critical thinking
As reported previously the NHS NATURAL HEALTH SCHOOL in Harrogate, is a service that offered a range of free complementary therapy treatments to patients and their relatives who are affected by a cancer diagnosis and are either receiving their cancer treatment at Harrogate or live in the Harrogate and Rural District.
This NHS school offered alternative treatments to cancer patients and claim that they know from experience, that when Complementary Therapies are integrated into patient care we are able to deliver safe, high quality care which fulfils the needs of even the most complex of patients.
In addition, they also ran courses for alternative practitioners. Their reflexology course, for instance, covered all of the following:
- Explore the history and origins of Reflexology
- Explore the use of various mediums used in treatment including waxes, balms, powders and oils
- Explore the philosophy of holism and its role within western bio medicine
- Reading the feet/hands and mapping the reflex points
- Relevant anatomy, physiology and pathology
- Managing a wide range of conditions
- Legal implications
- Cautions and contraindications
- Assessment and client care
- Practical reflexology skills and routines
- Treatment planning
I imagine that the initiators of the school are full of the very best, altruistic intentions. I therefore had considerable difficulties in criticising them. Yet, I do strongly feel that the NHS should be based on good evidence; and that much of the school’s offerings seemed to be the exact opposite. In fact, the NHS-label was being abused for giving undeserved credibility to outright quackery.
Therefore, I did something I do rarely: I filed an official complaint in September 2019.
What happened next?
Nothing!
I sent several reminders; and what happened then?
Almost nothing!
I got several assurances that a response was imminent.
And then I forgot all about it.
So, I was surprised to receive this email yesterday from the chief executive of the HARROGATE AND DISTRICT NHS FOUNDATION TRUST (I did not change or correct anything):
Thank you for contacting our Chair about the Natural Health School and my apologies for the extended delay in replying to you. We have reflected on the points you raised and I have set out a summary of this below in respect of the key issues.
- As a result of colleagues who set up the service having moved on to other posts outside of the Trust we have not been able to understand how the service was named. However, I agree that the terminology “NHS Natural Health School” could be interpreted in a certain way and as such we have agreed it should instead be referred to as the Natural Health School only to avoid any interpretation that it has national NHS endorsement. We will amend the information on the website and other material to reflect that the service is endorsed by the Trust.
- The service is hosted by HDFT, in that staff are employed by the Trust, but it is funded through charitable contributions. No NHS resources are used in providing the school, or the complementary therapies which are provided to patients receiving treatment at the Sir Robert Ogden Centre.
- There is no intention to assert that the services provided (ie the complementary therapies) are treatment for cancer. The ‘treatments’ referred to are complementary therapy treatments and are described as such. They are focused on wellbeing concurrently to the medical treatment of cancer, and we are satisfied that this is clear in the current description.
- Whilst recognising the differences of views on the complementary therapy treatments, the service regularly secures feedback from patients and this has been positive and as such we continue to offer it to those patients who would wish to take it up.
- The school provides training to allow participants to achieve a qualification which is awarded at level 3 by the International Therapies Examination Council.
I hope this provides clarity on the context to the service.
Best wishes
… … …
___________________________________________________________________
I find this response more than a little unsatisfactory; here are just a few points I find worth mentioning:
- As far as I can see, apart of the actual name of the school (it is now called ‘NATURAL HEALTH SCHOOL’), very little has changed. In particular, a NHS link is still implied in multiple different ways.
- To claim that ‘we have not been able to understand how the service was named’ seems like someone is taking the Mikey.
- So is the remark that ‘the terminology “NHS Natural Health School” could be interpreted in a certain way’.
- The statement ‘there is no intention to assert that the services provided (ie the complementary therapies) are treatment for cancer’ is simply untrue; symptomatic treatment of cancer is still a treatment for cancer!
- If the treatments are focussed on wellbeing, they nevertheless should be backed by evidence to show that they improve wellbeing. The label ‘complementary’ does not absolve a therapy from the need to be evidence-based.
- There may be ‘different views’ on complementary therapies; yet, there is only one set of evidence – and that fails to support several of the treatments on offer.
- Positive feedback from patients is no substitute for evidence.
I am not sure whether I should reply to the above letter. I take little pleasure in embarrassing chief excecutives.
WHAT DO YOU THINK I SHOULD DO?
Yesterday, we discussed a paper concluding (amongst other things) that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for cancer‐related pain. Today, we are looking at one that overtly contradicts this verdict.
This systematic review (published in JAMA Oncology) evaluated the existing randomized clinical trials (RCTs) for evidence of the association of acupuncture and acupressure with reduction in cancer pain. Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included. The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.
A total of 17 RCTs (with 1111 patients) were included, and data from 14 RCTs (with 920 patients) were used in the meta-analysis. Seven sham-controlled RCTs (35%) were notable for their high quality, being judged to have a low risk of bias for all of their domains, and showed that real (compared with sham) acupuncture was associated with reduced pain intensity. A favourable association was also seen when acupuncture and acupressure were combined with analgesic therapy in 6 RCTs for reducing pain intensity and in 2 RCTs for reducing opioid dose. The evidence grade was moderate because of the substantial heterogeneity among studies.
The authors concluded that this systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.
So, which of the two conclusions should we trust?
Personally, I find the JAMA paper unimpressive to the point of being suspect. Here are some of my reasons:
- About half of the primary studies are Chinese; and we have seen repeatedly that they are unreliable and report only positive results.
- Many of the trials are published in Chinese and can thus not be checked by non-Chinese readers (nor, presumably, by the experts who acted as peer-reviewers for JAMA Oncology).
- I have my doubts about the rigor of the peer-review of some of the journals that published the primary studies included in the review.
- One paper included in the review is even a mere doctoral thesis which usually is not peer-reviewed in the usual sense.
- The authors state that they included only clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care. However, this is evidently not true; many of the studies had the infamous A+B versus B design comparing acupuncture plus a conventional therapy against the conventional therapy. As we have discussed ad nauseam on this blog, such trials cannot produce a negative finding even if ‘A’ is a placebo.
- Contrary to what the authors claim, the quality of most of the included studies was extremely poor, as far as I can see.
- One included paper which I cannot access is entitled ‘Clinical observation on 30 cases of moderate and severe cancer pain of bone metastasis treated by auricular acupressure‘. Are the review authors seriously claiming that this is an RCT?
The more I study the details of the JAMA Oncology paper, the more I feel it might be worth a complaint to the editor with a view of initiating a thorough investigation and a possible retraction.
The aim of this review is to synthesise systematic reviews (SRs) of randomised clinical trials (RCTs) evaluating the efficacy of acupuncture to alleviate chronic pain. A total of 177 reviews of acupuncture from 1989 to 2019 met the eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate.
Having (co-) authored 13 of these SRs myself, I am impressed with the amount of work that went into this synthesis. The authors should be congratulated for doing it – and for doing it well! The paper itself differentiates the findings according to various types of pain. Here I reproduce the authors’ conclusion regarding different pain entities:
- Evidence from SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for chronic pain associated with various medical conditions. There is no specific NICE guidance about the use of acupuncture for chronic pain conditions irrespective of aetiology or pathophysiology, although some guidance exists for specific pain conditions (see respective sections below). Guidance by NICE on chronic pain assessment and management is currently being developed (GIDNG10069) with publication expected in August 2020.
- Evidence from the SRs suggests that acupuncture prevents episodic or chronic tension‐type headaches and episodic migraine, although long‐term studies and studies comparing acupuncture with other treatment options are still required. The current NICE guidance (clinical guideline CG150) is that a course of up to 10 sessions of acupuncture over 5–8 weeks is recommended for tension‐type headache and migraine.
- The most recent evidence from a Cochrane review of 16 RCTs suggests that acupuncture is not superior to sham acupuncture for OA of the hip, although in contrast, evidence from nonCochrane reviews suggests that there is moderate‐quality evidence that acupuncture may be effective in the symptomatic relief of pain from OA of the knee. Why there should be a difference in evidence between the knee and the hip is not known. Interestingly, guidance from NICE (CG177) states: “Do not offer acupuncture for the management of osteoarthritis”.
- Evidence suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for low back pain. In 2009, NICE published guidance for the management of nonspecific low back pain that recommended a course of acupuncture as part of first line treatment. This guidance produced much debate. Subsequently, NICE have updated guidance for the management of low back pain and sciatica in people over 16 (NG59) and currently recommend in Section 1.2.8 “Do not offer acupuncture for managing low back pain with or without sciatica”, even though the evidence had not significantly changed.
- Evidence from SRs suggests that dry needling acupuncture might be effective in alleviating pain associated with myofascial trigger points, at least in the short‐term, although there are insufficient high‐quality RCTs to judge the efficacy with any degree of certainty. There is no guidance from NICE on the management of myofascial pain syndrome.
- Evidence from the SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for cancer‐related pain and more high‐quality, appropriately designed and adequately powered studies are needed. The most recent guidance from NICE (CSG4) recognises that patients who are receiving palliative care often seek complementary therapies, but it does not specifically recommend acupuncture. It recognises that “Many studies have a considerable number of methodological limitations, making it difficult to draw definitive conclusions”.
- Evidence from SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for fibromyalgia pain. There is no NICE guidance on the treatment of fibromyalgia.
- Evidence from the SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for primary dysmenorrhea or chronic pelvic pain. There is NICE guidance on endometriosis (NG73) [200] but this does not recommend any form of Chinese medicine for this type of pelvic pain, although acupuncture is not specifically mentioned.
- Evidence from the SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for pain in inflammatory arthritis. There is a NICE guideline (NG100) [201] for the treatment of rheumatoid arthritis but this does not recommend acupuncture.
- Evidence from the SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for neuropathic pain or neuralgia. There is NICE guidance (CG173) on the management of neuropathic pain, but acupuncture is not included in the list of recommended/not recommended treatments.
- Evidence from SRs suggests that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for a variety of other painful conditions, including lateral elbow pain, shoulder pain and labour pain. There is no guidance available from NICE on the treatment of any of these conditions.
So, what should we make of all this?
Maybe I just point out two things:
- This is a most valuable addition to the literature about acupuncture. It can serve as a reference for all who are interested in an honest account of the (lack of) value of acupuncture in the management of chronic pain.
- If a therapy has been tested in hundreds of (sadly often flawed) trials and the conclusions fail to come out clearly in favour of it, it is most likely not a very effective treatment.
Until we have data to the contrary, acupuncture should not be considered to be an effective therapy for chronic pain management.
If you, like many of us, have heavily ‘toxed’, you might now consider ‘detoxing’. What I mean is that we have probably all over-indulged a bit over the holidays. Unless you were the guest of someone, you had to pay dearly for it (Champagne is not cheap!). And now, a whole industry of ‘detox’ entrepreneurs tells you to pay again – this time, for detox.
As you payed ‘through your nose’ for the ‘tox’, you might as well use the same orifice for the ‘detox’. An Indian tradition called Nasiyam (or Nasyam? or Nasya? – I am confused!) makes it possible. This website explains:
Nasal Instillation (Nasyam) is the practice of instilling medicated oils, fresh juices of leaves or flowers in the nostrils … Nasyam is specially directed towards the purification of various parts related to the head…
I don’t know about you, but I always felt that all my parts were related to my head! So, Nasyam is for purification of all my parts? The announcement below – I picked it up on Twitter – is much clearer: detox through the nasal doorway! Who would refuse such an offer after the festivities of late?
This sounds fascinating, I thought. Thus I ran a quick Medline search but only found this abstract:
BACKGROUND:
Ardita (facial paralysis) is a medical condition that disfigures or distorts the facial appearance of the sufferer causing facial asymmetry and malfunction. Ardita patients may benefit from considering alternative treatments such as Ayurveda, including Taila Nasya (nasal instillation of medicated oil).
OBJECTIVES:
To synthesize the best available evidence on the effectiveness of different Nasya oils in the treatment of Ardita.
INCLUSION CRITERIA TYPES OF PARTICIPANTS:
Studies conducted on adult sufferers (18-70 years) of Ardita (chronic or acute) in any setting were considered. Studies including participants who were pregnant or suffered allergic rhinitis, fever, intracranial tumor/hemorrhage and bilateral facial palsy were excluded.
INTERVENTION(S)/COMPARATOR(S):
Standalone treatment of Nasya (at all dosages and frequencies) compared to Nasya in combination with other Ayurvedic treatments was considered. Comparisons between different interventions including Taila Nasya alone, Taila Nasya in combination with other Ayurvedic interventions and Ayurvedic interventions that did not include Taila Nasya were also considered.
OUTCOMES AND MEASURES:
Changes in Ardita symptoms, including facial distortion, speech disorders and facial pain, were measured.
TYPES OF STUDIES:
All quantitative study designs (experimental, quasi-experimental and observational) were considered.
SEARCH STRATEGY:
Relevant studies were identified following a comprehensive literature search. References provided within these key studies identified additional resources. Indian universities were also contacted for results of Ardita studies undertaken in their institutions.A three-step search strategy aimed to find studies of published and unpublished studies was undertaken. Studies published in the English language were considered for inclusion, irrespective of publication date/year. Following an initial limited search of MEDLINE and CINAHL, the text words contained in the title and abstract, and of the index terms used to describe each articles were analyzed. From the identified keywords and index terms, searches were undertaken across all relevant databases such as PubMed, CINHAL, Cochrane (CENTRAL), Scopus, Centre for Review and Dissemination databases, Turning Research into Practice (TRIP), EMBASE, EBM Reviews, DHARA, Google Scholar, MedNar and ProQuest Dissertations. Finally, reference lists of identified theses and articles were searched for additional studies. Universities and website operators related to Ayurvedic research in India were contacted, including the National Institute of Ayurveda for relevant studies. Besides this, the University of Adelaide librarian was contacted to retrieve those studies identified in the reference lists of theses and articles.
METHODOLOGICAL QUALITY:
Studies were critically assessed by the review author and a secondary reviewer prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute.
DATA EXTRACTION:
Data was extracted by the primary reviewer using the standardized data extraction tool from the Joanna Briggs Institute.
DATA SYNTHESIS:
Different interventions and comparators across studies precluded meta-analysis. Narrative synthesis was performed.
RESULTS:
Only two pseudo randomized studies with a small number of participants met inclusion criteria and were included in the review. One study with 20 participants, divided equally into two groups compared the effectiveness of two nasal instillations in alleviating four Ardita symptoms. The second study of 15 participants each in two groups compared the effectiveness of nasal instillation with placement of medicated oil on the head on seven Ardita symptoms. Observational measurements of Ardita symptoms were graded as Mild, Moderate or Marked at baseline and after one month. The study conducted on 30 participants using Nasya intervention showed participants had better relief from the symptoms of facial pain, speech disorder and earache within the range of 78.2% to 90.9%, graded as Marked. Along with statistical data available in the studies, this review found low levels of evidence favoring Taila Nasya intervention. The review did not include any studies examining effectiveness of Nasya compared to conventional treatment for Ardita.
CONCLUSIONS:
This review presents extremely limited evidence from only two small experimental studies that administration of Nasya oil alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids/upward eye rolling and dribbling of saliva in adult patients. No strong conclusions may be drawn from the evidence included in the review due to the limited number of studies, limited number of participants and poor quality of studies.
IMPLICATIONS FOR PRACTICE:
Practitioners should advice Ardita patients that there is extremely limited evidence suggesting the potential effectiveness of Nasya oils alone or Nasya in conjunction with other Ayurvedic treatments in managing symptoms. However, given the absence of a strong evidence base, practitioners should be guided by clinical wisdom and patient preference.
IMPLICATIONS FOR RESEARCH:
Well controlled clinical trials comparing standalone Nasya therapy to other Ayurvedic treatments and/or conventional medicine for Ardita symptoms need to be conducted to examine the relative effectiveness of different Nasya oils in treating.
I think you agree, that’s nothing to write home about.
So, on second thought I might give Nasya (or whatever it is called) a miss. The same applies, by the way, to any other form of detox.
In so-called alternative medicine (SCAM), there is never a dull moment; for me, the last decade was hardly an exception.
2010: Simon Singh and I had just published our book ‘Trick of Treatment‘(see also below), and consequently, the SCAM community (after having been more than a little suspicious of me for years) decided to oust me. At my university, I had major battles after the complaint by Prince Charles’ private secretary regarding the ‘Smallwood report‘. I decided to preserve my department by going into early retirement.
2011: This plan did not work out. I did retire, but the department sadly was closed down. The deal was that I get re-employed by my university on a half-time basis and help to find and appoint a successor.
2012: This did not work out either. We did find one suitable candidate, but they offered him terms that were totally unacceptable. The result: no more ‘Complementary Medicine’ at Exeter (I must admit, that was tough!). My wife and I thus sold our flat in Exeter and moved into rural Suffolk.
2013: My wife fell seriously ill, and we decided to move to France for an entire year to get her cured. This turned out to be the right decision; today she is alive and kicking.
2014: To prevent slowly going insane over all this, I had started writing my memoir.
2015: The book was published under the title ‘A scientist in wonderland’ and got unbelievably positive reviews. Today, this memoir is available also in German, Spanish and Korean. In the same year, I received the ‘John Maddox Award for standing up for science‘. I donated the prize money to the ‘Good Thinking Society’.
2016: While lecturing in Germany, I was invited by Springer to publish a book with them, and I chose the subject of homeopathy. The book entitled ‘Homeopathy, the undiluted facts‘ was later also published in German.
2017: I was awarded an Ockham Award at the QED. Sadly, I could not attend in person but Simon Singh received it in my name. We sold our house in Suffolk, moved to Cambridge, and also spent much of our time in France.
2018: After a perfect co-operation with the ethicist, Kevin Smith‘, our Springer book on the ethical issues raised by SCAM was published. It is entitled ‘More good than harm? The moral maze of complementary and alternative medicine‘ and received an award from the BMA. The same year, I also published my book ‘SCAM‘ which shortly after also was published in German.
2019: I published, again with Springer, an analysis of 150 SCAM modalities. Ioannidis et al published an analysis of 100 000 scientists of all fields. It implied that I am the most ‘influential’ researcher in the area of SCAM. This came just as unexpected as the US ‘Bookauthority’ naming our book ‘Trick or Treatment’ amongst the ‘best mental health books of all times’.
(Oh, I almost forgot: I also published ~500 Medline-listed papers as well as >1 700 blog posts and gave about 300 invited lectures during the last 10 years. Retirement turned out to be busy indeed.)
Sadly, the last decade also meant losing several good friends. John Dormandy and Gustav Born are two I miss very badly.
Yes, it was a decade full of action, worries, happiness, achievements and also true sadness. I hope I will still be around in 10 years to report about the next one.
I WISH ALL MY READERS A HAPPY AND HEALTHY NEW YEAR.
I published this article 20 years ago! Yet, it is, I think, still relevant today. For the purpose of this blog, I have altered it marginally (mainly by using the acromym SCAM):
Whatever SCAM is, it is not an alternative to conventional medicine. Nevertheless, one might still ask why so many people pay for ‘unproven’ SCAM when they can have scientifically backed medicine at no extra expense. Chandola et al suggest that 44% who use CM hope for a cure, 30% fear adverse effects of mainstream drugs, and 27% are dissatisfied with conventional care. In a much larger survey conducted in the USA, Astin found that dissatisfaction with orthodox medicine was prevalent but did not predict use of SCAM. SCAM users tended to be better educated and to subscribe to a more ‘holistic’ philosophy of healthcare. Interestingly, they reported poorer health status than non-users. Moreover, SCAM attracts patients because it offers more personal autonomy or control and is less impersonal or high-tech than mainstream medicine. Finally patients, particularly those with chronic conditions, may simply try SCAM so as to leave no stone unturned.
‘Scientifically backed’ medicine may not be quite as helpful as one tends to assume at least not in the eyes of the patient. A survey of 1420 (mostly musculoskeletal) pain sufferers suggested that SCAMs were perceived as more successful than mainstream drugs. In fact, orthodox therapies such as parenteral injections and oral medications ranked only 8th and 11th, respectively. Perhaps more disturbingly, patients seem to experience the therapeutic encounter with SCAM practitioners as more satisfying, empathetic and informative than that with their general practitioners. While many physicians (rightly or wrongly) continue to see SCAM as a nuisance, maybe we should think again: SCAM’s popularity amounts to a biting criticism of mainstream medicine that ought to be taken seriously.
How are clinicians to reconcile the public demand for SCAM with the new zeal for evidence-based medicine? The apparently easy answer is to pursue a strategy of evidence-based SCAM. This is precisely what my department is doing. There are now about 2000 clinical trials in this diverse area. But clinical trials are often full of contradictions and seldom clarify clinical questions adequately. A US study, for instance, has contributed to increasing doubts about whether chiropractic is helpful for acute uncomplicated low back pain in a clinically relevant way. What we really need for informing clinicians’ decisions are systematic reviews incorporating the totality of the available data. For the past 5 years this has been the focus of my department’s work, and we have published a considerable number of such papers. The notion that SCAM is totally devoid of evidence is a cliché which, like many clichés, is not entirely true.
Undoubtedly, vast areas of uncertainty do remain. The more difficult question is, therefore, how should clinicians deal with their patients’ desire for SCAM in the absence of evidence? Embarrassingly few convincing answers are on offer. Physicians have become experts in dealing with uncertainty in many aspects of their work. A dose of common sense will usually go quite far. At the very least, doctors should know what type of treatments their patients are trying. Taking a detailed history should nowadays include asking specifically about use of SCAM. In order not to alienate patients, one should resist the temptation to be dismissive. If there are good reasons to warn of a certain form of SCAM, these are best offered in an objective manner. To give evidence-based advice, clinicians obviously have to be informed about the facts, and impartial information is hard to find. One ray of light in this relative darkness is the Cochrane Collaboration, which now has a ‘field’ working on SCAM. The number of systematic reviews available from the Cochrane database is growing rapidly.
Once a patient is using SCAM (with or against the doctor’s advice), it makes sense to monitor the effects. This increases the safety of the patient and contributes to the physician’s knowledge of and experience with SCAM. There is also a good argument for establishing working relationships with a selection of local SCAM therapists who have a good track record and adequate training. At present, communication between doctors and therapists is often poor or even non-existent. Surely this cannot be to the benefit of the patient.
For SCAM, the best chance of survival in a harsh climate of evidence-based medicine and increasing rationing of resources is to come up with the goods and demonstrate what treatments are effective, safe and cost-effective for which condition. For physicians, the best way of reconciling the ‘two worlds’ is to inform themselves adequately and guide their patients through the ‘SCAM maze’ with a generous helping of good common sense. For patients, last but not least, the best approach is to be cautious and remember that, if it sounds too good to be true, it probably is.
END OF QUOTE
Twenty years, and little has changed:
- There still are vast areas of uncertainty.
- Imparcial information about SCAM is still scarce.
- Patient demand for SCAM is still considerable.
- The implied criticism of conventional medicine is still not taken seriously.
- The communication between doctors and SCAM practitioners is still lamentable.
- Most doctors still do not include questions about SCAM in their medical history taking.
- Arguably, SCAM has become even less evidence-based.
- Most doctors remain blissfully uninformed about SCAM.
- Most of the claims made for SCAM are too good to be true.
- …
- …
- …
- etc.
I think you get the gist.
The current Cochrane review of clinical trials testing the effectiveness of manipulation/mobilisation for neck pain concluded as follows:
Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.
Such a critical assessment must be tough for chiropractors who gain a substantial part of their income from treating such patients. What is the solution? Simple, convene a panel of chiros and issue recommendations that are more prone to stimulate their cash flow!
Exactly that seems to have just happened.
The purpose of the researchers was to develop best-practice recommendations for chiropractic management of adults with neck pain.
A steering committee of experts in chiropractic practice, education, and research drafted a set of recommendations based on the most current relevant clinical practice guidelines. Additional supportive literature was identified through targeted searches conducted by a health sciences librarian. A national panel of chiropractors representing expertise in practice, research, and teaching rated the recommendations using a modified Delphi process. The consensus process was conducted from August to November 2018. Fifty-six panelists rated the 50 statements and concepts and reached consensus on all statements within 3 rounds.
The statements and concepts covered aspects of the clinical encounter, ranging from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral for patients presenting with neck pain.
The authors concluded that these best-practice recommendations for chiropractic management of adults with neck pain are based on the best available scientific evidence. For uncomplicated neck pain, including neck pain with headache or radicular symptoms, chiropractic manipulation and multimodal care are recommended.
Let’s be clear what this amounts to: a panel of highly selected chiropractors (sponsored by a chiropractic organisation) has reached a consensus (and published it in a chiropractic) which allows them to continue to treat patients with neck pain.
Isn’t that just great?
Now let’s think ahead – what next?
I suggest the following:
- A panel of homeopaths recommending homeopathy.
- A panel of faith healers recommending faith healing.
- A panel of crystal healers recommending crystal healing.
- A panel of colon therapists recommending colonic irrigation.
- A panel of supplement manufacturers recommending to buy supplements.
- …
- …
- …
I am sure you get the gist.
In the true Christmas spirit, I decided that I will give away presents to fans of homeopathy.
Here is the deal:
It is almost 2 years now that I asked all homeopaths, particularly those who believe that homeopathy works because it is ‘nano-medicine’, to answer the questions below:
- How (by what mechanism) does a nano-particle of coffee, for instance, affect the sleep centre in the brain to make the patient sleep? Or how does a nano-particle of the Berlin Wall or a duck liver affect anything at all in the human body?
- Most homeopathic remedies are consumed not as liquids but as ‘globuli’, i. e. tiny little pills made of lactose. They are prepared by spraying the liquid remedy on to them. The liquid subsequently evaporates. How is it that the information allegedly retained in the liquid does not evaporate with the diluent?
- The diluent usually is a water-alcohol mixture which inevitably contains impurities. In fact, a liquid C12 remedy contains dimensions more impurities than homeopathic stock. These impurities have, of course, also been vigorously shaken, i. e. potentised. How can we explain that their ‘potency’ has not been beefed up at each dilution step? Would this not necessitate a process where only some molecules in the diluent are agitated, while all the others remain absolutely still? How can we explain this concept?
- Some stock used in homeopathy is insoluble (for instance Berlin Wall). Such stock is not diluted but its concentration in the remedy is initially lowered by a process called ‘trituration’, a process which consists in grinding the source material in another solid material, usually lactose. Assuming that potentisation works in the way homeopaths think, how is information transferred from one solid material to another during trituration?
- Everything we drink is based on water containing molecules that have been inadvertently potentised in nature a million times and therefore should have hugely powerful effects on our bodies. How is it that we experience none of these effects each time we drink?
So far, I have not received any answers that stand up to scrutiny. Therefore, I now offer a present, free book on homeopathy,
to anyone who can provide a rational, scientifically sound answer to at least one of these questions. Just post your reply in the comments section. If it fulfils the above criteria, I will contact you, ask you for your postal address, and send you a free copy of my book.
MERRY CHRISTMAS!
Guest post by Richard Rasker
Almost two years ago, in March 2018, a group of 124 doctors and other medical professionals published an article in the French newspaper ‘Le Figaro’, warning the general public for the false promises, unproven claims and dangers of alternative medicine.
Homeopathy in particular is denounced as an unscientific belief in magic, utterly lacking in plausibility as well as in evidence of efficacy for any condition. Subjecting people to these kinds of unproven treatments is unethical, and may result in serious harm by delaying proper medical treatment. Also, homeopaths and other alternative practitioners often express anti-vaccine sentiments, endangering children by dissuading their parents from vaccination.
For these and several other reasons, these 124 medical professionals made an appeal for alternative and esoteric treatments to be excluded from the field of science-based medicine, and to stop reimbursement of homeopathic and other alternative treatments under France’s national health care insurance system.
In a somewhat belated response, French homeopaths are now filing no less than 63 disciplinary complaints with the French Medical Council against the signatories of the appeal in Le Figaro, apparently for “uncollegial behaviour” and “defiling medical ethics”. The homeopaths are represented by homeopathic doctor Daniel Scimeca, president of the French Federation of Homeopathic Societies, who also has close relations with Boiron laboratories, the biggest manufacturer of homeopathic products in the world.
At the time of this writing, 11 complaints have been adjudicated, resulting in 7 warnings, and 4 releases or dismissals. It is unclear how serious such a ‘warning’ should be taken, but it is clear that homeopaths are trying to punish real doctors for supporting and expressing an overwhelming scientific consensus, i.e. that there is no evidence whatsoever that homeopathy is actually good for anything.
And even though these French homeopaths do not resort to the sort of vile, underhanded media smear campaign perpetrated by the late Claus Fritzsche against Dr. Ernst, there are certain parallels – the most important of which is that proponents of unproven ‘medicine’ attempt to silence science-based criticism by unscientific means, instead of open discourse about the merits (or more precisely: the lack thereof) of their chosen profession.
I personally find it rather worrying that almost two-thirds of the complaints resulted in a slap on the wrist for the medical professional involved. Especially in a field that is so strongly dependent on both science and trust, well-founded criticism should be encouraged and made public, not punished and silenced.
At the heart of this story is Joseph Mercola, a dietary supplement entrepreneur and osteopath.
His website states that:
EVERYONE can benefit from Dr Mercola’s unparalleled knowledge. For expertise in alternative healthcare and high quality supplemental medicine, it’s hard to beat visionary Dr Joseph Mercola. The Chicago-based health wizard has his own website, Mercola.com (‘Take Control of Your Health’), but you can find so many of his health support products right here at Evolution Organics. Our customers swear by them. They love the diversity of the range, and that the products are priced affordably, meaning that everyone can benefit from Dr Mercola’s vast experience and unmatched know-how. And it’s not just men, women and children who can feel better ‘the Dr Mercola way’ – his brand includes health support products for pets, too.
However, an article in the Washington Post tells a different story; allow me to quote a few excerpts:
The Northern Virginia-based National Vaccine Information Center lists Mercola.com as a partner on its homepage and links to the website, where readers can learn about and purchase Mercola’s merchandise. Last month, Mercola wrote on his website that measles “continues to be a Trojan Horse for increasing vaccine mandates.” A page that was recently removed said that “vitamin C supplementation is a viable option for measles prevention.” Elsewhere on the site, a page about vitamin D includes the headline, “Avoid Flu Shots With the One Vitamin that Will Stop Flu in Its Tracks.”
Mercola … has also given at least $4 million to several groups that echo the anti-vaccine message… Mercola … offers “simple, inexpensive and safe alternatives to the conventional medical system, which is contributing to the premature death of millions and is causing needless pain and suffering in great part because multinational corporations want to increase their revenues.” … Supplements containing those vitamins are among Mercola’s “top products,” his website says… Earlier this month, Samoan anti-vaccine activist Edwin Tamasese, who touted vitamins as an alternative to vaccination, was arrested for allegedly claiming on social media that measles vaccinations would result in mass deaths…
The National Vaccine Information Center was founded in 1982 by Barbara Loe Fisher, who has said that her son was injured by a vaccine. The group claimed credit this year for helping to defeat legislation in a dozen states that would have made it harder for parents to opt out of vaccinating their children. At the beginning of last year’s flu season, Fisher and Mercola appeared in a YouTube video urging people to be skeptical about flu shots. Mercola claimed that vaccines have been associated with “deaths and permanent neurological complications,” and he said vitamin D supplements were among “far more effective, less expensive and less risky alternatives.” … Fisher said in an interview that Mercola has asked for nothing in exchange for his donations and that the National Vaccine Information Center does not sell or advertise Mercola’s products on its site. “I do not take funding for a quid pro quo,” she said. “When [Mercola] called me, he said, ‘I admire your work. I’d like to help you.’ ” The center’s homepage, which the group says was visited more than 1.2 million times last year, displays Mercola.com’s logo. An affiliated website run by Fisher’s group refers numerous times to Mercola.com as one of the most popular health and wellness websites…
In recent years, the center has been at the forefront of a movement that has led some parents to forgo or delay immunizing their children against vaccine-preventable diseases such as measles… The Northern Virginia-based National Vaccine Information Center lists Mercola.com as a partner on its homepage and links to the website, where readers can learn about and purchase Mercola’s merchandise…Asked if his companies benefit from his donations to the anti-vaccine group, Mercola said in an email that “being an adversary to powerful industries is not a positive for a business like mine.” …
The FDA has taken no enforcement action against Mercola over his vaccine claims. The agency said in a statement that it has no role in approving dietary supplements or in evaluating claims about them — unless those products are purported to treat, diagnose, prevent or cure diseases and are reported to the agency as unapproved drugs. Agency officials did not answer questions about Mercola’s claims regarding vitamins C and D…
The resurgent movement found a handful of wealthy patrons, including hedge fund manager and philanthropist Bernard Selz and his wife, Lisa. The Selzes gave $200,000 to a legal fund for Wakefield in 2012, and they went on to give more than $3 million to anti-vaccine groups, including one that held forums this year in Brooklyn, the epicenter of the measles outbreak…
The $2.98 million Mercola has given to Fisher’s group since 2009 came from the Natural Health Research Foundation, a private foundation that is entirely funded by his business and that he leads as president, tax records show. The foundation has also given more than $3.3 million to the Organic Consumers Association, a health and environmental advocacy group, tax records show. On its website, the organization advertises Mercola’s products and reposts some of his content about vaccines and other topics, as well as articles by prominent anti-vaccine activist Robert F. Kennedy Jr. …
While Fisher emphasized that she does not promote any retailers’ products, she told potential sponsors of an anti-vaccine conference her group held in 2009 that the event could help them gain “access to both national and international markets” and “increase sales and visibility,” promotional material shows. Mercola attended the conference and received an “NVIC visionary award.” Mercola did not respond to questions about whether he was a sponsor. He donated $20,000 that year to the National Vaccine Information Center through his foundation. Without elaborating, Fisher said the money “was not an earmarked donation.” The following year, Fisher’s group and Mercola.com launched a website that tracks vaccine-related legislation in every state. The site provides activists with detailed information, including how to sign up for public comment to support or oppose legislation in their state, where to park to attend a public hearing and what color T-shirt to wear to rallies.
In 2011, Mercola co-sponsored a 15-second video ad on a Jumbotron in Times Square. The ad featured an image of a woman holding a baby with the message “Vaccines: Know the Risks.” Logos of both the National Vaccine Information Center and Mercola.com were prominently displayed…
In addition to the large contributions from Mercola, Fisher’s group has received financial support from Focus for Health. That foundation, funded by wealthy New Jersey businessman Barry Segal, gave Fisher’s group more than $400,000 from 2011 to 2017, according to tax records.
In September of this year, as flu season approached, Mercola and the National Vaccine Information Center co-sponsored their 10th annual “vaccine awareness week.” Mercola offered to match all donations made to the center that week up to $100,000, according to a video posted to his YouTube channel. In a video posted the following day, Fisher described her group’s recent successes in state legislatures across the country. Those states include Colorado, Minnesota, Oregon and Texas, Fisher said. “I look forward to another 30 years of working with you,” she told Mercola.
_______________________________________________________________________
On this blog, I have repeatedly warned that many so-called alternative medicine (SCAM) practitioners recommend against vaccinations. Specifically implicated are:
- Physicians practising integrative medicine
- Doctors of anthroposophical medicine
- Naturopaths
- Homeopaths
- Chiropractors
We knew about the ‘ideology’ and the misinformation pushing SCAM-related anti-vaccination sentiments. The article in the Washington Post is a stark reminder of the financial interests behind all this. As a result, SCAM-use is associated with low vaccination-uptake (as we have discussed ad nauseam – see for instance here, here, here and here). Anyone who needs more information will find it by searching this blog. Anyone claiming that this is all my exaggeration might look at papers which have nothing to do with me (there are plenty more for those who are willing to conduct a Medline search):
- Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homeopathic physicians towards vaccination. Vaccine. 2001;19:4859–4864. doi: 10.1016/S0264-410X(01)00180-3. [PubMed]
- Halper J, Berger LR. Naturopaths and childhood immunizations: Heterodoxy among the unorthodox. Pediatrics. 1981;68:407–410. [PubMed]
- Colley F, Haas M. Attitudes on immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics. 1994;17:584–590. [PubMed]