s wishes regarding health care decisions. c) Engage in lifelong learning to maintain and improve professional knowledge and skills. d) Contribute when possible to the knowledge base of the profession by participating in research. e) Represent and support the specialty of paediatrics within the profession and to the broader healthcare and lay communities.
I find this remarkable in many ways. Let us just consider a few items from the above list of competencies:
Identify and differentiate evidence-based health care options… such options would clearly not include chiropractic manipulations.
Identify and differentiate clinical features and evidence-based health care options for the paediatric special needs population… as above. Why is there no mention of immunisations anywhere?
Perform age-appropriate and case-specific physical, orthopaedic, neurological, and developmental examination protocols. If that is a competency requirement, patients should really see the appropriate medical specialists rather than a chiropractor.
Establish a plan of management for each child, including treatment, referral to, and/or co-management with other health care professionals. The treatment plan is either evidence-based or it includes chiropractic manipulations.
Deliver skilful, competent, and safe chiropractic care… Aren’t there contradictions in terms here?
Manual therapy and instrument-assisted techniques including manipulation/adjustment, mobilization, and soft tissue therapies to address articulations and/or soft tissues. Where is the evidence that these treatments are effective for paediatric conditions, and which conditions would these be?
Clearly explain the role of chiropractic care to professionals, parents, and children. As chiropractic is not evidence-based in paediatrics, the role is extremely limited or nil.
Function as a primary contact, portal of entry practitioner… This seems to me as a recipe for disaster.
Demonstrate and utilize high professional and ethical standards in all aspects of the care of paediatric patients… This would include obtaining informed consent which, in turn, needs to include telling the parents that chiropractic is neither safe nor effective and that better therapeutic options are available. Moreover, would it not be ethical to make clear that a paediatric ‘doctor’ of chiropractic is a very far cry from a real paediatrician?
So, what should the competencies of a chiropractor really be when it comes to treating paediatric conditions? In my view, they are much simpler than outlined by the authors of this new article: I SEE NO REASON WHATSOEVER WHY CHIROPRACTORS SHOULD TREAT CHILDREN!
The Nobel laureate Venkatraman Ramakrishnan recently called homeopathy ‘bogus’. “They (homeopaths) take arsenic compounds and dilute it to such an extent that just a molecule is left. It will not make any effect on you. Your tap water has more arsenic. No one in chemistry believes in homeopathy. It works because of placebo effect,” he was quoted saying.
But what does he know about homeopathy? This was the angry question of homeopaths around the world when the Nobel laureate’s views became international headlines.
Nothing! Exclaimed the furious homeopaths with one voice.
If we want to get an informed opinion, we a true expert.
The Queen’s homeopath Dr Fisher? No, he has been known to tell untruths.
Doctor Michael Dixon, the adviser to Prince Charles who recently defended homeopathy? No, he is not even a homeopath.
Dana Ullman, the voice of US homeopathy? Heavens, he is a homeopath but not one who is known to be objective.
Alan Schmukler perhaps? He too seems to have difficulties with critical thinking.
Perhaps we need to ask an experienced and successful homeopath like doctor Akshay Batra; someone with both feet on the ground who knows about the coal face of health care today. He recently spoke out for the virtues of homeopathy explaining that it is based on the ingenious idea that ‘like cures like: “For example if you are suffering from constant watering eyes, you will be given allium cepa which comes from onions, something that causes eyes to water. Homeopathy works like a vaccine”. Dr Batra claims that the failure of allopathy (mainstream medicine) is causing the present boom in homeopathy. “With the amount of deaths taking place due to allopathic medicine and its side effects, we can see people resorting to homeopathy,” he said. “Certain children using asthma inhalers suffer from growth issues or develop unusual facial hair. Homeopathy avoids that and uses a natural remedy that treats the root cause,” he added.
The top issues treated with homeopathy, according to Dr Batra, are hair and skin problems. “A lot of ailments today effecting hair and skin are because of internal diseases. Hair loss in women has become very prevalent and can be due to cystic ovaries, low iron levels or hormonal imbalance due to thyroid,” explained Dr Batra. “We find the root cause and treat that, since hair loss could just be a symptom and we need to treat the ailment permanently. Allopathic medicines just give you a quick fix, and not treat the root cause, while we give a more long term, complete solution,” he added. Homeopathy is mind and body medicine: “A lot of people today are under pressure and stress. Homeopathic treatment also helps in relieving tension hence treating the patient as a whole,” said Dr Batra.
I bet you now wonder who is this fabulous expert and homeopath, doctor Batra.
He has been mentioned on this blog before, namely when he opened the first London branch of his chain of homeopathic clinics claiming that homeopathy could effectively treat the following conditions:
Yes, Dr Akshay Batra is the managing director and chairman of Dr Batra’s Homeopathic Clinic, an enterprise that is currently establishing clinics across the globe.
And now we understand, I think, why the Nobel laureate and the homeopathy expert have slightly different views on the subject.
Who would you believe, I wonder?
Consensus recommendations to the ‘National Center for Complementary and Integrative Health from Research Faculty in a Transdisciplinary Academic Consortium for Complementary and Integrative Health and Medicine’ have just been published. It appeared in this most impartial of all CAM journals, the ‘Journal of Alternative and Complementary Mededicine’. Its authors are equally impartial: Menard MB 1, Weeks J 2, Anderson 3, Meeker 4, Calabrese C 5, O’Bryon D 6, Cramer GD 7
They come from these institutions:
- 1 Crocker Institute , Kiawah Island, SC.
- 2 Academic Consortium for Complementary and Alternative Health Care , Seattle, WA.
- 3 Pacific College of Oriental Medicine , New York, NY.
- 4 Palmer College of Chiropractic , San Jose, CA.
- 5 Center for Natural Medicine , Portland, OR.
- 6 Association of Chiropractic Colleges , Bethesda, MD.
- 7 National University of Health Sciences , Lombard, IL
HERE IS THE ABSTRACT OF THE DOCUMENT IN ITS FULL AND UNABBREVIATED BEAUTY:
BACKGROUND:
This commentary presents the most impactful, shared priorities for research investment across the licensed complementary and integrative health (CIH) disciplines according to the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). These are (1) research on whole disciplines; (2) costs; and (3) building capacity within the disciplines’ universities, colleges, and programs. The issue of research capacity is emphasized.
DISCUSSION:
ACCAHC urges expansion of investment in the development of researchers who are graduates of CIH programs, particularly those with a continued association with accredited CIH schools. To increase capacity of CIH discipline researchers, we recommend National Center for Complementary and Integrative Health (NCCIH) to (1) continue and expand R25 grants for education in evidence-based healthcare and evidence-informed practice at CIH schools; (2) work to limit researcher attrition from CIH institutions by supporting career development grants for clinicians from licensed CIH fields who are affiliated with and dedicated to continuing to work in accredited CIH schools; (3) fund additional stand-alone grants to CIH institutions that already have a strong research foundation, and collaborate with appropriate National Institutes of Health (NIH) institutes and centers to create infrastructure in these institutions; (4) stimulate higher percentages of grants to conventional centers to require or strongly encourage partnership with CIH institutions or CIH researchers based at CIH institutions, or give priority to those that do; (5) fund research conferences, workshops, and symposia developed through accredited CIH schools, including those that explore best methods for studying the impact of whole disciplines; and (6) following the present NIH policy of giving priority to new researchers, we urge NCCIH to give a marginal benefit to grant applications from CIH clinician-researchers at CIH academic/research institutions, to acknowledge that CIH concepts require specialized expertise to translate to conventional perspectives.
SUMMARY:
We commend NCCIH for its previous efforts to support high-quality research in the CIH disciplines. As NCCIH develops its 2016-2020 strategic plan, these recommendations to prioritize research based on whole disciplines, encourage collection of outcome data related to costs, and further support capacity-building within CIH institutions remain relevant and are a strategic use of funds that can benefit the nation’s health.
AND WHY DID THIS SURPRISE ME?
Well, I would have expected that such an impartial, intelligent bunch of people who are doubtlessly capable of critical analysis would have come up with a totally different set of recommendations. For instance:
- Integrative health makes no sense.
- Integrative medicine is a disservice to patients.
- Integrative health is a paradise for charlatans.
- No more research is required in this area.
- Research already under way should be stopped.
- Money ear-marked for integrative health should be diverted to other investigators researching areas that show at least a glimpse of promise.
Alright, you are correct – my suggestions are neither realistic nor constructive. One cannot expect that they will turn down all these lovely research funds and give it to real scientists. One has to offer them something constructive to do with the money. How about projects addressing the following research questions?
- How many integrative health clinics offer evidence-based treatments?
- Is the promotion of bogus treatments in line with the demands of medical ethics?
- If we need to render health care more holistic, humane, patient-centred, why not reform conventional medicine?
- Is the creation of integrative medicine a divisive development for health care?
- Is humane, holistic, patient-centred care really an invention of integrative medicine, and what is its history?
- Which of the alternative treatments used in integrative medicine can be shown to do more good than harm?
- What are the commercial drivers behind the integrative health movement?
- Is there a role for critical thinking within integrative health?
- Is integrative health creating double standards within medicine?
- What is better for public health, empty promises about ‘the best of both worlds’ or sound evidence?
What a question, you might say. And you would be right, it’s a most awkward one, so much so that I cannot answer it for myself.
I NEED YOUR HELP.
Here is the story:
Ten years ago, with the help of S Lejeune and an EU grant, my team conducted a Cochrane review of Laertrile. To do the ‘ground work’, we hired an Italian research assistant, S Milazzo, who was supervised mainly by my research fellow Katja Schmidt. Consequently, the review was published under the names of all main contributors: Milazzo, Ernst, Lejeune, Schmidt.
In 2011, an update was due for which the help of Dr Markus Horneber, the head of a German research team investigating alt med in relation to cancer, was recruited. By then, Milazzo and Schmidt had left my unit and, with my consent, Horneber, Milazzo and Schmidt took charge of the review. I was then sent a draft of their update and did a revision of it which consisted mostly in checking the facts and making linguistic changes. The article was then published under the following authorship: Milazzo S, Ernst E, Lejeune S, Boehm K, Horneber M (Katja had married meanwhile, so Boehm and Schmidt are the same person).
A few days ago, I noticed that a further update had been published in 2015. Amazingly, I had not been told, asked to contribute, or informed that my name as co-author had been scrapped. The authors of the new update are simply Milazzo and Horneber (the latter being the senior author). Katja Boehm had apparently indicated that she did no longer want to be involved; I am not sure what happened to Lejeune.
I know Markus Horneber since donkey’s years and had co-authored several other papers with him in the past, so I (admittedly miffed about my discovery) sent him an email and asked him whether he did not consider this behaviour to amount to plagiarism. His reply was, in my view, unhelpful in explaining why I had not been asked to get involved and Horneber asked me to withdraw the allegation of plagiarism (which I had not even made) – or else he would take legal action (this was the moment when I got truly suspicious).
Next, I contacted the responsible editor at the Cochrane Collaboration, not least because Horneber had claimed that she had condoned the disputed change of authorship. Her reply confirmed that “excluding previous authors without giving them a chance to comment is not normal Cochrane policy” and that she did, in fact, not condone the omission of my name from the list of co-authors.
The question that I am asking myself (not for the first time, I am afraid – a similar, arguably worse case has been described in the comments section of this post) is the following: IS THIS A CASE OF PLAGIARISM OR NOT? In the name of honesty, transparency and science, it requires an answer, I think.
Even after contemplating it for several days, I seem to be unable to find a conclusive response. On the one hand, I did clearly not contribute to the latest (2015) update and should therefore not be a co-author. On the other hand, I feel that I should have been asked to contribute, in which case I would certainly have done so and remained a co-author.
For a fuller understanding of this case, I here copy the various sections of the abstracts of the 2011 update (marked OLD) and the 2015 update without my co-authorship (marked NEW):
OLD
Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous.
NEW
Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous.
OBJECTIVES:
OLD
To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin.
NEW
To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin.
SEARCH METHODS:
OLD
We searched the following databases: CENTRAL (2011, Issue 1); MEDLINE (1951-2011); EMBASE (1980-2011); AMED; Scirus; CancerLit; CINAHL (all from 1982-2011); CAMbase (from 1998-2011); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language.
NEW
We searched the following databases: CENTRAL (2014, Issue 9); MEDLINE (1951-2014); EMBASE (1980-2014); AMED; Scirus; CINAHL (all from 1982-2015); CAMbase (from 1998-2015); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language.
SELECTION CRITERIA:
OLD
Randomized controlled trials (RCTs) and quasi-RCTs.
NEW
Randomized controlled trials (RCTs) and quasi-RCTs.
DATA COLLECTION AND ANALYSIS:
OLD
We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria.
NEW
We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria.
MAIN RESULTS:
OLD
We located over 200 references, 63 were evaluated in the original review and an additional 6 in this update. However, we did not identify any studies that met our inclusion criteria.
NEW
We located over 200 references, 63 were evaluated in the original review, 6 in the 2011 and none in this update. However, we did not identify any studies that met our inclusion criteria.
AUTHORS’ CONCLUSIONS:
OLD
The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.
NEW
The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.
END OF ABSTRACT
I HOPE THAT YOU, THE READER OF THIS POST, ARE NOW ABLE TO TELL ME:
HAVE I BEEN PLAGIARISED?
P S
After the response from the Cochrane editor, I asked Horneber whether he wanted to make a further comment because I was thinking to blog about this. So far, I have not received a reply.
MORE than £150,000 was spent by NHS Grampian on homeopathic treatments last year. Referrals to homeopathic practitioners cost £37,000 and referrals to the Glasgow Homoeopathic Hospital cost £7,315 in 2014-15. In view of the fact that highly diluted homeopathic remedies are pure placebos, any amount of tax payers’ money spent on homeopathy is hard to justify. Yet an NHS Grampian spokeswoman defended its use of by the health board with the following words:
“We have a responsibility to consider all treatments available to NHS patients to ensure they offer safe, effective and person-centred care. We also have a responsibility to use NHS resources carefully and balance our priorities across the population as well as individuals. We also recognise that patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited. Homeopathy can be considered in this arena and we remain connected with the wider debate on its role within the NHS while regularly reviewing our local support for such services within NHS Grampian.”
Mr Spence, a professional homeopath, was also invited to defend the expenditure on homeopathy: “When a friend started talking to me about homeopathy I thought he had lost his marbles. But it seemed homeopathy could fill a gap left by orthodox medicine. Homeopathy is about treating the whole person, not just the symptoms of disease, and it could save the NHS an absolute fortune. If someone is in a dangerous situation or they need surgery then they need to go to hospital. It’s often those with chronic, long-term problems where conventional treatment has not worked that can be helped by homeopathy.”
What do these arguments amount to, I ask myself.
The answer is NOTHING.
The key sentence in the spokeswomen’s comment is : “patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited.” This seems to admit that the evidence fails to support homeopathy. Therefore, so the argument, we have to abandon evidence and consider experience, opinion etc. This seemingly innocent little trick is nothing else than the introduction of double standards into health care decision making which could be used to justify the use of just about any bogus therapy in the NHS at the tax payers’ expense. It is obvious that such a move would be a decisive step in the wrong direction and to the detriment of progress in health care.
The comments by the homeopath are perhaps even more pitiful. They replace arguments with fallacies and evidence with speculation or falsehoods.
There is, of course, a bright side to this:
IF HOMEOPATHY IS DEFENDED IN SUCH A LAUGHABLE MANNER, ITS DAYS MUST BE COUNTED.
