critical thinking
As I live partly in France, I often report about what is going on in this country in relation to so-called alternative medicine (SCAM). Here are a few recent posts:
- France outlaws practices which expose patients to a serious health risk
- Dispute about so-called alternative medicine practitioners in France
- Homeopathy in France: going, going, gone!
- Osteopathy in France: widely accepted yet based on little more than wishful thinking
- Alleged sexual misconduct serves a blow to osteopathy in France
- Homeopathy in France: a triumph of reason over profit
- HOMEOPATHY IN FRANCE: Cure cancer with homeopathy? “Let’s get real. We are doctors.”
- Random thoughts on my first SCAM-research conference in France
In general, it seemed that France was becoming more rational in its attitude towards SCAM. But now Franceinfo reported worrying developments:
Patrick Hetzel, the newFrench Minister for Higher Education and Research seems to have a less than academic approach to science. He has in the past taken positions on the fringes of the scientific consensus, supporting, for example, the use of the treatment praised by Didier Raoult during the Covid-19 crisis, or defending homeopathy.
In October 2020, Patrick Hetzel supported an amendment to the French Social Security Financing Bill (PLFSS) aimed at ‘creating a body specifically dedicated to evaluating complementary and alternative medicines, including homeopathy, and setting a reimbursement rate’. A month later, he co-signed a bill aimed at introducing a two-year moratorium on the reimbursement rate (15%) for homeopathy, rather than delisting it, so as not to upset the industry. These proposals were rejected and homeopathy, whose effectiveness was deemed ‘insufficient’ by the French National Authority for Health (HAS), has not been reimbursed in France since January 2021. To reach its opinion, the health authority scrutinised a number of studies on nearly 1,200 homeopathic medicines. ‘There is a scientific consensus that homeopathy should not be prescribed. At best it is useless, at worst it detracts from a useful treatment’, points out Jean-Michel Constantin, President of Sfar.
At the same time, Hetzel has fought to have chronic Lyme disease recognised as a disease through a bill tabled in September 2023. However, the chronic nature of this disease remains controversial, based as it is on a ‘scientifically unproven’ hypothesis, as denounced by the French Academy of Medicine in 2017.
More recently, during the debate on the bill to combat sectarian aberrations, Hetzel spoke out against creating an offence of ‘inciting abstention from medical care’. He cited a ‘legal reason’ before offering a curious view of science: ‘When you look at how scientific advances are made, very often the paradigm shifts (…) are made by people who are in the minority. So let’s be extremely careful about trying to develop a kind of dogma that would be that of an official science. I think that’s extremely dangerous’, he warned before the Assembly.
This anti-science rhetoric has not gone unnoticed. ‘Taking part in the debate on article 4 of the bill on sectarian aberrations [finally adopted], implying that official science is totalitarianism, and leaving the choice of alternative medicines to patients who have no discernment, I find that annoying. Especially for a minister whose remit includes scientific research’, laments Pierre Ouzoulias. ‘I’m struck by the fact that every time he takes a stand, it’s with conspiracy theories. This accumulation paints the picture of someone who doesn’t understand how knowledge evolves in the world of science.’
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Let’s hope the new development does not signal a general U-turn, that the appointment of Patrick Hetzel is just a little glitch, and that France will nevertheless continue on its path towards rationality.
So-called alternative medicine (SCAM) in the UK is subject to voluntary, publicly funded regulation. SCAM practitioners are known to make misleading health claims. This study used an artificial intelligence (AI) tool to measure the prevalence of such claims. Websites operated by practitioners of SCAM, registered with the UK ‘Complementary and Natural Healthcare Council’, were downloaded and assessed by the AI, which determined whether a website was relevant to the investigation and, if so, identified health-related claims that it judged as false or misleading, supplying a rationale.
Of 6096 registrants, 1326 met the selection criteria, of which 872 clinics had 725 relevant and operational websites. The AI assessed text from 11 771 web pages, identifying false or misleading claims in 704 (97%) of the websites. The AI’s performance was quality-assured by four human assessors, who manually reviewed 23 relevant web pages. Humans identified on average 39.5 claims likely to be judged false or misleading by advertising regulators, the AI identified 36. Humans misidentified an average of 4.8 claims, AI misidentified two.
The authors concluded that the overwhelming majority of practitioners registered with the CNHC who use pseudoscientific modalities are making false and/or misleading claims on their websites. This puts them in breach of their terms of registration. An AI tool can be used to monitor websites of practitioners promoting pseudoscientific modalities for breaches of compliance with regulators’ codes of conduct for advertising, and does so with a level of accuracy comparable with that of human assessors. It presents an opportunity for regulators to offer more effective consumer protection from their members’ online misinformation than at present.
The investigation was an unfunded project conducted entirely by volunteer scientists, motivated by the wish to protect consumers from health misinformation. The researchers acknowledge a grant of £550 from WePlanet to cover the cost of AI tokens used and thank University College London for paying the journal’s publication fee to enable the public to access their research.
The authors of this paper — emeritus professors David Colquhoun and Susan Bewley; retired clinical research consultant and HealthSense trustee Les Rose, and HealthSense newsletter editor Mandy Payne as well as IT scientist Simon Perry — feel that AI could be a game-changer in protecting the public by supporting regulators to quickly and cheaply clamp down on health misinformation so that the public can put their trust in the PSA Quality Mark logo displayed.
I congratulate the authors on their important study and hope they are correct – but I am not holding my breath.
Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in numerous case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). This study‘s hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.
A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES. Patients were divided into two cohorts:
- (1) LBP patients receiving CSM,
- (2) LBP patients receiving PT evaluation without spinal manipulation.
Propensity score matching controlled for confounding variables associated with CES.
67,220 patients per cohort (mean age 51 years) remained after propensity matching. CES incidence was 0.07% (95% confidence intervals [CI]: 0.05–0.09%) in the CSM cohort compared to 0.11% (95% CI: 0.09–0.14%) in the PT evaluation cohort, yielding a risk ratio and 95% CI of 0.60 (0.42–0.86; p = .0052). Both cohorts showed a higher rate of CES during the first two weeks of follow-up.
The authors concluded that the present study involving over 130,000 propensity-matched patients found that CSM is not a risk factor for CES. The incidence of CES in both CSM and PT evaluation cohorts aligns with previous estimates of CES incidence among patients with LBP, indicating a heightened risk of CES compared to asymptomatic individuals regardless of intervention. Moreover, these findings underscore the increased CES incidence within the first two weeks after either CSM or PT evaluation, emphasizing the need for clinicians’ vigilance in identifying and emergently referring patients with CES for surgical evaluation. Further real-world evidence is needed to corroborate these findings using alternative case-control and case-crossover designs, and different clinician comparators.
This is an interesting and well-reported investigation. Its particular strength is the huge sample size. Its weakness, on the other hand, is the fact that, despite the researchers best efforts, the two groups might not have been entirely comparable and that there could be a host of relevant factors that the propensity matching was unable to control for.
It is, I think, to the credit of the authors that they abstain from overrating their results and correctly emphasize in their conclusions that: Further real-world evidence is needed to corroborate these findings using alternative case-control and case-crossover designs, and different clinician comparators.
Advocates of so-called alternative medicine (SCAM) almost uniformly stress the importance of prevention and pride themselves to make much use of SCAM for the purpose of prevention. SCAM, they often claim, is effective for prevention, while conventional medicine tends to neglect it. Therefore, it seems timely to ponder a bit about the subject.
It makes sense to differentiate three types of prevention:
- Primary prevention aims to prevent disease or injury before it ever occurs.
- Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.
- Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.
Here I will includes all three and I will ask what SCAM has to offer in any form of prevention. I will do this by looking at what we have previously discussed on this blog in relation to several specific SCAM and add in each case a very brief evaluation of the evidence.
Acupuncture
- Acupuncture for the prevention of headache? How to fool (almost) everyone with an RCT – NO CONVINCING EVIDENCE
- Acupuncture for chronic migraine prevention? Two new systematic reviews yield encouraging evidence – ENCOURAGING EVIDENCE
Chiropractic
- Chiropractic manipulation and primary prevention. It’s time that chiropractors stop misleading the public in order to fill their pockets – NO CONVINCING EVIDENCE
- ‘Maintenance care’ is very good for chiropractic economics … but not for anything else! – NO CONVINCING EVIDENCE
- No evidence that spinal manipulation improves immune function – NO CONVINCING EVIDENCE
- Chiropractic maintenance care: boosting chiropractic cash flow in perpetuity – NO CONVINCING EVIDENCE
- Birth-trauma: a diagnosis that richly fills the pockets of many chiropractors – NO CONVINCING EVIDENCE
- If you don’t want to get the flu…consult your chiropractor urgently! – NO CONVINCING EVIDENCE
Herbal medicine
- Prevention of acute radiation-induced proctitis with Aloe vera – ENCOURAGING EVIDENCE
- Can Chinese Medicine Be Used for Prevention of Corona Virus Disease? – NO CONVINVING EVIDENCE
Homeopathy
- Effectiveness of Homeopathic Arsenicum album 30C in the Prevention of COVID-19 – NO CONVINCING EVIDENCE
- Disturbing news on the recent trial of homeopathy for COVID prevention – NO CONVINCING EVIDENCE
- A new study of homeopathy for the prevention of COVID-19 infections – NO CONVINCING EVIDENCE
- Is this the crown of the Corona-idiocy? Nosodes In Prevention And Management Of COVID -19 – NO CONVINCING EVIDENCE
- Homeopathic Prevention and Management of Epidemic Diseases – NO CONVINCING EVIDENCE
- Influenzinum: the homeopathic flu prevention that does not prevent flu – NO CONVINCING EVIDENCE
- Homeopathy for preventing and treating acute respiratory tract infections in children – NO CONVINCING EVIDENCE
- A new trial of homeopathy for preventing COVID-19 infections – NO CONVINCING EVIDENCE
- Oscillococcinum, the homeopathic solution to the coronavirus threat? – NO CONVINCING EVIDENCE
- An RCT suggests that homeopathy can prevent epidemics!!! But how reliable is this evidence? – NO CONVINCING EVIDENCE
- HOMEOPATHS LOVE IT: the epidemiological evidence suggesting that homeopathy works – NO CONVINCING EVIDENCE
- Understanding homeoprophylaxis: it is dangerous nonsense!!! – NO CONVINCING EVIDENCE
- “Homeoprophylaxis, the homeopathic vaccine alternative, prevents disease through nosodes.” NO CONVINCING EVIDENCE
- Boiron’s new study of homeopathy NO GOOD EVIDENCE
Mind-body therapies
- Meditation for the primary and secondary prevention of cardiovascular disease – NO CONVINCING EVIDENCE
- Transcendental meditation (TM) for the primary prevention of cardiovascular disease? – NO CONVINCING EVIDENCE
Osteopathy
Does Osteopathy Prevent Motion Sickness? – NO CONVINCING EVIDENCE
Supplements
- Multivitamins in the prevention of cancer and cardiovascular disease – NO CONVINCING EVIDENCE
- Zinc for the prevention or treatment of acute viral respiratory tract infections in adults? A new systematic review – NO CONVINCING EVIDENCE
- Vitamin D for the prevention or treatment of COVID-19? NO CONVINCING EVIDENCE
- Supplements for the prevention of cardiovascular disease and cancer – NO CONVINCING EVIDENCE
- Do Vitamin, Mineral, and Multivitamin Supplements Prevent Cardiovascular Disease and Cancer? – NO CONVINCING EVIDENCE
- Does vitamin D supplementation lower the risk of cancer and precancers? – NO CONVINCING EVIDENCE
- Glucosamine is associated with decreased risk of lung cancer – ENCOURAGING EVIDENCE
Yoga
- Yoga for the prevention of cardiovascular disease: more than wishful thinking? – NO CONVINCING EVIDENCE
- Who says it’s all negative? The addition of yoga to aerobic exercise programs reduces global cardiovascular risk – ENCOURAGING EVIDENCE
I hope you agree: this list is impressive!
- Impressive in the way of showing how often we have discussed SCAM for prevention in one form or another.
- Impressive also to see how little positive evidence there is for effective prevention with SCAM
Of course, this is merely based on posts that were published on my blog. Some will argue that I missed out on some effective SCAMs for prevention. Others might claim that I judged some of the the above cited articles too harshly. If you share such sentiments, I invite you to show me the evidence – and I promise to look at it and evaluate it critically.
Meanwhile, I will draw the following conclusion:
Despite the prominent place prevention assumes in discussions about SCAM, the actual evidence fails to show that it has an important role to play in primary, secondary or tertiary prevention.
Cupping is a from of so-called alternative medicine (SCAM) that has featured already many times on this blog, e.g.:
- Wet cupping in the management of cervical spondylosis? No!
- The effectiveness of cupping therapy for low back pain
- Cupping: “the propagation of ancient, scientifically unsound techniques that may cause more harm than benefit”
- Cupping therapy for non-specific chronic low back pain
- Cupping for Olympic swimmers. Or: why breaking your shoulder is not necessarily good for writing a successful book
- Wet cupping and dry humour
- Cupping for athletes: rubbish trials, rubbish review, rubbish journal
- The future of cupping: it’s bright, profitable and vacuous
Now a new and interesting paper has been published on the subject
This review aimed to investigate the effectiveness of cupping therapy on low back pain (LBP). Medline, Embase, Scopus and WANFANG databases were searched for relevant cupping RCTs on low back pain articles up to 2023. A complementary search was manually made on 27 September for update screening. Full-text English and Chinese articles on all ethnic adults with LBP of cupping management were included in this study. Studies looking at acute low back pain only were excluded. Two independent reviewers screened and extracted data, with any disagreement resolved through consensus by a third reviewer. The methodological quality of the included studies was evaluated independently by two reviewers using an adapted tool. Change-from-baseline outcomes were treated as continuous variables and calculated according to the Cochrane Handbook. Data were extracted and pooled into the meta-analysis by Review Manager software (version 5.4, Nordic Cochrane Centre).
Eleven trials involving 921 participants were included (6 on dry and 5 on wet cupping). Five studies were assessed as being at low risk of bias, and six studies were of acceptable quality. High-quality evidence demonstrated cupping significantly improves pain at 2-8 weeks endpoint intervention (d=1.09, 95% CI: [0.35-1.83], p = 0.004). There was no continuous pain improvement observed at one month (d=0.11, 95% CI: [-1.02-1.23], p = 0.85) and 3-6 months (d=0.39, 95% CI: [-0.09-0.87], p = 0.11). Dry cupping did not improve pain (d=1.06, 95% CI: [-0.34, 2.45], p = 0.14) compared with wet cupping (d=1.5, 95% CI: [0.39-2.6], p = 0.008) at the endpoint intervention. There was no evidence indicating the association between pain reduction and different types of cupping (p = 0.2). Moderate- to low-quality evidence showed that cupping did not reduce chronic low back pain (d=0.74, 95% CI: [-0.67-2.15], p = 0.30) and non-specific chronic low back pain (d=0.27, 95% CI: [-1.69-2.24], p = 0.78) at the endpoint intervention. Cupping on acupoints showed a significant improvement in pain (d=1.29, 95% CI: [0.63-1.94], p < 0.01) compared with the lower back area (d=0.35, 95% CI: [-0.29-0.99], p = 0.29). A potential association between pain reduction and different cupping locations (p = 0.05) was found. Meta-analysis showed a significant effect on pain improvement compared to medication therapy (n = 8; d=1.8 [95% CI: 1.22 – 2.39], p < 0.001) and usual care (n = 5; d=1.07 [95% CI: 0.21- 1.93], p = 0.01). Two studies demonstrated that cupping significantly mediated sensory and emotional pain immediately, after 24 h, and 2 weeks post-intervention (d= 5.49, 95% CI [4.13-6.84], p < 0.001). Moderate evidence suggested that cupping improved disability at the 1-6 months follow-up (d=0.67, 95% CI: [0.06-1.28], p = 0.03). There was no immediate effect observed at the 2-8 weeks endpoint (d=0.40, 95% CI: [-0.51-1.30], p = 0.39). A high degree of heterogeneity was noted in the subgroup analysis (I2 >50%).
The authors concluded that high- to moderate-quality evidence indicates that cupping significantly improves pain and disability. The effectiveness of cupping for LBP varies based on treatment durations, cupping types, treatment locations, and LBP classifications. Cupping demonstrated a superior and sustained effect on pain reduction compared with medication and usual care. The notable heterogeneity among studies raises concerns about the certainty of these findings. Further research should be designed with a standardized cupping manipulation that specifies treatment sessions, frequency, cupping types, and treatment locations. The actual therapeutic effects of cupping could be confirmed by using objective pain assessments. Studies with at least six- to twelve-month follow-ups are needed to investigate the long-term efficacy of cupping in managing LBP.
A crucial point here is that only 3 of the included studies were ‘patient-blind’, i.e. tried to control for placebo effects by using a sham procedure:
- The first of these used leaking vaccum cups that failed to create sucction. This would therefore not have resulted in the typical circular hematoma. In other words, patients were easily de-blinded.
- The second trial compared two different wet cupping techniques which involved different procedures. This would have been easily identifiable by the patients. In other words, patients were easily de-blinded.
- The third (which showed no effectiveness of cupping) supposedly patient-blind study used a similar method as the first. In other words, patients were easily de-blinded.
In addition, we ought to remember that in no study was it possible to blind the therapists. Thus there is a danger of verbal or non-verbal communications impacting on the outcomes.
In my view, it follows that the effectiveness of cupping is far lass certain than the authors of this paper try to make us believe.
Having recently come across the strange and scary story of the Nazi’s experiments on Caladium Seguinum, I did some research to find out about the current medicinal uses of this plant. Perhaps unsurprisingly, it is today mostly advocated as a homeopathic remedy. In particular, it is highly recommended for erectile dysfunction (ED) and premature ejaculation. Here are some extracts from a particularly ‘impressive’ article on this topic:
… [Caladium Seguinum] … is particularly suited for treating premature ejaculation and erectile dysfunction, since these two problems cause widespread testicular swelling. The genital swelling is often associated with pruritus and internal inflammation that can be effectively treated with caladium.
The use of Caladium Seguinum is more common among men who are diagnosed with typical symptoms, along with an established case of either premature ejaculation or erectile dysfunction. Prescription of caladium is more common among men who suffer from genitals lacking vitality, wherein the penis doesn’t enter a state of arousal in a normal manner.
It has been noted that emotional and stress-linked problems are often the cause of underlying, undiagnosable causes of sexual problems among men. Similarly, ED and premature ejaculation are more commonly associated with men who are mentally exhausted or suffering from a mental trauma. In such cases, the use of caladium is applicable.
In cases wherein male impotency is linked to lifestyle habits like smoking, caladium is often prescribed. Further, premature ejaculation and erectile dysfunction in men who also complain of motion sickness are more likely to be treated with caladium. Caladium is very helpful if the premature ejaculation or erectile dysfunction has resulted in visible inflammation of the penile region, particularly redness of the glans.
Men who are suffering from ED along with symptoms like cold sweats and thickening of the scrotum skin are ideal candidates for caladium treatment. Men presenting disturbed respiratory functions, often described as an asthma-like condition, along with having erectile dysfunction are better candidates for caladium treatment.
Some of the other symptoms that contribute towards premature ejaculation and erectile dysfunction and are usually treated with caladium or caladium-enriched homeopathic mixtures include:
- Propensity towards unintentional penile erection
- Painful erection
- Testicular discomfort associated with gonorrhea
- Itching or surface eruptions on scrotal sac
- Disturbed sleep patterns
- Nighttime discharge from penis
Advantages of Caladium Seguinum
The biggest advantage of using homeopathic remedies for male infertility problems like erectile dysfunction is their overall safety. None of the homeopathic medications, including caladium, are known to induce any serious side-effects. However, the use of Caladium without medical supervision of a homeopathic specialist is highly inadvisable. Caladium Seguinum is retailed in various potencies and gauging the required potency is rather difficult.
For instance, Caladium Seguinum is commonly retailed with potency grading between 6X and 30X. Here, determining the appropriate potency largely depends upon understanding the associated symptoms and past medical history. In some cases, Caladium of lower potency is better suited since it is prescribed in combination with other homeopathic medications for better results.
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I think I know the question you were about to ask:
IS THERE ANY EVIDENCE FOR THESE CLAIMS?
The short answer is NO!
- The article itself does not provide any.
- My Medline search did not identify any.
- Further searches were equally unsuccessful.
In fact, there is no homeopathic remedy that has been shown to be effective for the named conditions.
What is more, there is no homeopathic remedy that has been shown to be effective for ANY condition.
This begs the question as to what we should call the many claims to the contrary:
- Wishful thinking?
- Naive mistakes?
- Commercials?
- Fraud?
You decide.
This study analyzed the effect of a protocol based on the Mat Pilates method in an intervention group compared to a usual care control group, on quality of life, fatigue and body image of head and neck cancer survivors.
The study was designed as a randomized clinical trial with 30 survivors, allocated into an intervention group and a control group.
- The intervention group underwent a 12-week Mat Pilates, twice a week, one hour long.
- The control group attended two lectures and received weekly follow-up throughout the study period.
Data collection took place through individual face-to-face interviews, focusing on assessing the outcomes: quality of life (FACT-H&N); fatigue (FACT-F) and body image (BIS).
The Mat Pilates group showed significant improvements compared to the control group in both intra-group and inter-group analyses across the variables:
- quality of life (in total score (p = 0.007)/(p = 0.003),
- family well-being (p = 0.001)/(p = 0.008),
- functional well-being (p = 0.001)/(p = 0.001)),
- body image in the total score (p = 0.001)/(p = 0.001),
- subscales: body image (p = 0.046)/(p = 0.010),
- body care (p = 0.026)/(p = 0.010),
- body touch (p = 0.013)/(p = 0.022),
- fatigue (p = 0.006)/(p = 0.003).
The authors concluded that, based on these findings, future research could delve deeper into understanding the long-term effects of Mat Pilates interventions on quality of life, body image, and fatigue levels among survivors of head and neck cancer.
These conclusions are prudently cautious. The reason for this caution probably is the fact that the findings tell us far less than the results might imply.
The naive reader would think they show the effectiveness of pilates excercises. This, however, would be erroneous. The positive results are to be expected, if only due to the extra attention given to the verum patients or the disappointment of the control group for not receiveing it.
If we truly want to evaluate the specific effects of a treatment like pilates, we need to design a different type of study. Nobody doubts that group excercise can improve plenty of subjective parameters. The question, I think, is whether pilates is better in achieving this aim than other forms of excercise. Thus we might need an equivalence study comparing two or more forms of excercise. Such studies are more difficult to plan and conduct. Yet, without them, I fear that we will not be able to determine the value of specific forms of excercise.
This study aimed to determine the effects of Reiki on pain and biochemical parameters in patients undergoing bone marrow transplantation. This investigation was designed as a “single-blind, repeated measures, randomized prospective controlled study”. It was conducted between August 2022 and April 2023 with patients who underwent autologous bone marrow transplantation (BMT).
- In the Reiki group (n = 21), Reiki therapy was applied directly to the energy centers for 30 min on the 0th and 1st day of BMT, and from a distance for 30 min on the 2nd day.
- No intervention was performed on the control group (n = 21).
Data were collected using the Personal Information Form, Visual Analog Scale (VAS), and biochemical parameters. Pain and biochemical parameters were evaluated on days 0, 1, 2, and 10 before the Reiki application.
There were no statistically significant differences in pain scores between the groups before the intervention (p > .005). The Reiki group showed a significant improvement in the mean VAS score compared with the control group on days 1 and 2 (p = .002; p < .001, respectively). The measurement of procalcitonin showed a decrease in the Reiki group and an increase in the control group (p = .026, p = .001, p < .001, respectively). Although the Reiki group had better absolute neutrophil, thrombocyte, and C-reactive protein values than the control group, no significant difference was observed between the groups (p > .05).
The authors concluded that Reiki is effective for pain control and enhancing the immune system response.
For the following reasons, I beg to differ:
- The patients of the verum group were fully aware of receiving the therapy; thus they were expecting/hoping to benefit from it.
- The patients of the control group received no therapy; thus they were disappointed which may have influenced thie VAS ratings.
- The procalcitonin levels are of doubtful relevance; they changed only within the group which, in a controlled clinical trial that is supposed to compare groups is meaningless and most likely a chance finding.
- The only people who could have been blinded in this ‘single blind’ study were the evaluators of the results (even though the authors state that “patients were blinded to the group assignments”) which is meaningless if patients and therapists are not blinded.
Because of all this, I feel that the conclusions should be re-written:
Reiki is known to cause a placebo effect which most likely caused the observed outcomes.
“Is Chiropractic Worth the Taxpayer’s Expense?” is the interesting question asked in this article by Ikenna Idika Ogbu from the Department of Neurosurgery, University Hospitals of North Midlands, UK and Chandrasekaran Kaliaperumal from the Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, UK. Here is the abstract:
Chiropractic remains a service provided outside the NHS in the United Kingdom and the argument for inclusion has been ongoing since the 90’s. There are significant patient-reported benefits from chiropractic backed by evidence in specific use-cases as cervicogenic headaches and there are significant potential cost-savings from the inclusion of chiropractic as an NHS service. The evidence, however, does not particularly favour the use case of chiropractic, especially in the context of Low Back Pain (LBP) and the benefits of chiropractic are unclear. Considering the potential cost-savings for the NHS and the society, there should be consideration for its inclusion. However, the evidence will need to be clearer to argue for inclusion of chiropractic in the NHS spectrum of services, especially for spinal services.
So, the authors confirm that, even for back pain, “the benefits of chiropractic are unclear”, and in the next sentence they advocate “consideration for its inclusion.”
Does that make sense?
No!
Let’s be clear: the least expensive way to proceed in the short term is usually to do nothing. No treatment is invariably less expensive than treatment! Yet, this logic obviously does not account for the two most important factors in this equation: risk and benefit.
- Not treating a condition can cause prolonged, needless suffering.
- Not treating a condition can cause significant follow-up costs.
- Treating it can cause adverse effects and additional suffering.
- Adverse effects can cause significant follow-up costs.
- Treating the condition effectively will result in less suffering.
- Treating the condition effectively will result in less follow-up costs.
It follows that we should treat health problems:
- effectively,
- with few risks of side-effects,
- as cheaply as possible.
It also follows that costs are by no means the only factor in this complex equation. Cost-effectiveness without effectiveness is not possible. Moreover, cost-effectiveness withoout an acceptable degree of safety is unlikely.
In the case of chiropractic, we have hardly reliable proof of effectiveness or safety. And this means that, before we can consider chiropractic to be paid for from public money, we first need solid evidence for its safey and efficacy – each for the relevant health problem to be treated. Once we have reliable data about all this – AND ONLY THEN – might we consider including chiropractic into the public healthcare budget.
In other words, the above cited paper is naive and ill-informed to the extreme.
Many patients seek Chinese herbal medicines (CHM) from traditional Chinese medicine (TCM) clinics. This study aimed to estimate the risk of major adverse cardiovascular events (MACEs) in adults diagnosed with obesity, with or without CHM.
Patients with obesity aged 18 to 50 years were identified using diagnostic codes from Taiwan’s National Health Insurance Research Database between 2008 and 2018. The researchers randomized 67,655 patients with or without CHM using propensity score matching. All patients were followed up from the start of the study until MACEs, death, or the end of 2018. A Cox proportional regression model was used to evaluate the hazard ratios of MACEs in the CHM and non-CHM cohorts.
During a median follow-up of 4.2 years, the CHM group had a higher incidence of MACEs than the non-CHM control cohort (9.35 versus 8.27 per 1,000 person-years). The CHM group had a 1.13-fold higher risk of MACEs compared with the non-CHM control (adjusted hazard ratio [aHR] = 1.13; 95% confidence interval [CI]: 1.07–1.19; p <0.001), especially in ischemic stroke (aHR = 1.18; 95% CI: 1.07–1.31; p <0.01), arrhythmia (aHR = 1.26; 95% CI: 1.14–1.38; p <0.001), and young adults aged 18 to 29 years (aHR = 1.22; 95%
CI: 1.05–1.43; p <0.001).
The authors concluded that, although certain CHMs offer cardiovascular benefits, young and middle-aged obese adults receiving CHM exhibit a higher risk of MACEs than those not receiving CHM. Therefore, TCM practitioners should be cautious when prescribing medications to young patients with obesity, considering their potential cardiovascular risks.
I am not sure why the authors concluded that “certain CHMs offer cardiovascular benefits”; their data do not support this statement and I am not aware of any such evidence either. The more valid result of this study is that the use of CHMs is a risk factor for cardiovascular health in obese people. I fear that this might also be true for non-obese individuals and could also apply to non-cardiovascular areas of health.
Just like any other form of herbal therapy, CHMs can contain toxic ingredients and might interact with prescribed medications. Unlike most other forms of herbal treatments CHMs are known to be often contaminated (e.g. with heaviy metals) and/or adulterated (e.g. with illegal amounts of synthetic drugs). as they typically contain a multitude of herbs, the risk of interactions is also increased. Our 2013 review shoed that “herbal medicinal products (HMPs) were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively.”
My advice has therefore long been very clear and outspoken:
CHMs are best avoided!
